Inspection on 12/01/06 for Wemyss Lodge

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wemyss Lodge 31/01/07

Wemyss Lodge 16/06/05

Wemyss Lodge 01/12/04

Wemyss Lodge 27/04/04

Wemyss Lodge 23/10/03

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wemyss Lodge Ermin Street Stratton St Margaret Swindon Wiltshire SN3 4LH Lead Inspector Steve Cousins Unannounced Inspection 12th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wemyss Lodge Address Ermin Street Stratton St Margaret Swindon Wiltshire SN3 4LH 01793 828227 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wemyss Lodge Limited Mrs Kay Josephine Thompson Care Home 53 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (53), of places Physical disability (2), Terminally ill (2) Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. No more than 2 physically disabled residents at any one time No more than 2 persons in receipt of terminal care at any one time No more than 22 persons in receipt of nursing care at any one time The minimum staffing levels shall be as agreed on the Notice of Proposal dated 24 March 2003 No more than 6 persons with dementia to receive personal care only, at any one time 16th June 2005 Date of last inspection Brief Description of the Service: Wemyss Lodge is a purpose built care home situated in a residential area of Stratton St Margaret, Swindon .The accommodation spreads over 2 floors with en-suite facilities provided in the majority of the rooms, double rooms are also available. Externally there is a pleasant, accessible garden and adequate parking spaces. The home is registered with the Commission for Social Care Inspection (CSCI) to provide nursing care and support, and residential accommodation for up to 53 elderly service users. The home has a full time registered manager and there is a registered nurse on duty at all times, supported by care assistants. Administration, catering, domestic, laundry and maintenance support services are also provided. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Service users are known as residents in this home and will be referred to as such throughout this report. This unannounced inspection took place between 9.30am and 5.00pm. There were 51 residents in the home. The findings from this inspection are based on a tour of the premises, speaking to residents, relatives and staff, and visiting frail residents. A number of records were inspected, including care plans and staff files. The findings were discussed with Mrs Thompson, the registered manager, and Mrs Wemyss, the operations manager, at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Although generally satisfactory, some improvement is needed in care planning and assessment and care needs to be taken to ensure entries in plans are legible. Staff training in infection control is required Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 5. Standard 6 does not apply to this home. Prospective residents have the opportunity and the information they need to make an informed decision about the home and their needs are assessed before they are admitted. EVIDENCE: A statement of purpose and a service users guide are available and have been updated. A copy of the last CSCI inspection report was also available. A new resident stated that a family member had visited the home on his behalf prior to him moving in; the resident also confirmed that he had read the most recent CSCI report on the home. Other new residents confirmed they had visited the home prior to moving in. Residents’ care plans contained pre admission assessments, which had been carried out by the manager with the involvement of the resident. Where appropriate, supporting information from care managers and relatives was available. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10 Care plans generally reflect health, personal and social needs. Residents’ health care needs are being met and they treated with respect. EVIDENCE: The care plans seen were generally a good reflection of assessed needs and were reviewed monthly, although, as noted at the previous inspection, care needs to be taken to ensure that plans are legible. Social needs are also documented and residents or their relatives sign agreement to the plans. Residents who had been assessed as at risk of developing a pressure sore did not always have a care plan in place to direct care and this was discussed with Mrs Thompson during the inspection. It is also recommended that a recognised assessment tool be used when planning care for residents who are nutritionally at risk. Visits to residents indicated that appropriate equipment was in place to meet assessed needs and that interventions required were carried out and recorded. Residents had access to their GP’s and other health care professionals as required and there were positive comments from residents and relatives regarding the management of health problems. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 10 Staff were indirectly observed interacting with residents. They treated them respectfully and privacy was maintained where necessary. Residents spoken with said that the staff treated them well. Residents looked and felt well cared for. Some residents preferred to stay in their rooms and their wishes were respected, doors were closed and staff knocked before entering. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 15 Residents’ social, recreational and nutritional needs are met and they are able to maintain contact with family, friends and the community. EVIDENCE: It is evident that the home makes every effort to meet the social and recreational needs of the residents and there is a focus on providing a homely, relaxing atmosphere. An activity coordinator is employed and there was evidence of a good level of in-house and external social activity. Religious services are also held. The home has a mini bus and regular visits are arranged to local community facilities, one of which took place during the inspection. There are no restrictions on visiting and visitors were present in the home throughout the day. Residents voiced their appreciation of the home and comments included, ‘ I’m very happy here’, ‘it’s very good’ and ‘wonderful, ten out of ten’. Comments regarding the food available were very positive, although two residents felt that this could be further enhanced with a more varied choice. This was discussed with Mrs Wemyss who stated that a questionnaire had been circulated in order to ascertain residents’ views on the meals available. Residents can eat in the large dining room or small dining room, or in their room if they wish. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. As far as possible, residents are protected from abuse. EVIDENCE: Residents reported feeling safe in the home and reported the staff as being ‘kind’ and ‘very supportive’. Staff spoken to demonstrated an awareness of procedures for reporting abuse and training in abuse awareness is provided. Protection of vulnerable adults is also covered in staff induction and NVQ training. Policies and procedures are in place with regard to adult protection and the prevention of abuse, which relate to local guidelines. A selection of staff documents seen, and conversation with Mrs Wemyss, indicated that CRB checks had been obtained for all staff. POVA checks for new staff are also obtained before they commence employment. Staff are not involved in the management of residents finances. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20.21,22 and 26 The home is comfortable and accessible and specialist equipment is available to meet residents’ needs. There are sufficient toilet and bathing facilities. The home is clean, pleasant and hygienic. EVIDENCE: A tour of the home indicated that the building and equipment is well maintained. External areas are attractive and accessible. The building was purpose built as a nursing and residential home. A lift is installed and all corridors are accessible with ramps and handrails fitted where necessary. Mobility aids and hoists were available and assisted toilets and baths are installed. Accessible accommodation is provided for those who require wheelchairs. There is a call bell system installed. There are spacious communal areas, including a dining room, which are well lit, decorated and furnished. New carpets have been provided in the ground floor corridors and some new furniture in the sitting rooms. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 14 There were adequate numbers of toilets and bathrooms, which were clean and tidy. Some toilet seats had been replaced. The home was found to be clean and generally free of unpleasant odours apart from one area. This was discussed with the manager at the end of the inspection. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. The home has enough staff and they are suitably trained. Recruitment procedures protect the residents. EVIDENCE: There were two registered nurses and seven care assistants on duty during the morning of the inspection. Review of the staffing rota indicated adherence to the home minimum staffing notice. Residents and staff spoken with felt that there were normally enough staff on duty. 80 of care staff had obtained an NVQ qualification, which is commendable. Many care staff had received VRQ dementia care training and more had been arranged. An external training organisation now provides the majority of the training in the home. Recording of training had improved and individual records were now available which indicated that training had been received in mandatory subjects such as manual handling, first aid and food hygiene; and in other relevant subjects such as catheterisation and nutrition. No training had been provided regarding infection control and the need for this was discussed. Staff spoken to were happy with the level of training available. Staff recruitment records were reviewed and found to be satisfactory, with all required documentation in place. The need for CRB checks on younger people was discussed. Induction training is available. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 36 The home is effectively managed and residents’ opinion on the service is sought. Staff are appropriately supervised. EVIDENCE: Mrs Thompson, the registered manager is a registered nurse who is experienced in the care of elderly people. She is currently undertaking the Registered Managers Award. Mrs Thompson is supported in her role by Mrs Wemyss, the operations manager and Mr Freeland, the Registered Provider. There were positive comments from residents and staff about the management team. Residents’ opinion on the service is obtained via monthly audits and three monthly questionnaires. The management team also make themselves accessible to residents and actively seek their views. Formal staff supervision takes place and is recorded. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X 3 3 3 X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X X Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7OP8 Regulation 13 (4,c) 15 (1) Requirement The registered manager is required to ensure that all residents assessed as being at risk of developing pressure damage, have a care plan in place to direct care. The registered manager is required to ensure that staff receive mandatory training in infection control. Timescale for action 01/02/06 2 OP30OP38 12 (1,a,b) 18 (1,c,i) 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations It is recommended that a nutritional assessment tool be used to aid nutritional screening. Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wemyss Lodge DS0000039117.V275070.R01.S.doc Version 5.1 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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