Inspection on 02/10/07 for Wentworth

This inspection was carried out on 2nd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wentworth 25/07/06

Wentworth 22/11/05

Wentworth 22/06/05

Wentworth 15/11/04

Wentworth 06/07/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Wentworth 59 South Street St Austell Cornwall PL25 5BN Lead Inspector Alan Pitts Unannounced Inspection 2nd October 2007 10:00 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 Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 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. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wentworth Address 59 South Street St Austell Cornwall PL25 5BN 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) 01726 72941 Mrs Heather Patton Mrs Pauline Stockman, Mrs Nancy Gilbert Position Vacant Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named person in category (DE(E) within overall numbers. Date of last inspection 25th July 2006 Brief Description of the Service: Wentworth is an older property that has been extended and now provides care and accommodation for up to 20 older people. It is situated on higher ground overlooking part of St Austell and the surrounding countryside, but is still within walking distance of the facilities in town for anyone with reasonable mobility. As a family owned and run home, one or more of the registered providers are in the home daily. Accommodation is provided on three floors with stairlift access available to first and second floors. Communal areas are provided on the ground floor and comprise a dining room, two adjacent sitting rooms and a conservatory. The sitting rooms and conservatory overlook the gardens. The home is a non-smoking establishment. The home currently charges between £300 and £343 per week. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 2nd October 2007, over a period of approximately 6 hours. The inspector spoke with residents, the registered persons, staff, toured the premises, and inspected records. The home was seen to be providing a good service to its residents who stated that they were happy and had confidence in the staff. The home provides a high standard of individualised personal care to the residents, and is only let down by its records, which do not do justice to the hard work put in by staff and do not accurately reflect the care needs and capabilities, and lifestyle, of the residents. The requirements identified in this report, whilst important, should not detract from the overall judgement of an established home that offers individualised personal care, where the wishes of the residents are paramount. This report is largely a repeat of the previous report in 2006, and as such is indicative of the lack of effective management at the home. The home will benefit from clear day-to-day leadership and Mrs Patton, one of the registered providers, undertook to ensure the imminent submission of an application for a registered manager at Wentworth Care Home. What the service does well: What has improved since the last inspection? What they could do better: Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 6 There is no doubt about the quality of care provided at this home, but the registered providers must tackle the managerial issues in the requirements and recommendations identified in this and previous reports. These matters will be followed up again at the next inspection, after which if there is no improvement the Commission for Social Care Inspection will have to consider enforcement action. 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. The summary of this inspection report can be made available in other formats on request. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 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 Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed prior to admission to ensure that the home can provide for their care needs and capabilities. The home does not provide intermediate care. EVIDENCE: The care documentation for the most recent admission to the home showed that a pre-admission assessment had been carried out. One of the registered providers visited the resident prior to admission. The home is using a comprehensive document to gain information about a prospective service user prior to admission. It was clear from looking at the records that the people currently in Wentworth, although of a great age, are a stable group and there have been very few admissions for the last three years, apart from offering regular respite. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 9 The inspector spoke with one resident who had moved into the home in the past few months, who said that they “didn’t regret the move at all” and were very pleased with the care they received. The home does not provide intermediate care. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The delivery of care to promote the health and well being of residents is handled well, as demonstrated by the comments of the residents, but more information should be included in the care plans and daily records to substantiate this. Residents were unanimous in saying that staff were kind, respectful and attentive. Adherence to the home’s own medicine policy and procedure is needed. EVIDENCE: Generally the residents are in reasonable health and many are still quite active and alert. The services of professionals ancillary to medicine are used when necessary, especially the community nursing service. Residents complimentary about the way in which the staff offered help, though one said that “they are often too busy to talk”. The outcome for residents is a high standard of personalised care provided; unfortunately the home’s records do not reflect this. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 11 Care plans were satisfactory up to a point, but often did not provide sufficient information. The home must avoid generic statements such as “needs assistance with washing and dressing”, which still persist; rather say specifically what the care need is and what assistance is needed. Care plans are reviewed, with the involvement of the resident or their representative, where possible. There is a medicines policy and procedure, but this is not being adhered to. On arrival at the home the medicine cupboard, including the controlled drug cupboard, was unlocked and unattended. Medicine Administration Records were seen to be in order, properly completed. All the residents spoken with confirmed that the staff and managers were respectful and only too happy to help if they could. Residents confirmed that people always knock before entering rooms, and all said that they would feel able to express any concerns to the ‘management’. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All of the residents were complimentary about the lifestyle experience of living at the home, though none were aware of much in the way of activities being provided other than the occasional entertainer. Residents confirmed that they are free to maintain contact with friends and family. All the residents said that they would feel able to express a wish for choice or a concern to the staff. Meals are plentiful and varied, providing a balanced diet, though choice could be encouraged. EVIDENCE: The residents spoken with were able to express their wishes clearly and were heard to do so. The majority of residents choose to come to the lounges and, with the additional stimulus of visitors, there are opportunities for people to talk. Residents said they were happy with the flexibility of the home’s routines. Large print books are available for people who wish to read. Television is available in parts of the lounge but is not overpowering for those who do not wish to watch it. People have televisions in their own rooms if they wish to watch particular programmes. Some residents have their own telephones. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 13 There is an entertainments programme, and staff are expected to facilitate activities in the afternoons, but this was not found at the time of the inspection and was not reflected in resident’s comments. Also discussed were the practical implications of, as at the time of the inspection, having 3 staff who care, clean and do the laundry, whilst also being expected to provide social/recreational activities. Residents were largely happy with their lifestyle, but all were aware of only occasional visits from entertainers. The daily records do not demonstrate how residents spent their day, the predominant entry reading “fine today” or “well today”, or describing where they were rather than what they were doing. Care documentation and the comments of residents show that there are regular and frequent visitors to the home. Residents said that there was never a problem with visiting. Some residents go out regularly with family and friends. All of the residents spoken with said that they were largely able to determine their own lifestyle, within the parameters of their care needs and capabilities. Residents are encouraged to remain independent for as long as possible and choice is respected, but the home will advise on how help can be obtained if someone has a problem. One who said, “I wouldn’t want to be anywhere else”, summed up residents’ comments. Residents said that food was good and plentiful. There is a set menu at lunchtime for the main meal with personal preferences and dislikes being known and catered for. The menu is displayed on the notice board. Residents said that they would feel able to ask for an alternative if they did not want what was offered, but the registered providers could ensure that residents are offered an alternative, removing the responsibility from the resident to ask. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents said that they would feel able to express any concerns without recrimination. The Commission for Social Care Inspection has not received any complaints about this home since the last inspection. The home has a satisfactory complaints system, which residents feel protected by, and feel that their views would be listened to. EVIDENCE: The home has a complaints procedure and a Protection Of Vulnerable Adults procedure. The complaints procedure does not include the contact details for the local Adult Social Care office, and states that complainants can contact the Commission for Social Care Inspection if they are not happy with the home’s response. The registered providers should review and amend the complaints procedure to: 1. State that complainants are free to approach the Adult Social Care department or the Commission for Social Care Inspection at any time. 2. Provide the contact details of the local Adult Social Care office. The registered providers must review the Protection Of Vulnerable Adults procedure to ensure that it provides clear step-by-step instruction as to the actions to be taken in the event of an allegation of abuse, including relevant Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 15 contact information, and with reference to local government procedures. This has been drawn to the home’s attention at previous inspections. Residents said that they would feel able to express any dissatisfaction or concerns to the staff or management. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home is properly maintained, the facilities provided are clean and hygienic and they can have their own possessions around them. EVIDENCE: The premises are well maintained with an ongoing programme of decoration and refurbishment. People were able to have their own possessions with them in their rooms. Residents said they were pleased with their accommodation. The majority of people choose to sit in the sitting rooms during the day and almost all eat together in the dining room. Bathrooms and toilets were maintained in a clean and satisfactory manner. Toilet and bath equipment to aid independence was seen as well as individual walking frames etc. The home has adequate toilet facilities with some being positioned close to the communal areas. The home has two assisted baths and a shower facility. The home Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 17 provides access to the two upper floors by means of two stair lifts. Handrails and grab handles are provided at strategic points. The gardens are an attractive feature and reportedly well used in the hot weather. The registered providers are looking to open up the original main entrance again, with additional office space there. They are also hoping to be able to rearrange the existing office so as to provide more space and facilities. The premises were clean and free from undue odours, though environmental cleanliness will be a matter looked at in more depth at the next inspection. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were complimentary about the high standard of care provided at the home. Staff receive training to enable them to provide appropriate care. The home must adhere to a more robust recruitment procedure to protect residents, and provide greater numbers of staff. EVIDENCE: At the time of the inspection there were 19 residents at the home with 3 care staff and a cook on duty. The duty rota includes staff surnames. The duty rota does not distinguish between roles or duties (i.e. care duties, cleaning duties, kitchen duties). The three staff on duty at the time of the inspection provide care, clean, and do the laundry. There are insufficient numbers of staff, and as has previously been pointed out, the registered providers should ensure that the duty rota clearly shows in what capacity a staff member is on duty. The registered providers are aware of the need to clarify roles and thereby ensure that staff receive training relevant to their role. Thirteen out of twenty two care staff have achieved NVQ Level 2 or above, approximately 59 . There is ongoing training provided for staff, including 1st Aid, manual handling, basic food hygiene, and ‘No Secrets’ training. There is still no system in place for monitoring staff training though, e.g. when a refresher might be due, and this is further complicated by the current system Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 19 of staff carrying out multiple roles and requiring training in a wide variety of fields. Staff were observed to interact with residents in a friendly, relaxed manner. Residents said that the staff and the care provided were excellent, and without exception all said they would rather be there (Wentworth) than anywhere else. Three staff files were inspected. The records showed that: • The information collected in the application form is insufficient • Previous employer references are not being obtained, where possible • The references provided do not cross-reference to the referees given on the application form The inspector noted examples of National Training Organisation compliant induction training records. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 - Quality in this outcome area is (excellent, good, adequate or poor). This judgement has been made using available evidence including a visit to this service. There is no doubt about the quality of care provided at this home, but the registered providers must tackle the managerial issues in the requirements and recommendations identified in this and previous reports. There has been no change in the managerial arrangements since the previous two inspections. EVIDENCE: Wentworth has recently ceased operating a domiciliary care service as well as providing care and accommodation. Wentworth is a family owned and run business. Records and comments made to the inspector indicated that residents felt able to discuss any areas of concern with the managerial team. The son of one of the registered providers, Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 21 not currently on the registration certificate, has completed his registered manager’s award, the inspector was advised that an application for registered manager was to be submitted to the Commission for Social Care Inspection. The registered providers focus on resident care to their credit, but also to the detriment of the management of the home (i.e. acting upon identified requirements in previous reports). There are still some requirements and recommendations carried over from previous inspections that need the attention of the registered providers. The registered providers did conduct an audit of resident’s opinions earlier this year, but this is not sufficient. The registered providers must introduce an effective quality assurance programme, which seeks to ascertain the views of residents, representatives, and others (e.g. District Nurse, GP), a summary of the findings being published (the option of inclusion in the home’s Service User Guide was discussed). The registered providers have started to review and amend, where necessary, all the home’s policies and procedures to ensure accuracy and relevance. The registered providers ensure that all are freely available to staff. The home no longer handles any benefits for residents. Families or another responsible person are asked to undertake this instead. Any costs incurred on behalf of a resident are now invoiced retrospectively to the resident or their representative. Receipts are obtained and a copy included when invoicing. There is an ongoing maintenance programme, and the premises show that the home is financially viable. Maintenance and safety records were inspected, and were seen to be in order. Two staff have been trained as Fire Wardens in order to cascade training to staff, and the registered providers are considering an additional Fire Warden to ensure the inclusion of night staff. Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15 Requirement Timescale for action 01/11/07 2. 4. OP9 OP12 13 16 The registered providers must review and amend the care plans to ensure they accurately identify the care needs of the resident. Avoid the use of general phrases, such as “needs assistance with dressing”, say what assistance is needed. The home must ensure that all 01/11/07 staff are aware of the correct medicine procedures. The registered providers must 01/11/07 ensure that daily entries show how the resident has spent their day, and make arrangements to enable residents to participate (should they wish to do so) in a programme of activities. The registered providers must 01/11/07 review the home’s Protection Of Vulnerable Adults procedure to ensure that it provides clear step-by-step instruction as to the actions to be taken in the event of an allegation of abuse, including relevant contact information, and with reference to local government procedures. DS0000008923.V350149.R01.S.doc Version 5.2 5. OP18 13 Wentworth Page 24 6. OP27 18 The registered providers must ensure that the duty rota clearly shows in what capacity a staff member is on duty. The registered providers must ensure there are sufficient staff in clearly defined roles on duty to meet the needs of the residents. The registered providers must adhere to and record a robust employment procedure. 01/12/07 7. OP29 18, 19 01/11/07 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 OP16 Good Practice Recommendations The registered providers should review and amend the complaints procedure to: State that complainants are free to approach the Adult Social Care department or the Commission for Social Care Inspection at any time. Provide the contact details of the local Adult Social Care office. The registered providers should devise a method of monitoring staff training to ensure that training needs, such as refresher courses, are identified. 2. OP27 Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Wentworth DS0000008923.V350149.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!