Key inspection report CARE HOMES FOR OLDER PEOPLE
Wentworth Croft Bretton Gate Peterborough PE3 9UZ Lead Inspector
Elaine Boismier Key Unannounced Inspection 10th September 2009 09:45
DS0000024308.V377413.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wentworth Croft Address Bretton Gate Peterborough PE3 9UZ 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) 01733 269200 01733 269665 www.bupa.com BUPA Care Homes (CFHCare) Ltd Henry Mutambo Care Home 156 Category(ies) of Dementia - over 65 years of age (73), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (32), Old age, not falling within any other category (156), Physical disability (2), Physical disability over 65 years of age (83) Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Two named individuals with Physical Disabilities who are below 65 years of age (PD) for the duration of their residency Physical disability over 65 years of age (PD(E)) not exceeding 83 places. Mental disorder, excluding learning disability or dementia over 65 years of age (MD(E)) not exceeding 32 places Dementia over 65 years of age (DE(E)) not exceeding 73 places. Service users who are over 65 years of age, not falling within any other category (OP) not exceeding 156 places. 2nd July 2008 Date of last inspection Brief Description of the Service: Wentworth Croft is situated in Peterborough City, four miles from the city centre and is accessible by public transport. The home is situated in wellmaintained and landscaped gardens including an enclosed garden for those living at Harvester House. Wentworth Croft is arranged into four houses: Yeoman provides support and care, including nursing care, for people who have mainly a physical disability; Hayward provides support and care for people with dementia but who do not have challenging behaviours; Harvester provides care and support for people with mental health needs including challenging behaviours and Woolsack provides personal care and support. The age range is mainly for people over 65 years of age. An application to vary the registration has been submitted for the Care Quality Commission to consider; the application is to allow the home to have ten registered places for people over 50 years of age. Current fees range from £387.00 to £816.16. Additional costs include those for chiropody, hairdressing, toiletries and confectionary. Further information about the fees can be obtained from the home. A copy of the inspection report is available on request at the home or via the Care Quality Commission website www.cqc.org.uk Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This summary includes information about the home since our last key unannounced inspection (KI) that took place on the 2nd July 2008 when we assessed the home to provide good quality outcomes for the people living there. 2nd July 2009 On the 2nd July 2009 we looked at information that we had received about the home, since our last KI and we wrote an Annual Service Review (ASR). Because we had received none of the surveys we believed we had sent out, the ASR is yet to be completed. 10th September 2009 We, The Care Quality Commission (CQC), carried out this unannounced key inspection, by three Inspectors, between 9:45 and 17:00 taking 7 hours and fifteen minutes to complete. Before the inspection we received surveys from eleven of the residents and three from relatives. We looked at information that we have received about the home since our last key unannounced inspection. The home sent us, as requested, an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. During this inspection we looked around the premises and looked at some of the documentation. We case tracked four of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 6 What the service does well:
We found the home to have a relaxed and friendly atmosphere and that the activities and staff duties were carried out in an unhurried manner. The people we spoke with said that they had ‘Nothing to complain about’, were happy living at the home and were satisfied with their care and the standard of service provided. People have a good standard of information to help them in their decision where to live. This includes an up to date Statement of Purpose and a Service User’s Guide. Any person wishing to move into the home has their needs assessed before doing so. This is to make sure that the home can meet their needs. There is a range of activities that people can take part in: in 2009 people have visited country parks, a war museum, taken part in a sponsored walk and took part in the home’s summer fete. We received positive comments about the food and that there is a choice of menu; this includes a cooked breakfast. The home sensitively and actively responds to any concerns or complaints and has a good knowledge of what to do if there are any allegations of abuse against any of the residents. There is a low turnover of staff and the staff were happy working at the home. This means that the residents should receive safe and consistent care from a committed team of staff. We received positive comments about the staff such as ‘The staff are always cheerful & friendly’. We receive information about the home and there are good quality assurance systems in place that includes asking people and their relatives what they think about the standard of service. The residents’ surveys gave 93 overall excellent/very good rating and the relatives’ surveys gave 81 overall excellent/very good rating for the services provided by Wentworth Croft. The home regularly checks the accuracy of medication records to account for all medicines in use. Any deficiencies are quickly investigated and resolved. In August 2009 the home’s main kitchen was awarded a five star rating by the Environmental Health Officer, for the way the premises are kept clean and the way the storage, cooking and serving of food is dealt with. What has improved since the last inspection? Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 7 Following our last KI we made no requirements but we identified and reported on the following areas where the home could do better: The amount of detail about how to meet health care needs was to improve as not all of the recommendations made by health care professionals were written into plans. We have found evidence that this area has improved when we looked at a person’s care plan. We also found that there was an improvement in the standard of recording on the food charts as we found information about what the person ate for their breakfast and for their lunch. This could continue to improve to include information about what the person ate at supper time. The home was found not to be clean in all areas and we expected the home to manage this. We found, at this inspection of September 2009, the areas we visited were clean, including the furniture, and we found no areas that had offensive smells. There were some good examples of infection control procedures in place. There were concerns raised, in 2008, about the staffing numbers on night duty and that some of the staff, who did not have English as their first language, were difficult to understand. We found that there was enough staff on duty during the day time. We have received no further concerns and we found that we could understand the majority of the staff when we spoke with them. What they could do better:
It was expected the home would improve the standard of information provided on the repositioning charts. This improvement has not been made when we case tracked one of the people. The records were incomplete and the information provided was insufficient, so it was difficult to tell how this person’s health and personal care needs were being managed. We have made a requirement about this. We found that the care provided to a person with pressure sores had not followed the advice from a health care professional. We required the Manager to take immediate action to ensure that the person was receiving the right care and treatment as the home had been advised to do so. The standard of personal care for one of the people we case tracked was of a standard that posed a serious risk to the integrity of the skin of one of their hands. We required the Manager to take immediate action to ensure that the person was receiving the right care and treatment as the home had been advised to do so. Although some of the care plans, for people with dementia, had guidance for the staff in how to meet the special needs of the person and how the person’s condition affected them, this was not in all of those care plans that we did see. The home should consider ways to improve such deficiencies.
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 8 The care plan for one person who needs to use continuous oxygen therapy had not been updated, there was no written confirmation on how this was prescribed and risk assessments had not been completed. The home must take action to improve this. There were no specific monitoring tools that told us how people’s experience of their pain was being monitored or reviewed. Action must be taken to ensure that people’s pain is monitored and under control. The standard of record keeping must improve, within the care plans, to ensure that the staff know how to meet the changing and specialist needs of the people they are looking after: this includes their personal care and the accurate recording of which part of people’s bodies photographs are taken. People must have access to health care professionals, such as physiotherapist, for assessment and advice. We have made a requirement about this. People must have the means to call for assistance, such as a call bell. We have made a requirement about this. The use of communal razors and hand creams increases the risk of the spread of infection between residents. The home must take action to reduce this risk. Special instructions for the administration of medicines must be followed to ensure that people receive their medication safely. We have made a requirement about this. There must be sufficient supplies of medication held in the home for the continued treatment of residents. People must have their dignity valued and to be respected at all times to ensure that the staff knock before entering people’s rooms; that people’s mail is opened by staff only when they have had permission to do so and that no person wears other people’s clothes unless they have agreed to do so. We expect the home to address these issues about dignity. Improvements to the environment to Hayward house should be considered to help people with their orientation and their memories. Although some of the staff have attended training in tissue viability we recommend that all of the staff attend this training to ensure that people receive the right care to reduce the risk of developing pressure sores. We found discrepancies in the records for the fire alarm tests and the emergency lighting checks. Dates of when these tests were recorded as being carried out were inaccurate for August 2009 and tests for September 2009 were recorded in a future date. We also found other discrepancies that we discussed with the Manager and we have suggested that an investigation to explain these discrepancies is carried out.
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 9 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 10 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 Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 People using the service experience good quality outcomes in this area. People have a good standard of information to help them in their decision on where to live. Prospective residents have their needs assessed to ensure that the home is a suitable place for them to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: In December 2008 we received a revised Statement of Purpose and this has since been updated to reflect the change of name of the Responsible Individual. The details of this required document have met the Standard and the associated regulation. We found copies of the home’s Service User’s Guide in the entrance way of the main reception area and these provided sufficient information about what the person would expect to receive, such as the care and hotel services, if they decided to live at Wentworth Croft.
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 12 The Statement of Purpose was available in an information pack that we saw in some of the people’s rooms that we visited. One of the people told us that they had read the information pack and found it very useful. They also told us that they had a short stay at the home before they decided they wanted to become a permanent resident. We received eleven residents’ surveys: eight of these said that the person had received enough information about the home to help them in their decision where to live. Three of these surveys said the person did not know if they had received such information. We looked at five people’s care records and found evidence that the person had their needs assessed by social care workers/care managers and also by the home before the person moved in; this indicated that the home ensures that it can meet the assessed needs of the person. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. Most, but not all of the people, can be confident that they will always receive safe and proper care due to the standards of record keeping and the manner in which care is provided. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We case tracked one person who lived on Yeoman house; two of the people who lived on Hayward house and one person who lived on Harvester house. We also spoke with other residents who were not part of our case tracking, including a person who lived on Woolsack house. The AQAA told us that within the last twelve months six residents had acquired pressure sores whilst living at the home. A senior member of the staff told us
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 14 that the majority of these were ‘superficial’ sores. The senior member of staff told us that currently the home had at least two people with pressure sores who were receiving care and treatment. One of these people we case tracked and we found that their pre-admission assessment, dated the 2nd April 2009, noted that, prior to their admission into the home, the person had pressure sores on their bottom (sacrum). From our examination of their care plan we found that they had developed pressure sores due to their reluctance to go to bed at night; they had preferred to sleep in the chair. A care plan, dated 15th August 2009, noted that the person had pressure sores of both legs and buttocks and they were to be repositioned every four hours. On the 3rd September 2009 it was recorded that the person’s right buttock was ‘starting to break down again.’ There was a record that a tissue viability nurse (TVN) had visited the person that same day and had written the advice for the staff to follow to reduce the person’s pressure on their skin and to encourage the person to go to bed at night. The TVN also advised the staff to put the person in the hoist four times a day (this was to raise the person up to relieve the pressure on their skin). At our last inspection, in July 2008, we recommended that the recording of the repositioning charts to improve to provide evidence that care had been carried out. We looked at this person’s repositioning charts for the 7th September to the 10th of September 2009; we looked at how the person was lying in their bed and we spoke with a member of the staff. We found that these records provided insufficient evidence to say that the care had been provided in line with the care plan dated the 15th August 2009 and from the advice provided by the TVN on the 3rd September 2009. For example the repositioning record indicated that at 6:00, 10:55, 19:00 and 23:00 the person was ‘hoisted’ as advised by the TVN; at 1:20 the person was repositioned although there was no record of where the person was helped to lie in their bed; at 8:30 the person was ‘sat up’; at 14:00 the person was ‘repositioned’ although there was no record where the person was helped to lie in their bed (and we found no record of this elsewhere) and at 17:00 the person was ‘repositioned’. The record for the 8th September 2009 was blank and the member of the staff could not tell us why there was no record available. For the following day, the 9th September 2009, at 12:00 the person was ‘repositioned’ and the hoist was also used. At 16:10 the person was ‘repositioned’ in bed and the record thereafter, for that day, we were unable to read as the writing was ineligible. For the repositioning chart, dated 10th September 2009, there was a record that at 8:30 the person was ‘sat up’. A member of the staff, when we asked them about the repositioning charts, told us that they were helping to care for the person and they told us that the person was never helped to lie on their right side. We found no other record thereafter; when we visited the person in their room they were laying on their right side i.e. not ‘sat up’. It was unclear
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 15 how the resident was being safely cared for and it was unclear how the standard of the repositioning charts were protecting them. The TVN had advised the staff to place pillows in a manner to reduce the pressure on the person’s heels. When we were speaking with the person their legs were directly on the mattress as no pillows were provided as advised by the TVN. We told the Manager about this omission of care so that immediate action could be taken. He reviewed the person’s care and he agreed with our findings. The person told us that they were on pain killers as they had pain in their legs and had experienced this pain as there was a delay of ‘one and half hours’ before they were given their medication. They were unable to call the care staff to tell them that they had pain as their call bell was out of their reach, hanging over the call bell box attached to the wall behind the bed head. There was a care plan for giving the person their medication and for staff to ask the person, during the medication round, about their pain. We found that in May 2009 the person had a change of medication and was prescribed a morphinetype medication. We, including a member of the staff, were unable to find a pain monitoring record that would assist the staff in monitoring and reviewing the person’s personal experience of their pain and pain control. The person’s records for monitoring and reviewing their weight were seen and we spoke with a member of the staff. We noted that there were two care plans: the malnutrition universal screening tool or MUST, told the staff that the person was to be weighed every week; the home’s care plan said that the person was to be weighed every month. The person had had lost weight and this was recorded that this was due to the person losing unwanted water (oedema). We, including the member of the staff, were unable to tell how often the person was to be weighed due to the conflicting staff guidance within the two care plans that were currently in use. We saw that the standard of personal care provided, to this person, was of an unacceptable standard. We, including a member of the staff, were unable to find written guidance in how the staff were to manage the personal care of the person’s hands and finger nails. We visited the person’s room and when speaking with them we noted that the person had dirt under their finger nails which were moderately long. They told us, and we saw that this was the case, that they were unable to extend the fingers of their right hand; these, with the finger nails, were pressed against the palm where we found a watery blood stain. We alerted the Manager about this for immediate action to be taken to reduce the serious health risks to this person. He reviewed the person’s care and he agreed with our findings. As part of the home’s wound monitoring assessments the home takes photographs of the affected body area and charts the size and condition of any of the sores and records when dressings have been renewed. We looked at the
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 16 photographs of the person’s sores on their legs and buttocks and we asked the staff to clarify the information for us as one of the photographs, dated 17th August 2009, provided no information as to which side the sore was on (left or right); a member of the staff was unable to tell us which side of the body this photograph was of. A recommendation was made, following our last inspection in July 2008, for the food charts to provide sufficient detail to allow the reader to tell how much the person had eaten. We looked at the food and drink records for this person and, although there was no indication, for example what the person had eaten after their lunch for the 8th and 9th September 2009, the records for breakfast and lunch told us that the person had eaten all of their cooked breakfast and all of their three course lunch for these two days. They had drinks on a table in front of them and they demonstrated, to us, that they could get these when they wanted to help themselves. According to the home’s Statement of Purpose Hayward house provides care and support for people with dementia but who do not have ‘challenging behaviours’. During 2009 we had received information about one of the two people who we case tracked. For this person their care record indicated that their care plan provided assessments of how the person’s mental health affected their ability to communicate and what caused them to become upset. There was guidance for the staff in what they should do to reduce their distress. For the other person we were unable to tell, from their care plan, how their mental health condition affected the way they lived their daily life and how they could make choices. We read that the person had been formally assessed not to have mental capacity. We have made a recommendation for the care planning for people who have a prime mental health need, to be more person centred. We case tracked a person living on Harvester house and we found that the staff knew about the person’s care needs and we found that the care plans for this person were accurate, telling the reader what the person liked to do and what risks there were to other people, with regards to their behaviour, and how the staff were able to manage these risks. In May 2009 the home notified us that a person needed urgent medical care, which they received. We used this information as a base for case tracking this person. On their discharge from hospital we saw a care plan to note this event and what the care staff were to do to help the person recover from their treatment, including walking and observation of their surgical wound. There was a care plan assessment, dated 23rd May 2009, stating that the person was able to walk with the help of staff and the help of a walking frame. A record, dated 31st July 2009, noted that this person’s ability to walk was reduced, due to an infection. We noted from the subsequent recordings, in the person’s care plan, that they were unable to walk or transfer and they needed the assistance of a hoist to help them with these tasks. We could find no recorded evidence
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 17 that a health care professional had been consulted, such as a physiotherapist, and a member of the staff told us that no such referral had been made. We have made a requirement for people to have access to and treatment by a health care professional and any advice provided is followed by the staff. All of the eleven residents’ surveys said that the person always or usually received the care, including medical care, and support that the person needed. One of these surveys said ‘They look after us well’ with another survey saying that the home does well with ‘Looking after me.’ The three surveys from relatives said that they felt the home met the care and support needs, of the resident who they were related to. The other residents, who we spoke with and saw, had a good standard of personal care and they said they were satisfied with how the home took care of them. One of the people we spoke with, who was not part of our case tracking, said that the home had offered them the opportunity to be seen by a dentist and an optician. Medication administration records that we looked at indicated that those people who had the condition of diabetes (mellitus) had their blood sugar levels treated by the home and these levels were satisfactory. On Yeoman house, within a store cupboard, we found a number of items of toiletries; two electric razors and within a vanity case, tubes of hand creams with a bottle of nail varnish. A member of staff said that these items were for ‘general use’. We informed the Manager of the risks of the spread of infection with the use of communal razors and creams and action must be taken to reduce such a risk. We saw that medication is stored securely for the protection of residents in rooms that are temperature controlled to maintain the quality of medicines given to people. We watched medicines being given to some people at lunchtime and this was done with regard to their privacy and personal choice. We heard a member of staff asking a person if she was in pain and if she wanted any painkillers. We looked at the records of medication received into the home, records made when medicines are given to people and those when medicines are disposed of. In general these were in good order and account for all medicines in use. But for one person whose medication must be taken before the first food, drink and medication of the day, the record showed that it was given at the same time as all other medication. It was confirmed by a member of staff that it was given at the same time and that the leaflet provided with the medication which stated these special instructions had not been read, despite the medication record stating “Warning: Read enclosed instruction leaflet”. This could affect the person’s health and wellbeing and we reported this to the manager to resolve immediately. For another person, the time the medication was recorded was inaccurate and could result in medication being given too close
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 18 together. One person who was prescribed a medicine ‘when required’ to control behaviour had been given this medication but without any recorded justification for its use. The care plan for this person’s behaviour had no guidance for when the staff were to give the person their ‘as required’ medication. Medication for some people had run out before further supplies were received, for one person this was a period of 5 days and this could affect their wellbeing so we have made a requirement about this. For one person who is prescribed continuous oxygen therapy, their care plan had not been updated to reflect this, there was no record of the flow-rate at which the equipment should be set and no risk assessment or risk management plan in place for this. We have made a requirement about this. The home regularly checks the accuracy of medication records to account for all medicines in use. Any deficiencies are quickly investigated and resolved although we have found, as recorded in this inspection report, that one person was found to be without their medication for a period of 5 days. One of the relative’s surveys told us ‘My (relative) received “private mail” at the home which I was not aware of. This was opened by staff instead of being handed to me.’ Another of these relative’s surveys said that the staff treated their relative … ‘with patience courtesy and skill.’ There was a concern raised about the protection of people’s personal laundry within one of the relative’s surveys, saying ‘Residents’ clothing via the laundry service is often “mixed up” despite being labelled. My (relative) often wears clothes which are not (theirs).’ A copy of the minutes of a relatives’ meeting, held on the 19th December 2008, notes the views of some of the relatives regarding the laundry service. We visited the laundry and spoke with a member of the staff. We were told that the labelling of clothes is an ongoing issue: there were eight black bin bags of unlabelled clothes and it was unknown who these belonged to. We were also told that there is a small ‘stock pile’ of clothes that had belonged to people who no longer lived at the home; these are handed out to any person who has a shortage of clothes. The people we spoke with said that the staff treated them well and were respectful. We saw two members of staff enter people’s rooms without knocking before entering. We also noted that a person, on Yeoman house, was calling out during which time some of the staff were walking about in the vicinity of this person’s room and continued to walk by. We asked a member of the staff if the person had a tendency to call out; we were told ‘No’. The member of staff attended to the person’s needs after we asked the question. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 19 People’s dignity is not always valued and we expect the home to take action to ensure that people’s dignity is valued at all times. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. People have the opportunities to live a good social life. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Ten of the eleven residents’ surveys indicated that the home always or usually provided activities that the person could take part in with the remaining survey saying that sometimes such activities were provided. During our tour of the four houses we saw photographs of events that people have attended including visits to a zoo, a country park with some of the residents feeding geese, and the Imperial War Museum at Duxford and having a pub lunch. We also saw photographs of people taking part in a sponsored walk and enjoying the home’s summer fete. On Yeoman house we spoke with the Activities Co-ordinator and some of the residents and compared the information on the activities programme for the
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 21 morning of our inspection. We found that the activities programme was being followed as some of the people had been reading a Catherine Cookson novel. We spoke with other people about activities and we looked at some of the activities records. We found that people have the opportunity to select library books from a visiting library service. The three relatives’ surveys considered that the home allowed their relative to live the life that they choose. Those people, who were able to tell us about their experience of living at the home, said that they were satisfied with how they were able to choose how to live, including staying in their room and the times of when they had help to get washed and dressed. In the rooms that we visited we saw that people had their own pictures, photographs and some had their own bed linen. We saw people receiving visitors and the visitors’ records books, outside each of the houses, had the names and times of when people had visitors and we found their was no restriction on visiting during the day time. Some of the people we spoke with said that they received visitors. Ten of the eleven residents’ surveys indicated that the home always or usually provided meals that the person liked with the remaining survey saying that sometimes the person liked their meals. A relative’s surveys said ‘The meals are of a high standard.’ According to the AQAA 50 of the staff have attended training in malnutrition and how to help a person with their food if they are unable to feed themselves. We saw that when people needed help with their food, when we visited Hayward and Harvester houses at lunch time, the staff were doing this in a sensitive and sociable 1:1manner. A copy of the minutes of a relatives’ meeting, held in December 2008, noted a relative’s view, that lunch time on Hayward house was ‘chaotic’. At lunch time we watched the people, in the main dining area of Hayward House and we found that the staff were carrying out their duties in a calm and unhurried manner and allowing time for the residents to eat their food. During our tour of all of the four houses we saw that the dining tables were provided with table linen, ornamental centre pieces of flowers in vases, condiments and the day’s menu. This told us that the home values the people’s dining experiences. The people we spoke with said that the food was ‘good’ and that there was a choice available. One person said that they were looking forward to their tea of ‘beans-on-toast’. We examined copies of menus for two weeks and we found that for both lunch and tea/supper time there is soup available. For lunch there were options such as lamb or cod pasta bake with vegetables and a dessert such as cheese cake or chocolate sponge and sauce. For tea/supper there was, for example, a choice of scotch egg or spaghetti hoops, egg and
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 22 bacon and hot dogs, followed by a dessert, such as cakes and ice cream. For one of the people, who we case tracked, they did not eat their lunch and so they were given strawberry yoghurt, which they seemed to be enjoying. The staff were able to tell us if any person was on a special diet, such as pureed food and we found that such diets were recorded in the people’s care plans. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. People can be confident that any complaint they have will be responded to and action taken to address these. People can also be confident that they are safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We noted, from the AQAA, that there have been fourteen complaints made against the home and the home responded to 97 of these within the 28-day required time period. According to the AQAA six of the fourteen complaints had been substantiated. The record of complaints was examined and we found that there was no recurring theme. We also found that, where there was a delay in the response to one of the complaints, the home had sent a ‘holding letter’. We found that the responses to the complaints were of a ‘listening’ nature. All of the eleven residents’ surveys said that the staff listened to the person and acted on what was said to them. All of these surveys said that the person knew who to speak to, informally, if they were unhappy about something and eight of the eleven surveys said that the person knew how to make a formal complaint if they wanted to. Two of the three relatives’ surveys said that the person knew how to make a formal complaint whereas the third of these
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 24 surveys said the person could not remember how to make such a complaint. Two of the three relatives’ surveys said that they were satisfied with the how the home responded to their concerns although the remaining third survey said that the person felt the home sometimes responded appropriately to their concerns. The people we spoke with said that if they wanted to make a complaint or if they were unhappy about something, they would know who to speak to. One person said that they had ‘No complaints’ and all of the people said that they were happy with their care. A relative’s survey said ‘The staff are always cheerful & friendly.’ The AQAA told us that, within the last 12 months ‘Trained more staff in awareness of safeguarding of vulnerable adults’ and ‘Have trained more lead practitioners in safeguarding’ with plans to ‘Continue to raise awareness on safeguarding, mental capacity and depravation of liberty.’ The AQAA told us that within the last 12 months (since May 2009 when the AQAA was completed) there have been seven safeguarding referrals made with one of these becoming subject to the local authority’s safeguarding investigation procedures. We know, from our records, that the home has a clear understanding of how to follow the correct procedures when allegations or concerns are made that come under the local safeguarding procedures. For one of the people, who we case tracked, they had been visited by their social worker and they found that the home had correctly followed the safeguarding alerts. We examined other records, to follow up how the home had responded to the actions recommended by the safeguarding teams. We found evidence that the home had taken satisfactory action; this included carrying out investigatory interviews and ensuring that staff had attended any identified refresher training. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 People using the service experience good quality outcomes in this area. People live in a safe, clean and comfortable home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The AQAA told us that within the last 12 months the environment of the home has improved because ‘We have continued our refurbishment programme of the home in spite of economic and local authority funding challenges. We have refurbished all the units to improve the environment in the home.’ According to the AQAA the home has identified that outside seating arrangements need to improve for people and their guests to use during the summer time. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 26 We found that all areas of the home were safe and well-maintained and that the lawns were mowed and flower beds were kept free from weeds and had seasonal flowers such as gazanias and sun flowers. In the past Harvester house had improvements made, in keeping with the special needs of the people, such as the introduction of personalised memory boxes, outside people’s rooms. We discussed this with the Manager and compared this satisfactory environment to the current one of Hayward, which could be made better to become more individualised to reflect the special needs of the people. Apart from one person who had no access to their call bell (see Standard 8 of this report) we found that every person who we subsequently visited had means to call for assistance, with the use of a call bell. Records for the temperatures of hot water in baths were seen; the last monthly tests, for all of the houses, were recorded as carried out on the 29th August 2009 within the safe ranges of 38.3 and 40.8 degrees centigrade and these were satisfactory. In our last inspection, of the 2nd July 2008, we noted that not all of the areas of the home were clean. Within the copy of the minutes of the relatives’ meeting, held in December 2008, there was a record of an attendee’s view that some areas, such as the armchairs, could be cleaner. Ten of the eleven residents’ surveys said that the home was always or usually clean and fresh with the remaining survey saying that sometimes this was the case. The AQAA told us that, to eliminate unwanted smells ‘We use a specialist microfibre cleaning system that combined with effective cleaning regimes keeps the home clean and odour free.’ We found that those places we visited were clean and fresh. The staff working in the laundry told us how they would wash clothing and bed linen from any person who had an infection and we were satisfied that appropriate red bags were used to collect such items. The staff were confident that they knew how to reduce the risk of the spread of infection when dealing with any contaminated laundry. In February 2009 we received information from the home telling us that some of the residents had an infection. The information told us that isolation procedures were put in place, to reduce the risk of the spread of infection to other people living at the home and that the home had notified the appropriate public health authority, in line with correct infection control procedures. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. People can be confident that they receive care from a sufficient number of staff who are adequately trained and generally well-recruited. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Nine of the eleven residents’ surveys said that the staff were always or usually available when the person needed them with the remaining two surveys saying that sometimes this was the case. One of the relative’s surveys said ‘The nursing staff seem to be short-staffed at times compared to the number of residents they have to deal with. There is not always a nurse available if someone needs help from their room’. Staff were available, including the nurses, in corridors and the communal rooms in all of the houses, when we visited during the morning and early afternoon when these times are considered busy working times According to the AQAA six of the care staff have left their employment within the last twelve months; given the size of the home (156 places) this is a small turnover of staff indicating that people should receive care in a consistent way from a stable team of staff. The staff we spoke with said that they were happy
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 28 with working at the home and felt supported by the Manager. They told us that there was always enough staff on duty and we found no evidence, such as during the lunch time, that there was an insufficient number of staff. The AQAA told us that there are 90 care staff of which 30 have the National Vocational Qualification level 2, or equivalent, in care i.e. 33 . This Standard was not met at the last inspection, of July 2008, and remains unmet at this inspection of September 2009. We looked at five of the staff files, two of which were about nurses currently working at the home. We found that the staff had submitted an application form with information about their employment and medical histories; a minimum of two satisfactory written references had been received and the person had been interviewed before they were accepted for the post that they had applied for. A POVA first check was received before the person started working at the home, unless the results of an applied criminal record bureau check had been received. (POVA = protection of vulnerable adults against abuse; the POVA list is now the Department of Health’s Vetting and Barring scheme: this holds the names of people who should not be allowed to work with vulnerable adults in care settings). All of the information was satisfactory with one exception; there was no documentary evidence that the home had obtained proof that the nurses’ registration with the Nursing and Midwifery Council (NMC) was current. We discussed this with the Manager who told us that this had been received but was not kept on the file. However action was taken by the home to obtain this required information, while we were inspecting, and we saw that both of the nurses were currently registered with the NMC. The Manager agreed that this NMC registration information would be kept on any of the nurses’ recruitment files. Of the 90 care staff the AQAA told us that 82 of these have completed the induction training described and recommended by Skills for Care. The three relatives’ surveys said that the care workers always had the right skills and experience to look after the people properly. The staff told us that they have attended ongoing refresher training including dementia awareness. The staff training records were examined and we found that some of the staff had attended training in tissue viability, wound care and management of people with diabetes (mellitus). As a result of our findings, reported on in Standard 8, we recommend that the retraining of staff in tissue viability should be considered. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People using the service experience good quality outcomes in this area. People can be confident that they live in a home that is wellmanaged although they cannot be completely confident that they are safely protected by the fire safety records. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A copy of the revised Statement of Purpose was sent to us in December 2008. It told us that the home Manager, Mr Henry Mutambo, was registered as a general nurse in 1996 and had managerial experience overseas before becoming registered with the NMC in 2003. The Statement of Purpose told us
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 30 that he has the registered manager’s award, a certificate in business studies, a certificate in health and safety for care home managers and was a former registered manager of a BUPA care home, in Cambridgeshire. On the 8th January 2007 he became the home manager for Wentworth Croft and in July 2007 he was successful in his application to be the registered manager of the home. He demonstrated that he was willing to improve the standards of care by taking immediate action to our serious concerns (see Standard 8 of this report). He has also demonstrated a clear knowledge of compliance with regulation 37 as we have received required information such as safeguarding alerts and outbreak of any infection in the home. The staff said that felt well supported by him. The AQAA told us that the home has a number of quality assurance systems including ‘Monthly audits are conducted by the regional manager assessing many aspects of care to allow continual quality assessment and improvement. This is in addition to the Reg 26s and also detailed audits on specific aspects of care done at Home level (medication, care planning etc)’ and ‘A regular overview on the quality of resident care is provided by the regional manager, regional director and the Quality and Compliance team.’ The home values what people think about the home. In 2008 surveys had been carried out, by the registered provider, asking residents and relatives their views about areas such as the food, the environment and the home. The residents’ surveys gave 93 overall excellent/very good rating and the relatives’ surveys gave 81 overall excellent/very good rating for the services provided by Wentworth Croft. The AQAA was completed to a satisfactory standard and identified areas where the home does well in, such as the involvement of residents with ‘The introduction of residents (sic) committee has increased feedback from residents and improved their involvement in the running of the home. We meet quarterly with the relatives over themed cheese and wine evenings.’ The AQAA, as part of the home’s quality assurance also identified areas where the home could improve such as ‘Train staff in complaints handling that could be resolved at the lowest level.’ This tells us that there is an internal monitoring and reviewing of the overall quality of the service. We looked at how the home safeguarded the personal allowances of two of the people we case tracked. The home does not keep any individual monies although records of any transactions, such as money received and money spent on items such as chiropody, hairdressing, toiletries and confectionary, are recorded on individual balances. Numbers of cheques and numbers of receipts are recorded to provide a clear audit trial of any transactions carried
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DS0000024308.V377413.R01.S.doc Version 5.2 Page 31 out. One of the two balances was satisfactory; the other person was owed eight pence by the home: this minor error was due to transferring information from a receipt to the individual computerised record. The member of staff said that this error would be rectified. The staff told us that they had attended training in fire safety and moving and handling and we looked at the records of this training that confirmed this was the case. We also found certificates of this mandatory training in the three of the most recently recruited staff. The main kitchen was inspected by the Environmental Health Officer, in August 2009, and was given an excellent rating of five stars. We examined the records for the fire alarm and emergency light tests and spoke with a member of the staff and the Manager. We were informed that the emergency lights were tested on the last Tuesday of each month. The record for July 2009 indicated that the emergency lights were checked on the last Tuesday i.e. 28th July 2009. The following record indicated that the emergency lights were tested on the 28th August 2009, a Friday. The following record said that the tests were carried out on the 25th September 2009, although this date was in the future, and was signed as confirmation that these tests were carried out, on this (not yet occurred) date. For the fire alarm tests we found, that these were tested on the 15th September 2009 (this too was a date in the future) and that, under the section for faults found, the word ‘none’ was recorded. We discussed, with the Manager, the discrepancies that we found in these fire safety equipment tests and we suggested that he should carry out a further investigation. According to the AQAA 80 members of care staff and 9 of the kitchen staff have attended training in safe food handling. The AQAA also told us that service and service checks are in date for hoists, fire detection and fire fighting and emergency lights. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 32 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 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x x 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 33 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 OP8 Regulation 12 Requirement Timescale for action 10/09/09 2. OP8 12 3. OP8 13 4. OP8 17 People must receive the right care and treatment in accordance to the advice provided by a health care professional. This is to ensure that people get the right treatment with particular regard to pressure area care. People must receive safe and 10/09/09 proper personal care with particular regard to hand and nail care. This is to ensure that a person does not acquire an infection and broken skin. People must have access to a 25/09/09 health care professional, such as a physiotherapist, to ensure that the person receives an appropriate assessment and advice. This is to ensure that any suggested remedial treatment is provided. Records for the treatment and 10/09/09 care, provided to any person with a pressure sore, must be accurately maintained. This is to ensure people with this condition receive the right care and treatment.
DS0000024308.V377413.R01.S.doc Version 5.2 Wentworth Croft Page 34 5. OP9 13 6. OP9 13 7. OP9 13 8. OP22 16 Special instructions for the administration of medicines must be followed. This will ensure that people receive their medication safely. There must be sufficient supplies of medication held in the home for the continued treatment of residents. This will ensure they receive their medication as prescribed. Risk assessment and risk management plans must be in place for people using medical gases. This will protect residents from harm. People must be provided with equipment so that they can call for assistance. This is to protect people’s health, welfare and safety. 10/09/09 30/09/09 30/09/09 10/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 35 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk
We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Wentworth Croft DS0000024308.V377413.R01.S.doc Version 5.2 Page 36 - 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!