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Inspection on 03/07/07 for Wentworth Croft

Also see our care home review for Wentworth Croft for more information

This inspection was carried out on 3rd July 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People said that staff were caring and "It is a lovely home". The garden areas are well-presented and there is a refurbishment programme to make the place more homely and fresh smelling. Written comments that we have received said, "Action is always taken (in response to concerns made)" and "We have a very high opinion of all the staff and the care they provide." There have been sustained improvements in areas such as the quality of food, respect for people`s personal clothing, staff recruitment practices and staff training in protection of vulnerable adults against abuse.

What has improved since the last inspection?

Since the last key inspection of July 2006 and assessed during the random inspection of 19th December 2006 4 requirements had been met and 7 recommendations had been considered. A recommendation has been considered to reduce the number of staff that leave. Senior staff now have improved knowledge of the procedures for the safe use and handling of medicines which was a requirement of the previous inspection. The recommendation made to sign and date hand-written medication records has been considered. Senior staff have been given time to manage their units/houses, carry out audits on other units/houses and to carry out supervision of their staff.

CARE HOMES FOR OLDER PEOPLE Wentworth Croft Bretton Gate Peterborough PE3 9UZ Lead Inspector Elaine Boismier Unannounced Inspection 3rd July 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 Croft DS0000024308.V344547.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 Croft DS0000024308.V344547.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) Limited Manager post vacant Care Home 134 Category(ies) of Dementia - over 65 years of age (37), 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 (127), Physical disability (2), Physical disability over 65 years of age (60), Terminally ill over 65 years of age (60) Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 9. Two named individuals with Physical Disabilities who are below 65 years of age (PD) for the duration of their residency No more than 92 beds to provide nursing care Service users who are over 65 years of age, not falling within any other category (OP), not exceeding 127 places for the duration of Condition 1 & 8 Terminally ill over 65 years of age (TI(E)) not exceeding 60 places for the duration of Condition 1 Physical disability over 65 years of age (PD(E)) not exceeding 60 places for the duration of Condition 1 & 8 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 37 places. The maximum number of persons accommodated in the home at any one time is 134 5 named individuals over 65 years of age with dementia for the duration of their residency only (DE(E)) 4th July 2006 Date of last inspection Brief Description of the Service: Wentworth Croft is situated in Peterborough City 4 miles from the city centre and is accessible by public transport. The home is situated in well-maintained and landscaped gardens including an enclosed garden for those living at Harvester House. Wentworth Croft is arranged into 4 houses: Yeoman and Hayward provide up to 60 places for people over 65 years of age who have nursing needs; Harvester provides up to 32 places for people over 65 years of age with both nursing and mental health needs; Woolsack provides up to 42 places for people over 65 years of age with personal care needs. The Commission for Social Care Inspection has approved variations of registration for 2 named people below 65 years of age with personal care needs and 7 additional people, over 65 years of age, with mental health needs, to live at the home. The current certificate of registration is to be amended to reflect the correct number of people living in the home who are under 65 years Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 5 of age. Current fees range from £379.44 to £706.75. Additional costs include those for chiropody, hairdressing and private taxis. A vacancy has arisen for a registered manager of the home. An application has been made, for the Commission to consider, to register the home manager. An application also has been made, for the Commission to consider, to register an increased number of places. A copy of the inspection report is available on request at the home or via the CSCI website. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report is of the key inspection of Wentworth Croft. The inspection was unannounced and was carried out by two Inspectors between 10:00 and 16:45 and took 6.45 hours to complete. Information received between the last key inspection in July 2006 and this inspection will also be referred to in this report. On the day of the inspection there were 107 residents living at the home and a number of these were spoken to. A tour of the premises was made, documentation was seen and visitors, staff, including the Manager, were spoken to. Staff were also observed whilst carrying out their work. Medication practices were assessed on 3 of the 4 units/houses; Harvester, Woolsack and Hayward Houses. A visit was made to all four Houses. Before the inspection we sent out 134 residents’ surveys and received 26 of these back. We also sent out 60 relatives’/visitors’ comment cards and we received 3 of these back. Before the inspection the Manager also completed a questionnaire providing us with information about the home. For the purpose of this report those living at Wentworth Croft are referred to as “people” or “residents”. Meeting 27th November 2006 We attended a meeting held in the evening of 27th November 2006 that was attended by relatives of residents, representatives of BUPA Care Homes and the local authority. The purpose of this meeting was to hear the concerns relatives had about the standard of care and the standard of the home environment and the standard of management of the home. Random unannounced inspection 19th December 2006 We took these concerns about the standard of care and standard of the environment and used them as part of the focus for a random unannounced inspection that was carried out on the 19th December 2006. We also assessed what action had been taken to consider recommendations and comply with the requirements following the inspection in July 2006. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 7 We visited both Hayward and Harvester House and found these places to be clean and there were no offensive odours. We found that the standard of personal care provided to the people was of an acceptable standard and drinks were available for them. We found people’s clothes hung up in wardrobes or put in drawers rather than being left on the floor. We also looked at medication and documentation including medication and care plan records and we also spoke to staff including senior people in charge. We assessed that 4 requirements had been met and two requirements that had not been met were carried forward with a new timescale for action. These two requirements that had not been met were related to medication. Seven recommendations had been considered and two recommendations remained. These 2 recommendations that were to be considered in full were related to medication and the percentage of care staff with NVQ level 2. We made an additional recommendation following our inspection for the home to consider ways to reduce the high turnover of staff. The full report letter of the inspection of 19th December 2006 is available on request at our local CSCI Cambridge and Peterborough Office. Telephone 01223 771300. March 2007 During March 2007 we attended two meetings held under the local Protection of Vulnerable Adults (POVA) procedures. This was related to a person that the home was providing care for. The outcome of the following investigation was that the home had provided proper care to the person although BUPA Care Homes agreed that the standard of care records could have been better. Wentworth Croft provides an adequate quality service and has the potential to be that of a good quality service should action be taken in response to the requirements and recommendations made in this report and any improvements made, as a result of this action, be sustained by management of the home rather than by reliance on regulation. What the service does well: People said that staff were caring and “It is a lovely home”. The garden areas are well-presented and there is a refurbishment programme to make the place more homely and fresh smelling. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 8 Written comments that we have received said, “Action is always taken (in response to concerns made)” and “We have a very high opinion of all the staff and the care they provide.” There have been sustained improvements in areas such as the quality of food, respect for people’s personal clothing, staff recruitment practices and staff training in protection of vulnerable adults against abuse. What has improved since the last inspection? What they could do better: Care plans must provide more detail so that people receive the appropriate care. A requirement has been made about this. The standard of personal care must be improved with regards to hair and nail care. A requirement has been made about this. Stock control of medication is use could be improved since the quantities were higher than would be expected and some medicines had been supplied some six months previously. The accuracy of the records made when medication is prescribed and administered to residents must be improved and a requirement has been made about this. A requirement has been made for the home to provide suitable activities for everyone wishing to take part (including 1:1 activities). Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 9 Following our inspections of July and December 2006 there was a recommendation made for the home to have 50 of care staff to have NVQ in care. This recommendation remains as currently the home has 20.3 of care staff with this qualification. This recommendation will not appear in the recommendation table of this report but remains. 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 Croft DS0000024308.V344547.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.V344547.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Quality in this outcome area is adequate. People who intend to move in to the home do not always have information about the place to help them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation was made about information being provided to people when moving into the home. This was with particular regard to people receiving intermediate care. During our inspection of December 2006 the home was no longer providing intermediate care and as a result of this we made the decision that this recommendation was considered. However although 84 of residents’ surveys said that the person had enough information about the home before moving in 16 of residents’ surveys said that the person did not have this information before moving in. Of those Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 12 people who did not have this information it appeared that they were admitted to the home from hospital. We found this also to be the case from information provided by people and their guests during the inspection. We have not made any requirement or recommendation about this, as it is our expectation that action will be taken by BUPA Care Homes to improve the standard or methods of information provided before people move into the home particularly for those people being discharged from hospital. Examination of a number of people’s care records indicated that information about the person, including full assessments about their needs, was available before they moved in, so that the home could consider if it was able to meet the needs of the person. Since the key unannounced inspection of the 3rd July 2006 the home has ceased to provide intermediate care and therefore Standard 6 is no longer applicable. Wentworth Croft DS0000024308.V344547.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. People receive a standard of care that is adequate but could be improved upon to safeguard their health and welfare. Staff are kind and caring. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the inspection of 19th December 2006 we found that 2 recommendations had been considered with regards to care plans. During a Protection of Vulnerable Adults (POVA) meeting held in March 2007 BUPA Care Homes agreed that the standard of care records were to be improved upon to provide accurate details about the person that the records related to. During this inspection a number of people’s care records were examined in Harvester House, Woolsack House and Hayward House. The standard of care records varied in each of the Houses. On Hayward House care records were Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 14 detailed and reviewed each month. Discussion with staff and people indicated that the care records were accurate and reflected the care that the person was assessed to need. On Harvester House the care records were well detailed although did not include all the assessed needs of the person. This was noted during discussion with the person and their guest when it became clear the resident had severe hearing impairment that caused difficulties for the person with communication and taking part in activities. On Woolsack House the care records that were examined did not provide sufficient detail about the person and how staff were to care for them. This care included prevention and treatment of pressure sores, reducing anxiety and monitoring and taking appropriate action for a person who had had unintentional weight loss before moving into the home. Where medication is prescribed on a “when required” basis there were no details or guidance in care plans as to the circumstances such medication is to be used. This is needed to ensure that residents are not put at risk by being given medication when it is not necessary and other approaches can be used. A requirement has been made with regards to care plan documentation. Discussion with staff and examination of people’s care records indicated that residents have access to a range of healthcare professionals including specialist nurses, district nurses, speech and language therapists, dieticians and general practitioners. At the time of the inspection district nurses were visiting a resident, living on Woolsack House, who had additional health needs other than those the unit could provide. A requirement was made, following the inspection of 4th July 2006 for people to receive an acceptable standard of personal care to include hair, nails and teeth. During our inspection of the 19th December 2006 we found the standard of personal care to be of an acceptable standard and as a result of this evidence we considered that this requirement had been met. However during this inspection, of 3rd July 2007 it was noted that, during the visit to Hayward House, the cleanliness of some peoples’ hair and cleanliness of their nails was of a poor standard. Hair was greasy and fingernails had dirt underneath. Unsolicited comments were made, by a person’s relative to the Inspector, with regards to the cleanliness of the resident’s hair. A requirement has been made about this. 76 of respondents of the residents’ survey said that they always received the care and support that they needed; 20 of respondents of the residents’ survey said that they usually received the care and support that they needed; Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 15 4 of respondents of the residents’ survey said that they did not receive the care and support that they needed. 96 of respondents of the residents’ survey said that they always received medical support that they needed; 4 of respondents of the residents’ survey said that they usually received medical support that they needed. A visitor to the home said that the home had acted promptly when their relative, a resident, had become suddenly unwell. Medication storage and records were examined on three of the four houses/units. Residents are protected by adequate security of medicines and the temperature of the storage facilities ensures the quality of medicines in use. However, it is of concern that the temperatures of one of the medicines refrigerators was recorded outside the recommended range without action taken to investigate the performance of the fridge or if the medicines stored there were still usable. Stocks of medicines are higher than expected and some have been in stock for up to six months. This is wasteful and may increase the risk of medicines being used beyond their expiry date. Some medication was found still in stock which had been prescribed for a resident who has not been in the home for the last six months. Staff must take more control of the ordering process so that stock levels do not increase and make sure that medicines that are no longer required are disposed of promptly. There is generally a good audit trail to account for all medicines received into the home and disposed of, but the records of medicines received outside the monthly ordering cycle could be improved by an indication of the date of receipt. Records of medicines prescribed and administered were examined and there were a worrying number of gaps in the administration records for medicines giving no clear indication of whether medicines had been administered or not. Some of the printed instructions for medicines were different to the instruction on the label on the container of medicines. This is confusing and may have led to staff giving the wrong dose of a medicine to residents. Only trained staff are allowed to give medicines to residents and observation of this showed that residents choice and dignity was respected. However, one member of staff was seen to handle medication to give to several residents without washing her hands in between. This is an unacceptable standard of hygiene and infection control and must be resolved. We have received written comments that said, “We have a very high opinion of all staff and the care they provide”. We have received written comments in the relatives’/visitors’ comment cards that said, “Wentworth Croft is a super home for my Dad and I know he is well looked after. He is well fed, cared for and the atmosphere is good”. Other written comments that we have received included, “We have a very high opinion of all the staff and the care they provide.” We also received written Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 16 comments about staff that said, “Staff are always helpful and pleasant to speak too (sic) on the phone or when we visit”. We observed staff to be kind and caring when they were looking after the residents. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 17 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. People are given the opportunities to live an adequate quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made following the inspection in July 2006, and was considered met during the inspection in December 2006, for people to be given the opportunity to choose when they wanted to get out of bed. During this inspection people were offered choices of when to get up and when to stay in bed and these choices were recorded in some of the care records that were examined. It was observed, however, during a visit to one of the Houses, that a person was not given the choice if they wanted a drink or not. The drink was placed in front of the person without any consultation beforehand. There was no choice offered of what the person would like to drink e.g. hot or cold. The person was given a cold drink of orange juice although there was an alternative choice of apple and blackcurrant. We have taken the reasonable view that this issue will be managed by the home rather than by regulation. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 18 We received a range of views and comments from the residents’ survey with regards to activities. 26 of respondents of the residents’ survey considered that the home always provided suitable activities; 34.7 of respondents of the residents’ survey considered that the home usually provided suitable activities; 39.3 of respondents of the residents’ survey considered that the home sometimes provided suitable activities. One person wrote (with regards to the activities) “Very good. I enjoy them,” whereas another person wrote, “Activities could be a lot better for resident on a one to one and exersizes (sic)”. Other written comments that we received said that some people were unable to take part in activities because they were “bed bound”. Some activities were taking place at the time of the inspection although this was not throughout the home. As a result of this evidence a requirement has been made for the home to provide suitable activities for everyone wishing to take part (including 1:1 activities). Discussion with a visitor to the home and information provided at the meting held in November 2006 suggests that people have access to advocacy services including the Alzheimer’s Society. At the time of the inspection we noticed people receiving their guests in their rooms or in the lounges. All 3 relatives’/visitors’ comment cards said that they could visit the home at any time and meet the resident that they were visiting in private. However we received one comment within a resident’s survey, completed on behalf of the person that said, “Not happy about cleaners cleaning room while having visitors”. It is our expectation that the home takes action in response to such a comment rather than any action taken by us. Information provided by the Manager before the inspection included copies of menus. Examination of these indicated that people are offered 4 meals each day, including the option of a cooked breakfast and a choice of menu at lunch time. The copies of the menus indicated also that tea and coffee and biscuits were offered during the mid morning and during the mid afternoon and we saw this to be the case during the time of the inspection. 52 of people in the residents’ survey said that they always liked the food; 40 of people in the residents’ survey said that they usually liked the food; 8 of people in the residents’ survey said that they sometimes liked the food. Written comments that we received ranged from, “(If food is not liked) they always offer an alternative” to “Could be a better choice and better viraty (sic).” Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 19 A recommendation was made following the inspection in July 2006 for a review of the standard of food. During the inspection of December 2006 evidence suggested that the quality of food had improved and therefore this recommendation had been considered. During this inspection the food provided at lunch time was seen and residents showed us how tender the meat was. Vegetables also looked appetising. Pureed food was presented in separate constituents. People needing assistance with their food were helped by staff who were sat down and gave 1:1 attention to the person that they were helping. A concern that relatives expressed during the meeting in November 2006 was that people were not always provided with drinks. During our inspection of the 19th December 2006 we found that drinks were available and in reach of the residents. During this inspection drinks were offered and also in reach for people to get. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 20 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 good. People are listened to and protected from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 100 of the residents’ surveys and relatives’/visitors’ comment cards said that the person knew how to make a complaint. 60 of the residents’ survey said that the person always knew who to speak to if they were not happy; 28 of the residents’ survey said that the person usually knew who to speak to if they were not happy; of the residents’ survey said that the person knew who to speak to if they were not happy; 4 of the residents’ survey said that the person sometimes knew who to speak to if they were not happy. During this inspection both visitors and residents that were spoken to confirmed they knew what to do if they were unhappy about something. Information provided by the Manager before the inspection notes that within the last 12 months the home has received 16 complaints of which 7 were substantiated and 2 substantiated in part. Examination of the complaints record and discussion with a member of staff indicated that these complaints were mainly due to standards of care and food. All complaints had been responded to within 28 days. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 21 A senior member of staff said that the Home Manager speaks to relatives if they have a concern and this action has been effective to reduce the numbers of complaints made. 100 of the respondents of the residents’ survey considered that the staff always listened to the person and acted on what the person said to them. We received written comments about concerns made that included, “Action is always taken.” We received a copy of the monthly report, for June 2007, made by a representative of BUPA Care Homes and information provided in this report noted that no complaints had been made within the last month. Within the last 12 months the home has been subject to six POVA investigations and it is our experience that BUPA Care Homes has co-operated with the local authorities and the Commission during these investigations and taken appropriate action to protect vulnerable people from the risk of abuse. In May 2007 the home sought advice, from the POVA team, about how to care for a person with dementia in a non-abusive way. The advice sought was also about how care should be provided in accordance with the Mental Capacity Act and its Code of Practice. During the meeting held in November with residents’ relatives a concern was expressed by them that residents’ clothing was not hung up. During the inspection of December 2006 we found that people’s clothing was hung up in wardrobes and had been put away in drawers. We found this also to be the case during this inspection. Staff, that were spoken, to said that they had attended POVA training and on two of the Houses we saw the local reporting procedures for staff to follow if there are allegations or suspicions of abuse. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 22 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 adequate. People live in a home that is comfortable although not always fresh smelling. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was surrounded by well-maintained and well-presented gardens. The garden area around Harvester House is enclosed and during the inspection it was noted that a resident and their visitor were sitting outside in the garden in the fresh air. Currently Wentworth Croft is having building work carried out to increase the number of places on Yeoman and Hayward Houses. Changes of provision of care will also be made on Yeoman House. An application to register the increased number of places has been made for the Commission to consider. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 23 During this building work some carpets have been replaced and according to the Manager the carpet in the lounge area of Woolsack (that is stained in many areas) is due for replacement. During the meeting of 27th November 2006 we heard concerns from relatives of people about the poor standard of cleanliness of the home and the smell of stale urine. During our inspection of the 19th December 2006 we found the home to be clean and it smelled fresh. In June 2007 we received a verbal complaint, from a confidential source, that there was a strong smell of urine in Harvester House. We contacted the home Manager the same day and he reported that he was aware of this problem and had already taken action to remedy the situation. On entry to Harvester House, during this inspection, we noticed a strong smell of urine. Discussion with staff, including the Manager indicated that action has been taken to replace the carpet with a more suitable floor covering. As action is being taken we will not make a requirement on this occasion as the home is managing the issues with regards to improving the environment of the home. 60 of respondents of the residents’ survey said that the home was always clean and fresh; 40 of respondents of the residents’ survey said that the home was usually clean and fresh. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 24 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 good. People receive care, from staff who are generally well trained and well recruited, to ensure that there needs are appropriately and safely met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation was made following the inspection in July 2006 for communication between staff to be improved. This was with particular regard when the home was providing intermediate care. During our inspection in December 2006 as intermediate care was no longer provided at the home and we found staff were communicating well with each other. As a result of this evidence this recommendation had been considered. A recommendation was made following the inspection of July 2006 for the organisation of staff to be improved upon during meal times and there was a concern expressed by relatives at the meeting of November 2006. Their concern was that people were not being assisted with their food. During the inspection of December 2006 we found that people living in Harvester House were being assisted by a sufficient number of staff who were assisting people with their lunch in an unhurried manner. During this inspection we noted also the same and during other times of the working day when people were receiving care. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 25 Senior staff said that since the Manager was appointed to his position in January 2007 they have been provided with the opportunity, by having protected time, to manage their units, including supervision of staff and carry out audits of other Houses of the home. Two of the 3 relatives’/visitors’ comment cards said that there was always sufficient number of staff on duty. Comments made by visitors and people indicated that on the odd occasion staff were short in numbers, although we have no other evidence to support this, on this occasion. The Manager before the inspection sent copies of the duty rosters. Examination of these indicated that there is a sufficient number of staff on duty at all times of the day and night although BUPA Care Homes should be mindful that flexibility of this should be available to be responsive to people’s changing needs. The Manager reported that there has been no agency staff used as staff from other Houses work in other areas of the home should there be a need. Discussion with staff on Harvester House confirmed this to be the case although concerns were expressed about the lack of training of these staff in caring for people with challenging behaviour and mental health needs. The Manager reported that action has been taken for all staff to attend such training, by September 2007. As a result of this action we have made no requirement as the issue is being managed by the home. A concern expressed by relatives of residents, during the meeting of 27th November 2006, was that there was a high turnover of staff and as a result of this continuity of care for people was at risk. During our inspection of 19th December 2006 we had evidence to confirm that there was a high turnover of staff and as a result of this evidence made a recommendation to consider ways to retain staff. Information provided by the Manager before the inspection notes that 23 members of staff have left since the inspection within 12 months. At the time of the inspection the Manager considered this to be as a result of unclear management arrangements in one of the Houses. According to the Manager, sine the appointment of a new unit manager in this House, there has been a reduced turnover of staff. As a result of this action this recommendation has been considered. A recommendation remained for 50 of care staff to have NVQ level 2 in care. Information provided by the Manager before the inspection notes that these has been a reduction from 38 of care staff, who had this qualification at the time of the inspection of 19th December 2000, to a current 20.3 . Although Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 26 this recommendation will not appear in the recommendation table of this report, this recommendation remains. A requirement was made following our inspection of July 2006 about staff information. During the inspection of December 2006 we found that the requirement had been met. During this inspection all required information about staff was available within the 3 staff files that were examined. Information provided by the Manger before the inspection notes that all registered nurses are currently registered with the Nursing and Midwifery Council and this was also confirmed during examination of a nurse’s recruitment file. A requirement made following the inspection in July 2006 was for all staff to have attended training in POVA. This requirement was considered met during the inspection in December 2006. During this inspection, of July 2007, staff confirmed that they had attended POVA training. Information provided by the Manager before the inspection notes that staff have attended a range of training to include wound management, management of diabetes, infection control, care planning, nutrition and meals, pressure area care and care of catheters. Staff that were spoken to during this inspection reported that they had attended training in a range of subjects. Information provided by the Manager before the inspection included copies of the staff training and development plan for 2007 to 2010. Included in this plan is training for Care in Dementia, POVA, Food Hygiene, First Aid, Moving and Handling, Infection Control and Health and Safety. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 27 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): 31,32, 33,35 & 38.Quality in this outcome area is good. People benefit from a well-managed service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In January 2007 a new Manager was appointed to mange the home. He is a Registered General Nurse and has experience managing a care home, as Registered Manager, prior to his current position. He has attended a number of training sessions in management with in the last year and has also successfully completed the Registered Managers Award. An application is being made for the Commission for Social Care Inspection, to register the Home Manager. We received positive comments, from staff, about his style of management in that he listens to staff, relatives, visitors and residents and has provided senior Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 28 staff opportunities to develop their management and auditing skills. A member of staff said, “This home has never been better (since the manager came into post). We receive copies of reports made following monthly visits to the home by a representative of BUPA Care Homes. These reports include audits of complaints, staffing and changes to the home environment. BUPA Care Homes carried out surveys in 2006 asking relatives and residents their views about Wentworth Croft. The results of these surveys were available for inspection. Overall Wentworth Croft was viewed to be a good place to live, by the respondents of the surveys. Although were unable to assess in full the home’s financial procedures in safeguarding people’s monies, we examined a record of balances of monies. Each person, that the home safeguards monies for, had a separate balance. Records of hot water checks, fire alarm tests, emergency lighting checks, temperatures of the fridges and freezers in the main kitchen and records of staff training in moving and handling, fire safety and food hygiene were examined and these were satisfactory. During the tour of Harvester House a store cupboard was unlocked. Conditioning shampoo and skin cleaning agents were located in this store cupboard. The substances were not hazardous to health. Staff confirmed that the cupboard should have been locked, as there were a number of residents who are able to walk about in the home without supervision of staff. Action was taken immediately to lock the door. We have made no requirement about this, on this occasion, as the substances were not hazardous to people’s health. Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 29 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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 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 3 3 x 3 x x 3 Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1) Requirement The care plan must be sufficient in detail to guide staff in how to provide appropriate care to service users. Service users must receive personal care with particular regard to hair and nail care, to maintain their health and welfare. Service users must be given medication with regard to standards of hygiene and infection control. Records of medicines prescribed, received, administered (or not administered) for residents must be accurate and up to date. Suitable activities must be provided to all service users to prevent boredom and depression. Timescale for action 04/09/07 2. OP8 12(1)(a) 17/07/07 3. OP9 13(2) 17/07/07 4. OP9 13(2) 31/08/07 5. OP12 16(2)(n) 28/09/07 Wentworth Croft DS0000024308.V344547.R01.S.doc Version 5.2 Page 31 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.V344547.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Cambridgeshire and Peterborough Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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