CARE HOMES FOR OLDER PEOPLE
Wentworth House 8 Blantyre Road Swinton Gtr Manchester M27 5ER Lead Inspector
Adele Berriman Unannounced Inspection 27th October 2005 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 House DS0000008339.V260181.R01.S.doc Version 5.0 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 House DS0000008339.V260181.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Wentworth House Address 8 Blantyre Road Swinton Gtr Manchester M27 5ER 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) 0161 793 9090 Mr Antonio Belvedere Mrs Christine Belvedere Care Home 19 Category(ies) of Learning disability over 65 years of age (1), Old registration, with number age, not falling within any other category (18) of places Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service user category (LD) (E) is specifically for one named individual. If this person leaves the service user category will revert to (OP). 10th November 2004 Date of last inspection Brief Description of the Service: Wentworth House is a home that provides residential care for up to 19 service users over the age of 65. The home is situated on a quiet residential road in the Swinton area of Salford. The home is situated close to local amenities and close to public transport routes. Bedrooms are situated on both the ground and first floor of the accommodation. A passenger lift serves both floors. There are several communal lounges and two communal dining rooms that are situated on the ground floor of the accommodation. The home continues with on-going refurbishment to provide a pleasant environment. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted on 27 October 2005. During the course of the inspection time was spent talking to a number of residents, several relatives of residents, and the home managers. At the time of the inspection a representative from Salford City Council’s Environmental Health department was carrying out a health and safety inspection. Those key standards not assessed during this visit will be assessed during the next inspection. Examination of records, care plans, medication records, staff files, policies and procedures relating to the home took place. The home continues to provide long stay accommodation. Throughout the inspection the inspector observed a pleasant atmosphere around the home with lots of conversation taking place between residents, staff and visitors. The home provides a safe comfortable home for residents requiring personal care. What the service does well:
Staff and management of the home were seen to address and support residents in a respectful and polite manner and demonstrated that they had a clear understanding of individuals care needs, wishes, likes and dislikes. This was confirmed by residents in the home and visiting relatives. Residents and visitors to the home indicated to the inspector that they were happy with the service that they received from the staff team. One resident said that “they can’t do enough for you” and a visitor described the staff team as “angels”. Residents had regular access to their GP and other local health professionals. Relatives of residents in the home are kept fully informed about the welfare of their family member. The home offers a clean, tidy, comfortable homely environment with a pleasant atmosphere. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 6 Staff continue to study for their NVQ level 2 & 3 in care qualification. The manager demonstrated on several occasions during the inspection that he is ‘networking’ with other agencies and organisations within the local area to gain ideas on how to continually update best practice within the care sector. What has improved since the last inspection? What they could do better:
The Service User Guide and Statement of Purpose do not fully reflect the service that is provided by the home. It is essential that these documents include full details of all the services that are offered and any additional costs that service users may incur whilst living at the home. Some files did not contain a copy of the individual’s pre-admissions assessment. This document is essential as it forms the basis for the development of the individuals care plan.
Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 7 Improvements need to be made to the homes care planning process as they do not fully reflect the care and support that the service delivers. One area in particular is that of the reviewing of the care plans. Some of the information in the care plans was out of date and incomplete. It is necessary that care plans contain full, accurate and up to date information to ensure that staff are aware of individual’s changing needs and are able to deliver the appropriate care and support. Risk assessments formed part of the care plans. Some of these documents also lacked information and required updating. Risk assessments are required to be reviewed and where required updated on a regular basis to ensure the safety and wellbeing of all. A requirement has been made in this report that all staff receive regular updated training in all aspects of their role. Several areas of training appeared to be out of date. During the inspection the manager and the inspector discussed this issue and the manager stated that he is in the process of arranging training from several local resources and gave the example of a dementia training course that staff would attend with staff members from another local residential home. Formal, documented supervision sessions are required to take place on a regular basis for all staff. During the inspection it was evident that staff received regular support and advice from the managers of the home. 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. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 8 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 House DS0000008339.V260181.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 The Statement of Purpose and Service User Guide to the home require further development to ensure that they contain all the information about what the service offers. The lack of pre admission assessments on residents care plans does not reflect the practice of the home. EVIDENCE: The home had a Service User Guide and Statement of Purpose available in the home. These documents still required further development to ensure that they contained all the relevant information. The manager stated that he was in the process of developing the documents further to ensure that all the appropriate information was available for prospective and current residents of the home. Several documents that were to be contained in the Service User Guide and Statement of Purpose were viewed by the inspector. Relatives visiting the home confirmed to the inspector that the needs of their family members were fully assessed prior to their admittance to the home. Relatives commented that they were encouraged to visit the home prior to the admission and that information they wished to give regarding their relatives
Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 10 care and support needs was listened to and contributed to their relatives care plan. However, not all residents’ files contained a completed pre-admission assessment form. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Care plans within the home do not fully reflect the service that is provided. EVIDENCE: Individual care plans were available for each resident. The care plans contained personal information, weight management information, daily records of what care and support had been delivered to residents and care manager/social worker annual care reviews. There was also opportunity on the care plan for all aspects of individual’s needs and wishes regarding all aspects of day to day life to be documented. However, not all of the information was complete or up to date. Risk assessments formed part of the care plans. Some were found to be comprehensive and other were found to be in need of review and updating to ensure that any changes of the individuals needs have been documented and considered. There was documentary evidence at the home that confirmed that residents had regular access to their GP and other primary healthcare professionals when required. Three relatives of residents informed the inspector that they
Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 12 were always kept informed of any changes to their relatives’ health and wellbeing. One relative shared how the manager of the home, the GP and herself had communicated in ensuring that her relatives had the most appropriate care and support whilst coming to the end of a terminal illness. The relative said that she was confident that her relative was receiving the appropriate support from all the staff team and knew that she would be informed immediately of any changes. The home had a policy for the storage, handling, administration and disposal of medication. Medication within the home was stored appropriately. All staff responsible for the administration of medication received training of the managers of the home. A work book for staff to complete was also available regarding the administration and the manager of the home stated that he was working with Salford Social Services training department and the local pharmacist regarding medication training. Throughout the inspection staff were observed treating residents in a respectful manner and observed knocking on bedroom and bathroom doors and waiting for a response before entering. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Service users needs in relation to social, recreational, religious and cultural wishes are observed by the home. EVIDENCE: At the time of the inspection all lounges were in use by residents, several residents were watching TV, several residents were listening to music from the 1940’s and two residents were reading newspapers. Residents confirmed that they occasionally had entertainers visiting the home and that staff regularly reminisce about the local area, food and music. Playing cards, dominoes and games were available for use in the communal lounges. One family informed the inspector that the managers of the home had recently organised a party at the home for everybody to celebrate a special anniversary of a resident who was poorly. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Residents and their families were confident that any concerns/complaints raised with the home would be addressed. EVIDENCE: The home had a comprehensive complaints policy and procedure in the home. Information regarding the procedure was readily available in the home. Residents confirmed to the inspector that they knew who to speak to if they had a complaint or a concern regarding the service they receive. Visiting relatives informed the inspector that they would be comfortable in approaching the staff/management of the home if they had any concerns regarding the care that their relative was receiving, and they were all confident that any concerns raised would be dealt with appropriately. The home had a policy on the protection of vulnerable people along with a copy of Salford Social Services joint agency adult abuse policy. The managers of the home demonstrated a good understanding of these policies and procedures. The manager stated that not all staff had received awareness training in adult protection. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25, 26 The home provides a clean and comfortable environment in which to live. EVIDENCE: At the time of the inspection the home was found to be clean, tidy and well maintained. The home employed a part-time ‘handy person’ for day to day maintenance and gardening. Several residents’ bedrooms were inspected and all were found to be personalised with residents’ personal effects and contain appropriate furnishings and equipment for the individual. Indoor and outdoor communal areas were safe and accessible to all. Indoor communal areas were comfortably furnished and decorated. Since the previous inspection some areas of the home had been redecorated and recarpeted.
Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 16 Hot water temperatures were randomly tested around the building and found to be appropriate. Temperatures were monitored by the home on a monthly basis and a record kept. A requirement had been made in the previous inspection report that the home completes all outstanding requirements from the report produced by Greater Manchester Fire Service following their visit to the home in March 2004. The manager confirmed that these requirements had been met at the time of this inspection and the manager of the home confirmed that all work was completed. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 Staff provide a good service to residents. Regular refresher training is required to be given to staff to ensure this standard continues. EVIDENCE: At the time of the inspection there were two carers and a manager on duty to meet the needs of residents. Staffing rotas demonstrated adequate staffing levels throughout the day and night to meet the needs of individuals. The home did not employ a cook though efforts had been made by the home to recruit a suitable person for this role. The manager demonstrated a commitment to try to recruit a person for the role of cook. The senior carer on duty is currently responsible for cooking. The home must ensure that there is sufficient staffing available to meet the needs of service users whilst a member of the care staff is carrying out kitchen duties. The home had a recruitment procedure that clearly demonstrated that an appropriately completed application form was received from any candidate and that two acceptable written references and Criminal Record Bureau checks were received prior any person commencing employment. Staff files contained some but not all of the information required in schedule 2 of the Care Homes Regulations.
Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 18 At the time of the inspection several staff were in the process of doing their NVQ levels 2 & 3 qualifications in care. The manager stated that he was in the process of arranging training in food hygiene, manual handling and first aid for staff to attend. Throughout the inspection staff demonstrated a thorough knowledge of each residents’ needs and wishes. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 Policies and procedures do not fully reflect the homes practices. EVIDENCE: The home is jointly managed by Mr & Mrs A Belvedere, both of whom have professional qualifications in nursing and many years’ experience in caring for people. Relatives visiting the home spoke highly of the management of the service. Since the previous inspection a questionnaire regarding the service provided by the home was circulated in June 2005. The inspector read the completed questionnaire and all comments were positive. The manager of the home stated that he intended to circulate the questionnaires to residents and their families on a twice yearly basis. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 20 There was little evidence available that demonstrated that staff were in receipt of regular formal supervision. The manager stated that supervisions are ‘moving along’ but need to improve. The manager also stated that the homes appraisal system requires further development. The manager stated that monthly meetings were held with senior carers and then the senior carers carried out meetings with the carers. Minutes to these meeting were not available. The home purchases a health and safety management system that provides advice and support on all aspects of health and safety. The manager stated that some policies and procedures within the home were still under review. There was documentary evidence that the fires detection equipment around the home was tested on a regular basis and the home had a contract with a company that carried out checks on extinguishers etc. Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 21 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 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X X X 2 3 STAFFING Standard No Score 27 X 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 2 Wentworth House DS0000008339.V260181.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4,5 & 6 Requirement The home is required to develop further their Statement of Purpose and Service User Guide to ensure that they contain all the information required about the service. It is required that a written record of an individuals preassessment forms part of the care plan and be available at all times. Care Plans and risk assessments are required to be reviewed and updated on a regular basis and contain all the information required about the individuals’ needs and wishes. All staff are required to receive appropriate training in the administration, disposal and storage of medication. All staff are required to receive awareness training in adult protection. It is required that hot water temperatures are monitored and recorded on a weekly basis. All personal staff files must be updated to include all documents
DS0000008339.V260181.R01.S.doc Timescale for action 22/12/05 2 OP3 14 22/12/05 3 OP7 15 22/12/05 4 OP9 13 07/01/06 5 6 7 OP18 OP25 OP29 12 12 19 07/01/06 07/12/05 22/12/05 Wentworth House Version 5.0 Page 23 8 9 OP30 OP36 18 18 10 11 OP36 OP38 18 23 12 OP28 18 specified in Regulation 19 and schedule 2 of the Care Home Regulations. It is required that all staff receive regular updated training in all areas relating to their role. It is required that all staff receive appropriate formal supervision sessions on a regular basis that are recorded. It is required that all staff meeting are formally recorded. The manager is required to ensure that all aspects of health and safety are covered by policy or procedure to ensure that all requirements under the Care Home Regulations 2001 are met. It is required that any member of staff who is carrying out cooking/kitchen duties is supernumerary for that time to the staff carrying out care duties within the home. 07/01/06 22/12/05 22/12/05 22/12/05 22/12/05 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 House DS0000008339.V260181.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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