CARE HOMES FOR OLDER PEOPLE
Wentworth House 283 Clifton Drive South St Annes Lancashire FY8 1HN Lead Inspector
Mrs Lillian McMullen Unannounced Inspection 4th January 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Wentworth House Address 283 Clifton Drive South St Annes Lancashire FY8 1HN 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) 01253 724367 01253 724367 garthwaitemandmtinternet.com Mrs Margaret Garthwaite Mrs Margaret Garthwaite Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Wentworth House provides residential accommodation for up to 15 older people who do not require nursing care. The home is located in a convenient position on a main road position and in close proximity to the main shopping centre, local amenities and the Promenade. The home is arranged over two floors and offers individual bedroom accommodation to all service users which are comfortably furnished and personalised to suit the preferences and needs of the occupant. The majority of bedrooms provide an en-suite facility and a stair lift facilitates ease of access to the upper floor. Communal areas of the home are domestic in character, furnished to a high standard and designed to meet the needs of service users accommodated. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place over a period of six hours and was carried out in conjunction with the inspection of its sister home Villa Rose which is situated across the road from Wentworth House. The inspector spoke with the homeowners and individual discussion also took place with four staff members and the cook. In addition, discussion also took place with a number of residents within a group setting. A number of records, including staff recruitment and medication records were examined. What the service does well: What has improved since the last inspection?
Since the last inspection improvements to the environment continue at the time of the inspection work was being conducted to increase the size of an en suite bathroom. The homeowners have now both completed the NVQ Level 4 qualification.
Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 6 Care plans, are now being signed by the resident. Locks have now been fitted to the cellar and the laundry room to ensure the safety of residents. What they could do better: 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 DS0000009755.V276507.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: All of the above standards were assessed at the previous inspection. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Medication policies and procedures are in place. Records were seen to be up to date and measures are in place to ensure all medication is stored securely. EVIDENCE: A monitored dosage system is in place, which is provided by a local pharmacy. The medication administration records were examined, these were found to be correctly completed. All medication is stored securely with the keys held by senior staff only. At present no controlled drugs are in use. Residents should they wish and have the ability can retain responsibility for their own medication. A locked facility is provided and residents choosing to self medicate should be asked to sign a disclaimer accepting responsibility and agreeing to keep their medication locked at all times. Staff that have responsibility for administration of medication confirmed that they have received training.
Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 10 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): EVIDENCE: All of the above core standards were assessed at the previous inspection. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are protected by a robust policies and procedures that enable concerns to be raised and responded to and to protect residents from abuse. EVIDENCE: The home has an abuse policy in place, which includes guidance on whistle blowing, abuse by residents and advice for staff regarding challenging behaviour. This policy is easily accessible by staff and is compliant with the D.O.H. guidance ‘No Secrets’. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: All the above core standards were assessed at the previous inspection. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Staffing levels are satisfactory to meet the needs of the residents. Policies and procedures for the recruitment of staff are in place. Induction training should be appropriately recorded. EVIDENCE: Observation of the staff rota revealed, that adequate staff are on duty to meet the needs of the residents. Staff spoken to stated, that time is available to spend time with residents and that the routines of the home can be flexible. There is a policy in place in respect of staff recruitment, which is adhered to by the homeowners. Evidence of all required checks was viewed on file including references and verification of identity. Criminal Records Bureau checks were examined. However the homeowners were advised that current legislation states that all staff must be checked through the Criminal Record Bureau prior to them, commencing employment at the home irrespective of the length of time of any previous checks. The homeowners were also advised that all overseas staff must be cleared by the Criminal Record Bureau as an addition to any police clearances obtained from their country of origin. It was pleasing to note that no new staff have been employed since the previous inspection, this is evidently good for staff morale whilst ensuring residents receive a continuity of care. However the homeowners were reminded that all induction training should be recorded. The development of a checklist that records the training provided, which once completed should be
Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 14 signed by the new staff member and the person providing the training would provide an appropriate record. The inspector also provided some advice and a copy of The Skills for Care induction standards. Individual records of training were viewed which confirmed mandatory training was in place, however these records should be extended to record other internal and external training undertaken. The homeowners were also advised to develop an up to date training matrix to be able to identify collectively the skills and knowledge of the staff team at any given time and to identify when training updates are required. Staff confirmed during discussions that they are actively encouraged to access training. One member of staff said, “the homeowners are really good and have encouraged and supported us all to do our NVQ training”. It is to the credit of the homeowners and the staff that good progress has been made with the numbers of staff that have achieved an NVQ qualification. Eight of the ten staff has achieved an NVQ level 2 or equivalent. This standard has now been exceeded with well over 50 of the staff group now being appropriately qualified. Annual appraisals have been introduced and staff spoken to confirmed that they found the appraisal forum to be useful in discussing their role and identifying future training needs. The inspector now hopes that the appraisal system will develop into regular supervision. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 15 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): 31,33,35,36 and 38 Resident’s finances are protected. Systems need to be put into place to reduce the risk of Legionella. Risk assessments need to be put into place for all safe working practices. EVIDENCE: Staff members were very positive in their comments about the homeowners and the support they provide. One staff member stated, “the homeowners are really good they do whatever they can to make sure the residents have everything they need”. The quality of the service provided is closely monitored and this is evidenced as the home has achieved the Investor in People award for two consecutive periods of time. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 16 Formal supervision was discussed with the homeowners and it is there intention to introduce this once all the staff has received their annual appraisal. Inspections of records for residents were comprehensive, well written and up to date. Records of money being handled by the homeowner for residents were up to date, explaining the reason for any expenditure and the balance of the money that was being retained. The inspector advised that a second signature in the form of a witness should be obtained for any expenditure of resident’s money. The homeowners are very conscious of health and safety and have good policies in place. A health and safety inspection was carried out by the health and safety executive employed by Fylde Borough Council on the 13th October 2005 in the sister home, Villa Rose, and it is the intention of the homeowners to act upon the advice provided in respect of both homes. This includes having systems in place to minimise the risk of Legionella and having risk assessments in place for the use of COSHH products. The inspector discussed the need to have risk assessments in place for all areas that could be a potential hazard, in particular to the use of cot sides and safe working practices. The inspector advised that a critical view should be taken of the whole environment and work practices and risk assessments developed that should then be read and signed by the whole staff group. Records provided evidence that regular fire drills take place and fire safety equipment is checked regularly. Staff do receive training in mandatory subjects, however due to the lack of a training matrix it was difficult to establish if all staff had current certificates. The inspector provided advise as to the training that should be provided and informed the homeowner that a named first aider must be on duty at all times. A training matrix should be in place and the inspector recommended that this be kept up to date in order to assess and evaluate what training has taken place and when refresher courses are due. Whilst a number of documents were examined that confirmed equipment is service as per manufactures recommendations some safety certificates could not be located. The homeowner was asked to complete and forward the pre inspection questionnaire in order to provide evidence to confirm that all equipment is maintained and serviced at appropriate intervals and safety certificates are in place. The homeowners was reminded that that all significant events including the death of a resident must be reported to The Commission for Social Care Inspection. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 X 2 Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 18 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Risk assessments for the use of cot side must be an integral part of the care plan. (not met from previous inspection) A system must be put into place in order that the risk of Legionella is minimised. All induction training must be recorded. Regulation 37 notices must be forwarded to the Commission for Social Care Inspection. All staff must be referred to the Criminal Record Bureau for clearance prior to employment, this also refers to the overseas staff. Risk assessments for all potential hazards including the use of COSHH products should be in place. Timescale for action 31/08/05 2. 3 4 5 OP38 OP30 OP33 OP29 23 18 37 19 31/01/06 31/01/06 04/01/06 04/01/06 6 OP38 23 31/01/06 Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4 Refer to Standard OP28 OP36 OP9 OP38 Good Practice Recommendations A training matrix should be developed in order that a up to date record is maintained of all training undertaken by the staff group. Formal staff supervision should be in place. Residents who self medicate should be asked to sign a disclaimer agreeing to accept responsibility for the safe storage of their medication. Evidence should be forwarded to the Commission for Social Care Inspection to confirm that all maintenance and safety checks are in place. Wentworth House DS0000009755.V276507.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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