Inspection on 10/09/07 for Wessex House Nursing & Residential Home

This inspection was carried out on 10th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wessex House Nursing &... 11/03/08

Wessex House Nursing &... 16/11/06

Wessex House Nursing &... 20/06/06

Wessex House Nursing &... 22/02/06

Wessex House Nursing &... 27/09/05

Wessex House Nursing &... 09/03/05

Wessex House Nursing &... 09/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Wessex House Nursing & Residential Home Pesters Lane Somerton Somerset TA11 7AA Lead Inspector Gail Richardson Unannounced Inspection 10th September 2007 09:30 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 Wessex House Nursing & Residential Home DS0000003307.V348812.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. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wessex House Nursing & Residential Home Address Pesters Lane Somerton Somerset TA11 7AA 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) 01458 273594 01458 273665 shelagh.underwood@somersetcare.co.uk Somerset Care Limited Mrs Shelagh Anne Underwood Care Home 50 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (31), of places Physical disability (8) Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 30 persons aged from 60 years who require general nursing care (OP). May accommodate up to eight persons aged from 40 years who require general nursing care by reason of physical disablement (PD). May accommodate up to eleven persons aged from 65 years with a dementia care need and who require personal care only (DE(E)). Room South 2 is only to be used for persons with non-nursing needs who require minimal moving and handling. Date of last inspection Brief Description of the Service: Wessex house was purpose built in 1981 as a residential home and now accommodates up to 50 people for nursing and personal care needs. People with dementia care needs can be accommodated where these needs do not include nursing. Day care is also provided at the service for up to six people. The service is divided into four units. These units all accommodate people with both nursing and personal care needs. Service users are not restricted to remain in their units and benefit from meeting together to socialise and for events and activities. Range of fees are £295.00 to £580.00 Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on the 10th September 2007 by inspectors Gail Richardson and Justine button over 7 hours (14 inspection hours). A tour of the home took place and a selection of bedrooms, communal areas, kitchens and laundry were seen. There were 46 people using the service currently residing at the home, 26 nursing residents and 20 Residential residents The inspector’s spoke to 10 people using the service and 10 members of staff, the registered manager was available throughout the inspection. Prior to the inspection the home completed a CSCI pre-inspection questionnaire about service provision, staffing, resident admissions, complaints procedures, meal times and arrangements made for community health care support for residents. A good amount of responses were received and the results and comments are included in the body of the report. Records relating to care, medications, staff, finances and health and safety were examined Staff spoken appeared busy and time spent by the inspectors observing staff, evidenced that they were kind and caring towards service users and spoke to them at all times with respect and courtesy. The inspectors would like to thank the service users and staff for their time and hospitality through out the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. What the service does well: The general environment of the home is much improved and the home appears clean with no malodour. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 6 People using the service were happy with the care they received and were complementary about the staff. Comments included “The staff are helpful and considerate” and “The home respects people as individuals”. Visitors to the home are always made welcome and can visit at any time. What has improved since the last inspection? What they could do better: The home is required to improve care planning systems to ensure that all preadmission assessments are signed and dated when undertaken. Care plans are required to include all the assessed care needs of the person and to include the views of the person using the service, their relative/representative .Further systems must be in place to provide an updated hard copy which is regularly reviewed to contain the current identified needs and a plan of care for those needs. End of life care planning needs improving to ensure that all needs are identified and met. The registered manager is required to review staffing levels on day and night duty to ensure that adequate staff are available in sufficient numbers to provide the care as identified in the care plan and the supervision at the level required. This review must also consider the geographical layout of the home when organising staff allocation and staffing levels. It is further recommended that staff skill mix is reviewed to ensure that the busiest units of the home are not staffed by inexperienced staff. The home is required to ensure that at least 50 of staff are qualified to NVQ level 2 in health and personal care and is recommended to review and update the staff training matrix to identify staff training needs and ensure those mandatory training needs are met. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 7 The registered manager is required to ensure that the organisation of the home is appropriate to ensure that the needs of the people using the service are met with regard to allocation of placement of people with nursing needs and the regular review by the qualified nurse. The home is required to provide appropriate activities on a regular basis, for all people who use the service, including one to one session as needs identify to meet their social and recreational needs. The registered manager must ensure that people with identified dietary needs receive the correct diet to ensure their nutritional needs are met. The registered manager must ensure that prior to commencement of employment all prospective staff receive 2 satisfactory references and that appropriate risk assessments are in place for any inclusions on the Criminal Record Bureau (CRB) check. A previous Immediate Requirement was made that the ramp to outside area of the Camelot Unit be made safe and appropriate for use on 01/08/06.This requirement remains ongoing until the ramp is made appropriate for use. The home is required to store all confidential records securely on each unit in line with the Data Protection Act 1988 to ensure that the confidentiality of people using the service is maintained. The registered Manager is required to audit all accidents for incidences and trends and ensure that action is taken to reduce the risk of further accidents/injuries to people using the service. The home is required to ensure that cleaning solutions are stored safely in line with the COSHH Regulations to ensure there is no risk of accidental ingestion. Action must be taken to rectify the hot water temperatures which exceed 43 degrees to reduce any risk of scalding to people using the service. The manager is strongly recommended to provide suitable access to a call bell in the lounge of the Camelot unit to ensure that people using the service can summon help when needed. The registered manager is recommended to audit all responses and comments received from the Quality assurance review and implement a plan of action to meet any identified issues. The management of the home are recommended to ensure that 2 staff sign for all financial transaction of people using the service personal monies. Please contact the provider for advice of actions taken in response to this Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 8 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. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 9 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 Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 10 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 4 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be able to provide prospective residents and relatives with sufficient information in the format of the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective people who will use the service receive a pre admission assessment by the registered manager to ensure the home can meet the assessed needs identified. This assessment is recommended to be signed and dated. EVIDENCE: 7 Residents surveys received stated that all 6 had received a contract and 6 felt they had received enough information prior to admission, about the home to make an informed decision, 1 person did not. Copy of the Statement of Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 11 Purpose and Service User Guide was located in the from hall and is available on request. The homes AQAA states that- A full assessment is undertaken by the manager or deputy manager following referral and this can include other professionals and the family, occasionally a service user will visit prior to admission, families are positively encouraged to look around the home and speak to staff and service users. This was discussed with some people using the service and found to be the case, One person commented “My daughter chose the home”. At inspection 4 people using the service details were seen. All had received a pre-admission assessment. It was noted that one pre admission assessment had not been signed and dated when completed. This is recommended to ensure that a clear assessment of all identified needs are recorded. Contracts were not examined at this inspection Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 12 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 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Each person who uses the service has a computerised care plan, the assessed areas of need were not all reflected in hard copy format, the detail recorded did not ensure that staff were advised of care all the care needs identified. The management of medications systems meets the required standard. Staff were observed to treat the people using the service with dignity and respect at all times and residents felt well cared for. EVIDENCE: The home has implemented a computerized care planning system with an access point in each unit of the home. The registered manager explained that the implementation of this system has taken some time to ensure that the staff are supported with training to use the system. One staff was being assisted to understand the system by another staff on the day of inspection. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 13 She also explained that some technical difficulties have occurred. She confirmed that hard copy care plans are available in the case of these technical difficulties to support both the homes staff and visiting agency staff. The inspectors examine both the computer care plans and the hard copy. The computer plans were detailed and provided staff with enough information in most cases to provide the care required. In some cases the care needs identified were not included in the care plan. It was observed that on Greenlawns unit, the care plans were not computer accessible and staff confirmed that this is often the case. Staff are required to leave the unit to access their care plans on the Camelot unit upstairs. The hard copy was examined and found to be out of date. On person using the service’s hard copy stated that they were being assisted to wash, dress and sit in the lounge when observation and confirmation by the registered manager was that the person was at this time receiving end of life care in bed. The homes AQAA identifies the need for improvement planning for the next 12 months to include- On going support and training to develop care plans, in house skills training programme. The care plans seen in each unit did not always provide the details required and were not always reflective of peoples current needs.There was no evidence of input by people using the service and their relatives/representitive. The homes statement of Purpose states that “Care plans are reviewed monthly and at each review the client or significant other is asked if the care plan continues to meet the individuals needs.”. This was found not to be the case and subsequent information received from the area manager confirs that where families do not visit regularly they are contacted by telephone and this recorded by staff. The home is currently providing end of life care for 2 people, niether care plan evidenced the specific needs which staff were dealing with. The home is recommended to research the use of the Liverpool Care Pathway and Gold Standard Framework to support staff to provide care planning and care for end of life needs. This was confirmed to be the case following inspection by the area manager. There was evidence of the input of visiting health professionals and one comment received was “Support from nursing staff is excellent and I’m impressed by the GP involvement”. When asked do you receive the care and support you need, 4 surveys said always, 2 said usually and 1 said sometimes, 6 responded that staff listen and Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 14 act on what the residents say, 1 said usually and 4 felt they received the medical support they needed, 2 said usually and 1 said sometimes. Comments received about the care given were varied and included ; “(they) show patience and understanding especially when things are not quite right, which is frequently” “I think they always keep my relative clean and tidy”. Things could be improved by “Greater attention given to individual needs eg. personal hygiene” “It appears the role is to maintain but not try to improve any quality of life” “My relative is well looked after and if I have a problem it is sorted” 2 staff surveys were received, both confirmed that they were involved in care planning for residents. It was noted that only one qualified nurse and the registered manager-who is also a registered nurse were available for those people receiving nursing care throughout the 4 units of the home. This nurse undertakes the medication round for both residential and nursing people using the service and appeared to very busy. Staff when asked were not clear about which people on each unit were receiving nursing care and who were receiving residential care. The registered manager is required to ensure that the people receiving nursing care have regular supervision by the qualified nurse to ensure that all changes in needs are assessed and acted upon immediately. It is further recommended that staff be made aware of which registration each person is accommodated under. One comment received from a relatives was “I was not told when (my relative) changed from residential to nursing”. Another comment from a visiting health professional was “It is a large home which has different areas/locations. I think this can make it more difficult to be responsive”. The home has written protocols in place on the Medication Administration Records for the administration of most medications. There were no gaps evident in the Medication Administration Records and there was evidence of variable doses being recorded and hand transcribed entries being signed by 2 staff. A system is in place to record the administration of all prescribed creams on the Medication Administration Records. People using the service have the option to self medicate should they want to and risk assessments are in place to ensure safe practice is maintained. Lockable storage is available as required. A homely remedy policy is in place with signed consent on agreed protocols by the relevant GP’s. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 15 All medications were stored safely and securely with systems in place for ordering and disposal. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a limited range of opportunities for social stimulation and residents are supported to join in with organised activities or pursue their own interests. Service users are supported to maintain contact with friends and families and visitors are always made welcome. The meals in the home are of a good quality and a range of choice is available. EVIDENCE: The inspectors spent time talking with people using the service and observed people reading newspapers and chatting to other people using the service and staff. Day care is provided at the home and whilst this service is not regulated by CSCI these people spend time in the foyer of the home and partake in activity provided. The home employs one full time activity coordinator. The people using the service are advised in advance of the planned activities by a weekly newsletter and they confirmed that activities take place. On the day of inspection the planned activities were advertised as a morning flexercise Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 17 class in Brookside Unit Foyer and the afternoon was planned a mini bus trip and library trolley and a planned walk into town for people from Camelot Unit. Inspectors were advised that the flexercise class took place, the mini bus trip and trip into town did not take place and were replaced by cooking in the Camelot unit which took approximately 40 minutes. Inspectors were advised after inspection that the mini bus trips and library trolley take place alternate weeks. The library trolley was not observed and activity staff were seen doing one manicure. One staff confirmed that on one unit activities had not been observed for a period of months. The planning of activities does not appear to be reflective of choice and has limited one to one time. People using the service/relative commented that they would like “More social activities, one to one time”. A visiting health professional commented, “I have never seen many people in the garden which is quite small. More activities needed” Resident’s surveys asked are there activities arranged by the home that you can take part in, 0 -always, 3 -usually, 1-sometimes,2-never. The people using the service confirmed that they maintain contact with relatives and community activities and that visitors are always made welcome. However one relative commented that “I would like to be given more information regarding my relatives when I visit.” Some people using the service’s rooms were decorated in a manner which reflected their tastes and lifestyles. Evidence was seen in some cases of people’s own furniture in their bedrooms. Those people who were able confirmed that they could get up and go to bed within a reasonable time of request. Lunch was observed being served in each unit of the home with the majority of diners eating in the large dining room adjacent to Brookside Unit . The meal was a choice of braised chicken thighs or cheese and potato cakes with tomato sauce with potato, runner beans and grilled tomato. Desert was roasted pears with ginger with custard or rice pudding or fresh fruit. The meal was appetising and plentiful and those people requiring puree diet were served each portion individually to identify taste and textures. Those people who needed assistance were seen to assist in an appropriate manner, one comment made by a relative was that “Staff customise food to encourage mother to eat, she is eating more now than in the past and her weight loss is monitored”. Resident’s surveys asked if residents like the meals at the home, 4-always, 3 usually. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 18 It was noted that in the kitchen a wipe board displayed a range of specialised diets being catered for in the home. Inspectors did not see any specialised diet other than puree diet being provided in each unit. No alternative food was available containing calorific enhancers being used for people with identified need for increased calories or reduced calorie foods for people on reducing diets. The registered manager is required to ensure that specialised diets identified be provided as a clearly identifiable alternative to support staff to provide the correct diet to the person using the service. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 19 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 17 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff and people who use the service are confident that the homes management team would appropriately deal with any complaints or concerns. Training is available to staff to ensure they have the knowledge to prevent service users from the risk of abuse. Recruitment procedures do not protect service users from the risk of abuse. EVIDENCE: The home has a complaints procedure which was displayed in the main body of the home. 7 relatives surveys and 7 people using the service surveys, confirmed that they knew how to make a complaint and surveys confirmed that people knew who to speak to if they were unhappy. Residents surveys confirmed that if unhappy they would know who to talk too, 4 -always, 3-usually. 2 staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. On the day of inspection, one staff was not aware of the whistle blowing policy. The manager is recommended to ensure that all staff are aware of the whistle blowing policy and its content. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 20 Staff training records indicated that no training had been undertaken in abuse awareness. All people using the service have been registered to vote and have access to an advocacy service. Both staff surveys received confirmed that they had received a Criminal Record Bureau Check and examination of recruitment files confirms that these check were undertaken before staff commenced employment. Recruitment files evidenced that 2 staff had not received both required references prior to commencing employment and had not been obtained to the date of inspection. The registered manager was unaware of this. This practice may place people using the service at risk and the manager is required to ensure that the correct recruitment procedures are maintained at all times. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 21 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 20 21 22 23 24 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a large building which has undergone an extensive maintenance program and is comfortable and well decorated. The home has a good standard of hygiene. The gardens are attractively laid out and are being adapted for people using the service use. EVIDENCE: A tour of the home was made by the inspectors and a selection bedrooms and all communal areas were seen. All the bedrooms seen were comfortable and some people using the service had been supported to personalise their own rooms. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 22 The communal areas were pleasantly decorated and the home appeared clean and no malodours were noted. It is recommended that a call bell system be provided in the Camelot lounge to ensure that people using the service have means of summoning assistance when needed. The kitchen was noted to have been refurbished to a good standard and the kitchen appeared clean and well organised. There appear to be suitable and sufficient toilet and bathing facilities for all people using the service. However one survey received indicated that there was ” Not enough disabled toilet facilities for number of patients/residents who use a hoist” and another surveys stated that an improvement would be made by “Maintenance of wheelchairs needed, punctures repaired etc”. The area manager confirmed after inspection that checks and maintenance procedures are in place for wheelchairs. Further comments received about the home included; What the home does well ; “cleanliness “and “On the whole I feel the home provides a feasible service in a difficult environment”. 7 residents surveys confirmed that the home is always clean and fresh 3always, 3- usually and 1-sometimes, one comment made was that “Rooms are neat and tidy”. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are not adequate to meet the assessed needs of people using the service considering the geographical layout of the home and the dependency level of the people using the service. Staff training matrix does not give a clear indication that staff have received adequate mandatory training. Recruitment practice is poor and may put people using the service at risk of abuse.(See standard 18) EVIDENCE: The homes AQAA states -Rotas are done over a 2 week period using additional staff to meet any increased needs of the residents, rigorous induction process are in place relating to SCL policy and procedures, the recruitment process is in accordance with SCL policy and procedures for all potential staff and volunteers. Evidence from inspection does not confirm that this statement is correct. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 24 On the day of inspection there were 2 care staff on each unit, the Registered Manager who is a qualified nurse, one qualified nurse, one day care staff, 1 student nurse, 3 kitchen staff, 1 laundry staff and 1 activity co-ordinator. These staffing levels drop by one carer in the afternoon leaving the Greenlawns unit with one carer. Overnight there are 3 care staff and 1 qualified nurse for the 4 units. Discussion with staff identified that on the Greenlawns unit, staff are required to leave the unit to attend to 2 people who reside in a small area 2 floors above. In the afternoon, staff from Brookside unit undertake the care of these 2 people. It was noted that staff allocated to Greenlawns in the afternoon have to request assistance from other units for people who require hoisting or a change of position thus leaving other areas with a reduction in staff. This issue was a requirement at previous key inspection. Overnight staff on Greenlawns have to leave the unit to assist else where , leaving the unit unsupervised. Accident records and other people using the service, indicated that a person on that unit sometimes wanders, is unsteady and is at high risk of falls. Also on that unit is a person receiving end of life care who requires a high level of care and supervision. Overnight one qualified staff is required to visit all other areas of the home to review people using the service with nursing needs which requires they leave their own unit unattended. The registered manager is required to review the staffing levels provided to ensure that they meet the dependency level of the people using the service and take into consideration the geographical layout of the home. Resident’s surveys asked if staff were available when you need them said, 3always, 3-usually and 1-sometimes. It was discussed with the registered manager that staff confirmed to inspectors that some people using the service, as many as 5 on one unit, are washed and dressed prior to the staff arriving at 07:30am. The registered manager must ensure that people using the service are assisted to rise each morning at a time of their choice. 2 staff returned comment cards to CSCI, both staff confirmed that they felt they had received adequate induction and supervision when they commenced their job. Both staff confirmed that they were clear of what the service users needs were and also were aware of the duties they must not undertake. Information supplied after inspection states that 64 of care staff have qualified NVQ 2 or 3. The staff training records provided did not indicate that Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 25 adequate mandatory training has been undertaken by all care staff in the previous year. The skill mix of staff did not appear to be related to the dependency of the people using the service. The Meadowview unit was confirmed by all staff as the unit with the highest dependency level, but was staffed by 2 care staff who had not been employed at the home above a period of 5 months. Comments received by people using the service, relative and visiting health professionals all indicated that whilst the quality of the staff was high and all were very complementary about the standard of care and the quality of the regular staff, the staffing levels were of concern. Comments included; “On a regular basis the Meadowview unit appears to be significantly understaffed with experienced carers, especially with the complex needs of many of the residents”. “The staff are helpful and considerate”, ”Mum says she is happy and well looked after”. My relative “Have a long time to wait for staff” “Staff seem extremely stretched” “2 inexperienced staff on duty together on a very demanding unit and some don’t appear to have skills and special knowledge to work effectively” “ A lot if new staff especially at the weekends” The home employs agency staff to complete the staffing levels and several comments were received about the lack of skills displayed by some of the agency staff. The registered manager must ensure that all agency staff have received the appropriate training to support the people using the service. One comment stated that; “Need more permanent staff or make sure agency staff are trained to the level of permanent staff.” The recruitment procedures of the home were mostly satisfactory , however the home must ensure that prospective staff receive 2 satisfactory references prior to commencing employment to ensure that people using the service are not placed at risk. It was also discussed with the registered manager that any staff who have a criminal conviction must undertake a risk assessment and this be recorded in their staff file. (See standard 18) Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 26 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 36 37 38Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is recommended to have greater awareness of the routines of the home and the staffing requirements of the home. The financial procedures as satisfactory. Further improvements are required to ensure the health and safety of service users, staff and visitors to the home. EVIDENCE: The registered manager of the home is Shelagh Underwood. She has been the registered manager for one year but has previous experience as a registered manager. Some staff felt supported by the management of the home and some did not. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 27 One relative commented that “I have always found the present head of staff very approachable and will do their up most to resolve any problem”, another person stated “A plain down to earth philosophy seems to be adopted”. Quality assurance records were seen at inspection, the most recent quality audit was undertaken in May 2007.Comments received were varied however there was no audit available and no action plan to follow up issues identified. The registered manager is recommended to undertake an audit of results and comments and implement an action plan Records seen at this inspection were not all stored securely and the cupboard on Greenlawns were unlocked an the cupboard on Camelot unit has no lockable facility. The registered manager must ensure that all records are stored securely in line with the Data Protection Act to maintain the confidentiality of people using the service. The home manages personal monies for people using the service. The records of these monies were examined at this inspection. Financial transactions were recorded and signed by the administrator. It is recommended that 2 people sign for all transactions. Receipts were kept and the administrator advised that the money is audited regularly. Accident records were viewed and it is recommended to the registered manager that the accidents must be audited monthly for trends and regular occurrences and action taken to reduce any risks of further accidents taking place. Maintenance records were reviewed and the findings were as follows : Fire Safety. Alarms systems are checked weekly and the fire equipment was last serviced on 16/08/07. The servicing of the fire detection system was undertaken 11/12/06. The home has a Fire Risk Assessment last reviewed 23/05/07. Emergency lighting is tested monthly last checked 02/08/07 Electrical Safety – The home has a hard wiring certificated dated 25/02/05.which is valid for 5 years. The last PAT certificate was received after inspection and confirmed PAT tests were completed March 2007 Gas Safety - The home is required to forward the current Gas Safety certificate to CSCI offices. Areas of concern include: The registered manager is required to ensure that hot water temperatures are tested monthly and recorded and the appropriate action taken to correct hot water levels above 43 degrees. Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 28 The storage of hair lotion (perm lotion) in the hairdressers room must be reviewed to ensure that all substances hazardous to health are stored securely under the COSHH guidelines to prevent the risk of accidental ingestion. Wessex House Nursing & Residential Home DS0000003307.V348812.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 3 X 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 2 3 2 3 3 3 3 STAFFING Standard No Score 27 1 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 3 1 1 Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1)15(1 ) Requirement It is required that the care records are fully reviewed to ensure that they are systematic and up to date. The care plans must be reviewed regularly with the service user or representative and any consent forms signed by a suitable representative as required. Previous timescale of 31/01/06 and 30/11/06 ,30/01/07, 05/07/07 not met 2. OP7 15(2)(b) The registered manager must ensure that a system is implemented to provide a regularly updated hard copy care plan to support staff to give the car needed when the computer system is unavailable. The registered manager is required to ensure that care planning for end of life care is provided and maintained. The registered manager is DS0000003307.V348812.R01.S.doc Timescale for action 30/11/07 30/11/07 3. OP7 15(2)(b) 30/11/07 4. OP8 12(1)(a)( 30/11/07 Version 5.2 Page 31 Wessex House Nursing & Residential Home b) required to ensure that the organisation of the home is appropriate to ensure that the needs of the people using the service are met with regard to allocation of placement of people with nursing needs. The registered manager must ensure that people with identified dietary needs receive the correct diet to ensure their nutritional needs are met The registered manager must ensure that prior to commencement of employment all prospective staff receive 2 satisfactory references and that appropriate risk assessments are in place for any inclusions on the CRB check. An Immediate Requirement was made that the ramp to outside area of the Camelot Unit be made safe and appropriate for use on 01/08/06. Previous timescale of 01/08/06, 30/11/06, 30/01/07, 05/07/07 not met This requirement remains ongoing 30/11/07 5. OP15 1291)(a)( b) 6. OP18 19 Schedule 2 30/11/07 7. OP19 13(4)(a) 31/03/08 8. OP27 18(1)(a) The registered manager is required to review staffing levels on day and night duty to ensure that adequate staff are available in sufficient numbers to provide the care as identified in the care plan and the supervision at the level required. This review must also consider the geographical layout of the home when organising staff allocation and staffing levels. 30/11/07 Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 32 9. OP37 17(1)(b) The home is required to store all confidential records securely on each unit of the home, in line with the Data Protection Act 1988. The registered Manager is required to audit all accidents for incidences and trends and ensure that action is taken to reduce the risk of further accidents/injuries to people using the service. 30/11/07 10. OP38 12(1)(a) 30/11/07 11. OP38 13(4)(a) The home is required to ensure 30/11/07 that cleaning solutions are stored safely in line with the COSHH Regulations. Previous timescale of 01/08/06 and 30/11/06 not met Action must be taken to rectify the hot water temperatures which exceed 43 degrees RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The registered manager is recommended to ensure that all pre admission assessments are signed and dated when undertaken. Care plans should be reviewed each month. It is recommended that action from these reviews forms the plan of care undertaken by staff. DS0000003307.V348812.R01.S.doc Version 5.2 Page 33 2. OP7 Wessex House Nursing & Residential Home 3. 4. 5. OP7 OP22 OP28 It is recommended that service users/representatives have more input into the care plan process. The manager is strongly recommended to provide suitable access to a call bell in the lounge of the Camelot unit. The registered manager is recommended to maintain an up to date copy of the staff training matrix and to identify any current staff training needs with regard to mandatory training. These staff training needs must then be met. The registered manager is recommended to review the skill mix of the staff to ensure that the highest dependency areas are not staffed by inexperienced staff. The registered manager is recommended to be aware of the staffing routines of the home to ensure that staff are supported to maintain their roles in the home. This is with reference to the role of the RGN and the night time staffing routines. The registered manager is recommended to audit all responses and comments received from the Quality assurance review and implement a plan of action to meet any identified issues. The management of the home are recommended to ensure that 2 staff sign for all financial transaction of people using the service personal monies. 6. OP30 7. OP32 8. OP33 9. OP35 Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wessex House Nursing & Residential Home DS0000003307.V348812.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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