CARE HOMES FOR OLDER PEOPLE
Wessex House Nursing & Residential Home Pesters Lane Somerton Somerset TA11 7AA Lead Inspector
Sue Hale Unannounced Inspection 10:10 11 March 2008
th 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.V356925.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.V356925.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 Old age, not falling within any other category registration, with number (50) of places Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admisssion to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 50. 10th September 2007 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. Day care is also provided at the service for up to six people. The service is divided into four units. Certain units accommodate people with nursing needs only, and certain units accommodate people with both nursing and personal care needs. People are able meet together to socialise and for events and activities. Range of fees are £390.00 to £650.00 Wessex House Nursing & Residential Home DS0000003307.V356925.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 11th March 2008 by inspectors Sue Hale and Gail Richardson over 6.50 hours (13.40 inspection hours). A tour of the home took place and a selection of bedrooms; communal areas, kitchens and laundry were seen. There were 42 people using the service currently residing at the home, 29 nursing residents and 13 residential residents 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. We (the Commission for Social Care Inspection) sent out surveys to residents, relatives/visitors, staff, care managers and health professional. Five responses were received from residents; nine from relatives/visitors and two from care managers. The results and comments are included in the body of the report. We undertook a tour of the premises and looked at records relating to care, medications, staff and health and safety. We spoke to the registered manager, Mrs Shelagh Underwood, 10 residents and seven members of staff. Five residents chose to respond anonymously to our written survey, four defined themselves as British and one as Scottish. Four people described themselves as Christians and four as having a disability. 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. As a result of this inspection 10 requirements and 2 recommendations have been made. Two requirements have been outstanding from previous inspection reports. The quality rating for this service is 0 stars. This means the people who use this service experience poor quality outcomes. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The home has reorganised the units following the removal of the dementia care registration and Greenlawns, Meadowview and Camelot all provide nursing care with Brookside providing residential care and day care. This was undertaken in conjunction with residents and their families and was undertaken in a sensitive manner to reduce possible stress and anxiety for the people involved. Hard copies of the care plans are printed off monthly or earlier if necessary due to changing needs. Consent forms in relation to risk assessments such as bed rails are now signed and agreed with relatives. Improvements continue to be made in care planning although as detailed below this still needs further work to make sure peoples needs are fully met. Special diets are now identified on the trolley to make sure residents receive the correct food. The night shift has been reorganised and staff remain on duty until 10. a.m. to assist day staff when residents are getting up. The manager told us that that staff have been very positive in their feedback on how this has improved morning routines for both staff and residents.
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 7 Cabinets in which resident’s records are kept are now kept locked to make sure they are secure. A call bell system has now been fitted in Camelot to make sure residents and staff can call for assistance if they need to. The outside area of the home continues to improve with the courtyard garden outside Camelot now a pleasant area with raised beds and seating for residents and their visitors. The issues concerning the safety of the ramp outside Camelot have now been resolved to make sure people are safe. Chemicals are now stored securely in the hairdressing room to reduce the risk of accidents. Several members of staff are undertaking training in palliative care to be able increase their skills and understanding of the care needed at the end stage of life. Staff have access to training and the majority are qualified to NVQ level 2 or above. Recruitment files have been audited and the majority contained all the information required. Quality assurance work is being carried out in line with the organisations policy and Mrs Underwood responds individually to respondents as necessary. What they could do better:
All pre admission records should be dated and signed to evidence that it has been completed before the person moves into the home. Prospective and existing residents must be involved in care planning and review. Prospective residents must also be involved during the assessment process prior to moving into the home to make sure that they agree with decisions being made about them. All care plans should be reviewed monthly with the resident and relatives involvement as far as possible. All personal razors should be capped to reduce the risk of injury to residents. Positional change charts should be completed at the time it is carried out to make sure it is an accurate reflection of when this took place. This should take place with a frequency determined by the assessment and recorded in the care plan. The fluid /food balance charts must be completed daily as required, the amount taken should be totalled and detail of any action necessary should the intake be less than that recorded on the care plan. All residents should be
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 8 weighed monthly and their weight recorded so that any action necessary can be taken should a weight loss or gain occur. These should also be used in conjunction with nutritional care plans and weight records. Prescribed medication such as creams, ointments and dietary supplements must be recorded when given. A protocol in relation to the administration was not seen at inspection but it was confirmed by the manager that it is in place. Further efforts need to be made to improve activities and stimulation for all residents, including those who are less able. Policies and procedures in relation to adult protection and resident’s rights should be updated to reflect current good practice advice. The use of extension leads should be risk assessed and consideration given to providing sufficient numbers of permanent sockets to ensure that there is no risk of injury due to falls and trips. Although the home has a rolling programme of replacement of furnishings, fitting and carpeting, an audit should be undertaken in relation to furniture in resident’s private rooms to see what needs to be replaced due to wear and tear. An audit of carpeting should also be undertaken to see what would benefit from deep cleaning and what needs to be replaced due to wear and tear. Clinical waste bins should be in place in all bathrooms to reduce the risk of cross infection. Records should be kept of staff interviews and photographic proof of identity must be obtained to make sure of applicants identity. Records should be readily available to show that staff has completed mandatory training. Although the staffing levels have been reviewed since the last inspection and some positive changes made staffing levels remain a concern 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 supervision at the level required to keep people safe and well cared for. This review must also consider the geographical layout of the home when organising staff allocation and staffing levels. The statement of purpose and service user guide should make clear that for some periods of the day there may not be a member of staff on the units. Supervision records should not contain personal details of individual residents so that information is recorded in a way that complies with the Data Protection Act. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides 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. Pre admission assessment is not always fully completed. EVIDENCE: The home produces a statement of purpose and service guide both of which are readily available in the home. These provide prospective residents and their families with the information they need to make an informed decision about moving into the home. Five residents who returned surveys said that they had been given enough information about the home, four relatives said
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 12 they had with 3 relatives saying they had usually been given enough information and 2 saying that only sometimes had they received enough information. One person surveyed said that they knew of the home before they moved ‘so I was happy to come here’. Prospective residents and their families are encouraged to visit the home and spend time there before they move in. Contracts were not looked at during this visit. All five residents who responded to our survey said they had been given a contract. We looked at the care files of two people who had recently moved into the home. The pre admission assessment form covers all the topics recommended in the national minimum standards. There were pre admission assessments in place on both files. However, on one file the assessment had not been dated or signed so it was unclear if it had been completed before the person moved in. On the second file the majority of the customer information record had not been completed including diet and nutrition, personal hygiene, history of falls, skin condition and continence. There was no evidence that the prospective residents to all their families had been involved with the assessment. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care planning showed some improvement but was inconsistent. People have access to medical and health care as necessary. Staff were observed to treat the people using the service with dignity and respect at all times and residents felt well cared for. Medication systems need to be improved to keep people safe. EVIDENCE: The home has a computerised care planning system with hard copies available for staff to refer to and complete. Hard copies are printed off monthly or as necessary if a persons needs changed. The inspectors examined both computerised records and hard copies. The computer records are now
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 14 accessible on all units. There have been some improvements in care plans, which contain more detail and are more reflective of peoples needs. Five people who live in the home returned surveys with four people saying they always receive the care and support they needed and one said that this was usually the case. Pressure relieving equipment including mattresses and cushions were in place. Positional change charts were in individual residents rooms as deemed necessary. However, the time recorded on the charts was the same for a number of residents on the same unit. On two residents positional change chart no changes were recorded on five/six afternoons in March 2008. In relation to one of these residents, the care plan clearly stated that the person must be assisted to change position every two to three hours because of the risk of pressure sores developing. On the occasions detailed above there was no record that this had taken place in the afternoon or evening and there was also no record that any personal care had been given during this time on either the hardcopy all the computer. Fluid balance charts were in place but these are not always been completed and not always totalled to record the daily intake. There was no evidence that any action was taken if the total was less than that recommended. However, one residents care plan stated that they needed a fluid balance chart but this was not in their private room and no drink was available. It was observed that not all residents had access to fluids in their private rooms. The home has facilities for weighing residents but on some care plans checked this had not taken place between November 2007 and January 2008. On one care plan looked at the nutritional care plan did not contain any information or guidance on what to do with the information that was being recorded by care staff in relation to diet and fluid taken. The organisation told us that an error has occurred in the computerised care planning system and that when this has been realised weights were recorded manually until this was resolved. This was not evident in all care files looked at. Residents have access to medical and health care professionals as required and this is recorded in care plans. All five people surveyed said that they always received the medical support they need. There were several uncapped razors in resident’s bedrooms that could present a risk to resident’s safety. In one file looked at reviews had taken place in June 2007 and January 2008 these had been signed by the resident’s relative. On another file checked staff had spoken to the resident’s relatives to review the care being given but it was unclear why the residents themselves had not been involved with the care review. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 15 Some relatives surveyed were very satisfied with the care that the residents received one person commented that the care is’ wonderful everything is catered for ’, was another commented that their relative was given’ every care and support’ they needed. One relative surveyed asked if the home had any facilities for rehabilitating residents to improve their mobility for example physiotherapy. They went on to comment that they felt that the role of the home was to’ maintain but not try to improve any quality of life’. One relative surveyed said that the continence products supplied were inappropriate and their numbers restricted to one per night. The person concerned has been told to ‘hold themselves and call for staff’ but this is not possible and causes the resident discomfort and a loss of dignity. Medication practice was looked at. Medication is administered by qualified nurses for all areas of the home. Hand transcribed medication had been dated and signed by two people. Risk assessments of self-medication were in place. Controlled drugs were checked and found to be correct. Variable doses were recorded. Opening and expiry dates were seen on creams and treatments that were kept in resident’s private rooms. On one record checked there were three days when there was no record that dietary supplements had been given as prescribed. The same person was prescribed a cream and there were no records on two days that this had been applied as prescribed. There was no record that creams, ointments and dietary supplements are given as prescribed. There was no record of protocols for medication to be given as required (PRN) , however the manager confirmed subsequently that the protocol is in place and is to be reviewed at the next inspection. The suction equipment at last been serviced in July 2006 and the nebuliser had not been pat tested. There were no residents receiving palliative care on the day of the inspection. Thirteen staff have been undertaking training on palliative care and Mrs Underwood has reviewed the way this is managed as required in the last report. Wessex House Nursing & Residential Home DS0000003307.V356925.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 range of opportunities for social stimulation and residents are supported to join in with organised activities or pursue their own interests. Residents 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 home employs an activities organiser who has undertaken training and has worked hard to set an activities programme up. The activities programme included flexicise, board games, craftwork, and bingo. However, the only activities observed on the day the inspection were four residents colouring in the dining room with 2 residents observing. There were no activities observed on any of the units. The organisation later told us that the activities organiser had also spent time that day talking to individual residents throughout the
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 17 home. The activity timetable displayed on Greenlawns had expired on the 7th March 2008 Activities were planned for Easter and details of local church services over Easter were displayed. The designated driver of the minibus has been seconded to another home so the bus is not always available. However, two members of staff are currently undertaking training to be able to drive the bus. The activities organiser told us that it was also planned to set up a shop in the dining room every Thursday so that residents could buy sweets, cards and toiletries. A photographic record of activities and special events is kept at the included Halloween, harvest festival and a Christmas bazaar. Two residents surveyed said that there were always activities available that they could take part in; two said they usually were once said that they were sometimes activities suitable for them. One resident commented that they liked the bingo evenings and always enjoyed the bus trips. One relative surveyed said that they felt the social activities care was very good, whilst two commented that there could be more efforts made to provide a stimulating environment’ to improve quality of life’. The hairdresser was at the home on the day of the inspection and residents told us that they enjoyed being able to have their hair done on a regular basis. Visitors are made welcome to the home and are able to visit at times convenient to them. One relative commented that as the units communal areas were very small for the number of residents it would be useful for the home to provide folding chairs so that visitors are able to sit down with their relatives. The lunchtime meal was observed and appeared plentiful and appetising. Serving dishes are used in the dining room with staff assisting people discreetly when they were unable to serve themselves. Specialist diets such as pureed food were available and served appropriately. Kitchen staff now identifies specialist diets on the heated trolleys that go out to the individual units. Links are being made with the kitchen staff and the activities organiser and this has meant that special food is available for St Georges Day, St Patricks Day and a recent Mexican taster day. All the residents spoken to were very satisfied with the quality and quantity of food served at the home. One person said that the home provided’ a varied diet, always appetising and well presented. Five people replied to the survey four of whom were always liked the meals at the home and one usually did. One resident said’ the food is always good and home cooked with no problems’. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 18 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. Policies and procedures in relation to adult protection and resident’s rights required updating to reflect good practice and current guidance. Employment checks are in place to keep residents safe. EVIDENCE: The home has a complaints policy this needs to be updated to give the regulatory bodies current title (Commission for Social Care Inspection) and the contact address. Neither the home nor the Commission for Social Care Inspection have received any complaints since the last inspection. All the residents spoken to were clear that they could raise concerns or complaints with any members of staff and were confident that they would be listened to. of five residents surveyed three people always knew how to make a complaint, one did not know how to make a complaint, and one response was blank. The policy relating to the protection of vulnerable adults available for the registered manager and staff on the day of the inspection was not the organisations current guidance on how to deal with allegations of abuse. The locally agreed Somerset guidance of vulnerable adults was not available for
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 19 reference with the policies and procedures. The area manager advised us that this would be updated. The home has a whistle blowing policy but this does not include the contact details of Public Concern at Work. A member of staff spoken to said that they were aware of the whistle blowing policy and complaints policy and felt confident to use them if needed. The advocacy policy includes the addresses of external agencies but not the contact telephone numbers. Staff do not start work at the home until a satisfactory POVA first and CRB check have been received to make sure residents are safe from the risk of abuse. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 20 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, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is a large building that has undergone an extensive maintenance programme. Some areas of the home would benefit from further ongoing refurbishment. The gardens are attractively laid out and accessible for residents. Infection control measures are in place to reduce the risk of infection. EVIDENCE: Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 21 A tour of the home was made by the inspectors and a selection of bedrooms and all communal areas were seen. Four residents surveyed said that the home was always fresh and clean, one response was blank. All the bedrooms seen were comfortable and some people using the service had been supported to personalise their own rooms. Although the home has been refurbished to redecorate it in recent months, some furniture is worn through age and wear and tear and should be replaced. Some carpeting in resident’s rooms and corridor areas were stained and in some cases needed replacement if deep cleaning is not effective. Comments from relatives surveyed varied with two people saying that their relatives room was ‘always very clean and tidy’ whilst two other people said that rooms needed to be hoovered and dusted more often and one relative saying that family members clean the room themselves weekly. Some staff commented that although Mrs Underwood has reorganised and improved staff routines the geography of the building continues to cause problems. We were told that on some occasions there is only one cleaner available and that the relief cleaner is frequently sent to assist in the kitchen if needed as this is seen as a priority. The communal areas were pleasantly decorated and the home appeared reasonably clean. There was only one room with an unpleasant odour. There were tiles missing in some bathrooms. One bathroom on Greenlawns did not have a clinical waste bin in place. The garden area outside Camelot has been refurbished and now provides a pleasant accessible area for residents and their visitors. The kitchen is equipped to a good standard and appeared clean and well organised. A call bell system has been fitted in Camelot to make sure that residents and staff are able to call for assistance if they need to. However, the lead is in the dining room and would have to be laid across the corridor to be available to residents in the lounge area. Hand wash, paper towels and protective clothing were provided for staff to reduce the risk of cross infection. Infection control policies and procedures were in place to reduce the risk to residents and staff of infection. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is 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. The staff training matrix does not give a clear indication that staff have received adequate mandatory training. Recruitment files have improved. EVIDENCE: All the residents spoken to on the day of the inspection were very pleased with the way they were treated by staff although some commented that staff were very busy and that they felt sorry for them. Five residents who replied to the survey said that staff always listened and acted on what they said, four said they were always staff available when they were needed in one said there was usually staff available. Two residents spoken to said that staff ‘were very nice’. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 23 There were some positive comments from relatives about staff including the care staff were’ very good and worked very hard’, ‘ experienced staff are very good’. Although Mrs Underwood has reviewed and made some changed to the staffing as required in the last inspection report, there were still issues of concern in relation to staffing levels. There were several comments from relatives in relation to the staffing levels at the home. One person said’ we feel that now Greenlawns unit is totally nursing care they should be two members of staff on duty at all times, at least until people are settled in bed for the night. Another relative said that on Greenlawns’ there are frequently no members of staff on the unit’ this occurs when staff have a break. Another comment made in relation to staffing is that relatives had observed’ the extreme workload particularly at either end of the day’. One relative said that ‘its takes a very long time to answer call bells’. It was evident from observation that staff were very busy throughout the day. The staffing allocation at night is 1 qualified nurse and 4 carers. However, currently at night there are 4 carers and one qualified nurse on duty five days a week with 3 carers and one qualified nurse on the remaining two days. The organisation has told us that they are actively recruiting to fill vacant hours. For the two weeks before the inspection the night staff shift has been changed at staffs own request and night staff stay on until 10 am to assist day staff with assisting people to get up in the morning. Staff have told the manager that this is working well so far. One relative surveyed said that because of this change ’staff seem less stretched’. It was commented on by some staff that it was very difficult to complete written and computerised care records and deliver care while working alone on the unit. Some turn charts were noted to regularly not have been completed in the afternoon, this may be a reflection of limited staff to undertake the turns or record the turns being done We looked at the recruitment files of three members of staff. All had completed an application form and health questionnaire, two suitable references and satisfactory POVA first and CRB checks were in place. However, was no record of interview and on one file there was no photographic proof of identity. The organisation has told us that because of recent recruitment of staff the use of agency staff has reduced. However, the home does 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. One relative surveyed said that there was a ‘lot of agency staff, no continuity’, another relative said that’ frequently agency staff are not told what is expected of them and dont know what to do’ and a third relative said that usually’ with agency staff some dont appear to liaise with experienced staff or consult care plans’. An example was
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 24 given by a relative of the problems this caused when their relative who needed a beaker cup to drink safely was given a cup and saucer by an agency member of staff. The manager stated that all staff completed the organisations induction programme although this is not in line with the Skills for Care programme and on staff files checked this seemed to be recorded as taking only one day, subsequent information was provided to support that staff receive a 2 week induction program. Information supplied by the home stated that 71 of staff are qualified to NVQ level 2 or above with one member of staff currently registered on NVQ level 2 training. The home supplied a training matrix listing the number of staff with NVQ qualifications and also detailing some courses undertaken such as nutrition and CPR, but this did not evidence that all staff had completed mandatory or foundation training. On the day the inspection Mrs Underwood was not able to provide a training matrix specific to Wessex house and this was forwarded after the inspection. Mrs Underwood told us that she has been reviewing the skill mix of staff on each unit as recommended in the last report and this is now being taken into account when rotas are drawn up. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 25 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): 31.33,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed in relation to the management of the home. Improvements in the management of health and safety, the security of written records and quality assurance has been made. EVIDENCE: The registered manager of the home is Shelagh Underwood. She also has previous experience as a registered manager. Some relatives commented about the management of the home. It was commented on by relatives that
Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 26 when concerns have been raised with the manager and other senior staff these have sometimes been discussed with the resident causing them distress. Regular staff meetings are held with five having taken place since January 2008. A residents and relatives meeting was held in December 2007 and minutes taken to recall the issues discussed. The home uses the organisations quality assurance system and this was last used in October 2007. Mrs Underwood told us that any comments made in relation to the service were responded to individually. One comment had been made by a respondent in relation to the lack of consistency of staff and concerns about whether there was enough staff in the home. Staff files showed that they had received regular supervision by staff senior to themselves covering topics such as fire safety, moving and handling, and health and safety. These records also included personal information about individual residents. This practice should be reviewed, as supervision records should not contain personal details of individual residents, as this does not comply with the Data Protection Act. Resident’s records are now kept in locked cabinets to make sure they are secure. A relative surveyed raised the issue of the homes security and commented that in the early evening the front door was unlocked and they are able to walk throughout the home, sometimes without seeing a member of staff. This may present a risk to people using the service and must be reviewed. Chemicals are now stored securely in the hairdressing room to reduce the risk of accidents. An accident book is used to record any injuries or accidents that occur to residents all staff. In relation to one accident in February 2008 a resident had fallen onto the floor from a wheelchair. The recording of the accident was poor and the circumstances unclear. The persons care plan clearly stated that a lap strap was to be in place when using a wheelchair and that the level of risk in relation to falls was high. The fall was not recorded on the daily record. However, the person complained on the two following days of pain in their wrist but there was no record of any action taken There was no evidence that Mrs Underwood had audited the accident book in relation to this entry to make sure that the records were being completed correctly or to investigate why the resident had been left alone. Fire safety training had taken place and the maintenance person regularly tested fire equipment. A training matrix was supplied by the home after the inspection but it was not possible to evidence that all staff had completed mandatory training. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 27 Information supplied by the home told us that equipment in use at the home is regularly serviced and maintained. The water system is serviced by a contractor and measures in place to reduce the risk of legionella and scalding. Servicing of the hoists in the home was overdue and Mrs Underwood arranged this during the inspection. Monthly visits to the home are undertaken by the organisation and records kept of the findings. Resident’s finances were not checked on this visit. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 28 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 X X X 2 X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X X 2 3 2 Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14(1)(c) Requirement The registered manager must ensure that prospective residents are involved in pre admission assessments and the plan of care relating to admission. 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. (Previous timescale of 31/01/06 and 30/11/06, 30/01/07, 05/07/07, 30/11/07 not met). 3 OP8 12 (1) The registered manager must ensure that fluid balance charts are completed daily as required and any results actioned appropriately. The registered manager must ensure the positional change charts are completed as per the frequency recorded in the care
DS0000003307.V356925.R01.S.doc Timescale for action 30/04/08 2 OP7 12(1) 15(1) 30/04/08 30/04/08 4 OP8 12(1) 30/04/08 Wessex House Nursing & Residential Home Version 5.2 Page 30 plan and any results actioned appropriately. 5 OP9 13(2) The registered manager must ensure that medication is administered as prescribed including creams, ointments and dietary supplements. 30/04/08 6 OP12 17(2)(m) (n) The registered manager must 30/05/08 consult service users about their interest and make arrangements in relation to activities within and outside the home. The registered manager must ensure clinical waste bins are available in all communal bathrooms. 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. 30/04/08 7 OP26 13(3) 8 OP27 18(1)(a) 18/05/08 9 OP29 10 OP38 Schedule 2 (1) 19 (1) (b) (i) 12(1)(a) The registered manager must ensure that all staff files contain a recent photograph. 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. (Previous timescale 3011/07 not 30/04/08 30/05/08 Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 31 met). 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, dated and fully completed when undertaken. Care plans should be reviewed each month. It is recommended that action from these reviews form the plan of care undertaken by staff. All residents should be weighed monthly and their weights recorded. Staff should ensure that the caps of razors are replaced after use. The whistle blowing policy should include the contact details of Public Concern at Work. An audit should be undertaken of all the furniture and carpeting that is worn through wear and tear An audit should be undertaken in relation to the carpeting that is stained, worn and needs deep cleaning or replacement. 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 person should keep records of interviews of prospective members of staff. The registered manager is recommended to be aware of
DS0000003307.V356925.R01.S.doc Version 5.2 Page 32 2. OP7 3 4 5 6 7 OP8 OP8 OP38 OP18 OP24 OP24 8 OP28 9 10 OP29 OP32 Wessex House Nursing & Residential Home 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. 11 OP35 The management of the home are recommended to ensure that 2 staff sign for all financial transaction of people using the service personal monies. The recommendation was made previously was not reviewed at this inspection. 12 OP36 Supervision records should not include personal information about individual residents. Wessex House Nursing & Residential Home DS0000003307.V356925.R01.S.doc Version 5.2 Page 33 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
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