Inspection on 16/11/06 for Wessex House Nursing & Residential Home

This inspection was carried out on 16th November 2006.

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 &... 10/09/07

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 16th November 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wessex House Nursing & Residential Home DS0000003307.V319662.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.V319662.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 Somerset Care Limited Derek Paul Mills 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.V319662.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Elderly persons of either sex, not less than 60 years, who require general nursing care. Up to eight persons of either sex, between the ages of 40-60 years, who require general nursing care by reason of physical disablement Registered for up to 20 personal care places in categories OP and DE (E) with a maximum of 11 DE(E) Up to 30 clients for `nursing care` Category DE(E) does not apply to nursing care. Room South 2 - this room to be used for service users requiring personal care only (not nursing care) and for service users who do not need the regular use of a hoist for their daily living activities. 20th June 2006 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. People with dementia care needs tend to be accommodated in one unit (Camelot) with other service users. Another unit (Greenlawns) is primarily for younger people although the service is not accepting any new admissions for this category. 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.V319662.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 16th November 2006 by inspectors Gail Richardson and Susan Hale over 7 hours. A tour of the home took place and all the bedrooms, communal areas, kitchens and laundry were seen. There were 45 service users currently residing at the home, 26 nursing residents and 19 Residential residents The inspector’s spoke to 7 service users, 2 volunteers and 9 members of staff, the manager designate 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. Further review of the homes quality assurance audit will be undertaken following the homes surveys in January 2007. Records relating to care, medications, staff, finances and health and safety were examined The inspectors noted that the service users appeared settled and comfortable and there was a calm atmosphere within the home. Staff spoken appeared settled and time spent by the inspectors observing staff, evidenced that they were kind and caring towards service users and spoke to them at all time with support and reassurance. 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: Service users benefit from a clean and currently updated environment. The maintenance of the home is ongoing, clear and current records were available of all maintenance undertaken to ensure the health and safety of service users. The service users bedrooms are decorated to the individuals personal tastes. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 6 Inspectors observed that staff treated service users with dignity and respect at all times. What has improved since the last inspection? What they could do better: Care plans show improvements in some areas, however, further work is needed to ensure that reviews are maintained and that service users and their representatives are involved in the care planning process. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 7 The manager designate is required to ensure that all aspects of care are included in the care plan and that records of creams and dietary supplements are maintained correctly. It is further recommended that an audit system is implemented to see how the Medication Administration Records are completed. The manager designate is recommended to ensure that planned activities take into consideration service users capability’s and include those service users who remain in bed. It is recommended that the vegetarian menu provided contains enough dietary provision for service users , this includes the use of protein substitutes. Furthermore the home must be aware that alternative ingredients are required to ensure that all parts of the menu remain vegetarian. The ramp to the outside area of the Camelot Unit continues to require improvement to ensure that it is safe and appropriate for use. The manager designate is required to review staffing levels on the late afternoon and evening shift to ensure that there are suitable staff on duty in each unit of the home to avoid staff having to move between units. Staff supervision is required to be undertaken and recorded 6 times per year for all members of staff. The manager designate is required to ensure that cleaning solutions in the Camelot Unit are stored safely in line with the COSHH regulations. The storage of Dental Tablets must be risk assessed for each service user and stored safely. 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.V319662.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12345 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective resident. Prospective service users, relatives and friends are able to visit the home prior to admission. EVIDENCE: The home carries out pre-admission assessments and the manager or senior nurse will visit the place of residence for the purpose of assessment. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 10 At inspection 6 service users details were seen. All had received a preadmission assessment or an assessment by a relevant health professional if distance has obstructed visiting the service user. A statement of purpose is available on request to all prospective service users and a copy was seen in the front hallway of the home. Service users and their families are offered the opportunity to visit the home before making a decision to move in. One service user was able to confirm that a representative had visited the home prior to admission. Contracts were not available at inspection but were forwarded on to the inspector. On examination they appeared clear in content but did not contain number of the room to be accommodated. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans give information to enable staff to meet residents’ health and social care needs. Care plan reviews need further attention to ensure an on going plan of care is maintained and that all aspects of care are detailed in the care plan. The management of medicines in the home was found to be improving. Staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. EVIDENCE: Six care plans were examined at this inspection. Inspectors case tracked these service users care from pre-admission , care planning, involvement of other care professionals, observation of care and included other issues such as quality assurance, accident reports. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 12 The Manager Designate advised that the home is intended to have a computerised care planning system implemented in the new year and preparations for this were evident at this inspection. The inspectors felt that there had been significant improvements in the planning of care for service users, however further development was needed to ensure that all identified care needs were care planned and involvement of service users and their representatives was clearly identified. Further reviews of the planned care needs were not all current and required further input to monitor care and update the care plans. The manager designate explained that staff now have30 minutes per day to update and review care plans. The home has implemented a change of chart for recording change of position and fluids given. These charts were noted to be well filled in and supplied a means of review for the previous days care. There was clear documented evidence of input from visiting healthcare professionals. The home now has a system of recording food supplements and creams applied in the service users care plans. This was noted to have significant gaps and the manager designate must ensure that all prescribed creams and dietary supplements are administered as prescribed and recorded accurately. The inspector observed that staff spoke respectfully to service users and respected their privacy by always knocking on bedroom doors before entering. Service users were seen to be in lounge areas or in their rooms and confirmed that this was their personal choice. Call bells were being answered within reasonable timescales, service users who were able confirmed that staff were kind and helpful. One comment received was that staff were sometimes slow to answer bells in the afternoon. This was discussed with the manager designate at feedback. Service users commented to inspectors that they felt well looked after, comments included “They look after you very well here” and “On the whole staff are kind “ Medication Administration Record (MAR) charts were mostly well filled in. Some discrepancies were found for the administration of some medicine prescribed with a variable dose. Separate record sheets were used to record the application of creams and the supply of nutritional supplements. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 13 For medicines prescribed with a “when required” dose separate guidance sheets are available, however these do not list the actions to be taken before administration only what action to take after administration. Most hand written entries on the MAR charts had been signed and dated by the person making the entry and had been checked and signed by a second person. The temperature of the medicine storage areas was found to be well controlled. For a service user with insulin controlled diabetes regular blood sugar monitoring takes place although the care plan does not indicate the normal range for the service user. Information is available of action to be taken for High levels but not for Low levels. All sterile products in the home were found to be within the manufacturers recommended expiry date. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 14 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. The home employs 2 activity staff who work to provide activities and support to service users. Service users are supported to maintain contact with friends and families and visitors are always made welcome. Service users are able to exercise choice and control over their lives, Service users rooms are decorated to reflect their own choices and lifestyles. The meals in the home are currently undergoing a change of menu. EVIDENCE: The home has now employed a dedicated activity organiser for 27 hours per week who is assisted by a further member of staff. Initial activity plans have been drawn up and the activity staff are undergoing training and visiting other company homes to observe activity provision for service users including those service users with specific dementia care needs. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 15 On the day of inspection the activity planned was a visit by the Body Shop but unfortunately this was cancelled, the previous Saturday a bazaar had been held at the home. Further planned activities include Flexicise classes, puzzles, arts and crafts, cookery and shopping. There is planned to be one to one sessions with service users once each week , the inspectors would recommend further activity planning is made for those service users who are not able to join in the planned events or remain in bed. Social care records were examined for service users case tracked and these included a detail of content of activity and if the activity was enjoyed or successful. The inspectors look forward to seeing further development of this role and programme within the home. On the day of inspection, taking place in the main dining room was a coffee morning organised and run by the company volunteer group. This was very well attended and provided a social link with the community and appeared to be enjoyed by all involved. Some rooms were very personally decorated and reflected the personal tastes of the service user. Personal furniture is also evident, within the room’s size constraints. The home is divided into units so service users can choose where they spend their time. Each unit has a small lounge with kitchenette area, all service users were offered the opportunity to visit the coffee morning but some chose to remain in the smaller lounges and were supported by staff to do this. Service users are also free to choose where they eat their meals. Breakfast and evening meal appeared to be taken mostly on the smaller units however a large amount of people appeared to eat lunch in the dining room. The menus are devised by the Somerset Care Limited and on the day of inspection the cook confirmed that a newly devised menu had just been commenced. Specialised diets were catered for and the specific\preferences and dietary requirements were recorded on both menu sheets and also a board in the kitchen. It was noted by the inspectors that not all specialised diets recorded in the care plans were recorded on the board in the kitchen. Furthermore the vegetarian diets provided did not evidence entirely vegetarian contents and did not appear to have sufficient protein substitutes contained within the options available. This was discussed with the manager designate at inspection. Service users stated that they can always ask for an alternative if there is nothing on the menu that appeals to them. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 16 Break fast was served in each unit and the main dining room, it was noted that some service users had been assisted to the dining area very early, the had received a cup of tea but did not receive breakfast until 08:30. Lunch was observed and was fruit juice, Roast Chicken and stuffing, boiled and roast potato, sprouts and swede . The alternative was cheese and broccoli bake. Desert was bread and butter pudding , stewed rhubarb and custard or fresh fruit. The evening meal was carrot and coriander soup, ham/tuna sandwiches. The liquidised lunch was served separately. The meal appeared plentiful and appetising. Staff were seen offering appropriate assistance over lunch to those who needed it in a supportive and discreet manner. The service users who commented had mixed opinions about the food. One service user expressed a preference for larger meat portions to be served, all confirmed that there was a choice available and that meals were served hot. The manger designate explained that the kitchen is planned in the near future to be refurbished and the company are currently exploring alternative arrangements for the period of time the kitchen would be out of use. Meal supplements are available in the smaller units dining rooms. These supplements were all labelled, each unit has the facility to make hot drinks and light snacks such as toast. Staff confirmed that supper is available for all service users and snacks available throughout the night on request. Service users owns snacks and drinks were clearly labelled and stored correctly in the fridges on each unit. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 17 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. The home has a satisfactory complaints procedure that enables action to be taken. The homes recruitment procedures protect service users from the potential risk of harm or abuse. EVIDENCE: The complaints procedure is displayed in the home and is contained in the homes Statement of Purpose. The home has received one complaint since the last inspection. This issue has been investigated and an outcome reached within an appropriate timescale. The manager designate has reflected on the homes practise in response to the complaint and adjustments in the homes procedures have been made. Service users spoken to stated that they would be comfortable to raise any concerns with a member of staff or the manager. All felt confident that any concerns would be listened to and action taken to address any issues. Issues regarding restraint were discussed with the manager designate and further investigation will be made into ensuring that correct equipment is provided to ensure service users safety and well-being. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 18 Staff spoken to stated that they were made aware of the whistle blowing policy when they began work at the home. All staff are checked against the Protection Of Vulnerable Adults (POVA) register before commencing work and all undergo an enhanced Criminal Records Bureau (CRB) check, 3 staff files examined confirmed this. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 19 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 15 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has undergone a major refurbishment programme. The environment of the home has improved and service users now benefit from light, airy lounges and corridors. The majority of bedrooms have been re decorated and Service users are able to personalise their own rooms. The standard of hygiene within the home is good. Bathrooms are provided in sufficient numbers and are clean. EVIDENCE: The home is divided into 4 units, all of which have their own lounge and kitchenette area. The home has undergone a major refurbishment programme which Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 20 significantly improves the environment of the home with corridors and lounges feeling light and airy. Most bedrooms have been re decorated with only a few remaining. Pipe work has been boxed in bedrooms. The dining area has a new flooring which is a great improvement. The home has purchased new chairs and soft furnishings and service users confirmed that although they were not involved in the choice of colours they approved of the changes and fell the home is looking much better. The home employs a handy man and an ongoing programme of maintenance is underway. Various aids and adaptations are in place to enable service users to maintain independence and there are sufficient assisted bathing and toilet facilities with in the home. There are current difficulties with hot water delivery in one area, this has been discussed by the company and avenues explored to improve the situation. Safe, alternative arrangements for hot water delivery are being arranged by the home. Inspectors noted that locks have been fitted on cupboards in kitchen and bathrooms in some areas. On the Camelot Unit that the ramp to the outside area continues to be inappropriate for use, the manager designate confirmed that this issue continues to be discussed. There is suitable living space and equipment for all service users available. The laundry was well organised with good infection control systems in place. The home generally clean and no malodour was evident. On the day of inspection staffing levels for cleaners were low due to illness, however the home appeared clean and generally tidy. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 21 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): 227 28 29 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels are sufficient to manage the current care needs of residents. Previous requirements made require the Manager Designate to ensure that service user dependency levels are monitored daily to ensure adequate staffing and avoid the use of a “Runner”. This practice continues to take place on the evening shift. Residents have confidence in the staff that cares for them. Staff training is ongoing. The homes recruitment procedures are robust and protect the service user from the risk of abuse. EVIDENCE: On the morning of inspection there was 1 Qualified Staff and 8 care staff on duty. Two agency staff were on duty that day. Other staff included, the manager designate,3 kitchen staff,2 cleaning staff,1 handyman, I activity staff from 10am. On the afternoon shift there was 1 qualified staff and 7 care staff. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 22 The manager designate confirmed that staffing hours and rotas have been reorganised to create a more uniform approach to staff hours worked and responsibilities have been allocated to areas providing a lead nurse and supervisor for each area. The RGN on duty visits each area throughout the shift , for example, the RGN will visit the Camelot unit 3-4 times each shift to provide support and assistance. Agency staff are currently being used until full recruitment has been achieved. The care staff deployment throughout the day means a period of time in the afternoon where two areas have only one staff member and a “runner” between two areas .The level of dependency of the service users would mean that for effective care and for the safety of the service users, to take place, two staff would be required in each area. This had been discussed at previous inspection , staff and residents meetings and continues to be the practice. The manager designate is required to ensure that adequate staffing levels throughout the day meet dependency needs of service users. The inspector examined staff rotas and noted that as at the previous key inspection, night shifts are covered by some staff working regularly 5-6 nights per week and qualified staff regularly working 5 nights per week. It was noted that one qualified member of staff worked 2 night shifts finishing at 07:45 and then returned to work the late shift 6 hours later at 2pm. The manager designate must ensure that staff working hours ensure safe practice and conform with Health and Safety Working Time Guidance. Two service users confirmed with the inspectors that they sometimes had to wait for periods of time to get assistance from staff in the afternoon. Staff who spoke to inspectors felt that levels were adequate but shifts remain busy, especially when they have to help out on other units, further assistance from qualified staff was discussed with the manager designate at feedback. Laundry staffing levels have been increased since the previous inspection. The inspectors observed that interaction between staff and service users was warm and friendly and that staff responded to cal bells promptly and pleasantly. Staff spoken to were happy with the training provided and felt that their opinions and views were listened to, staff felt able to approach the management of the home with any concerns and they would be taken seriously. The inspectors saw evidence that a range of training is available to all staff, all staff have completed manual handling training, however, according to the training matrix supplied prior to inspection not all staff have undertaken health and safety and regular fire training. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 23 NVQ 2 training is underway for some staff members. The manager designate confirmed that the percentage of staff who are qualified to NVQ 2 is calculated at around 60 . The inspector viewed the recruitment files of the 2 most recently appointed members of staff and one previously employed staff member. These gave evidence of a thorough and robust recruitment and induction process. The manager also confirmed that all volunteers to the home have also undergone a Criminal Record Bureau Check. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 24 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 35 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The position of Registered Manager has recently been filled therefore this standard cannot be judged at this time Financial arrangements within the home are good. Record keeping and storage are in line with the Data Protection Act. Health and safety arrangements ensure that staff and service users are protected in most areas. Systems within the home relating to COSHH regulations do not meet the standard EVIDENCE: Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 25 The inspectors could not assess standards 31 until the new manager is established in the home. However, it would appear to inspectors that manager designate is settling well into her new role and instigating changes required in the home. Further Quality assurance audit have not been undertaken by the home since March/ April 2006 and the planned for the new year. The information from the previous audit has not been collated or action plan implemented. The company (Somerset Care) has recently introduced new quality assurance systems, which the home will begin working though shortly. The financial arrangements for the administration of service users own monies were examined. The home has changed the previous system and now all monies are stored and recorded separately. This system is audited weekly and money checked randomly by the inspector were correct. The administrator in charge of this system is recommended to ensure that receipts are kept for all transactions. All money is stored securely. Records are stored in accordance with the Data Protection Act, inspectors evidenced that care plans are stored securely on each unit. All accidents are recorded and audited monthly by the manager. Staff supervision has been continuing and supervision forms had been completed, but from the evidence seen by the inspectors not all staff receive supervision regularly, staff were able to confirm this is the case. A fire log is maintained that shows that fire detection equipment is regularly serviced by outside contractors and checked weekly by the home. All staff receive training in fire safety at least twice a year. Staff also receive training in manual handling, health and safety and health and hygiene. During the inspection some records were examined to ensure that the health and safety of service users was being well managed. These included Fire alarm system Emergency Lighting Fire Extinguishers service Gas certificate Hardwiring certificate LOLER certificate Clinical Waste Disposal Lift Certificate. COSHH sheets Environmental health Report. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 26 Nurse Call System. Hazardous waste disposal Areas of health and safety concern discussed at inspection are; Sluice areas were not kept locked and a cleaners cupboard in the Camelot unit which contains substances hazardous to health is easily accessible. Small hallway cupboard in Camelot unit open and contains 5 small screws. Dental tablets and toiletries were stored in service users bed rooms within the Camelot Unit. This area of risk requires risk assessment and suitable action. Further substances hazardous to health were evident around the home including nail varnish remover and superglue within easy access of service users. These substances must be risk assessed and appropriate action taken. Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 3 3 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 X X 3 1 3 1 Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 28 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 not met Timescale for action 30/01/07 2 OP8 12(1)(a) and 13(1)(b) The Acting manager is required to ensure that service users assessed as requiring nursing care are suitably placed within the home and receive the care assessed. Not examined at this inspection 30/12/06 3. OP9 17(1)(a)( k) The home must ensure that records of creams and food supplements administered to service users are recorded daily. DS0000003307.V319662.R01.S.doc 30/12/06 Wessex House Nursing & Residential Home Version 5.2 Page 29 Previous timescale of 01/08/06 and 30/11/06 not met 4. OP19 13(4)(a) An Immediate Requirement was made that the ramp to outside area of the Camelot Unit be made safe and appropriate for use Previous timescale of 01/08/06 and 30/11/06 not met 5. OP27 18(1)(a) The home is required to review the practice of having one staff member on each unit and a Runner between 2 units. Previous timescale 01/08/06 and 30/11/06 not met 6. OP36 18(2) Staff supervision must be reintroduced to support staff development and working practices. Previous timescale of 01/08/06 and 30/11/06 not met 7. OP38 13(4)(a) The home is required to ensure 30/12/06 that cleaning solutions are stored safely in line with the COSHH Regulations. All sluices are required to be kept locked on all units The storage of Dental Tablets must be risk assessed for each service users and stored safely 30/01/07 30/12/06 30/01/07 Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 30 Previous timescale of 01/08/06 and 30/11/06 not 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 OP7 Good Practice Recommendations Care plans should be reviewed each month. It is recommended that action from these reviews forms the plan of care. It is recommended that service users/representatives have more input into the care plan process. It is recommended that the home develop an audit system to monitor how the record charts are completed. The manger designate is recommended to ensure that all service users abilities are considered when activity planning to include service users who remain in bed and those with specialist care needs. The manager must ensure that vegetarian diets contain the appropriate dietary compliment and contents. 2. OP7 3. 3 OP9 OP12 4. OP15 Wessex House Nursing & Residential Home DS0000003307.V319662.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Somerset Records Management Unit 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. 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