Inspection on 20/06/06 for Wessex House Nursing & Residential Home

This inspection was carried out on 20th June 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 &... 16/11/06

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 09:30 20th June 2006 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.V292911.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 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.V292911.R01.S.doc Version 5.1 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. 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. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over 1 day on the 20th June 2006. A tour of the home took place and all the bedrooms and communal areas were seen. There were 47 service users currently residing at the home. The inspectors spoke to 10 service users, 3 visitors, one Care worker and 7 members of staff. The home has a temporary Manager in place, Mrs Vera Fellows and a new manager Mrs Sheelagh Underwood is currently under going an induction process. Both Registered Managers were available throughout the inspection. The inspectors are aware of the considerable work currently being undertaken by Mrs Vera Fellows to support and promote the standards of care at Wessex House. Evidence was seen of the positive ongoing changes underway. As part of this inspection the inspectors surveyed the opinions of a selection of service users and their representatives, GP’s, District Nurses and Care Workers. A reasonable amount of responses were received. Records relating to care, staff, finances and health and safety were examined The inspectors noted that service users appeared settled and comfortable. Time spent by the inspectors observing staff, evidenced that they were kind and caring towards service users and spoke to them at all times with support and reassurance. Visitors spoken to were pleased to confirm that they were always made very welcome to the home at any time. 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: Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 6 The service users spoken to by the inspectors were all happy and positive about the staff, all were satisfied with the care they are receiving. In excess of 50 of staff have undertaken NVQ training. What has improved since the last inspection? What they could do better: The home is required to update the Service User Guide to contain up to date Management information. The home must also ensure that the most recent inspection report is available to service users/representatives. Care Plans continue to need further improvement to ensure that staff are able to meet service users needs. Care plans need to take a person centred approach to care containing details such as the time wishing to get up and retire to bed. Consent forms within the care plans need to be signed by a service user or an appropriate Representative. The recording of prescribed creams and food supplements within the care plan must be done on a daily basis. Charts recording the change of position of service users require more detail and require signing and dating. The systems for ordering medication require review to ensure service users have the stocks of medication they require. Medication Administration Records need to be fully completed. The records relating to the storage of Oxygen must be updated. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 7 Further review of activity provision is required to ensure service users receive a range of choices of activities and includes service users with dementia and those service users who remain in bed. Continued refurbishment of the home is required to ensure that service users have a safe and well maintained environment. Exposed pipe work in bedrooms must be addressed to prevent risk of injury to service users An Immediate Requirement was made to ensure that the ramp area to the outside of the Camelot Unit is made safe and appropriate for use. Another Immediate Requirement was made to ensure that window restrictors were in place on the Camelot Unit to ensure the safety of Vulnerable Service users. The home must ensure it can provide equipment such as sterile gloves and suction catheters to meet service users need. Staffing levels are in need of review to ensure that each unit has two staff each afternoon and the need for a “Runner” is removed, further review of cleaning and laundry hours is recommended. Service user finances require review to ensure that each service user had independent resource to their money. Staff Supervision is required to cover all topics identified in the National Minimum Standards. Various Health and Safety issues are required to be addressed which are outlined in the requirements. 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. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 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.V292911.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1345 The overall quality rating in this section is assessed as adequate. The Service User Guide requires updating to ensure the correct management details. Contracts do not contain all the required information. The home has thorough pre admission arrangements and provides good opportunities for the service user to make decisions about moving in. The opportunity is available for service users and their relatives or representatives 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. Service users and their families are offered the opportunity to visit the home before making a decision to move in. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 10 At inspection 4 service users details were seen. All had received a preadmission assessment. A statement of purpose is available on request to all prospective service users and a copy is also available in the front hallway of the home. One service users survey commented that ” Unfortunately not enough information given at the time which may have altered the decision” The home is recommended to ensure that all prospective service users receive a copy of the Service User Guide and that this guide is updated. The results of the relatives surveyed also indicated that residents and visitors do not have access to the most recent inspection report. Contracts were not available at inspection but were forwarded on to the inspector. The Somerset Finance Team is currently reassessing the contracts. The contacts did not contain the number of the room to be occupied or details of what specific items the contract covered, for example, laundry, newspapers, dry cleaning. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 The overall quality rating in this section is assessed as adequate. Care planning is currently under review to provide a more efficient system of care planning to adequately provide staff with the information they need to satisfactorily meet service users needs. Service users are treated with respect and appear well cared for. The medication systems have improved but areas of procedure for dispensing medication are of concern. EVIDENCE: Four 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. The Registered Manager provided an example of the new format of care planning which was significantly improved and easier to use. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 12 Each care plan now contains a past social history of each service user and the inspectors felt that this was very helpful to staff in providing an extended level of understanding of the service user. All care plans examined lacked the full range of headings as recommended by the National Minimum Standards and failed to include input from service users and their representatives. Nutritional assessments were now in place for each service user, however review and action taken from the nutritional assessments was not documented. One service user had indicted a preference for breakfast but had received something else. Another service user was in considerable pain and no care plan existed to monitor the level of pain and action to be taken. 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 system is an improvement but requires staff to update the record on a daily basis. Further improvement ls recommended ensuring that accurate records of baths and all personal hygiene are maintained. The inspectors observed that a service user who was unable to make an informed consent had signed a bed rail consent form and Care plan review. The Registered Manager must address this area. Staff were seen as attentive and service users rooms had “Do not disturb signs” in use for those receiving care in private. Call bells were being answered within reasonable timescales and inspectors observed that service users being nursed in bed were receiving a change of position regularly. The inspectors discussed with the Registered Manager the need for more detail on the charts recording positional change. These charts were in the form of a clock chart and required directions for frequency of change and date, time and signature of staff providing the care. Service users who wished to were able to self medicate and a risk assessment was in place. Lockable storage within the service users bedroom was available. Oxygen storage is now adequate, however audit records relating to the amount of oxygen in store were incorrect. Medication‘s fridge temperatures were within suitable range. The inspector noted that there was only one pair of sterile gloves available within the home. The Manager felt that gloves were contained within packs of Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 13 sterile equipment. It is recommended that suitable stocks of available sterile gloves are purchased. It was also noted that no sterile suction catheters were available. One service user is currently using the suction machine and no catheters were evident in the room. Stock levels were adequate for service users needs and systems for storage of medication had improved. It was evident that stock levels are not adequately monitored to ensure service users medication is always available. An error was noted on a controlled drug, this matter was dealt with immediately by the Registered Manager as per the homes policies and procedures. Further gaps were noted in the Medication Administration Records without explanation in either the Daily Record or Care Plan. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 The overall quality rating in this section is assessed as poor. Service users spoken to and survey results received confirm that service users all enjoy the friendly and homely atmosphere. The opportunities for appropriate social and recreational activities, for all service users, are limited. Arrangements for service users to maintain contact with family and friends are good. The dietary needs of the service users are met by a set menu .A varied selection of food is available with alternatives available for each meal. EVIDENCE: Service users spoken to were generally happy with the social, religious and recreational activities provided. The Registered manager confirmed that there had been further input in this area from the company Occupational Therapist. Some service users commented that the mini bus seating capacity was inadequate to allow many people to go out at the same time. Another relative survey commented that more activities could be in place for service users. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 15 One service users commented that “It is a bit boring, nothing to do” On the day of inspection the activity planned was cake decorating with a theme of the world cup and the hairdresser was visiting. Social care records were examined for a service user case tracked and these included a trip to the village and a game of snakes and ladders. The inspectors spoke to 2 visitors who said that they visited frequently but did not see much evidence of activities. Collages made at the previous inspection were still on display. The notice boards in each area contained a plan of activities, which had run out on the 18th June 2006. Due to the redecoration service users were using the front hallway as a seating area, not enough suitable tables and seating was provided to make this area a suitable temporary replacement. There was no evidence of appropriate activities planned or taking place for those service users with Dementia or those service users who are remaining in bed. Two visitors spoken to by the inspector was very satisfied with the care their relatives are receiving and confirmed that they were always made welcome at any time. 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. Lunch was observed and was Boiled Ham and Parsley Sauce or Sausages in Onion Gravy and three choices of desert. 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. Service users spoken to made varied comments about the food, which included “Food is quite nice, they will bring me another choice if I don’t like it” “Food is good but tasteless”, “Food could be improved” Service users who were spoken to, who remained in their rooms were unsure about what was for lunch. Meal supplements are available in the smaller units dining rooms. These supplements were all labelled and staff were clear when asked by the inspector who these supplements were for. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 16 Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 The overall quality rating in this section is assessed as adequate. There has been one complaint received since the previous inspection. The complaints policy now contains all the correct details required. The recruitment procedures carried out; ensure that people are protected from the 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. Three staff files were examined. All contained evidence of POVA and CRB checks having been received or applied for. Evidence was not available to confirm that staff were being supervised whilst the CRB checks are completed Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 The overall quality rating in this section is assessed as poor. The environment is improving with further refurbishment required in many areas. Service users safety is not being maintained in some areas. Specialised equipment is available. The cleanliness of the home has improved since the previous inspection. EVIDENCE: The home is undergoing refurbishment and many areas are significantly improved. However further work is required, many service users bedrooms are shabby and are in need of repairs. The Registered Manager confirmed that not all bedrooms are being redecorated. Two service users told inspectors that they had been involved in selecting the colour of the new decoration. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 19 On the day of inspection a new floor covering was being laid in the main dining room and painters were seen re decorating throughout several areas of the home. Inspectors noted curtains needed correctly re-hanging and window ledges needed cleaning. Some wheelchairs were also noted to be very dirty and several pedal bins were broken. Furniture and bed covers in several bedrooms appear shabby. In the Camelot Unit it was noted that window restrictors were not in use in one bedroom and on the adjacent landing area. *An immediate requirement was made that window restrictors were fitted in all windows of Camelot unit to ensure the safety of vulnerable service users. It was also evidenced on Camelot Unit that the ramp to the outside area was inappropriate for use. The doors to outside had been opened and chairs placed in front of the ramp to prevent its use. A risk assessment was stuck to the door. *An immediate requirement was made that the ramp to the outside area of the Camelot unit be made safe and appropriate for use. There is suitable living space for all service users and suitable equipment is available for service users. One relative survey commented that there was a lack of chairs for visitors and there was also not a relative’s room where visitors could see their relatives in private. A further comment received was that there were inadequate parking facilities for visitors. It was noted by inspectors that attempts to provide an adapted environment for service users with dementia was being undertaken with doors to toilets been painted in a different colour and improved door naming systems being fitted. Clocks in service users bedrooms were generally incorrect. One service user had three clocks and each told a different time. The home appeared generally clean and no malodour was evident. Cleaning staff who spoke to inspectors advised that insufficient time is available to ensure a continuous level of hygiene within the home. This was discussed with the Manager at the time of inspection. Some broken bins were evident throughout the home and dirty hairbrushes were seen in the home. Plug sockets located at the side of sinks had been blanked off, however, exposed pipe work including valves and connections were seen under the sinks of many bedrooms. This may present a risk of injury to service users. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 20 Tiles were broken in several bathrooms and an inappropriate toilet handle consisting of a wire hook, was seen in Camelot Unit Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 28 29 307 The overall quality rating in this section is assessed as adequate. There are sufficient numbers of staff on duty to ensure that service users are kept safe. The recruitment procedures are mostly satisfactory but further recruitment is required to ensure full staffing. Staff training records are available but a staff-training matrix is required to provide the Registered Manager with an overview of staff training undertaken. EVIDENCE: On the morning of inspection there was 2 Qualified Staff and 8 care staff on duty. One agency staff was on duty that day. On the afternoon shift there was 1 qualified staff and 6 care staff. 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. The acting manager was not aware of this practice and will look at this situation. One Relatives survey commented “Not always 2 staff available to get mum to the loo” Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 22 One visitor commented that there was not enough staff available. Service users were complimentary about the care they received, comments included “ They take good care of me” Staff training records are being audited and an updated copy will be forwarded to CSCI. Staff records available confirmed that staff induction and mandatory training is taking place. A further audit of staff recruitment files is also being undertaken and any missing details are currently being requested. Evidence of this audit provided a clear and detailed plan of action to update all staff files. NVQ 2 training is underway for some staff members. The Service User Guide states that 2 staff have NVQ 3, however, staff wishing to continue to NVQ 3 are not supported by the company to do so and so limiting career progression for staff within the home. Cleaning and laundry staff commented that they felt they did not have sufficient hours to ensure that they were able to complete their job to a high standard. Laundry is currently staffed at 5 hours per day for 47 residents. The equipment available slows down the process of ensuring the laundry is completed within the 5 hours. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 37 38 The overall quality rating in this section is assessed as poor. A acting Manger Mrs Vera Fellows is currently managing the home and a newly employed acting Registered Manager is being inducted into the home. Service users finances require a review of procedure. Staff supervision required updating to cover all aspects detailed in the National Minimum standards. The management of health and safety continues to be less than satisfactory in many areas. EVIDENCE: The inspectors could not assess standards 31 until the new manager is established in the home. However , the temporary manager Mrs Vera Fellows had implemented a series of audits and measures to improve many aspects of Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 24 the management of the home and is to be commended on the systems implemented in the short time she has been at Wessex House. Mrs fellows appear to be resident focused and is aware of current developments both nationally and by CSCI and plans the service accordingly. Quality assurance audit results were seen and the outcomes are to be collated by Mrs fellows and form the basis on a plan for further improvement action within the home. The financial arrangements for the administration of service users own monies were examined. The current system involves pooling the finances. An improved system was discussed with the temporary manager, which would enable each service users finances to be stored in separate envelopes to ensure clear financial accountability. Staff supervision has been continuing and supervision forms had been completed, but from the evidence seen by the inspectors not all subjects had been covered. Staff training is planned in this area, the supervision seen did not encompass the philosophy of care in the home and all aspects of care practice. Records are stored in accordance with the Data Protection Act. Inspectors expressed some concern over the content of communication diaries in each area. The temporary manager must ensure staff are aware of the risk of breach of confidentiality by the information within these diaries. During the inspection some records were examined to ensure that the health and safety of service users was being well managed. These included Fire Risk assessment Fire alarm system Emergency Lighting Gas certificate Hardwiring certificate LOLER certificate Clinical Waste Disposal Lift Certificate. COSHH sheets Environmental health Report. Nurse Call System. Some Health and Safety records were not available and are to be forwarded on to CSCI, these include PAT electrical checks Staff Training Records. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 25 Areas of health and safety concern discussed at inspection are; Some bedrails were noted to be very unstable and require further fitting to ensure they are safe. Cleaning chemicals were stored in the unlocked laundry room on Camelot unit and further cleaning solutions were stored under the kitchen sink next to service users drinks in the Camelot Unit. Sluice areas were not kept locked. Extension leads were connected to further extension leads across a lounge in Camelot to provide electricity supply for a recliner chair. 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. The toilet handle in the toilet in Camelot is inappropriate for use. Exposed pipe work evident in many bedrooms presents a risk to service users. Clinical waste collection bins in each area need to be clearly labelled to ensure staff are aware of the content of the bins. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 26 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 1 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 1 3 1 3 3 1 2 STAFFING Standard No Score 27 1 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 1 1 2 1 Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5(1)(b) Requirement The Registered Manager is required to update the Service User Guide to contain correct Management information. The home must also provide prospective service users/representatives with the recent inspection report. 2. OP7 12(1)15(1 ) It is required that the care records are fully reviewed to ensure that they are systematic with up to date, accurate assessments and care plans that contain sufficient information to guide staff to provide consistent care. The care plans must be reviewed regularly with the service user or representative and any consent forms signed by a suitable representative as required. The home is required to ensure that Charts used to record changes of position contain sufficient detail about care needed and are suitably signed and dated DS0000003307.V292911.R01.S.doc Timescale for action 01/08/06 01/08/06 3. OP8 17(1)(a)( p) 01/08/08 Wessex House Nursing & Residential Home Version 5.1 Page 28 4 OP9 17(1)(a)( k) 13(2) 5 OP9 6 OP9 13(2) 7. OP12 16(2)(m)( n) The home must ensure that records of creams and food supplements administered to service users are recorded daily. The Registered Manager is required to ensure that the systems for ordering of medications are adhered too ensuring service users have adequate stocks of medications. The home is required to ensure that staff record all medicines given or a suitable indicator recorded for any omissions The manager and provider must review the provision of social and psychological opportunities to take account of the abilities and preferences of all service users. Previous timescale not met 01/08/06 01/08/06 01/08/06 01/08/06 8. OP19 13(4)(c)2 3(1)(a) The home is required to continue with the refurbishment programme to ensure all areas of the home meet the required standard. 01/08/06 9. OP19 10 OP22 11 OP25 12 OP27 13 OP28 An Immediate Requirement was made that the ramp to outside area of the Camelot Unit be made safe and appropriate for use 16(2)(c) The home is required to ensure that suitable equipment for service users are purchased with reference to Sterile Gloves and Sterile Suction Catheters. 13(4)(a)(c The home must ensure that ) exposed pipe work in service users bedrooms are risk assessed and made safe. 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. 18(1)(a) The Registered manager is required to provide CSCI with an DS0000003307.V292911.R01.S.doc 13(4)(a) 01/07/06 01/08/06 01/08/06 01/08/06 01/08/06 Page 29 Wessex House Nursing & Residential Home Version 5.1 14. OP36 18(2) updated training Matrix for all staff01/08/06 Staff supervision must be reintroduced to support staff development and working practices. 01/08/06 15 OP35 20(1)(a) 16. OP38 13(4)(b) 17. OP38 13(4)(a) The Registered Manager is 01/08/06 required to review the process of banking service users finances in a joint account and to ensure each service user has an individual amount of money available within the home. The home is required to ensure 01/08/06 that all bedrails are fitted appropriately to ensure there is no risk of entrapment The home is required to ensure 01/07/06 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 The Registered manager must review the practice if electricity wires across communal areas and appropriate action be taken. An Immediate Requirement was made to ensure that window restrictors were fitted and working in the Camelot Unit for the safety of vulnerable service users . 18. OP38 13(4)(a) 01/07/06 19. OP38 13(4)(a) 20/06/06 Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP7 OP14 OP16 OP26 OP37 OP38 OP38 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 follow up action taken by the Registered Manager is recorded on all complaints. It is strongly recommended that Operations Manager and Registered Manager review the provision of domestic and laundry staff hours. It is recommended that the content and storage of communication books on each unit is reviewed. Inspectors would recommend the removal of the inappropriate toilet handle discussed at inspection. The inspectors recommended that clinical waste bins be marked as such to ensure staff are aware of the contents of these bins. Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wessex House Nursing & Residential Home DS0000003307.V292911.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!