Inspection on 22/02/06 for Wessex House Nursing & Residential Home

This inspection was carried out on 22nd February 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 &... 20/06/06

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

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

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

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Queensmount

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Didsbury Court Rest Home

Belma

Hunters Care Centre

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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 Ms Sue Hale Unannounced Inspection 22nd February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wessex House Nursing & Residential Home DS0000003307.V276789.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.V276789.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.V276789.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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. 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 (Green lawns) 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.V276789.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 by two inspectors, which lasted 7.5 hours. The inspectors had a tour of the home and spoke to service users and staff members. The inspectors observed lunchtime in all areas and observed staff interacting with service users. Two care plans were seen, staff training and staff rotas were examined, medication systems were examined and complaints, accidents and protection records were all seen. The inspectors were concerned that requirements and recommendations highlighted in the previous inspection had not been addressed. What the service does well: What has improved since the last inspection? The registered manager explained that a review has been undertaken with reference to reorganising of service user areas to cater for their specific needs, but no changes have occurred to date. Service Users requiring specialist equipment have now had their rooms risk assessed and reorganised as required, to be better accommodated. The time spent by service users at the dining table has been reduced and the puree diet now reflects the general menu. A revision of staff rotas has taken place with additional staff hours in some areas. The refurbishment programme continues, but has not yet reached completion. Some staff training has taken place regarding care plans, care plans are now stored securely in the areas being used by the service Users. Safer systems have been implemented to manage service users creams and denture tablets. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 6 A programme of activities is now in place and staff are allocated time to ensure service users are supported during these activities. There has been a review and alteration of the activities coordinators hours. The domestic staff arrangements have been reorganised, broken bins replaced and there was a general improvement in the standard of hygiene within the home. Health and safety checks have improved with opened food stored in the fridge was dated and labelled. The medicine administration is now done by two staff members. What they could do better: Care plans examined for service users do not cover the care required in enough detail and consistency for the staff to be able to use them to their full potential and ensure service users receive the care they need. The system of care plan assessment and review requires continued improvement and the evidence of involvement of residents and relatives in care planning is missing. It is strongly recommended that further staff training and support is given in the completion and review of care plans for those service users with personal care needs to ensure that their needs are tailored to them .By having several care staff receiving this training the workload of assessment may be more widely spread and also enable staff to feel more supported. The home is required to demonstrate that people with dementia are receiving a specialised service tailored to their needs. As in the previous inspection inspectors could see no evidence of any specific service. The environment continues to need further refurbishment to meet the required standard. Further attention by the registered manager is required for the system of ordering medication. Medication practice in respect of ordering, storage and administration is in need of review .The inspectors suggested a more suitable ordering system for oxygen needs to be implemented with a facility for ensuring how much oxygen is required before ordering and a record kept of number of cylinders in case this information is needed urgently. A suitable system needs to be put in place to ensure correct labelling of the prescribed supplements and evidence that the service user prescribed is receiving the supplements. Staff training on the use of these supplements and their inclusion in the care plan is recommended. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 7 The manager is required to ensure that risk assessments are in place where creams and toiletries are not locked away in rooms where service users have cognitive difficulties. Particular risk assessment must also be undertaken for the plug sockets located by each sink to ensure the safety of the service users who have reduced cognitive ability. Staff files require reorganisation and staff training and recording requires further input to ensure that all staff are trained to a suitable standard. All staff are required to receive induction training and this be recorded in the staff members files. Staff are required to have a contract / terms and conditions of employment with a copy recorded in staff files. Supervision records did not cover all the recommended topics. The quality assurance survey was limited. Some adjustment to this survey would provide Mr Mills the opportunity to measure the pervious responses to this current survey. A greater awareness is required of the nutrition needs of the residents by both the catering and care staff. The storage for puree diet, from lunchtime to evening meal requires addressing to ensure the maximum nutritional content is maintained for those service users who require a soft diet. 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.V276789.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.V276789.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): 3 4 5 ( standard 6 does not apply ) 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. At inspection two service users details were seen. One Service User was assessed in hospital but the pre admission assessment was not signed or dated. The second admission was an emergency admission for a short-term placement from another care home. The home concerned provided the appropriate paperwork, which the Wessex House has continued to use and has not transferred to the companies documentation. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 10 The home can meet the current service users physical needs, following reorganisation within some rooms. Previous inspection has highlighted that the home was not meeting the holistic needs of a significant number of service users, including those with dementia needs. There has been some staff adjustment to support service users holistic needs more effectively. On the day of inspection the inspectors saw no evidence of activities specifically aimed at service users with dementia. Wessex House Nursing & Residential Home DS0000003307.V276789.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 As in the previous inspection, there is no clear and consistent care planning system in place 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 ordering arrangements are in need of review. EVIDENCE: Two care plans were examined during this inspection. The inspectors tracked the care plans through many aspects of care, these included accident reports, medication sheets, risk assessments for bedrails and nutritional assessments The home uses a system of standard care plans. The previous inspection had identified that care plans required further review and that they are accurate, detailed and reflect the changing needs of service users. These care plans must be regularly updated by staff trained to do so. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 12 The registered manager is required to ensure that the care plans are completed correctly and involving the service users and their relatives or representatives. This continues to be a concern for the inspectors as both care plans seen were incomplete and inconsistent. Both care plans would not direct staff to the care required by the individuals .One care plan seen had not been fully completed and very few assessments had been signed and dated. Nutrition assessment had not been completed and one person had received dietary supplements not prescribed for them. Nutritional risk assessments contained contradictory information, which resulted in an incorrect assessment of the persons needs. Risk assessments were incomplete and lacked sufficient detail to ensure correct risk identification and action plan. Risk assessments had been completed for all bed rails and this task had been specifically allocated to a staff member .The next date for review of risk was not stated and the risk assessments had not been signed. Moving and handling plans did not reflect the same information on the mobility assessment. There was no evidence in the care plans of other health care professionals visiting or referrals to them. Staff seen, were attentive and personal care was provided in private. Some ground floor rooms, whose windows faced the public footpath and road would benefit from the use of one-way window coverings, which would ensure privacy and dignity from the general public who use the road. The service users call bell system was tested and staff responded promptly. One resident seen was able to self medicate ,the inspectors saw that this medication in the service users bedroom, was stored correctly. A risk assessment must be completed for any resident who chooses to and is able to self medicate. Oxygen was being used but storage was not suitable. The registered manager assured the inspectors that the correct storage facility had been requested and was awaiting construction. On the day of inspection numerous oxygen cylinders were stood in the treatment room, not secured. The staff had no recording system for ordering. Two service users commented on the fact that some medication prescribed for them had not been available Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 13 The medicine ordering and storage systems were not satisfactory and a referral to CSCI Pharmacy Inspector was made. A separate report will be provided by the Pharmacist Inspector and this will be published separately. Fridge storage for medication was satisfactory but the medications fridge was in need of defrosting. Wessex House Nursing & Residential Home DS0000003307.V276789.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 15 Service users spoken to were all enjoying 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. Staff awareness is needed of the nutritional requirements of the service users. EVIDENCE: Service users spoken to were happy with the social, religious and recreational activities provided. Volunteers from the local church take 5/6 service users to church each week. A theatre group had visited the previous day and coffee mornings happen regularly. The home employs an activities organiser and a team of volunteers who have altered their hours to be able to fulfil their role more productively. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 15 On the day of inspection the activities organiser had organised a shopping trip for one service user and another service user was being assisted to make a collage. No other activities were seen for the remaining service users. A selection of activities for that day was seen on the notice board of each area The activities were the same for each area. The inspectors could not evidence the provision of any appropriate opportunities for activities specifically for service users with dementia. The home is fund raising to replace the existing mini bus with one more suitable to service users needs. A visitor spoken to by the inspector was very satisfied with the care their relatives are receiving. 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 by the inspectors, on the day of inspection the choice of lunch was meatballs with cheese sauce, potatoes carrots and brussel sprouts or curried eggs and rice. The desert was bread and butter pudding or rhubarb and custard .The bread and butter pudding appeared burnt, this was confirmed by service users. Staff were seen offering appropriate assistance over lunch to those who needed it in a supportive and discreet manner. The home is geographically arranged in four areas, the area known as Camelot has service users who have dementia. The inspectors evidenced in the Camelot unit, that one service users lunch sat on the side, unheated, until everyone else had been served before anybody was free to assist them with it. Staff advised inspectors that a 3-course meal is provided for all service users. Service user feedback indicated that 2 out of 3 courses were made available with a choice of soup and main course or main course and desert. People were able to eat in a place they choose to and a main dining room is available or smaller dining rooms in each unit. The evening meal was a single choice but an alternative was available on request. Service spoken to, who were able said that they enjoyed the food. The dessert seen by the inspectors was burnt and unsuitable for the service users, an alternative was available. All service users spoken too stated that they enjoyed the variety and standard of food. Each day’s menu was displayed in the dining room. The menu is set and is changed every three months. This set menu has not been reviewed for some time. The puree diet was served in an attractive manner and it has been clarified that the alternative for lunch will be the puree diet for tea. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 16 The registered manager explained that the previous arrangement of seating for long periods of time at the dining tables had been resolved. Catering and care staff were unaware of the nutritional needs of the service users and in particular those people with dementia. Meal supplements are available in the smaller units dining rooms. These supplements were not all labelled and staff were unsure when asked by the inspector who these supplements were for. Wessex House Nursing & Residential Home DS0000003307.V276789.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 There have been no complaints received. The complaints policy needs to specify that any complainants can be directed to CSCI. 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. CSCI have not received any complaints about the home since the last inspection. Three staff files were examined. All contained evidence of POVA and CRB checks having been received. Wessex House Nursing & Residential Home DS0000003307.V276789.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 23 24 25 26 The environment is improving with further refurbishment required in most areas. The home continues to remain shabby in some areas with the continued need for improvement to décor and comfort for the whole environment. The cleanliness of the home has improved since the previous inspection. EVIDENCE: The home continues to be in the process of being redecorated and re carpeted and when this work is complete it is anticipated that the standard will be met. The registered manager assured the inspectors that this should be achieved with the current programme of works. Until this completion the registered manager must ensure that risk assessments are completed for any areas that do not meet the health and safety standard. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 19 There is suitable living space for all service users and suitable equipment is available for service users. A unsuitable wheelchair was noted to be used for a service user and a replacement containing the specialist equipment for the transportation of oxygen is required urgently. This was discussed with the registered manager. The registered manager explained that the previous practice of hoisting service users outside of their rooms no longer happened as the rooms have been reorganised to accommodate any specialist equipment required. The home appears much cleaner since the previous inspection and inspectors saw two cleaning staff on duty. Bathrooms were clean and safety notices in place. Dirty hairbrushes were seen in a bedroom. In the Camelot area, a cleaning solution had been decanted into a coffee jar and left in an unlocked sluice room. The registered manager said that all broken bins had been replaced. Suitable protective clothing and hand gel was seen regularly throughout the home to reduce any risk of cross infection. Plug sockets were seen located at the side of several sinks. It is required that risk assessments be undertaken to ensure the suitability of service users to those rooms with plugs sockets by sinks. The manager must ensure that those people with cognitive impairment were not put at this risk. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 There are sufficient numbers of staff on duty to ensure that service users are kept safe. Service user dependencies must be assessed to ensure that all physical needs are met and each area staffed to provide this. Staff rotas require some amendment to make clear the designation of staff. The recruitment procedures are mostly satisfactory but further recruitment is required to ensure full staffing. Staff training records are available but staff training is not adequate to meet the care requirements of the service users. EVIDENCE: Rotas were examined for the current and previous week in February 2006. The registered manager confirmed that the staffing ratio was directly related to a service user dependency assessment. This takes place every six months but may be reviewed is there is a need, in the interim period. A copy of this dependency audit tool was not available at inspection. There are two registered nurses on duty each morning, one on each afternoon and one on a night shift. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 21 This does not continue over the weekend when there is one qualified staff member each morning .The qualified staff are not designated to work in a particular area but help out as required. The previous inspection had highlighted a concern that one nurse assumed responsibility for all medication dispensing. This has now been adjusted. There was positive feedback from a qualified member of staff that this change had improved work practice for the staff. The service users and relatives spoken to at this inspection, spoke very highly of the staff. They felt that they were being well cared for but several commented that the ‘staff were very busy’. One service user said that they ‘would like a bath more often’ but felt the staff were too busy. The inspectors observed two members of staff who spoke to service users in a brusque manner. This was brought to the attention of the registered manager on the day of the inspection. A relative told the inspectors that they had experienced some problems with the laundry service. 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 registered manager confirmed this to be normal practice. This was identified at the previous two inspections and has not been addressed by the company. The inspectors strongly recommend that this situation is adjusted to improve patient and staff safety. It is the inspectors judgement from the evidence seen and noted above that the system of staffing each area independently does not work efficiently and safely. Staff spoken to who were working in a different area than their normal area were unable to answer questions about the alternative area. Rotas examined for domestic staff show an improvement since the previous inspection, however the staffing day to day was erratic and inconsistent. Ancillary staff rotas seen, evidenced that there is not always there correct amount of cleaning and laundry staff on duty. Staffing levels indicated that some staff are working unacceptably large amounts of hours each week. This practice is unsafe and needs review. Information supplied by the registered manager that the home requires a total of 25 RGN hours per week and over a two-week period 53 hours of Care Staff. Rotas examined showed that one member of staff is has consistently worked in excess of 50 hours per week. Another member of staff following a period of ill health worked 6 consecutive nights. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 22 Staff training records were provided .It is not possible to ascertain in each staff members records the dates and amount of training received. A spreadsheet of staff training was available, this indicated that staff training is inadequate and some staff are not being suitably trained and supported to fulfil their roles. Further information has subsequently been received by the inspectors which evidences that further training has taken place. Over 50 of care staff have completed or are undertaking NVQ 2 training. Some training had taken place on Drug administration, Dementia Care, Oral Health and MRSA. Most staff members have completed a Manual Handling course and Safe Food Hygiene. There was no evidence any staff receiving Basic First Aid ,Health Safety training and Infection control training. Some staff had attended fire awareness training but there was also evidence that some staff had received no training on any aspect of care. Three staff files were seen and only one contained an induction -training programme. Only one copy of a staff contract was evident and four references were not dated and one not signed. Wessex House Nursing & Residential Home DS0000003307.V276789.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): 31 32 33 36 37 38 The overall leadership and management of the home has not successfully implemented the agreed action to effect improvement in the service. The management of health and safety continues to be less than satisfactory in all areas. EVIDENCE: Mr Mills is an experienced nurse and manager. On the day of inspection he had had difficulty in providing all the information required by the inspectors. Mr Mills has a good relationship with service users. Other staff extended roles to support Mr Mills. The manager has recently had an extended period of absence where the home was supported by a senior manager from Somerset Care. Inspectors evidenced some improvements since the last inspection. However, significant progress in key areas is yet to be made e.g. Medication management, care planning, specialist dementia care provision and staff organisation. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 24 The inspectors considered that more management support is required by Somerset Care for Mr Mills. It is required that a copy of visits by Somerset Care Management are to be sent to CSCI office. Three further rooms have recently been registered, two for service users who require nursing and one for service users requiring personal care only. The geographical layout of the room will have some bearing on the selection of service user for each room .The registered manager discussed with the inspectors the possibility of offering the new rooms to any existing service users but he felt that the cost was prohibitive for existing residents. A quality assurance survey was being prepared to send out. No evidence was seen of any previous survey. Staff have met recently with either the manager or area manager. Staff supervision forms had been completed but from the evidence seen by the inspectors not all subjects had been covered. Staff training had been covered but the supervision did not encompass the philosophy of care in the home and all aspects of care practice. Care plans are now stored securely in the areas of use. Staff training on fire safety, health and safety, safe food handling, first aid and manual handling was inconsistent and the manager must ensure that the outstanding staff receive the relevant update training During the inspection some records were examined to ensure that the health and safety of service users was being well managed. The following areas were identified for improvement: *Accident records were not all complete and were not reflected by any risk assessments and any outcomes in the service users care plans. *Bed rails had been checked but not signed for or further review dates planned. *An uncovered disposable razor was found in one bedroom *An out of date cream was found in a bedroom * A tray was observed in a service users bedroom containing medication, sinex, eardrops, an unidentified solution in two bottles and a urine sample bottle labelled vinegar. *Steredent dental tablets were seen in two rooms. *Two commodes were seen which held cardboard inserts instead of commode bowls. *Plug sockets were seen by several sinks. *Two oxygen cylinders were strapped horizontally to the arms of a wheelchair. The oxygen on this wheelchair, was prescribed for another resident who is not resident at the home. Wessex House Nursing & Residential Home DS0000003307.V276789.R01.S.doc Version 5.1 Page 25 Wessex House Nursing & Residential Home DS0000003307.V276789.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 X X 3 2 X N/A 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 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 2 2 2 Wessex House Nursing & Residential Home DS0000003307.V276789.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 OP7 Regulation 15 (1) Requirement The home is required to demonstrate that people with dementia are receiving a specialised service tailored to their needs. (Previous timescale of 28/02/06 not met) 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. (Previous timescale of 31/01/06 not met) The registered manager is required to ensure that all staff adhere to safe systems for recording, storage, handling, administration and disposal of medicines. The home is required to store all oxygen cylinders safely and in the correct environment. The registered manager must DS0000003307.V276789.R01.S.doc Timescale for action 28/05/06 2. OP27 12(1) 15(1) 28/05/06 3. OP9 17 (1)(a) 28/05/06 4. 5. OP9 OP9 17 (1)(a) 12 (2) 28/04/06 28/04/06 Page 28 Wessex House Nursing & Residential Home Version 5.1 6. OP9 17 (1)(a) 7. OP9 16(2)(m)( n) 8. OP15 12 (1)(a) 9 OP19 23 (2) 10 OP26 18(1)(c) 11 OP27 18 (a) 12 OP30 13 (4) ensure that any service users who are able to or wish to self medicate must have a risk assessment for this and reviewed regularly. The registered manager is required to ensure that staff monitor the change in service users conditions and consult with the GP to adjust any changes in medication. The registered manager must review the provision of social and psychological opportunities to take account of the abilities and preferences of all service users .This plan of activities must be tailored to all service users needs, specifically service users with dementia must be catered for. (Previous timescale not met 31/12/05) Catering and care staff must undertake training to improve their knowledge of the nutritional needs of older people, particularly those with dementia. The home requires further refurbishment to ensure a comfortable environment for all service users. A system of recording staff training must be implemented that can demonstrate the training that staff have received. (Previous timescale not met 31/12/05) The home is required to ensure suitable staffing levels are achieved to provide adequate care for all service users throughout all periods of the day. The home is required to ensure that all staff receive induction training and a copy is kept on staff files. DS0000003307.V276789.R01.S.doc 28/05/06 28/05/06 28/08/06 28/08/06 28/04/06 28/04/06 28/04/06 Wessex House Nursing & Residential Home Version 5.1 Page 29 13 OP31 10 (1) 14 OP38 13(4) 15 OP38 13 (4)(a) 16 OP38 13 (4) (b) The home is required to ensure that Somerset Care supports the management of the home. Under Regulation 26 (5)(a) of the Care Standards Act the home is required to provide evidence of management visits to the CSCI office. The following health and safety checks must be maintained; Monthly checks to bedrails and staff instruction regarding safety and use. (Previous timescale of 31/11/05 not met) Staff training in manual handling, first aid, fire safety and food hygiene must be undertaken and updated as required. The home is required to ensure that risk assessments are undertaken for all rooms with plug socket located next to sinks The home is required to ensure that decanting of any cleaning solutions into alternative containers are clearly labelled and storage arrangements comply with COSHH Regulations 2000. 28/04/06 28/05/06 28/04/06 28/04/06 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 strongly recommended that several experienced care staff are trained and supported to draw up care plans for those with personal care needs. Nutritional risk assessments should be undertaken on admission and regularly thereafter. DS0000003307.V276789.R01.S.doc Version 5.1 Page 30 2 OP88 Wessex House Nursing & Residential Home 3 4 5 6 7 OP9 OP15 OP15 OP23 OP27 8. 9. 10 11. OP27 OP29 OP36 OP38 Risk assessments should be undertaken for all creams, denture tablets and toiletries in rooms occupied by service users with cognitive impairments. Staff should ensure suitable labelling and storage of food supplements in each kitchen area to ensure dispensing and recording by care staff of all supplements given It is recommended that special diets are also available on the menu board for staff information It is recommended that the home provides one-way covers for ground floor windows, to ensure privacy for the service users. It is recommended that the manager review the amount of individual staff hours worked to ensure that excessive hours are not worked and to maintain safe working practice. The staff rota should make clear each staff member’s designation. The registered manger should ensure that all staff receive a contract /terms and conditions of employment and a copy kept on the staff files for reference. Staff supervision should include all topics detailed in standard 36.3. All staff should undertake training in infection control. Wessex House Nursing & Residential Home DS0000003307.V276789.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.V276789.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. 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