Inspection on 27/09/05 for Wessex House Nursing & Residential Home

This inspection was carried out on 27th September 2005.

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 &... 22/02/06

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 :Sue Burn Unannounced Inspection 27th September 2005 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.V249726.R01.S.doc Version 5.0 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.V249726.R01.S.doc Version 5.0 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.V249726.R01.S.doc Version 5.0 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 (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.V249726.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out as part of the planned annual programme of inspections. Two inspectors carried out this unannounced inspection over one day. The last inspection was unannounced and took place on 9 March 2005. As a result of the last inspection a meeting was held with the inspector, registered manager and the regional manager to review the dementia care provision at the home. Since the last inspection the company has added 3 more bedrooms and has applied to the CSCI for registration of these rooms. This application is not yet complete. Derek Mills, the Registered Manager was available throughout most of the inspection and was also providing staff training and working as the nurse in charge of the shift. All staff were very helpful and welcoming throughout the inspection. 45 people were living in the home, including 3 with specific dementia care needs. 23 people were receiving nursing care and 22 were receiving personal care only. All service users spoken to, who were able, told the inspector that the staff were very kind and caring at the home and they enjoyed the food. Some were satisfied with the activities provided whilst others felt that the days could be long and there was not much to do. Staff were described as ‘good loyal staff’. The home is undergoing extensive refurbishment, including extending some areas and redecoration and re-carpeting throughout. The manager is successfully managing this to minimise the disruption to service users living at the home. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. 28 service users, 10 staff and 2 visitors were spoken to. What the service does well: Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 6 Service users benefit from a kind and committed staff team and a homely atmosphere. Visitors are made welcome and kept informed. The home offers a varied menu of home cooked and nutritional meals. Lunch, seen during the inspection, was appetising and plentiful. Staff are able to meet the physical needs of service users and make opportunities for people to maintain their own routine. What has improved since the last inspection? What they could do better: The organisation and staffing arrangements in the home do not meet the needs of people with wide ranging dependency. The provider has been required to review these arrangements to ensure that the social and psychological needs of all can be met, safe medication administration supported and the home’s housekeeping can be improved. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 7 Social and recreational opportunities need to be developed to ensure that they are appropriate for people’s needs and preferences. Care plans require development to include greater detail about service user needs and regular reviews. Records examined indicated that staff supervision and audit of various aspects of the home have not been carried out for some time. The provider has been asked to reintroduce these to support the development of standards within the home. Not all health and safety arrangements are adequate to protect service users from potential risks and the home has been asked to ensure that action is taken to address the following; bedrails and hot water must be checked and staff instructed in safe use of bedrails and some food hygiene practices in the kitchen need to improve. 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.V249726.R01.S.doc Version 5.0 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.V249726.R01.S.doc Version 5.0 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 that also provide good opportunities for the service user to make a decision about moving in. The home lacks the capacity to meet the wide range of service user needs accommodated at the home, this is due to the accommodation and staffing arrangements at the home. EVIDENCE: The home carries out pre-admission assessments and the manager or a senior nurse will visit the person. Service users and their families are offered the opportunity to visit the home before making a decision to move in. The home can meet the physical needs of the current service users and all seen were well cared for and safe at the home. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 10 Inspectors evidenced throughout the inspection that the home is not meeting the holistic needs of a significant number of the service users, including those with dementia care needs. Service users in the home have wide ranging needs. These include people with a level of independence requiring help with personal care needs only, complex nursing needs and some with behaviour that challenges the staff. The organisation of the home makes it difficult to deploy staff effectively and support service users to meet their individual needs. Service users with different needs are accommodated together in the different units, including those with dementia care needs. During the inspection inspectors were concerned, as at the last inspection, that due to these arrangements a specific service was not being provided for people with dementia care needs. The provider must review the provision at the home to better meet these needs as detailed in the following report. The home is required to demonstrate that people with dementia are receiving a specialised service tailored to their needs. A meeting will be arranged with the provider to jointly review these arrangements. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 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 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 care is provided in private. EVIDENCE: 6 care plans were examined during the inspection. The home uses a system of core or standard care plans and has documentation available to record preadmission assessments. Care plans and reviews for the nursing team completes all service users and they also liaise with GPs and other health professionals for all service users in the home. Each nurse is allocated to a unit and the deputy confirmed that 2 care assistants on night duty will also review plans. 2 care plans examined did not have a documented pre-admission assessments on file to inform staff of the person’s initial needs on admission. 2 of the plans lacked care plans to direct staff in the care of the individuals concerned. An Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 12 Immediate Requirement was issued to ensure that plans were drawn up based on the assessed needs of these service users. All the care plans examined lacked regular assessments and sufficient detail to support staff to provide the care required for this group of service users with wide ranging needs. In a significant number of care records the core care plan was in the file but had not been individualised or fully completed. Care plans examined did not address the assessed needs of service users including; • Nutritional assessments were not always completed and plans drawn up lacked detail, including where it had been recorded that a person was not eating and drinking. • Fall risk assessments had not been completed where falls had been recorded. • Risk assessments and sufficiently detailed care plans were not in place where nursing procedures were required or behavioural or psychological monitoring or plans were indicated from the daily records. • Moving and handling plans did not always reflect the interventions used by staff and 2 staff were lifting one person manually. This was not reflected in the care records and advice on safer alternatives had not been sought. • Care plans lacked information about meeting social care needs, including the provision of appropriate stimulation where people have cognitive deficits. • There was no risk assessment in place for the use of bedrails or evidence that the service user/representative had been consulted. • Details of the specific type of equipment to be used were not included in the care plans. • Care plan reviews were erratic and did not evidence that the service user and/or representative had been involved in the care planning process. 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. These reviews should take place on a monthly basis. It is very strongly recommended that experienced and competent care staff are trained and supported to draw up and review care plans for those service users with personal care needs. This will spread the workload amongst all staff where nursing numbers are limited, as the home is only required to provide nurses for a 30-bed nursing home. This should help to ensure that plans are drawn up and reviewed more frequently and are completed more thoroughly where one member of staff has a smaller group of service users to consult with. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 13 There was evidence that the advice of other professionals was sought and that sufficient equipment was available to support staff and service users. The manager should ensure that details of equipment used by the service user are recorded. District nurses visit to provide any wound care needed by service users with personal care needs. The home maintains a file to record and monitor all wounds in the home; this should be reviewed to ensure that old records are removed to avoid confusion. All staff interventions seen were kindly and personal care was provided in private. Staff were attentive and aware of service user needs. Service users spoken to all felt that the staff were respectful and kind, although some felt that the staff can be very busy. Due to the layout of the home, people accommodated in specialist chairs are hoisted in the corridor and pushed into their bedrooms in the hoist. Staff spoken to have concerns about the dignity of this practice. There may be risks moving some service users in this way and the manager must ensure that a full risk assessment is made and recorded in the care plan. The supplying pharmacist was inspecting the home on the same day and found the systems to be satisfactory. CSCI inspectors made a limited inspection. A number of creams were found in rooms and communal areas, which were not identified for the service user or dated when opened to indicate an expiry date as, required. The manager should ensure that risk assessments are in place where creams and denture cleaning tablets are not locked away in rooms where service users have cognitive problems. Fridge storage was satisfactory; it is recommended that the daily temperature be recorded as a minimum and maximum. The inspector raised concerns about the administration practice in the home at the last inspection and a review was recommended following consultation with the CSCI Pharmacy Inspector. One nurse administers the medication for about 50 service users at each round. This includes all those service users living at the home and during the day the day care clients. The concerns raised include whether all service users receive their medication at appropriate times and that the potential for drug errors is greater. It is strongly recommended again that the manager review this practice to take account of these concerns and demonstrate that medication is given at the prescribed times. The Pharmacy Inspector will be asked to visit the home to assist with this review. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 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 benefit from a friendly and homely atmosphere, however 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. Dietary needs of service users are well catered for with a home cooked, varied selection of food available that meets service user needs. EVIDENCE: All staff seen engaged with the service users in the different units in a pleasant and sensitive way. Service users spoken to were satisfied with the routines at the home. The home has an employed activities organiser who works 12 hours a week and a team of volunteers. Volunteers provide most of the activities programme. The home has links with local churches that provide communion at the home and volunteers will take some people to church. The home has a regular mini-bus trip that a number of service users enjoy and also arranges Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 15 social events. Staff and a small number of service users had just been away for a weekend break. During the inspection 3 service users were being assisted to make Xmas cards in the main dining room. A number of service users were spoken to and observed and care records were examined. A number of service users did not feel that there was enough to do in the home and they were bored, some others were happy with the provision. There are no activities programmed for the afternoon. The care records indicated that there were few opportunities available to people who were unable or did not want to be involved in the programme available, which is limited. There were no relevant or specific activities provided for people with dementia. Staff spoken with confirmed that they are very busy with necessary tasks that there is little time to spend with service users. 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. It is recommended that the provider review the activities coordinator hours available to better reflect the size and complexity of the home. Visitors spoken to felt welcomed by staff and were able to visit at any time. Lunch was observed and was appetising and plentiful. Staff were seen offering appropriate assistance to those who needed it. The menu offers seasonal choices of 2 main meals and a choice of puddings. People are able to eat where they choose and there is a main dining room and smaller areas on each unit. Each unit has a small kitchen where breakfast and drinks are prepared and, where able, people are supported to make their own drinks as they wish. Snacks are available between meals and in the evening. Puree diets were attractively served, however the same meal is sometimes provided for lunch and tea. This should be reviewed to ensure that all have choice and variety. Service users able to comment stated they enjoyed the food. It was observed in Camelot that service users were sat at the table for 50 minutes before lunch was served, which was not in the service users best interests. Menus were not displayed and people were not aware of what was for lunch, it is recommended that ways to display the menu are found that suit individual capabilities, this could be a menu board, pictures or menus on tables for example. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 16 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 Arrangements for complaints are satisfactory. The recruitment and training 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. The manager was meeting with a complainant and representative during the inspection. The meeting resolved the complaint. 4 staff recruitment records were examined. All contained evidence that POVA and CRB checks had been received before employees started work. Service users spoken to felt safe and well cared for. Staff spoken to indicated their commitment to the welfare of service users. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 17 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, 24, 25, 26. The environment is improving with refurbishment completed in some areas. The home remains shabby in parts with a continued need for improvements in the décor and comfort of the home. This should be achieved with the current improvement programme of works. The cleanliness of the home is not adequate to maintain hygienic and pleasant surroundings. EVIDENCE: The home is in the process of being redecorated and re-carpeted and when this work is complete it is anticipated that the standards will be met. It was noted during the inspection that service users requiring specialist chairs needed to be hoisted from the chair in the corridor into their bedroom as the chairs will not fit through the door. This practice is potentially hazardous and does not support the dignity of the service user. As part of the refurbishment this must be addressed to ensure that all possible alternatives have been considered to find/create room for people needing these chairs to be better Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 18 accommodated. In the meantime a risk assessment must be carried out to ensure that any risks to service users and staff are minimised. Since the last inspection the bathroom refurbishment has been completed and over the past year necessary building and maintenance works have been done. During the tour of the premises it was noted that some tiles had come off in 2 of the bathrooms and need to be re-fixed. Staff have encouraged people to personalise their rooms and the home has sufficient equipment to meet people’s needs. Many areas in the home were not adequately clean, including the kitchen areas on each unit. This appeared to be reflective of the low numbers of domestic staff available. On the day of the inspection one person was cleaning the 4 units and there was 1 person in the laundry. The housekeeper was on duty assisting in all areas. Rotas examined and staff feedback confirmed that this situation was not unusual. Adequate measures must be put in place to ensure that all areas of the home are kept clean and that there are sufficient staff available to achieve this in a large home (See Staffing). A number of bins were broken where personal care is provided. These require replacing to ensure that infection control measures remain effective Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 19 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, 29, 30. There are sufficient numbers of staff on duty to ensure that service users are kept safe and physical needs are met. The home is not fully meeting the social and psychological needs of service users. The recruitment procedures are mostly satisfactory but require further attention to ensure that suitable staff are recruited. Staff training records are not adequate to fully inspect this standard. EVIDENCE: Rotas were examined for the last 3 weeks in September 2005, observations made and feedback obtained from staff. The manager confirmed that he and the Regional Manager had assessed dependency levels and concluded that additional staff are required. This report has been sent to the company but the manager was not aware of any outcome. The nurse on duty assumes responsibility for administering the medication, care planning and medical needs of all service users (see standards 7, 8 and 9). At the last inspection concerns were raised that this may impact on care delivery when staff are very busy and given the high dependency and mix of Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 20 service users. The nurse staffing level was set prior to April 2002 as the requirement for 30 nursing clients. On the day of the inspection the nurse was effectively providing the input for all 45 people. This has impacted on the quality of the care planning and the daily life of the home. As at the last inspection staff felt pressured and service users felt that staff were very busy, this was found again at this inspection. The 4 units all accommodate people with nursing and personal care needs, including Camelot that also provides care for people with dementia. This arrangement makes it difficult for the manager to effectively deploy staff where each unit has a number of people who require 2 staff to assist them. This was raised at the last inspection and has not been addressed by the company. Rotas examined for domestic staff indicated that there is an average of 5 hours per day for laundry provision. Staff feedback and observations made during the day indicated that this is not sufficient for this large home and rely on staff working in their own time and night staff clearing any backlog. These hours should be reviewed. The rotas confirmed that domestic cover is erratic and not always sufficient for such a large home (see Environment). On the day of the inspection the cleaning time available was 1 hour per unit. The rotas examined indicated that the home complies with previous requirements issued by Somerset Health Authority and Somerset County Council (applicable until 31/3/02). The rotas indicated that there is a suitably qualified registered nurse on duty 24 hours a day. During the morning 8 care staff are on duty, 2 in ach unit. There is regularly only 6 staff on over lunchtime, a peak period. There are 6 staff on duty during the afternoon. During the inspection some staff were moving from different units to assist units where there was only one care assistant. This contributed to staff pressure. During the evening there are usually 6 or 7 care staff on duty. This may not be sufficient to effectively staff 4 separate where every unit has a number of people who require the assistance of 2 staff. As the nurse takes responsibility for the whole building this limits their involvement in care tasks and monitoring. It is required that the provider review the current organisational arrangements for the home to better reflect the dependency and needs of service users, the layout of the building, the staffing provision and the home’s registration. Staff training records were provided. These were not arranged systematically or fully completed and it was not possible to see clearly what training each staff member had received. This has been raised before. A system of recording staff training must be implemented that can demonstrate the training that staff have received. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 21 The staff records examined indicated that a systematic recruitment process is followed. Not all references examined had been dated and should be verified more thoroughly. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 22 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, 35, 36, 37, 38. The home is satisfactorily managed by the manager who has developed positive relationships with staff and service users. Service users personal monies are well managed. The management of health and safety is not satisfactory in all areas. EVIDENCE: Mr Mills is an experienced nurse and manager and has managed Wessex House for 2 years. Mr Mills has been managing the building works effectively, minimising disruption to service users. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 23 Mr Mills works some shifts to enable him to maintain contact with the needs of service users. Staff spoken to felt able to take concerns and comments to Mr Mills. Some of the registered nurses have devolved responsibilities to assist with the management of the home. Staff meetings are held. All staff were very open and accommodating to the inspector during her visit and knew about the planned changes to environment. Service users who were able to express a view were satisfied that they were sufficiently included in the home. The home has added 3 new bedrooms to the home, which are not yet registered. It is strongly recommended that existing service users are offered the opportunity to accommodate these rooms as part of their inclusion in the running of the home. A satisfaction survey was conducted for relatives/carers during May 2005. 6 responses were received, all of which indicated good or excellent as response to the questions. The home has a range of corporate audit tools. These have not been completed recently, it is recommended that these audits be recommenced to support the development of the home. Personal monies were inspected. Small amounts are held and managed by the administrator behalf of service users. The records and systems examined indicated that these monies are well managed. Staff supervision has not been carried out frequently or systematically. This must be re-introduced to support staff to develop their practice and support them with a high workload (see Health and Personal Care and Daily Life and Social Activities). The manager should review the storage of service user records (care plans) to ensure that they are stored securely. During the inspection a range of records was examined and observations made to ensure that the health and safety of service users was being well managed in some areas: • The management of building works has minimised risks to service users. • The legionella water check has been carried out. • Hot water temperatures are checked monthly and bath/shower temperatures regulated safely. • The fire system is tested weekly. • Accident records were mostly satisfactorily maintained. The following areas require attention: Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 24 • • • • Bedrails are not checked each month to ensure that they are safe for use. The last check was March 2005. A number of bedrails were found to be badly fitting or not compatible with the mattress in use. The manager must ensure that all rails are checked each month and that staff are instructed about fitting and safe use. The food in use in the fridges was not covered or dated, and some cleaning and defrosting was required in the kitchen. This must be done to ensure that this is done to maintain safe standards of food hygiene. The sluice on Camelot were unlocked posing a potential risk to service users who may gain access. The sluices must be locked to minimise risks to this client group. The wooden ramp to the Camelot courtyard is in need of repair. Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 25 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X X 3 3 2 STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 2 2 Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 26 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 OP4OP27 Regulation 12(1)(a) 18(1)(a) Requirement Timescale for action 28/02/06 2. OP7OP8 12(1) 15(1) 3. OP9 13(2) 4. OP12 16(2)(m) (n) It is required that the provider review the current organisational arrangements for the home to better reflect the dependency and needs of service users, the layout of the building, the staffing provision and the home’s registration. The home is required to demonstrate that people with dementia are receiving a specialised service tailored to their needs. It is required that the care 31/01/06 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 A safe system of managing 31/12/05 creams and denture tablets must be implemented as detailed in this report. The manager and provider must 28/02/06 review the provision of social and DS0000003307.V249726.R01.S.doc Version 5.0 Wessex House Nursing & Residential Home Page 27 5. OP19 13(4)(c) 23(1)(a) psychological opportunities to take account of the abilities and preferences of all service users. As part of the refurbishment the access to bedrooms by those using specialist chairs must be addressed to ensure that all possible alternatives have been considered to find/create room for people needing these chairs to be better accommodated. In the meantime a risk assessment must be carried out (by 30/11/05) to ensure that any risks to service users and staff are minimised. Adequate measures must be put in place to ensure that all areas of the home are kept clean and that there are sufficient staff available to achieve this in a large home. The broken bins must be replaced where personal care is provided. A system of recording staff training must be implemented that can demonstrate the training that staff have received. Staff supervision must be reintroduced to support staff development and working practices. The following health and safety checks must be maintained; • Monthly checks to bedrails and staff instruction regarding safety and use. • Opened food stored in the fridge must be dated and labelled. • The sluice in Camelot must be locked or risk assessed and appropriate measures taken. • The wooden ramp must be repaired. DS0000003307.V249726.R01.S.doc 31/01/06 6. OP26 13(3) 30/11/05 7. OP30 18(1)(c) 31/12/05 8. OP36 18(2) 31/01/06 9. OP38 13(4) 30/11/05 Wessex House Nursing & Residential Home Version 5.0 Page 28 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 experienced care staff are trained and supported to draw up care plans for those with personal care needs. Following consultation with the CSCI Pharmacy Inspector it is strongly recommended that the manager review the practice of one nurse administering all the medicines to take account of the concerns detailed under standard 9 and to demonstrate that medication is given at the prescribed times. It is recommended that the provider review the activities co-ordinator hours available to better reflect the size and complexity of the home. Suitable menus should be made available to service users. The puree diet should vary to reflect the menu. Individuals should not be sat at the table for long periods prior to a meal being served. It is strongly recommended that existing service users be offered the opportunity to accommodate these rooms as part of their inclusion in the running of the home. The corporate audits should be recommenced. The storage of care plans records should be reviewed to ensure that are kept secure and confidential. 2. OP9 3. 4. OP12 OP15 5. OP33 6. OP37 Wessex House Nursing & Residential Home DS0000003307.V249726.R01.S.doc Version 5.0 Page 29 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.V249726.R01.S.doc Version 5.0 Page 30 - 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!