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Inspection on 01/06/06 for Wey House Nursing Home

Also see our care home review for Wey House Nursing Home for more information

This inspection was carried out on 1st 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users looked well cared for on the day of inspection. Those seen were well attired and complimented the staff at the home stating that they were well cared for and that the food was very good. Staff work very hard to maintain a high standard of personal care at the home given the amount of agency staff used and lack of continuity. The atmosphere at the home was relaxed and happy. The interaction between staff and service users was happy and relaxed. Service users are able to access the community and go to the local college and go out on organised trips. A mini bus is available with a designated driver.The home ensures where possible that all service users have access to appropriate health care professionals and will offer support to attend appointments where appropriate. A hydrotherapy pool is available for those who would benefit, with dedicated physiotherapy assistants to give support. Families can visit at any time and are made welcome at the home.

What has improved since the last inspection?

A manager has been appointed since the last inspection, which will enable the staff group to have more support and leadership. Service users have attended a meeting with the activities co-ordinator to air their views and choose which activities they enjoy. Staff have commenced having 1to1 formal supervision, which will allow for managers to assess for individual training competencies and needs. A qualified physiotherapist was seen being shown around the home with a view to employment this month, which will greatly enhance service users lives and allow them to have their independence promoted. Service users risk assessments sampled had been completed as required at the last inspection. Individual bedrooms continue to be decorated on a rolling programme. Specialised upgraded chairs continue to be provided on an individual basis. Kitchen equipment has been replaced as necessary.

What the care home could do better:

Service users would benefit if care planning systems were simplified, reviewed and reflected current personal, specialist, social and cultural care needs. Service users would be at a lesser risk of harm if all prescribed medications, in particular creams, hand wash and mouthwash were stored appropriately, were dated and named and given to the individual service user it is prescribed for. Service users would be at a lesser risk of harm if their en-suite facilities were kept clean and tidy and the provision of storage areas for toiletries and creams, and disposable razors (for example, bathroom cabinets) were supplied, with particular regard to shared accommodation.Service users would benefit from their furnishings being maintained and kept in good order. Also where a service user requires bed rails they would benefit from having bumpers that were clean and not worn. Service users would benefit form all equipment, for example mobile hoists being in working order to ensure their moving and handling needs are met. There were two mobile hoists seen in a corridor with `Out of Order` attached. Service users would be at a lesser risk of harm if all departments in particularly the physiotherapy department were kept clean and tidy. Also if their en-suites had foot operated flip-top bins available in line with infection control guidelines to store any items containing bodily waste. Service users would benefit if there were always a competent staff team in sufficient numbers on duty who have received adequate training to understood their individual complex and specialist needs. Service users, staff and visitors would benefit if they were given opportunities to air their views on the conduct of the home through surveys and quality monitoring systems, in line with the homes policies. Accident records have been maintained however had not been audited since January 2006. Service users would benefit if accidents were audited to highlight any patterns emerging in regard to times for example, when staff may be short or busy. As before at the last inspection, recruitment of staff, and the high use of agency staff needs addressing as this could potentially jeopardise continuity of care. The CSCI acknowledges that the home tries to use the same agency staff to ensure continuity. Given the concerns raised at this inspection the CSCI will expect an improvement plan from the registered person in response to this report.

CARE HOME ADULTS 18-65 Wey House Nursing Home Norton Fitzwarren Taunton Somerset TA4 1BT Lead Inspector Caroline Baker Unannounced Key Inspection 1st June 2006 09:15 Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 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 Wey House Nursing Home DS0000003310.V290721.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 Adults 18-65. 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. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wey House Nursing Home Address Norton Fitzwarren Taunton Somerset TA4 1BT 01823 337391 01823 326652 sandra.whitfield@robinia.co.uk 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) The Robinia Group PLC Vacant Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37), Physical disability (37) of places Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Person of either sex, in the age range 18-59 years, who require general nursing care within the registered numbers. Registered to provide a service for up to 37 persons who fall within categories OP and PD 28th October 2005 Date of last inspection Brief Description of the Service: Wey House is a Registered Care Home with Nursing for younger adults with acquired brain injuries and progressive neurological diseases. The home is also registered for up to 7 elderly persons not less than 60 years, who require general nursing care. The home is on the outskirts of Norton Fitzwarren, 5 miles from Taunton and is set in large grounds. There is an area of fenced garden to the front of the house. The accommodation is divided into three units. The home has wide corridors and good size communal rooms. All bedrooms are 12 sq.metres or more in size. Two bedrooms in unit one have steps and are for independently mobile residents only. All other areas of the home are accessible by lift. A thirteenperson lift has been installed. The home is suitably adapted for the client group accommodated. The home has a large hydrotherapy pool and dedicated assistant physiotherapy staff. There is a skill mixed team of professional staff and care workers. The current fee ranges from: £560 to £1600 per week. Placement fees are currently £1242. Hairdressing, aromatherapy, toiletries and vouchers for college are not included. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was unannounced and took place on 28th October 2005. On 9th March 2006 an additional unannounced inspection took place to follow up compliance of the requirements made at that inspection. This inspection took place over one day (16.5 inspector hours) by two inspectors. At the time of this inspection there was manager designate Mr Guy Martindale who was available throughout the inspection process. Thirty-five service users were residing at the home including two who were in hospital. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least eleven service users, two visitors and five staff were consulted with. The manager was available throughout the inspection. Throughout the day the inspectors were able to observe interactions between staff and service users. Records relating to the care of the service users, staff and health and safety were examined. The inspectors would like to thank the service users, and staff for their help and time during the inspection. What the service does well: Service users looked well cared for on the day of inspection. Those seen were well attired and complimented the staff at the home stating that they were well cared for and that the food was very good. Staff work very hard to maintain a high standard of personal care at the home given the amount of agency staff used and lack of continuity. The atmosphere at the home was relaxed and happy. The interaction between staff and service users was happy and relaxed. Service users are able to access the community and go to the local college and go out on organised trips. A mini bus is available with a designated driver. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 6 The home ensures where possible that all service users have access to appropriate health care professionals and will offer support to attend appointments where appropriate. A hydrotherapy pool is available for those who would benefit, with dedicated physiotherapy assistants to give support. Families can visit at any time and are made welcome at the home. What has improved since the last inspection? What they could do better: Service users would benefit if care planning systems were simplified, reviewed and reflected current personal, specialist, social and cultural care needs. Service users would be at a lesser risk of harm if all prescribed medications, in particular creams, hand wash and mouthwash were stored appropriately, were dated and named and given to the individual service user it is prescribed for. Service users would be at a lesser risk of harm if their en-suite facilities were kept clean and tidy and the provision of storage areas for toiletries and creams, and disposable razors (for example, bathroom cabinets) were supplied, with particular regard to shared accommodation. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 7 Service users would benefit from their furnishings being maintained and kept in good order. Also where a service user requires bed rails they would benefit from having bumpers that were clean and not worn. Service users would benefit form all equipment, for example mobile hoists being in working order to ensure their moving and handling needs are met. There were two mobile hoists seen in a corridor with ‘Out of Order’ attached. Service users would be at a lesser risk of harm if all departments in particularly the physiotherapy department were kept clean and tidy. Also if their en-suites had foot operated flip-top bins available in line with infection control guidelines to store any items containing bodily waste. Service users would benefit if there were always a competent staff team in sufficient numbers on duty who have received adequate training to understood their individual complex and specialist needs. Service users, staff and visitors would benefit if they were given opportunities to air their views on the conduct of the home through surveys and quality monitoring systems, in line with the homes policies. Accident records have been maintained however had not been audited since January 2006. Service users would benefit if accidents were audited to highlight any patterns emerging in regard to times for example, when staff may be short or busy. As before at the last inspection, recruitment of staff, and the high use of agency staff needs addressing as this could potentially jeopardise continuity of care. The CSCI acknowledges that the home tries to use the same agency staff to ensure continuity. Given the concerns raised at this inspection the CSCI will expect an improvement plan from the registered person in response to this report. 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. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1; 2 and 5. Quality for this outcome group was adequate. Service users are able to make an informed choice from the Statement of Purpose available. There had been no new service users admitted since the last inspection. Service user contracts are kept at Head office therefore this standard was unable to be assessed. EVIDENCE: Since the last inspection the Statement of Purpose has been updated. It is in line with Schedule 1 of the Care Home Regulations 2001. There had been no new admissions since the last inspection. When the inspectors asked the administrator for samples of service user contracts for assessment to ensure the home was meeting this standard they were told that all contracts are kept at Head office. It is therefore recommended that copies of contracts for service users are kept at the home in service users individual files for follow up at the next inspection. The CSCI received one survey out of 10 sent to service users. The survey indicated that they had not received a contract with the home. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6; 7; and 9. Quality in this outcome group was poor. The home’s care planning system demonstrated that care plans are not always kept under review; there was no evidence of service user input. Service users are generally supported to make decisions and to live an independent lifestyle in accordance with their plan of care and agreed risk assessments. EVIDENCE: Six care plans were examined as part of the case tracking process and five of the individual service users were met. Care planning systems in place continue to be in need of re-developing as identified at the last and previous inspections. They were detailed and the majority had been reviewed however one had not been since 2004. Some care needs plans were incomplete and many were not signed or dated. Individual cultural needs were not always recorded. Activities assessments were not always reviewed; one had a review of July 2005. One care plan did not give clear instruction for a service user Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 11 with Type 1 diabetes controlled with insulin, putting the individual service user at risk of harm. An immediate requirement notice was issued in this regard. Risk assessments in regard to manual handling and pressure relief were in place. Risk assessments had been completed in regard to falls and the use of specialist beds and bed rails. The types of hoists in use for the individual were reflected. It was concerning to see two hoists labelled as ‘Out of Order’ at this inspection. Input by community health professionals was documented, such as G.P and dietician. Service users consulted with and able were complimentary about the staff group and indicated that they were able to make decisions about their life in the home. Evidence was seen of residents able, accessing many parts of the home and the garden. Interaction seen between the staff and the service users was good. Three surveys received from nine sent to relatives indicated that they were satisfied with the overall care provided. Evidence of placement reviews were in place and the action taken as recommended at the reviews was recorded and evidenced. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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; 16 and 17. Quality in this outcome group was good. Service users benefit from good support, which enables them to learn and develop skills, enjoy a range of leisure activities and to access local community facilities. Service users are offered a choice of nutritious well-balanced menus promoting their health and well-being. EVIDENCE: Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 13 The homes mini-bus was out of action at the time of this inspection however the manager had hired a mini-bus to allow those service users who regularly went to SCAT to continue. The mini-bus and driver support access to local amenities in Taunton and the surrounding area. Staff support is normally given to service users who are able to go out. No residents of Wey House are currently employed. There is an Activities Co-ordinator, who leads specific interventions with service users. She was on leave at the time of this inspection. Activities records were available and two were sampled. Life histories had been completed for individual service users and evidence was recorded of activities that had taken place. Service users consulted and able indicated that activity provision was adequate at the home. Evidence of minutes of a meeting which took place on 15/02/06 with service users, in regard to which activities they would like, were seen. Speech and language therapy is accessed via the NHS, on referral by the GP. There is a hydrotherapy pool, which is used mainly for therapeutic activities and managed by two physiotherapy assistants. One was on leave at the time of this inspection. The pool is available for more leisure-orientated sessions, with music and soft lighting to promote relaxation. One comment received from a relative via a survey sent by CSCI highlighted the fact that a Physiotherapist and Occupational Therapist (OT) had not been employed at the home for at least 2 years. At the time of the inspection the inspectors met the Physiotherapist who is soon to join Wey House as a full time employee. This will enhance and help develop the Physiotherapy department at the home. The manager designate told inspectors that the home is also actively trying to recruit an OT and psychologist. Aromatherapy is available on a fee-paying basis. Family and friends of service users are welcomed to Wey House. Visiting is ‘open’ and would be at the request of the service user. Visitors seen at the home and consulted were satisfied with the overall care provision. Comments Service users were seen being treated and addressed appropriately by staff. Service users can lock their bedroom doors from the inside if they wish and staff would be able to access the rooms from outside in an emergency. Care is delivered on a one to one basis with only manual handling assistance given by more than one member of staff. This promotes dignity and privacy with all aspects of personal care giving and assistance by staff. Feedback from service users consulted and able was that they could spend their time as they wish; this was confirmed through direct observation. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 14 The kitchen was not assessed at this inspection however kitchen records seen were up to date. Catering staff told inspectors that equipment required in the kitchen, had been supplied by the company. All residents have nutritional assessment and those requiring gastric PEG feeding (at least 12 at the time of this inspection) have specialist community dietary support. The menu is on a two-week cycle. Lunch was seen to be unhurried and the assistance given to service users at meal times was seen to be sensitive. The puree food given to service users was well presented at this inspection in individual portions. Feedback from service users consulted indicated that the food is always good with a good choice. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18; 19 and 20. Quality in this outcome group was poor. Service users receive an appropriate level of support to meet their personal and health care needs. The management, administration and recording of medication were generally good, however the procedures for the storage of prescribed creams was poor and put service users at risk of harm. EVIDENCE: Evidence was seen that service users are able to choose the way they are cared for, for example the clothes they wear, their preferred name, where they want to spend their day and how. Care plans did not always reflect this however (See ‘Individual Needs and Choices’). Feedback from service users consulted was positive and they indicated that the staff were kind and caring. Service users were well attired and appeared well cared for. Service users were seen using specialised equipment to enable them to maintain their independence. Physiotherapy is available on a daily basis and is conducted by physiotherapy assistants. A qualified physiotherapist is available Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 16 for advice and assessments and has visited the home on a monthly basis. The home is recruiting a full time physiotherapist as previously mentioned. The home has the services of a local G.P to provide care for the service users at Wey House, if the service users so wish. This service is at no extra cost to the residents. This GP holds a ‘surgery’ in the home for four hours each week. Health care input was satisfactory. The service users in Wey House have a high level of physical nursing needs and these appeared well managed. Surveys were received from three healthcare professionals in regard to the conduct of the home. Positive comments were received and all indicated that they were satisfied with the overall care provided at the home. Other comments included: ‘Communication with Wey House has improved since the new manager has been in post’ and ‘Lack of detailed communication between Robinia Care and the nursing staff at Wey House about details i.e. that we are funding extra hours for social support per week – staff seemed unaware of this. Comments from 3 surveys received from Healthcare Professionals indicated that service users medication was appropriately managed at the home. Medication Administration Records sampled indicated overall good practice, however on assessment of service users private accommodation it was concerning to note that: Prescribed creams, hand lotions and mouthwash prescribed for other service users were found in five rooms assessed. Prescribed creams that had expired found in one room were handed to the nurse in charge – these creams were not identified on the individual service users Medication Administration Record. Many creams were stored inappropriately in the rooms assessed and only one had been dated with an opening date but this read: 04/09. Many creams were not named for the individual service user. In the shared room none of the creams were named or stored appropriately so that staff could identify which cream belonged to whom. An immediate requirement notice was issued in this regard. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome group was good. Appropriate steps are taken to reduce the risk of harm or abuse to service users. EVIDENCE: The home had a complaints procedure, which was available to service users, staff, and visitors. It was seen displayed in the main entrance hall. It also forms part of the Service User Guide and is detailed in the Statement of Purpose. Service users able and staff spoken with informed the inspectors that they would not hesitate in raising concerns and have done so. No complaints had been received by the home since the last inspection in October 2005. The CSCI had not received any against the home since the last inspection. Complaints records were maintained. Staff spoken to understand the lines of communication should they suspect any form of abuse. Abuse and challenging behaviour training has now been provided as required. Staff spoken to confirmed this. POVAFirst checks had been undertaken before staff had commenced working at the home. The home also had a ‘zero tolerance to bullying’ policy. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24; 25; 26; 29 and 30 Quality for this outcome group was poor. Many areas of the environment and the outside of the premise appeared unkempt. Service users are able to personalise their rooms with their favourite items and have the specialist equipment required to meet their individual needs. Some parts of the home were not clean at this inspection and many en-suites seen were untidy and unclean. Infection Control was compromised. EVIDENCE: All communal areas and at least fourteen bedrooms were sampled at this inspection. The majority of service users are accommodated in single bedrooms, which are fitted with en-suite wash hand basin and toilets. There is one shared room, in use. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 19 It was concerning to note at this inspection that the majority of en-suite facilities were untidy and unclean with over stacked shelves of toiletries (often without lids), uncapped disposable razors and prescribed unnamed and undated and often out of date creams (See ‘Personal and Healthcare support’). Items with bodily waste were seen in open top bins containing yellow bags, indicating clinical waste. The shared room had recently been redecorated according to the manager and handyman. It was disappointing therefore to see that the en-suite toilet did not have a door and the curtain used was not attached. The curtains to the window were ill fitting and the en-suite was seen as noted above, unclean and over stacked. Action was taken during inspection to re-fit the curtain to the en-suite for privacy. Furniture, for example wardrobes and chests of drawers, were in need of repair or replacement in some of the rooms seen. At least four sets of bedrail foam bumpers seen were in need of replacement. Bedrooms are situated on the first and second floor and are accessed by two passenger lifts and stairs. A wheelchair lift is installed to the stairs on the first floor, which access two rooms. This enables service users with mobility problems to access those rooms. Service users are encouraged to personalise their rooms. Service users rooms seen had accessible locks on their bedroom doors. The majority of doors were seen to have doorknockers. Service users spoken with informed the inspectors that they liked their rooms. Specialist equipment was available to assist with maintaining independence. Many service users had their own specialist chairs, which had and were continuing to be replaced. During the inspection, service users were observed utilising all communal areas. Two mobile hoists were seen with ‘Out of Order’ signs in a corridor as mentioned previously. This potentially could compromise the manual handling needs of service users at the home and a faster system of repair or replacement should be implemented. The company uses contract cleaners to maintain the cleanliness of the home. A housekeeper is employed to oversee this. The physiotherapy department was untidy with the floor in need of deep cleaning. All en-suites sampled had unlidded non-foot operated bins and continence aids were being disposed of in these bins. The company submitted a refurbishment plan to the CSCI however target dates for the plans to commence the outside of the building had not been reached at the time of this inspection. Individual rooms continue to be redecorated. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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 and 36. Quality for this outcome group was adequate. Staffing levels were maintained at minimum and below at times. The high use of agency staff and lack of continuity put pressure on the core staff group. Staff supervision had commenced. Staff with NVQ qualifications are below 50 and specialist training to meet the needs of service users had not commenced. Service users will benefit from the newly appointed full time physiotherapist. EVIDENCE: Staff spoken with were clear about their own roles and the roles and responsibilities of others. They appeared pleased that a manager was now in post. The deputy manager was more positive and felt that she could now concentrate on training and supervision of staff. Feedback from service users consulted was positive about the support they received from the manager, deputy manager and staff. Staff were positive regarding the support they received, however felt pushed and unable to find time to ensure service users individual rooms and en-suites remained tidy and clean. Registered nurses spoken to told inspectors that they Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 21 often take work home with them for example writing up of care reports and medicine orders. This should be reviewed to ensure staff are not undertaking these tasks in their own time as this also compromises service users confidentiality. It was evident that although staff felt pushed they concentrated on the care of the residents, which was seen to be very good. The atmosphere was happy and residents looked well cared for with their individual needs being met. Four surveys were received from relatives and all indicated that they were satisfied with the overall care at the home and felt there were adequate staff on duty at the home. Three staff had been newly appointed to the home since the last inspection, they had transferred from another home in the company. Their recruitment files were found to be satisfactory however references were held at head office for two, which were faxed across during the inspection. The home had not reached a target of 50 of care staff having a care NVQ that should have been achieved by 2005. At present 31 of care staff have a care NVQ according to the training records and the manager. The NVQ Assessor told inspectors that they needed more money to enrol more staff and continue with the NVQ programme. Training in specialisms e.g. Huntingdon’s Disease and Picks Disease to meet the needs of the service users at the home are still to be implemented. Many of the trained staff were receiving training in supervision and awareness since the last inspection, which will enable them to implement supervision of care staff on a 1 to 1 basis. The manager had supervised the trained staff on a 1to1 basis since taking up his post. According to Duty rotas and on the day of the inspection two Registered Nurses (RN) and 9 care staff (there should be 10) have covered mornings at the home; two RN’s and eight care staff are on duty in the afternoon and two RN’s cover nights with three care staff. One of the service users was receiving 1to1 care therefore only 8 care staff were available to meet the needs of the remaining residents during the morning and 7 during the afternoon. There were three agency care staff working at the home on the morning of the inspection. These levels have decreased by 1 since the last inspection and must be reviewed to ensure staff are able to fulfil their roles and meet all needs of the service users. The manager told inspectors that the home is trying to actively recruit staff, and a discussion took place on how the home could attract and retain new staff. Staffing levels will be monitored by the CSCI. The manager told inspectors that the home requires a further 13.5 fulltime care assistants and was short of 50 hours of registered nurse time. At this inspection there was no activities co-ordinator or second physiotherapy assistant on duty. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 22 Access workers, who support service users to access leisure facilities and activities, are in addition to the care staff. A fulltime-qualified physiotherapist was being appointed and the person was met at inspection. The deputy manager was now able to fulfil her role now that a manager designate had been appointed since March 2006. An occupational therapist had not been appointed in line with the homes Statement of Purpose however the manager is actively trying to recruit someone, he told inspectors. This will be followed up at the next inspection. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37; 39 and 42 Quality in this outcome group was adequate. The home has recruited a manager. The home is generally taking appropriate steps to ensure the health and safety of service users, staff and visitors. EVIDENCE: Since the last inspection Mr Guy Martindale has taken up the post of Manager. The CSCI await his application for registration. The manager has worked at the home since March 2006. Since that time he has managed to ensure the home has complied with four out of the six requirements made at the last inspection, however it was identified at this inspection that more regulations had not been complied with. The inspectors acknowledge the fact that the manager designate is working hard to ensure the home is being run in the interests of its service users and in line with NMS and legislation and that improvement takes time. However if staffing levels are allowed to go below minimum for any Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 24 length of time, the home will begin to struggle to meet the needs of the service users. The area manager regularly completes Regulation 26 visits and copies are sent to the CSCI. These have been more detailed to include sampling of care plans, staff supervision and training. Fire records were examined and were found to be up to date. Weekly in house checks are recorded for the home’s fire detection system. Monthly checks are maintained for the emergency lighting. Servicing records indicated that all servicing of equipment including hoists was up to date. A record is kept of all portable appliances at Head Office. The last test carried out was recorded as 12/05 – records were faxed to the CSCI as requested during the inspection. A record of accidents and incidents in the home is maintained. Audits have not taken place since February 2006. These should be monthly to identify any traits or patterns. 61 accidents had been recorded since October 2005. Individual staff training files were sampled and evidence was seen of mandatory training and induction. Abuse and challenging behaviour training has been provided as mentioned previously. The home displays appropriate employers liability insurance, which expires, the end of September 2006. Quality Assurance and Monitoring in regard to the views of service users, staff and visitors had not yet been implemented as required at the last inspection. The manager designate faxed the homes policies on Quality Assurance, which had not been followed in regard to gaining views on the conduct of the home. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 X 28 X 29 2 30 1 STAFFING Standard No Score 31 X 32 1 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 1 X X 2 X Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 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 YA6 Regulation 15(2) b Requirement The registered person must ensure that service users individual care plans are reviewed and updated and all current care needs are reflected. to include clear detailed plans for example in diabetes care. (Previous timescales of 1 July 2005, 15 December 2005 and 1 April 2006 not met) 2 YA6 12(1)[a] [b] The registered person must 01/06/06 ensure that all specialist needs e.g. Diabetes have clear detailed care plans written to ensure service users are not put at risk. An Immediate Requirement Notice was issued. 3 YA6 12(1) (2) The registered person must 30/07/06 and 15 review the homes care planning systems in consultation with the service users and staff to ensure a workable, more practical and less time consuming system is in place. Timescale for action 30/07/06 Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 27 4 YA20 13(2) The registered person must 01/06/06 ensure that all prescribed medications, in particular creams, hand wash and mouthwash are stored appropriately, are dated and named and given to the individual service user it is prescribed for. An Immediate Requirement Notice was issued. 5 YA24 12(1) 13(4)[c] The registered person must ensure that all en-suite facilities are kept clean and tidy and the provision of storage areas for toiletries and creams, and disposable razors must be considered, with particular regard to shared accommodation. 20/07/06 6 YA24 12(4)[a] 23(2)[b] The registered person must 30/07/06 ensure that furnishings in service users individual rooms are kept in good order. Also worn foam bedrail bumpers must continue to be replaced. Also as agreed and in line with the company’s refurbishment plan maintenance work must commence on the outside of the building. (Also relates to YA26) 7 YA29 23(2)[c] The registered person must 30/07/06 ensure that equipment for example mobile hoists are always in working order to ensure service users moving and handling needs are not compromised, by a lack of equipment. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 28 8 YA30 13(3) The registered person must 20/07/06 ensure that all departments in particularly the physiotherapy department are kept clean and tidy. Also all en-suites and communal toilets and bathrooms must have foot operated flip-top bins available in line with infection control guidelines to store any items containing bodily waste. (Also relates to YA26) 9 YA32 18(1)[a] The registered person must 30/09/06 [c] ensure that up to 50 of the staff team have gained a National Vocational Qualification (NVQ) in care and that specialist training is given in e.g. Huntingdon’s Disease and Picks Disease to ensure staff can understand and can meet the needs of individual service users at the home. 18(1)[a] 37 The registered person must 20/07/06 review staffing levels at the home to ensure there is sufficient staff to assist with service users changing needs. If staffing falls below minimum levels the CSCI must be informed. Live duty rotas which reflect persons on duty at all times must be submitted to the CSCI on a two weekly basis until further notice. 10 YA33 Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 29 11 YA39 24 The registered person must ensure that quality-monitoring systems in place are implemented to include gaining views of service users, staff, and visitors on the conduct of the home. (Previous timescale of 30 December 2005 and 30 April 2006 not met). 30/07/06 12 YA42 17(1)[a] The registered person must ensure that all accidents recorded are audited on a monthly basis to identify any patterns or traits. 20/07/06 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 YA5 Good Practice Recommendations Copies of service users contracts should be available at the home to evidence service users are given a contract, and to allow access for designated staff to answer any queries the service user may have. Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 30 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 Wey House Nursing Home DS0000003310.V290721.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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