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Inspection on 17/01/07 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 17th January 2007.

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 15 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 the high standard of care provided given the recent changes of management. The atmosphere at the home was relaxed and happy. The interaction between staff and service users was cheerful and relaxed. Service users are able to access the community, go to the local college and go out on organised trips. A mini bus is available with a designated driver. The home ensures 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 staff to give support. Families can visit at any time and are made welcome at the home.

What has improved since the last inspection?

A new manager has been appointed since the last inspection, which will enable the staff group to have support and leadership. A qualified physiotherapist has been employed at the home, which enhances service users lives and allows them to have their independence promoted. Further beds and equipment has been purchased to support service users assessed needs. Overhead tracking hoist systems have been installed in some bathrooms. There continues to be further beds, mattresses, and physiotherapy and activity equipment is on order. Some decoration of the internal building has taken place and the outside of the home has received some renovation. A clinic room has been developed using existing space. The manager designates office has been moved to the main part of the home and is easily accessible by service users, relatives and staff. All accidents are now audited. The physiotherapy and Hydro-pool area are now clean and tidy.

CARE HOME ADULTS 18-65 Wey House Nursing Home Norton Fitzwarren Taunton Somerset TA4 1BT Lead Inspector Gail Richardson Unannounced Inspection 17th January 2007 09:30a Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 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.V321287.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V321287.R01.S.doc Version 5.2 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.V321287.R01.S.doc Version 5.2 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 1st June 2006 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 physiotherapy staff. There is a skill mixed team of professional staff and care workers. The current fee ranges from: £560 to £1600 per week. Hairdressing, aromatherapy, toiletries and vouchers for college are not included. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was unannounced and took place on 1st June 2006. On the 6th November 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 (17.50 inspector hours) by inspectors Gail Richardson and Sally Murphy. At the time of this inspection manager designate Helen Smith was available throughout the inspection process. Helen has been in post since November 2006 and secured the position as manager designate from January 2007. On the day of inspection 33 service users were residing at the home. An assessment of the premises took place, inspectors case tracked 5 service users and observed the care being given by staff, their accommodation and facilities and all documentation relating to them. Records relating to the care of the service users, staff, health and safety were examined. Prior to the inspection the home completed a CSCI pre-inspection questionnaire about service provision, staffing, resident admissions, complaints procedures, meal times and arrangements made for community health care support for residents. Comment cards about the service were also received at the CSCI from residents, staff and visiting health professionals following the inspection visit. At least 8 service users and 10 staff were consulted with. Throughout the day the inspectors were able to observe interactions between staff and service users. 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 the high standard of care provided given the recent changes of management. The atmosphere at the home was relaxed and happy. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 6 The interaction between staff and service users was cheerful and relaxed. Service users are able to access the community, go to the local college and go out on organised trips. A mini bus is available with a designated driver. The home ensures 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 staff 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. No clear plan of care is provided in all assessed areas of need. Service users are not currently involved in the care planning process. Storage of care plan documents containing service users details are recommended to be stored in line with the Data Protection Act 1998. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 7 Service users would be at a lesser risk of harm if all prescribed medications, in particular creams, hand wash and mouthwash were stored appropriately and were named and dated when opened. 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. The storage of Oxygen must be addressed to ensure cylinders are stored securely in an upright position and the correct signage to indicate rooms in which oxygen is stored and used. This is to prevent risk of injury to service users if cylinders should fall or be knocked over. Medication Administration Records must be maintained without unexplained gaps to ensure that service users receive all medication prescribed for them. The practice of using prescribed medications as stock for “as required “ use, for example ,Paracetamol , is poor practice and is required to be discontinued. The provision of suitable and appropriate clothing protection during mealtimes would ensure service users dignity and adequate clothing protection. Access to suitable levels of toiletries is recommended and it is further recommended that service users choice of products is sought. Further development and implementation of social and recreational assessments for all service users is required to ensure that all service users have access to activities tailored to their preferences and abilities. Service users would benefit from the refurbishment of areas of the home and the replacement of worn equipment. The standard of hygiene within the home is poor with malodours evident in several areas. This is not satisfactory and may pose a health and safety risk to service users Service users would benefit if there were always a competent staff team in sufficient numbers on duty who have received adequate training to understand 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. Regulation 26 visits to the home have not been undertaken since September 2006. This is a requirement and is required to monitor and support the staff and service users. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 8 Further development of the smoking policy is required to ensure that the needs and rights of service users who choose to smoke are addressed and suitable facilities provided for this. Several maintenance documents were out of date and some were not available this may pose a health and safety risk to service users. The manager designate confirmed that all maintenance documentation is being audited and will be forwarded to CSCI when complete. 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. The summary of this inspection report can be made available in other formats on request. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 9 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.V321287.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 (Standards 2,3,4,5 could not be assessed at this inspection) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The information provided by the Statement of Purpose for Wey House is out of date in several areas of content. No admissions to the home have taken place since the previous inspection. EVIDENCE: The home has not admitted any new residents since the previous inspection and therefore a correct assessment of standards 2,3,4 and 5 could not be made at this inspection. These standards will be reviewed again at the next key inspection. At the previous key inspection it was recommended that copies of contract be kept at the home. At this inspection no contract were available and continue to be stored at head office. 11 service user questionnaires were sent out, the replies confirmed that 2 had received a contract and 1 had not, 3 questionnaires remained blank in this area. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 11 The Statement of Purpose for Wey House is incorrect and out of date in several areas relating to Schedule 1 of the Care Homes Regulations 2001. This document is required to be updated to contain the correct details relating to the manager, complaints and staffing. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s care planning system demonstrated that care plans do not always provide a clear plan of care for all identified service user needs. 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: 5 care plans were examined as part of the case tracking process and all 5 of the individual service users were met. Care planning systems in place continue to be in need of re-developing as identified at the previous 3 inspections. Some care plans examined had good detail and instruction for staff, however, some care needs plans were incomplete. Specific needs had been identified but Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 13 no care plan was available to ensure that staff could provide the detailed care required. One care plan did not give any instruction for a service user with Type 2 diabetes, putting the individual service user at risk of harm. A further care plan identified a specific need but gave only indications of action without the specific detail required. No service user or representative involvement in the care planning process was evident. Some details were noted to be available in a different language and further plans are in place to teach staff the signs used at college to support and promote continuity for service users in the home. 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 and there were records of input from visiting health professionals and reviews of care. Service users consulted with and able were complimentary about the staff group and confirmed that they had been to meetings were issues regarding the home are discussed. 4 service users confirmed that staff always listen and act on what they say, one service user commented “Sometimes, not always” 3 staff confirmed that they always received the care they need, 1 said usually and 3 said sometimes. All three relatives/visitor surveys received confirmed that they were happy with care given, one comment noted that some relatives had asked to be informed of appointments /accidents but this did not always happen. The manager designate has implemented a key worker system, which is planned to develop relationships between staff and service users and promote autonomy and choice. The manager designate confirmed that further communication aids are to be implemented to assist service users to communicate their needs. One service user questionnaire comment was that “whilst they had flash cards in their room nobody used them “. Service users care plans and details were not stored securely and were seen to be on occasion accessible and unsupervised on both floors of the home. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 14 15 16 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from good support, which enables them to learn and develop skills and be able to access local community facilities. The provision of social assessment and activities requires further development to ensure all service users have access to activities which suit their choice and abilities. Service users are offered a choice of nutritious well-balanced menus promoting their health and well-being. EVIDENCE: Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 15 The homes provides a mini bus and regular driver to drive service users who regularly to go SCAT, 2 service users attended SCAT on the day of inspection. Staff confirmed that escorts are provided on these journeys. No residents of Wey House are currently employed. There is an Patient Centred Planning Manager who is currently undergoing social assessments and developing a plan of activities for all service users, this activity plan is not currently underway. Staff and service users confirmed that there is very little activity provided with in the home. Staff told inspectors that the staffing levels did not allow time for specific social activity. No activities were planned for the day of inspection as staff meetings were taking place. Activity trolleys were available on each floor, 2 staff confirmed that these had not been used for some time. Service users questionnaires stated that 2 service users said activities happened 3-usually and 3-sometimes. Comments included, “There have not been so many (Activities) this last year” and “There are no activities arranged which suit my level of ability” 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 was managed on the day of inspection by one physiotherapist and one Physiotherapy assistant. The physiotherapist confirmed that currently 10 service users use the pool regularly. The pool is available for more leisure-orientated sessions, with music and soft lighting to promote relaxation. On the day of inspection both the physiotherapy and pool areas were in use. Aromatherapy is available on a fee-paying basis. One service user confirmed that he would be taking his annual holiday with support from the home and all service users are registered to vote. Family and friends of service users are welcomed to Wey House. Visiting is ‘open’ and would be at the request of the service user. 3 surveys received from relatives/visitors confirmed that they were always made welcome at the home. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 16 Service users were seen being treated and addressed appropriately by staff. Service users have the facility to lock their rooms should the wish too, staff can access in case of emergency. Inspectors observed that care was given discreetly and privately and all service users were complementary about the staff confirming that they are all kind and caring towards them. Staff were observed to knock on doors before entering and service users were seen moving freely and unrestricted around the home. Inspectors observed that the facilities for service users who choose to smoke were restricted to an outside area, which had no shelter. No details regarding smoking are available within the Statement of Purpose for the home and contracts were not available to the inspectors. A smoking policy is available but this does not address the needs and rights of service users who choose to smoke. One service user was seen smoking outside on several occasions inappropriately dressed for the weather and time of year. The inspector recommends that this issue be addressed with the service users. The kitchen was assessed at this inspection and kitchen records seen were up to date. Catering staff told inspectors that equipment required in the kitchen had been supplied by the company. A dishwasher had been available for some time but has not yet been connected. The kitchen appeared clean and well organised. All residents have nutritional assessment and those requiring gastric PEG feeding (7 at the time of this inspection) have specialist community dietary support. The menu is on a two-week cycle but service users confirmed that there is a wide choice and specific preferences are catered for. Lunch was seen to be unhurried and the assistance given to service users at meal times was seen to be sensitive. Food was served hot and appeared plentiful and appetising The puree food given to service users was well presented and in individual portions, however staff must be discouraged from then mixing these individual portions together. Feedback from service users consulted indicated that the food is always good with a good choice. The clothing protection provided for service users consisted of blue plastic aprons tied around service users. This manager designate is planning to investigate alternative clothing protection to ensure that service users have the appropriate equipment they need. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users receive an appropriate level of support to meet their personal and health care needs. The management, administration and recording of medication evidenced that some procedures undertake require review. 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. 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 a qualified physiotherapist and assistant physiotherapist. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 18 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. The service users in Wey House have a high level of physical nursing needs and these appeared well managed. One comment received from a visiting health professional was “In my opinion a superbly well run institution” Comments from 2 surveys received from Healthcare Professionals indicated that service users medication was appropriately managed at the home and service users confirmed that they receive the medical support they need, 5 said always and 2 said usually. Service user surveys received indicated that service users felt that they receive the care and support they need.-3, always and 3, sometimes. Medication Administration Records sampled indicated some good and some poor practice, however on assessment of service users private accommodation it was concerning to note that: Prescribed creams were not all named and dated when opened and one label had been removed, this may place service uses at risk. Some gaps were noted in the Medication Administration Records, all medications not administered are required to have the indication code recorded. Oxygen storage and signage was not correct and needs urgent attention as this may present a risk to service users. The current practice of using service users prescribed stocks of paracetamol and Idrolax for general PRN use is required to discontinue as all prescribed medications are for that service user only. Hibiscrub hand wash was found in the ground floor bathroom. This solution was prescribed for a specific service user in 2003. The storage of medications and controlled medications was appropriate and the practice of attaching any Blood glucose monitoring to the appropriate Medication Administration Records is useful to staff. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Complaints are dealt with promptly. 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. Service users able and staff spoken with informed the inspectors that they would not hesitate in raising concerns and have done so. Service users questionnaires confirmed that they would know how to make a complaint, 1-always, 2 usually,2-sometimes and 1-never. 2 out of the 3 responses received from relatives/visitors knew about the homes complaints procedure. The home has an ongoing complaint which is being investigated by the manager. Records relating to this complaint are auditable and detailed. The CSCI has received one complaint against the home since the last inspection and this is currently being investigated by the manager. Staff spoken to understand the lines of communication should they suspect any form of abuse. Abuse and challenging behaviour training has been Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 20 provided for many staff in 2006, staff spoken to were able to confirm this. POVA First checks had been undertaken before staff had commenced working at the home. The home has a whistle-blowing policy and the manager designate confirmed that the policy regarding abuse is to be added to the policies and procedures held within the home. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Many areas of the environment showed signs of wear and tear associated with the use of the building. 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 malodours were evident in some areas. EVIDENCE: All communal areas and 8 bedrooms were seen. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 22 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. All en-suites now have named boxes for storage of each service users toiletries. Flip top bins were noted in all en-suites and bathrooms and the home plans to have lockable storage in each en-suite but these cupboards have not yet been ordered. It was concerning to note at this inspection that the majority of en-suite facilities contained uncapped razors, some en-suites were noted to have a poor standard of hygiene for example; a dirty en-suite curtain and a dirty edge of bed. The bases of some toilet surrounds were noted to be rusty and dirty. Malodours were evident in some area. 1 housekeeper and 2 cleaners were on duty on the day of inspection. One en-suite was noted not to have a door or curtain and had visible access from an adjacent corridor window. Bedrooms are situated on the first and second floor and are accessed by two passenger lifts and stairs. Service users are encouraged to personalise their rooms. Service users rooms seen had accessible locks on their bedroom doors, 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 and tracking hoist have been fitted in several bathrooms to assist staff and service users During the inspection, service users were observed utilising all communal areas. The manager designates office has been moved to the main part of the home and is easily accessible by service users, relatives and staff, this is a huge improvement in accessing the manager designate and centralising the managing of the home. The home has now developed a clinical room which will store feeds etc, freeing up space in service users bedrooms. Areas of the home appear worn and the company submitted a refurbishment plan to the CSCI and refurbishment is ongoing. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Staffing levels remain at a minimum, staff confirm lower levels on occasion. Staff have received some mandatory training and most staff have received abuse training. Training to NVQ 2 remains below 50 of the staff. Staff confirm that supervision is ongoing. Some recruitment records were incomplete and may place service users at risk. EVIDENCE: Staff spoken with were clear about their own roles and the roles of others. The appointment of a new manager appears to have had a good effect on the staff team and staff seemed very supportive of her. A clinical manager is due to start at the home on the 22/01/07 to develop the care planning and documentation of care given. Staff commented to inspectors that staffing levels were sometimes low and this was mainly due to sickness, the manager has recruited more staff and this Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 24 means that agency use has reduced, this is a positive move for both service users and staff. However, staff said that the practice of a staff member escorting to SCAT means that they are one less nurse available in the home for that period of time. Also, they confirmed that staffing levels sometimes dropped in the afternoon. The manager is required to ensure that staffing levels are adequate to meet service users assessed dependency levels at all times. One staff commented “Most days of working on shift we are working short staffed and the manager is well aware of this. We are refused cover with agency. “ and a visitor to the home commented “They don’t open or answer outside doors all of which are locked within a reasonable time.” It was evident that although staff felt understaffed, the service users appeared settled and well cared for, the atmosphere in the home was relaxed and cheerful. Several staff commented to the inspectors about the telephone system within the home, the telephone is located in the nurse’s office and staff found the constant interference of answering the telephone during the day detracted from the continuity of care they were giving. This was discussed with the manager and will be addressed within the management of the home. Several staff had been newly appointed to the home since the last inspection, inspectors examined three files, there were noted to be unexplored gaps in the recording of one staff members registration pin number. The manager subsequently began an investigation into how this error has occurred and what remedial action must been taken. Service users surveys noted that, when asked if staff were always available when you need them 1 said always,3 said usually and 3 said sometimes. 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 25 of care staff have a care NVQ according to the training records and the manager advised that 2 staff are currently undertaking NVQ 2. One staff member commented that “We have no access to NVQ assessor at the moment “ Some new staff have relevant overseas qualifications which the home is attempting to have validated in this country. Training in specialist e.g. Huntingdon’s Disease and Picks Disease to meet the needs of the service users at the home are still to be implemented. The implementation of a training plan is recommended to enable the manager designate to have an overview of training needs and training undertaken. Evidence of induction training was not seen at this inspection, however one staff member confirmed that they were half way through their induction and Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 25 another staff member expressed an opinion that induction training in some areas is inadequate and should be longer. According to Duty rotas and on the day of the inspection two Registered Nurses (RN) and 10 care staff covered mornings at the home; two RN’s and 10 care staff are on duty in the afternoon and two RN’s cover nights with 4 care staff. One of the service users was receiving 1to1 care therefore only 9 care staff were available to meet the needs of the remaining residents during the morning and 9 during the afternoon. Furthermore one staff member was escorting to SCAT in the morning and so was missing from the staff team for a period of the morning. Following the recently recruited staffs employment checks there will be just one RGN vacancy. This vacancy has been temporarily filled by a regular agency staff to maintain continuity for service users and staff. On the day of inspection there was a full time Physiotherapist and Physiotherapy Assistant on duty. The Patient Centred Planning staff member was off sick. Staff meetings are now taking place and all minutes are recorded, a qualified staff meeting took place on the day of inspection. Staff were able to confirm that a plan of supervision is now underway. On the day of inspection there was one housekeeper and 2 cleaning staff and one laundry staff. Areas of the home were unclean and malodours were noted in some areas. This was discussed with the manager designate and this area is currently under review. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 39 40 41 42 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has recruited a new manager. The new manager is making every effort to improve standards within the home. Appropriate steps are being taken to ensure the health and safety of service users. EVIDENCE: Since the last inspection Helen Smith has taken up the post of Manager designate. The CSCI await her application for registration, the manager has worked at the home since November 2006. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 27 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. Standards 37 and 38 have not been inspected at this time due to the short period of time Helen Smith has been in post. The area manager has not completed any Regulation 26 visits since November 2006, the inspector requested copies be sent in December 2006, no copies have yet been received. An quality audit profile was completed 01/12/06 but no copy was forwarded to CSCI. Policies and procedures are currently being updated and the manager designate was able to show inspectors the updated and current policies available so far. However policies regarding, pressure areas, volunteer workers, conduct and continence are yet to be developed and implemented. 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. However, the fire risk assessment was pending completion and the service records indicated that fire equipment checks were out of date. A record is kept of all portable appliances and was last checked on 18/12/06. The manager advised that a monthly walk around check of the maintenance of the home takes place with her and the maintenance staff. Further records were not available and the administrator will forward to CSCI offices Gas Certificate Emergency lighting Nurse call system service Hardwiring certificate Wheelchair servicing A record of accidents and incidents in the home is maintained. Audits have now been undertaken to identify and trends or regular incidents. There are currently 5 staff with a first aid certificate. It is required that further staff training is implemented to ensure that a suitably trained first aid staff member is available on each shift. Individual staff training files were sampled and evidence was seen of mandatory training. Abuse and challenging behaviour training has been provided as mentioned previously. The home was able to supply but does not display appropriate employers liability insurance, which expires, the end of September 2007. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 28 Quality Assurance and Monitoring in regard to the views of service users, staff and visitors had not yet been implemented, but the manager designate confirmed that she has plans to do so. Financial arrangements with reference to the storage and records of service users own monies were examined. These were clear and auditable, each service user has a financial profile and their specific requests are catered for. Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 29 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 1 2 X 3 X 4 X 5 x 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 3 27 1 28 3 29 3 30 1 STAFFING Standard No Score 31 3 32 1 33 1 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 1 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 X x X X 2 3 1 1 3 Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 30 yes Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 4(1)(c) The registered person shall compile in relation to the care home a written statement of purpose, which shall consist of, a statement as to the matters listed in schedule 1. The manager designate is required to ensure that the statement of purpose is updated and contains correct details in all areas. 2. YA6 15(1) The Manager Designate should as far as is practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. This is in reference to involvement of residents and their relatives in the care planning process. 3. YA6 15 (1) The registered person must ensure that in consultation Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 31 Requirement Timescale for action 30/03/07 30/03/07 30/03/07 with individual residents; prepare a written plan as to how the service users needs in respect of health and welfare are to be met. This is with reference that care plans are specific and that identified care issues are appropriately care planned. 4. YA19 13 (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home This relates to; • Prescribed creams were not all named and dated when opened and may place service uses at risk. • Some gaps were noted in the Medication Administration Records, all medications not administered are required to have the required indication code recorded. • Oxygen storage and signage was not correct and needs urgent attention as this may present a risk to service users. • The current practice of using service users prescribed stocks of paracetamol and Idrolax for general PRN use is required to discontinue as all prescribed medications are for that Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 32 30/03/07 service user only. 5. YA14 16(2)(n) The registered person shall having regard to the size of the care home and the number and needs of the service user -consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation The manager designate is required to ensure that suitable activities are provided for all service users. 6. YA24 12(1) 13(4)c 30/03/07 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. Previous timescale of 20 July 2006 not met. 7. YA24 12(4)a23(2)b As agreed and in line with the company’s refurbishment plan maintenance work must continue throughout the home. 8. YA27 16(2)(c) Service users en-suite facilities are required to have a door or curtain to ensure privacy and dignity at all times. 9. YA30 16(2)(j) The registered manager is required to review the cleaning provision to ensure adequate Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 33 30/03/07 30/03/07 30/03/07 30/03/07 and suitable standards of hygiene are met at all times. 10. YA32 18(1)a & c The registered person must 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. Previous timescale of 30/08/06 has not been met 11. YA33 18(1)(a) The registered manager is required to ensure that staffing levels are monitored and reflect the dependency levels of service users at all times. 12. YA34 18(1)(a) The registered manager is required to ensure that all staff are suitable qualified and records of these qualifications are verified regularly. 13. YA41 17(1)b The registered person must ensure that all individual records are secure and used in accordance with the Data Protection Act 1998. This is in regard to service users care plans and records which were observed to be accessible on both floors. Previous timescale of Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 34 30/03/07 30/03/07 30/03/07 30/03/07 30/08/06 was not met 14. YA42 12(1)(a) There must be at least one first aid trained person in the home at all times, to make sure that people who use services receive appropriate treatment in an accident 15. YA42 12(1)(a) The manager designate is required to ensure that all areas of health and safety are maintained and updated and relevant documentation is in place. This is with reference to maintenance documents listed in the body of the report 30/03/07 30/03/07 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. The manager is recommended to seek the views of service users regarding the provision of facilities for service users who smoke. A smoking policy relating to the needs and choices of service users is strongly recommended. The provision of appropriate clothing protection for service users as needed is recommended. 2. YA16 3. YA17 Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wey House Nursing Home DS0000003310.V321287.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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