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Inspection on 24/04/08 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 24th April 2008.

CSCI found this care home to be providing an Adequate service.

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 5 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

The service offers a spacious accommodation. People in residence have high dependency and require support with daily living, nursing interventions and monitoring of complex conditions. The home is well equipped and the specialist facilities on site are accessed to the benefit of the people living at Wey House. The local medical service supports the home with a regular in house surgery session for people living at the home. The AQAA was fully completed and detailed the progress of the service over the past year and the plans for the next twelve months.

What has improved since the last inspection?

The most recent complaints and safeguarding matters have been handled more effectively and in line with the protocol for safeguarding vulnerable adults in Somerset. The call bell system has been improved as a result of the management responding to people who use the service. Five requirements and three recommendations made at the last inspection have been met.

CARE HOME ADULTS 18-65 Wey House Nursing Home Norton Fitzwarren Taunton Somerset TA4 1BT Lead Inspector Barbara Ludlow Unannounced Inspection 24th April 2008 10:00 Wey House Nursing Home DS0000003310.V363275.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.V363275.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.V363275.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 helen.smith@robinia.co.uk www.robinia.co.uk The Robinia Group PLC 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) Miss Helen Angela Smith Care Home 37 Category(ies) of Physical disability (37) registration, with number of places Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing- Code N to people of either gender whose primary care needs on admission to the home are within the following category: 2. Physical disability- Code PD The maximum number of service users who can be accommodated is 37. 8th November 2007 Date of last inspection Brief Description of the Service: Wey House is a Registered Care Home with Nursing for adults with physical disabilities, acquired brain injuries and progressive neurological diseases. 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 accessible by stair lift. All other areas of the home are accessible by lift. 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 (Nov. 2007) Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor for the seven chapter outcome groups and an overall quality rating is then calculated: : The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection was conducted over one day by two inspectors. There were 30 people in permanent residence at the home. The Inspectors viewed the premises, which included a selection of bedrooms and all communal areas of the home. Three people remained in bed at the start of the visit, one person got up later in the morning. Records were sampled these included care and support plans, staff recruitment, health and safety records and medicine administration records. The Inspectors spoke to ten people using the services and six members of staff. Surveys were received from eight people using the service; two surveys were received from relatives and visitors, one from staff. The feedback and some of comments received are included in the body of the report. The atmosphere was calm and appeared well organised. The manager was having a day off but came to the home when notified that the inspection was underway. People were being supported in their daily lives and those requiring one to one attention had staff allocated to be with them. A tour of the premises was made. The home was clean, tidy with no malodour. Bedrooms are well equipped for the individual people. People living at Wey House were seen in the communal rooms and in private in their bedrooms during the day. Staff were seen and spoken with. Lunchtime was observed and the kitchen was clean and well managed. The food looked varied and appetising. People asked said they enjoyed their meal. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 6 One sitting area is being converted into a sensory room and new blinds were being installed. Records required by inspection were sampled these included servicing and maintenance. Recruitment, staff supervision and training records were sampled. Time was spent reviewing care plans for individuals who were case tracked as part of the inspection process. The manager was given some feedback towards the close of the visit and was asked to submit further documents to CSCI after the inspection visit. The Annual Quality Assessment Audit required by regulation had been sent out to the manager but was not due to be returned. The manager agreed to return this at her earliest convenience and the detail from this document has been incorporated into this inspection report. The surveys sent to people living at the home ask ‘Is there anything else you would like to tell us?’ comments included ‘I really like it here and would like to stay as long as I can..’ and ‘I am contented and happy’ and two added ‘No’. The inspectors would like to thank the manager and people living and working at Wey House for their cooperation and the feedback given to assist with the inspection process. What the service does well: What has improved since the last inspection? Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 7 The most recent complaints and safeguarding matters have been handled more effectively and in line with the protocol for safeguarding vulnerable adults in Somerset. The call bell system has been improved as a result of the management responding to people who use the service. Five requirements and three recommendations made at the last inspection have been met. What they could do better: 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.V363275.R01.S.doc Version 5.2 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.V363275.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, Quality in this outcome area is good All prospective people will receive a pre admission assessment by two senior staff, which may include the registered manager; to ensure their care needs can be met by the service offered at Wey House. People are invited to visit the home prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Service User Guide and Statement of Purpose for prospective people using the service to be able to make an informed decision about the home. This had been updated at the last key inspection in November 2007. This was not examined in detail at this inspection. Surveys were received from eight people living at Wey House and two relatives. The feedback indicated that five people were asked if they wanted to move to this home, two said no. One person said their social worker helped them arrange the transfer and they were happy about it. One person indicated that they were misled pre admission, by a previous manager concerning the Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 10 client group in residence, (2005). Four people said they had enough information before moving into the home and four said no. One person mentioned having an admission pack sent to them and another person commented ‘Yes, I got enough information about Wey House’. The AQAA states that the Single assessment Process (SAP) is obtained prior to admission from the professional care manager. The SAP was seen on file for the people recently admitted to Wey House. The home has admission and assessment polices and procedures in place. Two people more recently admitted to the home were case tracked, their care records indicated a visit from the registered manager. An assessment had been made and their care needs had been assessed. This included their views and those of their carer / relatives. Hobbies and interests had been explored. To ensure the care home was going to meet their needs. A placement agreement with terms and conditions of residency and the fee was recorded. The fee included the cost of £500 towards a holiday. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 11 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): 6,7,9 Quality in this outcome area is adequate Care plans were in place and had been updated to be more person centred. Not all assessments were found to be completed or up to date. People using the service are supported to make decisions and choices about their daily lives and are being actively involved in some aspects of the home. Risk assessments are used to support people using the service to maintain their independence, not all had been thoroughly reviewed within the planned timescales. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Inspectors viewed five care plans including the care and admission plan for two people most recently admitted to the home. One care plan had behavioural strategies but no mental health assessment another assessed that Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 12 a monthly weight check was required, there had been no weight monitoring since February 2008. The commission was notified prior to the draft report being issued that the scales were replaced on May 8th 2008. The AQAA stated ‘support plans are individualised to ensure that all areas of need are addressed. Service users support plans identify the level of need and areas of development.’ Support plans are audited and reviewed monthly to ensure service users and key workers are happy they reflect needs and wishes. At the last inspection it was reported that: The home provides each person using the service with a personal profile, which is available, both in their room and in their care plan. This profile is detailed providing staff with a clear account of each person using the services abilities, choices and aspirations and covers aspects of personal and social support. This is unchanged. This system of profiling and care planning is being developed and was seen to be an improvement. Records identify when people receive visits from health care professionals including GP’s, Chiropodist, Dentists and the community Mental Health Care specialists. Day-to-day records of the care given to each person were seen and care monitoring charts kept in bedrooms were seen to be used to log care interventions. Care plans were stored in a lockable cupboard in the office and were safe. The storage of all records within the home is in line with the Data Protection Act. The AQAA stated that all information in regards to service users is treated in confidence and with respect. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 13 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): 12,13,15,16 and 17 Quality in this outcome area is good People using the service are offered a wide range of activities and experiences both at the home and at venues outside the home. Links are maintained with relatives. The home provides a varied menu of good quality food. People are offered menu choices and can choose what and where they would prefer to eat. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The following was reported at the key inspection in November 2007 and is unchanged: Leisure activities include Karaoke, review of newspapers, television and videos. The Registered manager confirmed that home supports trips out. The home has a hydro pool and full time physiotherapy staff and it Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 14 was confirmed that some people using the service have access to the pool with assistance. Individual records are being developed to record all of the activities that each person has accessed. The home enables some people using the service to go to college and also has a visiting IT facility to enable people to develop IT skills within the home. The manager later confirmed that the college provides a weekly art session at the home offering an additional opportunity for those who may not be able to attend college or wish to take part in further activities. The home supports people using the service to take trips. There are good links with the relatives although one person commented that agency staff seen at weekends are not always familiar faces. On the day of the inspection three of the four people on courses at Somerset College of art and technology (SCAT) attended their session. One person has been assessed to require one to one support with their placement and is supported by staff regularly once per week. Later in the day people were seen engaged with staff and having fun playing Connect 4 (large set). The AQAA stated that holistic therapies are available in the home from outside agencies. Religion is respected and supported for all service users. Church services at the home take place and are open to all. Service users who wish to go to Church are supported. The inspectors observed lunchtime experience for people living at Wey House. Tables were laid for lunch, in the dining room. The meals were varied in choice and were reflective of people’s preferences and choices. The head chef was off duty but called into the home and was spoken with. The chef has a good knowledge of people using the service, knowing their individual likes and dislikes. The lunch routine was well organised and people requiring one to one support and those who require less assistance were carefully helped at the meal tables. Specialist diets are catered for and puree diet is available served in individual portions to ensure that people using the service can identify different tastes and textures. The kitchen was clean and tidy. Records are well maintained. People are weighed and their weight is monitored for gain and loss on a monthly basis. However a hoist scales have not been available therefore some people have not been weighed regularly. One care plan examined indicated that one person had not been weighed since February 2008 yet their care plan Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 15 required a monthly check on their weight. This was brought to the attention of the manager; funds had been requested to purchase a replacement hoist scale. The commission was notified that the scale was replaced on May 8th 2008. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 16 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): 18,19,20 Quality in this outcome area is adequate People receive support in the manner they prefer. The people have access to appropriate community health care professionals. The home does not have a registered mental health trained nurse on the staff team. Medication administration records were completed and systems were in place to support the safe management of medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care profiles indicate how people prefer to receive their personal care. The daily record within the care plans is completed to detail the care given. Five care plans were sampled and these showed that all areas of assessed needs were care planned, not all the care plan reviews were up to date. Some areas of need were not care planned which included mental health care needs assessment. The home no longer has a registered mental health care nurse (RMN) on the staff. A number of people living at the home have some Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 17 degree of mental health care needs and would benefit from the input and overview of a registered mental health (RMN) care nurse. The RMN has previously played an important role with people living at the home. The provision of specialist input into care planning and strategies for managing behaviour that is challenging for staff to deal with is required. The manager must ensure that the skill mix of her team meets the needs of the people in residence. People were tidily dressed in a manner of their choosing and all people seen looked comfortable, well groomed and appeared to be well cared for. One person was not attended between 10.30 am and 12 midday yet needed personal care; they were seen to be resting safely and were undemanding. The staff stated that the timing of their care was delayed as a result of the people going out to college having to take priority. This was brought to the attention of the manager and an investigation was undertaken. The manager was keen to review college mornings to reduce the impact upon others who are not going out but are very dependent upon staff for their personal care. All people using the service have an allocated key worker. Reviews involving multi-disciplinary healthcare professionals have been undertaken at the service. New people have a review after one month, three months and after one year. People are enabled to attend appointments with the dentist and opticians. The local GP holds a regular session at the service and will attend to those who request a consultation or those who are unwell at any time. All specialist health care visits and contacts are recorded in the care records. Health action planning could be improved, the samples seen in the care plans examined was just a list of the professionals’ names with whom appointments are made and supported. Surveys from relatives and visitors were asked ‘ Do you feel that the care home meets the needs of your friend / relative?’ Two said usually. ‘Do you feel the care home gives the support or care to your relative that you expected or agreed’, 2 said usually. ‘Are you kept up to date with important issues affecting your friend / relative?’ one said always and one said usually. People using the service surveys asked Do you make decisions about what you do each day? Five said always, two said usually and one said sometimes. One person said ‘every morning they get a choice of what to wear’, they choose what to ‘eat and drink’ and if they choose ‘to go out’. ‘Do the carers listen and act on what you say?’ four said always, three said usually, comment included ‘yes they do’. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 18 The Medication Administration Records were examined and were well maintained. There was photographic identification, personal information such as past medical history and date of birth. Special instructions were recorded for what the choice of drink is with the medications, choking risks were identified. There is a homely remedies policy. Risk assessments were present where medication is used outside of the licence for example when crushed for administration via a gastric feeding tube (PEG). Good information was recorded where subcutaneous fluids were administered. The people do not have a descriptor list for their medications to indicate what they are prescribed for. This is recommended for practice as in some instances where medication has more than one indication for use; a personal record for each individual would give clarity to why a medication has been prescribed. The manager has confirmed to CSCI that this good practice has been put into place. The AQAA stated that the service have good service user profiles which give detailed care and choices for the service users. They are updated and reviewed regularly and when changes are needed. These also contain the risk assessments needed to give care effectively and safely. The home has an emergency policy, which states the wishes for treatment the service users would like to receive if they were ill. The AQAA also indicates that staff have been trained to use the Liverpool care pathway to ensure good standards of end of life care. Wey House Nursing Home DS0000003310.V363275.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. The home has a complaints procedure and there are policies and procedures to safeguard vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure and the registered manager maintains a log of concerns. People using the service were asked if they knew how to raise a concern those asked were clear about doing this. The surveys from people using the service indicated that all eight would know who to speak to if unhappy. Comments included, ‘I go to the manager of the home, she is very helpful,’ ‘I will talk to my Mum’, ‘Boss lady in the office’, ‘to somebody in charge’, ‘the manager or assistant manager.’ Six said they would know how to make a complaint and two said no. Comment included speaking to the manager and writing to the manager. Two relatives said they know how to make a complaint. At the last inspection in November CSCI had received 6 concerns/complaints since the previous key inspection and had one ongoing Vulnerable Adults strategy in place. The home had received 7 concerns/complaints. There had been no further separate complaints made to the service or CSCI. One complaint remains open and ongoing, care management professionals were involved. The complaints process/ vulnerable adults strategy was being Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 20 followed and work was undertaken in partnership with the local authority protocol for safeguarding vulnerable people. The home has a whistle-blowing policy, which includes the contact details of CSCI. The AQAA states in detail the procedures that are followed in various circumstances to protect the people in residence from the risk of harm. The recent evidence supports the following of adult protection procedures and company policy to address concerns and complaints raised at the home. At the last key inspection it was reported that: Detailed records are kept at the home of all people using the service individual expenditure with receipts obtained wherever possible. The inspector audited 3 financial files and all monies stored were correct. There was no change to the process at this inspection. Wey House Nursing Home DS0000003310.V363275.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): 24,29, 30 Quality in this outcome area is good The home appears comfortable and safe. Bedrooms can be personalised and ‘owned ‘by the people using them, reflecting their individual needs and lifestyles. The home provides specialised equipment required as per assessed need. The home provides a clean and hygienic environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wey House is an old house that has been extended and refurbished in the past eight years. Part of the old house had some water ingress and two rooms have been vacated in order for the damage to be repaired. There is ongoing redecoration of bedrooms. The home has a handyman to assist with day to day repairs and maintenance. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 22 The home has a main lounge area downstairs with a dining area and a lounge upstairs. This upstairs room was being refurbished as a sensory area and blackout blinds to enhance light projection were being added to the windows at the time of the inspection. All communal rooms are suitably furnished, comfortable and are well used, many people have specialised seating or individual wheelchairs to meet their comfort and individual safety needs. The bedrooms are well maintained, comfortable and are furnished with soft furnishings of person’s choice; the colour and decoration can also be chosen. All en-suite facilities are fitted with individual store cupboards. The AQAA stated that new privacy locks would be fitted to doors where service users wish to have a key to lock up when they go out. Also stated was that the redecoration programme will continue and there may be additional ceiling track hoists installed. The home has an attractive garden area, which has been adapted to allow wheelchair access. The AQAA indicated that the home wish to develop a sensory garden with service user participation. On the day of the inspection the home was clean and hygienic. Hand washing facilities are provided in all appropriate areas. There are adequate laundry facilities and staff are aware of infection control procedures in the laundry. The call bell system is new but still had some technicalities being addressed by the service engineers. The home has a hydrotherapy pool and physiotherapy facilities and a staff team to manage this specialised equipment and deliver the care. This facility is used by some of the people in residence and is also used by external clients. Wey House Nursing Home DS0000003310.V363275.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): 32,33,34,35 Quality in this outcome area is adequate On the day of the inspection the staffing level was at a minimum level, this was having an adverse impact on the prompt delivery of morning personal care. Recruitment was satisfactory and staff receive regular supervision. The skill mix would benefit from RMN input. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection there were eleven care staff were on duty plus two qualified staff. There were eleven care staff plus two qualified staff on duty in the afternoon and one qualified staff and four care staff on night duty. The duty rota for the week was copied for inspection purposes, this demonstrated the nurse and care staff cover being provided at this level throughout the week. The care staff number includes the staff rostered to work one to one with three named clients, throughout each day. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 24 The home has recently increased staffing levels to meet the dependency of people using the service following the review of the dependency level of people in residence. The inspectors were aware that time pressures are experienced by staff when a small group have to be up and ready for college at the same time. This was the case on the day of the inspection and there was an adverse impact upon people who were in bed waiting for personal care and attention. This was brought to the attention of the manager and was investigated after the inspection visit. The people living at the home and staff were observed throughout the day. Friendly, patient and caring interactions were observed. Some of the people enjoyed a friendly banter with staff. The atmosphere at the home was relaxed staff did not seem rushed and gave the impression of having time for each person they were with. The Inspectors spoke to a small number of staff at the time of the inspection and one staff survey was returned. This survey indicated that up to date information is given to staff about the support needs of the people they care for. Also that recruitment checks had been undertaken and induction and training had been given. The respondent also said that they knew how to raise a concern. Asked what the service does well? Their response included the comment ‘clients are at the centre of what we do here’. Two staff recruitment records were examined one had only one reference on file, head office were referred to and the second reference was confirmed to CSCI. Supervision records were seen in the staff personal file inspected. At the last inspection it was reported that ‘the supervision form contains all the topics indicated in the National Minimum Standards’. Staff training opportunities are available and the staff files evidenced that mandatory training is in place. Staff spoken and the survey received, confirmed that staff had received induction training and receive on going training and updating. Six staff are undertaking NVQ Level 2 and two staff are due to undertake NVQ 3. The present NVQ total does not reach the 50 required by the National Minimum Standards. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 25 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): 37,39,42 Quality in this outcome area is good The home is well managed by Miss Smith. There is leadership from the top and care management is moving forward. The Health and safety management within the home is well maintained and recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes registered manager Miss Helen Smith, has implemented changes that are having a positive effect on the running of the home during her first year in post. There is good area operational management input to the home that has supported complaints investigations and safeguarding strategies. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 26 Staff meetings are held. There have been changes to care practices for the benefit of people living at Wey House. There was more social integration seen and the manager explained how she had made some of the changes to the environment and social care practices. The AQAA confirmed what had been achieved over the previous twelve months that focussed on the efforts made with safeguarding people, complaints handling and systems for auditing money and processes. There have also been efforts made to increase contact and the involvement of families and service users in the development of the home. The inspectors declined the opportunity to examine the quality assurance records, which were collated in November 2007. Robinia has comprehensive policies and procedures that are available at the home. All records seen by the inspectors were appropriately stored. The home keeps records of all incidents and accidents and the Manager reviews them before they are sent to Head Office for further audit. Slips, trips, falls, abuse, self-harm, major and minor incidents are all recorded and analysed to improve practice. The Inspectors sampled and viewed the following records relating to health and safety: • • • PAT testing records, due 12/08 Fire service records including fire extinguishers, weekly fire tests, staff fire training Emergency lighting checks All records maintained were clear and well recorded. Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 27 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 X 2 3 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 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 3 X X 2 X Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 28 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 YA19 Regulation 15 (2)(b) Requirement Where a risk assessment determines a monthly weight check the home must have equipment available at all times to enable people to be weighed. (This refers to a hoist scale being available for people who cannot use sit on or stand on weigh scales.) Timescale for action 30/06/08 2. YA6 15(1)(2) Care plans are required to be 30/06/08 further developed to ensure that all areas of need are assessed and have an up to date care plan. People with a mental health need must have their needs assessed by a suitably qualified person. Then the strategy for addressing their needs must be determined by a suitably qualified person. The staffing on particularly busy mornings (college days) should be reviewed to prevent priority care taking care away from undemanding dependent people requiring personal care. 30/08/08 3. YA6 YA33 15(1) 14(2)(a) 4. YA18 12(1)(a) 30/06/08 Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 29 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 YA32 Good Practice Recommendations The registered manager is required to ensure that 50 of staff achieve NVQ level 2 to support people using the service. Health Action planning should be developed to be more detailed and person centred rather than just being a list of professional contacts. Individuals should have a list of their medications and the reason for them being prescribed with either their MAR charts or their care plan records. This will provide clarity of use for medicines that have more than one therapeutic effect. The skill mix should be reviewed to determine the need for an RMN / mental health skilled staff on the staff team. 2. 3. YA19 YA20 4. YA33 Wey House Nursing Home DS0000003310.V363275.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V363275.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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