Inspection on 27/06/07 for Wey House Nursing Home

This inspection was carried out on 27th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wey House Nursing Home 12/05/09

Wey House Nursing Home 24/04/08

Wey House Nursing Home 08/11/07

Wey House Nursing Home 17/01/07

Wey House Nursing Home 01/06/06

Wey House Nursing Home 28/10/05

Wey House Nursing Home 09/06/05

Wey House Nursing Home 14/01/05

Wey House Nursing Home 11/06/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Wey House Nursing Home Norton Fitzwarren Taunton Somerset TA4 1BT Lead Inspector Gail Richardson Unannounced Inspection 27th June 2007 09:30 Wey House Nursing Home DS0000003310.V339214.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.V339214.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.V339214.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 26stmarksroad@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) 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.V339214.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 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 accessible by stair lift. All other areas of the home are accessible by lift. A thirteen-person 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 and vouchers for college are not included. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last On the random made at inspection was unannounced and took place on 17th Jaunuary 2007. 14th February,15th march and 26th April, additional unannounced inspections took place to follow up compliance of the requirements that inspection. This inspection took place over one day (14 inspector hours) by inspectors Gail Richardson and Sally Murphy. At the time of this inspection manager designate Helen Smith was on annual leave and the inspectors appreciated the assistance of the nurse in charge. On the day of inspection 31 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 5 service users and 12 staff were consulted with. Throughout the day and evening 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 care plans have been updated to include the opinions, choices and preferences of the service users. The management and staff of the home are working hard to develop a staff team whilst experiencing many changes within the home. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 6 The interaction between staff and service users was cheerful and relaxed. One service user commented “I am happy to stay here” 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? The en-suite facilities available in each room, have been reorganised and now have suitable storage for toiletries. The bathrooms are now tidy and clean and have reduced the risk of cross infection. The registered manager has developed a system of care planning which addresses all identified care needs and involves the views, choices and preferences of the service users. The ongoing refurbishment programme within the home is evident and the environment now has more storage and is subsequently tidier and reduces the risk of trips and falls to service users. Some areas of the home are now running smoothly and the service users are benefiting from a well managed unit. Some staff has undertaken mandatory staff training and a training programme is planned to include all staff. The home has developed a Statement of Purpose and service user guide which contains the updated information to enable prospective service users to make an informed decision about moving into the home. The medication systems within the home have improved and systems are now in place to provide safe storage and records of the administration of prescribed creams to ensure service users are not at any risk of incorrect administration. The home now employs suitable trained first aid staff to ensure appropriate action would be taken in the case of an accident. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 7 The provision of suitable and appropriate clothing protection during mealtimes has now been purchased to ensure service users dignity and adequate clothing protection. What they could do better: 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. The mealtimes evidenced a wide choice of meals which appeared to be plentiful and appetising, however puree diet was served in an acceptable manner but staff were observed to mix the food together which prevented service users from being able to discern different tastes and textures. Service users would benefit from an increase in staff hours to ensure service users do not have to wait to have assistance with eating and drinking. The evening meal was chaotic and lacked organisation. The mealtime was further disrupted by the medication round being done at the same time. Service users would benefit from the refurbishment of areas of the home and the replacement of worn equipment. The policies and procedures for the action to take to make a complaint, whistle blowing, action to take for challenging behaviour and acceptance of gifts lacked sufficient detail to prevent service users and staff from the risk of harm. Service users would benefit if there were always a staff team in sufficient numbers on duty who have received adequate training to understand their individual complex and specialist needs. Appropriate staff levels are needed to ensure adequate supervision of staff at all times of the day to prevent accidents and incidents developing which could be avoided. Recruitment records require further details of the staff employed to ensure service users are not at risk of abuse The laundry service does not follow the correct guidance for the laundry of items which have been in contact with MRSA. This guidance is provided to ensure there is no risk of cross infection. There was no evidence of the protective safety equipment being used for service users who have MRSA to prevent the risk of cross infection. 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. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 8 No fire risk assessment was available. Some health and safety issues have been identified which are detailed in the body of the 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.V339214.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.V339214.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 2 3 4 Quality in this outcome area is good. 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 has been updated to ensure prospective service users have the information required to make an informed decision about the home.. Robust pre admission assessment had taken place for one service user admitted. EVIDENCE: The home has had one new admission since the last key inspection. Pre admission assessment and details were received prior to admission to ensure the home could provide the care needs identified. Copies of service users contracts are now stored in the service users care files and contain the correct information. This contract was noted as previous inspection, to have been signed by the service user. Service user questionnaires were sent out, 6 of the replies confirmed that they had received enough information prior to admission to the home. The Statement of Purpose and Service User Guide for Wey House has been updated to contain the correct information required for prospective service users and their relatives to make an informed decision about the home. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 11 Wey House Nursing Home DS0000003310.V339214.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 good. This judgement has been made using available evidence including a visit to this service. Care plans have been updated and improved and involve the service user in decision making and choice preference. Action is taken to minimise risks whilst supporting the service user to maintain independence, however not all information relating to service users is stored correctly. The home responds promptly to absences by service users according to the correct procedure. 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 have been developed to include profiles of all care needs including risk assessments and plans of care. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 13 These profiles support service users preferences and involve the service users in making decisions, it was evident that these profiles supported and developed the service users abilities and promoted independence. Whilst these profiles are being developed for all staff the previous care plan system is also in place for some service users. These care plans had been updated to include plans for service users with specific care needs and included updated risk assessments as needed. Evidence was seen of service user involvement in these care plans. One care plan however did not have a care plan for one specific nursing intervention and one did not contact a specific risk assessment identified and seen to be action-ed. Another risk assessment did not give sufficient detail of assessed risk to a service users of attempting to use the bath unsupervised to enable staff to be aware of the high risks involved. 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, some service users informed inspectors that staffing levels were sometimes low Four service users confirmed that staff always listen and act on what they say, one service user said usually. The key worker system is now fully operational and identifies for service users their allocated key worker, which is planned to develop relationships between staff and service users and promote autonomy and choice. One visiting health professional commented that the staff have been very supportive. Service users care plans are now stored securely within the home however it was noted that observation books in use for 2 service users were not stored in line with the Data Protection Act and would compromise service user confidentiality. Wey House Nursing Home DS0000003310.V339214.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): 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 on a regular basis. Service users are offered a choice of nutritious well-balanced menus promoting their health and well-being. The organisation of mealtimes requires further development. EVIDENCE: Wey House Nursing Home DS0000003310.V339214.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, escorts are provided for these journeys. One service user has been assisted to continue an education programme at another college. No residents of Wey House are currently employed. Staff and service users confirmed that there is some but very little activity provided with in the home. Activity trolleys were seen on each floor. The registered manager confirmed that activities had been planned but had not taken place, staff training was taking place on the day of inspection. During the day of inspection, staff advised that activities did not take place on that day although inspectors observed periods of time when activities could have been undertaken. One comment received was “activities could be better, O.T. could be better,” There is a hydrotherapy pool, which is used mainly for therapeutic activities and had been used on the day of inspection. Aromatherapy is available on a fee-paying basis. One service user was being supported to maintain friendships outside of the home and access recreational activities such as bowling and the cinema. Family and friends of service users are welcomed to Wey House. Visiting is ‘open’ and would be at the request of the service users. Service users were seen being treated and addressed appropriately by staff, there was evidence of staff being very busy and this was seen to have a bearing on how much time was able to be given to service users. 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 and service users were supervised when smoking. A smoking policy is now in place. The kitchen has been maintained and a new flooring has been fitted in one area. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 16 All residents have nutritional assessment and those requiring gastric PEG feeding 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. The evening meal was observed on both floors. The mealtime on the ground floor appeared chaotic with the medication round interrupting the course of the meal for some service users. There was a wide choice of food available and assistance given to service users at meal times was seen to be in some cases distracted, with staff talking to other staff and service users having to wait whilst others ate, for their turn to be assisted. 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. This issue was also raised at the previous key inspection. . Feedback from service users consulted indicated that the food is always good with a good choice. Wey House Nursing Home DS0000003310.V339214.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 20 Quality in this outcome area is good. 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 in a manner they prefer. The management, administration and recording of medication evidenced that systems in place had improved. EVIDENCE: Evidence was seen within the newly instigated profiles that service users has significant input into how they live their lives and are supported to remain as independent as possible. The profiles focus on what the service user can achieve and how they would prefer their care to be delivered. They demonstrated a good insight into developing person centred care. 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.V339214.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; 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. Service user surveys received indicated that service users felt that they receive the care and support they need.4- always and 1- sometimes. One service user commented that the home “Looks after me carefully and efficiently” Medication Administration Records sampled indicated that the management of medications had improved with only one medication prescribed “As Required” and 3 gaps noted in the Medication Administration Records. One dose of medication had been altered on the Medication Administration Records and not re written. Systems are now in place to ensure creams are named and dated when opened and the manager is sourcing new oxygen signage. 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. The home has a clear homely remedy policy and had protocols in place for the rationales behind crushed medications. Wey House Nursing Home DS0000003310.V339214.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 adequate This judgement has been made using available evidence including a visit to this service. Complaints are dealt with promptly with outcomes agreed within an appropriate timescale. Policies and procedures within the home need development to ensure service users are not at risk of harm. 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. One comment received when asked, Do you know how to make a complaint was “Go to Helen Smith”. There have been 3 complaint raised with CSCI and 3 concerns raised with CSCI. The issues returned to the manager have been investigated and responded to promptly. The complaints record at the home identifies that complaints are responded to promptly and the outcomes identified within an agreed timescale. Six service users confirmed that knew who to speak to if they were not happy, 3 service users whew how to make a complaint and 2 did not. Abuse and challenging behaviour training has been provided for many staff in 2006, staff spoken to were able to confirm this. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 20 It was discussed with the registered manager the procedure to follow should prospective staff disclose any previous convictions before the person should be considered for employment to ensure service users were not at any risk The home has a Whistle-Blowing policy and the policy for Dealing With Suspected Abuse, require further development to ensure that staff have clear guidelines and contact details to follow should they wish to report any instances of abuse. The policy within the home for the guidance of staff for gifts, bequests and wills also requires further detail to ensure that staff and service users are not at risk of any potential financial abuse. The registered manager is advised to ensure the home has a copy of the current Adult Protection Policy for Somerset is available within the home. Wey House Nursing Home DS0000003310.V339214.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. The standard of hygiene within the home has improved and the home appears much more hygienic, laundry systems require review to ensure the practices used present no risk of cross infection. EVIDENCE: The majority of service users are accommodated in single bedrooms, which are fitted with en-suite wash hand basin and toilets. There is one shared room, in use. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 22 Almost all en-suites now have suitable storage cupboards for toiletries and incontinence products are required. This has improved the tidiness and hygiene of the en-suite bathrooms. 2 cleaners were on duty on the day of inspection and inspectors noted that whilst some areas remain n need of repair/replacement the general standard of hygiene had improved since the last key inspection. 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. 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. All bathrooms now have key pad locks to ensure the safety of service users. During the inspection, service users were observed utilising all communal areas. Storage around the home has been developed to ensure a better utilisation of the space available. Areas of the home appear worn and there was evidence of an ongoing maintenance programme. Wires were seen to be taped outside one room and this was discussed with the manager and some fittings and furniture is in need of repair/replacement. The laundry service is provided 7 days each week. Staff and service users were able to confirm that this can create a back up of laundry and shortages of linen up to Tuesday as the backlog is cleared. Safe systems of infection control are required to be put in place for the washing separately of clothing of service users with an acquired infection. Further supplies of disposable gloves and aprons and foot activated flip top bins are also required for the laundry to prevent the risk of cross infection. Wey House Nursing Home DS0000003310.V339214.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 will be monitored by both the registered manager and CSCI to ensure the minimum staffing level is maintained. Staff have received some mandatory training and most staff have received abuse training. 50 of staff are now trained to NVQ level 2 and above. 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 clinical manager has provided leadership of the clinical care within the home. Staff commented to inspectors that staffing levels were sometimes low, this was later discussed with the manager who felt that the staffing levels meet the assessed dependency of the service users and that development of staff Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 24 management skills required addressing within the home. The registered manager has since inspection forwarded to the home a minimum staffing level calculated on the dependency needs of the service users and will advise if these shift levels drop below a minimum. Staff said that the practice of a staff member escorting to SCAT(College) means that they are one less carer available in the home for that period of time. The manager confirmed that this loss is offset by the reduction in service users in the home as they are attending college. Care staff explained that each unit needs staff to working pairs and the work is much harder if staff shortages mean they work individually and have to wait for another staff to assist. On the day of inspection staff were unable to find a service user who had been unobserved for an undetermined period of time. The service use was found on the floor behind the door of an empty room. Inspectors spoke to the night staff and examined previous nights staffing rota. It was evident that there was not always 4 care staff on duty at night. The registered manager confirmed that the level of 3 care staff is a result of calculated staff dependency levels. The registered manager must ensure that other contributing factors are considered when staffing the home to include the geographical layout of the home and the times of dependency and staff to meet those variances. The manager is required to ensure that staffing levels are adequate to meet service users assessed dependency levels at all times. One service user commented that the home could improve by keeping staff employed and not using agency staff so much. Staff meeting take place regularly but night staff meetings have not yet been commenced by the registered manager. The timing of meetings have been scheduled to a time which is accessible to the night staff. 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. A visiting health professional commented that the staff were very professional but felt the home could be improved by keeping staff in post and not having long breaks between staff leaving and replacing them. 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 employment history, one staff member only had one reference received and there was no relevant risk assessment in place for one staff member and one file lacked a photograph. POVA First checks had been undertaken before staff had commenced working at the home, these records were not available for inspection and will be reviewed at next inspection. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 25 The home has reached a target of 50 of care staff having a care NVQ .The notice board in the staff office showed that staff training is planned in areas including, wound management, end of life care and mental health. Staff training was taking place on the day of inspection. The registered manager has confirmed that staff are allocated days of training to ensure a good level of attendance and to ensure all staff are appropriately trained. On the day of inspection On-Call arrangements were in place to support the nurse in charge of the home but staff were unclear as to what these arrangements were. Evidence of induction training was not seen at this inspection, however one staff member confirmed that they were half way through their induction and 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, one of the staff on both day shifts was an agency carer and two RN’s cover nights with 3 care staff, one RGN was an agency nurse. 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 and afternoon. Staff meetings are now taking place and all minutes are recorded and staff were able to confirm that a plan of supervision is now underway. On the day of inspection the hydrotherapy pool was in use and 3 physiotherapy staff were on duty. On the day of inspection there was 2 cleaning staff and one laundry staff. Wey House Nursing Home DS0000003310.V339214.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): 37 38 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 now has a registered manager in post. 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 Registered Manager. The Annual Quality Assurance Audit provided by Helen highlighted the difficulties in stabilising a staff team and has clear plans for the development of a team approach. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 27 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 16 staff with a first aid certificate, the registered manager has confirmed that this would enable a trained first aid staff be on each shift.. Individual staff training files were sampled and evidence was seen of mandatory training and plans in place for further service specific training were seen. Quality Assurance and Monitoring was identified on the Annual Quality Assessment Audit provided prior to inspection as a change already implemented the results of surveys undertaken was not seen at inspection. 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 which includes an assessment of ability to understand the connection between money and what it buys, this is undertaken to support service users input in managing their own finances. Two bedroom windows in one room were noted to open unrestricted to a width exceeding the Health and Safety guidance of 10 cm. This risk was discussed with the manager who will investigate and correct as required. This bedroom also contained a pestle and mortar which were cracked and broken and may present a risk of cross infection. Staff confirmed that the stock levels of protective clothing and incontinence products was varied and it was sometimes the case that prior to a delivery stocks of gloves and incontinence products were very limited. COSHH records were available and had last been reviewed 20th October 2006. Fire records examined showed that a fire risk assessment was in place but was dated out dated. Further updated records were not available to the inspectors and are to be forwarded to CSCI. These are to include : weekly fire alarm tests staff fire training weekly emergency lighting test records. The registered manager has subsequently forwarded to CSCI servicing and testing records for fire service equipment and emergency lighting. The registered manager confirmed that some gaps in regular checks were evident but routine checks had now been resumed. Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 28 2 Staff informed inspectors that the current fire plan to their understanding required one member of staff to leave the home to await the fire engine on the road. The registered manager is advised to discuss this plan of action with the fire officer. Maintenance records seen to be up to date included : Gas certificate PAT Certificate Waste Disposal Contract Certificate for Fire Alarms and Emergency Lighting Lift Legionella report A satisfactory hardwiring certificate is to be forwarded by the home to CSCI. Wey House Nursing Home DS0000003310.V339214.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 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 1 STAFFING Standard No Score 31 3 32 3 33 1 34 1 35 3 36 3 CONDUCT3 AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 1 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 1 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 X 3 3 1 3 Wey House Nursing Home DS0000003310.V339214.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 YA10 Regulation 12(4)(a) Requirement The registered manager is required to ensure that records relating to service users are stored in line with the Data Protection Act- This is with reference to the access of observation books within the home. 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. Timescale for action 01/08/07 2. YA14 16(2)(n) 01/08/07 3. YA30 12 (1)(a)(b) Safe systems of infection control are required to be put in place for the washing DS0000003310.V339214.R01.S.doc 01/09/08 Wey House Nursing Home Version 5.2 Page 31 separately of clothing of service users with an acquired infection. Further supplies of disposable gloves and aprons are also required for the laundry. 4. 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. Staffing levels are maintained and staff not reallocated to other areas including the laundry. The manager is required to forward to CSCI each time the levels drop below the assessed minimum. 5. YA34 19(1)(b) 01/08/07 The registered manager is required to ensure that recruitment procedures protect service users from any risk of abuse. • All gaps in employment history are explored and documented. • 2 references are received for all staff employed • Risk assessments are in place for identified staff. 30/09/07 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 30/09/07 6. YA42 12(1)(a) Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 32 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. 2 3. Refer to Standard YA17 YA17 YA23 Good Practice Recommendations The registered manager is recommended to review the routine of teatime to avoid interruption by the medication round. The registered manager is recommended to ensure that all staff are trained to support service users during mealtimes by not mixing the separately served puree diet together. The registered manager is strongly recommended to ensure that policies used within the home regarding whistle blowing, abuse awareness and gifts to staff are developed to ensure service users and staff are not at risk of abuse. As agreed and in line with the company’s refurbishment plan maintenance work must continue throughout the home. 4. YA24 Wey House Nursing Home DS0000003310.V339214.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Taunton Local Office 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. 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