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Inspection on 28/10/05 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 28th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

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

What has improved since the last inspection?

Medication systems have improved, staff are adhering to the homes medication policies and have complied with requirements made. Activity provision has improved although needs further development to ensure all service users receive social stimulation on a regular basis. Some of the individual bedrooms have been refurbished.

What the care home could do better:

This inspection identified many areas that need improvement. These were in regard to the Statement of Purpose, Service User Guide, and assessment of service users, provision of qualified specialist staff, and the overall management of the home, staff training and supervision, care planning and risk assessing, quality assurance, and refurbishment of the home. It was disappointing that many of these areas had been identified at the last inspection and action had not been taken to comply with those requirements made. The home is without a manager again therefore a robust support network must be in place to ensure the home continues to maintain its high standards of care. Recruitment of staff and the high use of agency staff needs addressing as this could potentially jeopardise continuity of care. The CSCI acknowledges that the home uses the same agency staff to ensure continuity. Staff training must be addressed with special regard to Vulnerable Adult, Challenging Behaviour and specialist training.Service user meetings must take place on a regular basis to ensure the client group have input in to the day-day running of the home. This had not taken place for at least 12 months. The home does not have a full time qualified physiotherapist or occupational therapist therefore was not fully meeting the needs of some of the service users admitted.The CSCI has arranged a meeting with the Regional Manager for the home, to take place on Thursday 3rd November 2005, to review and agree an action plan and improvement strategy for the future of Wey House. At the meeting the regional manager acknowledged and agreed that systems would be put into place to meet the requirements of this inspection and the CSCI felt assured that action was and would be taken.

CARE HOME ADULTS 18-65 Wey House Nursing Home Norton Fitzwarren Taunton Somerset TA4 1BT Lead Inspector Caroline Baker Unannounced Inspection 28th October 2005 08:40 Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 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.V253648.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V253648.R01.S.doc Version 5.0 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 Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Not more than 7 persons of either sex, not less than 60 years, who require general nursing care. Person of either sex, in the age range 18-59 years, who require general nursing care - which may include persons with brain injury and/or physical disablement. Registered for 37 persons in categories OP and PD Date of last inspection 9th June 2005 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 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 assistant physiotherapy staff. There is a skill mixed team of professional staff and care workers. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was unannounced and took place on 9th June 2005. At that inspection seven requirements were identified and one recommendation was made. At the time of this unannounced inspection evidence was seen that action had been taken to meet just three of the requirements. This inspection took place over one day (12 inspector hours) by Caroline Baker and Shelagh Laver. Since the last inspection the Registered Manager had left the home. At the time of this inspection there was not a manager in place. The deputy manager was acting up. Thirty-four service users were residing at the home. Staffing levels were adequate on the day of inspection. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least six service users were spoken with and two staff were interviewed. The acting manager was available throughout the inspection. Throughout the day the inspectors were able to observe interactions between staff and service users. Records relating to the care of the service users, staff and health and safety were examined. The inspectors would like to thank the service users, and staff for their help and time during the inspection. What the service does well: Service users looked well cared for on the day of inspection. Those seen were well attired and complimented the staff at the home stating that they were well cared for and that the food was very good. Staff work very hard to maintain a high standard of care at the home given the amount of agency staff used and lack of continuity in leadership. The atmosphere at the home was relaxed and happy. Staff morale was good. The interaction between staff and service users was happy and relaxed. Service users are able to access the community and go to the local college and go out on organised trips. A mini bus is available with a designated driver. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 6 The home ensures where possible that all service users have access to appropriate health care professionals and will offer support to attend appointments where appropriate. A hydrotherapy pool is available for those who would benefit, with dedicated physiotherapy assistants to give support. Specialist equipment is available to ensure independence can be promoted and maintained. 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: This inspection identified many areas that need improvement. These were in regard to the Statement of Purpose, Service User Guide, and assessment of service users, provision of qualified specialist staff, and the overall management of the home, staff training and supervision, care planning and risk assessing, quality assurance, and refurbishment of the home. It was disappointing that many of these areas had been identified at the last inspection and action had not been taken to comply with those requirements made. The home is without a manager again therefore a robust support network must be in place to ensure the home continues to maintain its high standards of care. Recruitment of staff and the high use of agency staff needs addressing as this could potentially jeopardise continuity of care. The CSCI acknowledges that the home uses the same agency staff to ensure continuity. Staff training must be addressed with special regard to Vulnerable Adult, Challenging Behaviour and specialist training. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 7 Service user meetings must take place on a regular basis to ensure the client group have input in to the day-day running of the home. This had not taken place for at least 12 months. The home does not have a full time qualified physiotherapist or occupational therapist therefore was not fully meeting the needs of some of the service users admitted. The CSCI has arranged a meeting with the Regional Manager for the home, to take place on Thursday 3rd November 2005, to review and agree an action plan and improvement strategy for the future of Wey House. At the meeting the regional manager acknowledged and agreed that systems would be put into place to meet the requirements of this inspection and the CSCI felt assured that action was and would be taken. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 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.V253648.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Service users are provided with information they need to enable them to make an informed choice about moving to the home, however this needs reviewing. The home was able to demonstrate that service users are assessed prior to admission however was not fully meeting their needs in regard to specialist needs. EVIDENCE: The home has a Statement of Purpose and Service User Guide and copies were given to the inspectors to take away. Evidence was seen that service users receive the service user guide. Both documents need to be reviewed and further developed to ensure the contents are in line with the NMS and reflect the services offered at the home. As part of the case tracking process the inspectors examined four individual care plans and met with the individual service users, including the most recently admitted service user. Evidence was seen of a comprehensive preadmission assessment for the most recent service user. Other care plans sampled contained evidence of assessments undertaken by other health care professionals indicating what should be provided at the home for the service users to include physiotherapy and in two cases rehabilitation. The home does Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 10 not have a full time qualified physiotherapist or occupational therapist therefore was not fully meeting the needs of the service users admitted. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, and 9. The home’s care planning system demonstrated that care plans are not always kept under review. Service users are not always involved in all aspects of life in the home. Service users are supported to make decisions and to live an independent lifestyle in accordance with their plan of care and agreed risk assessments. Some risk assessments were incomplete. EVIDENCE: As previously mentioned four care plans were examined as part of the case tracking process and the individual service users were met. Care planning systems in place were in need of re-developing as identified at the last inspection. They were detailed and had been reviewed however it was difficult to ascertain current needs as the needs and abilities of service users case tracked had changed. Some care needs plans were incomplete. Where there was loss of weight a care need had not always been flagged up. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 12 Physiotherapy assessments had been carried out by the company’s own qualified physiotherapist on 21/10/05. Recorded evidence of implementation was being developed. The involvement of service users in the running of the home needs developing. There had not been any service user meetings held since the last and previous inspection in January 2005. Service users who were asked were complimentary about the staff and acting manager and said that they felt able to talk to them about their life in the home. Interaction seen between the staff, acting manager and the service users was good. Risk assessments in regard to manual handling and pressure relief were in place. Some risk assessments were not completed in regard to falls and the use of specialist beds and bed rails. The types of hoists in use for the individual were reflected. Input by community health professionals was documented, such as G.P and dietician. Evidence of placement reviews were in place and the action taken as recommended at the reviews was recorded and evidenced. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Service users benefit from good support, which enables them to learn and develop skills, enjoy a range of leisure activities and to access local community facilities. Service users are offered a choice of nutritious well-balanced menus promoting their health and well being however some practice in assistance at mealtimes gave rise for concern. EVIDENCE: During this inspection it was half-term so the local college - S.C.A.T was closed. During the inspection at least three service users were seen being taken out in the mini bus for an afternoon trip. The home has its own minibus and a driver and this enables individuals to be transported to the local college. No residents of Wey House are currently employed. There is an Activities Co-ordinator, who leads specific interventions with service users. She was on leave at the time of this inspection and activities records were not available. It was difficult therefore to determine how much Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 14 activity provision had been given to those service users unable to join in with planned activities as identified as needing developing at the last inspection. Service users consulted and able indicated that activity provision was adequate at the home. The storage of records must be reviewed to ensure they are available. There is no longer in-house speech and language therapy, and this service is accessed via the NHS, on referral by the GP. The statement of purpose should reflect that this is no longer available. The home’s mini bus and driver support access to local amenities in Taunton and the surrounding area. Staff support is normally given to service users who are able to go out. There is a hydrotherapy pool, which is used mainly for therapeutic activities and managed by two physiotherapy assistants. One was off sick at the time of this inspection. The pool is available for more leisure-orientated sessions, with music and soft lighting to promote relaxation. Aromatherapy is available on a fee-paying basis. Family and friends of service users are welcomed to Wey House. Visiting is ‘open’ and would be at the request of the service user. Service users were seen being treated and addressed appropriately by staff. Service users can lock their bedroom doors from the inside if they wish and staff would be able to access the rooms from outside in an emergency. Care is delivered on a one to one basis with only manual handling assistance given by more than one member of staff. This promotes dignity and privacy with all aspects of personal care giving and assistance by staff. Feedback from service users consulted and able was that they could spend their time as they wish. The kitchen at Wey House was seen to be clean and tidy and food stored appropriately. One fridge was in need of replacement as the seal was broken. The chef informed the inspector that the company were aware. Cleaning records were up to date. All residents have nutritional assessment and those requiring gastric PEG feeding (up to 14 at the time of this inspection) have specialist community dietary support. The menu is on a two-week cycle and the choices are being reviewed at present. Personal preferences and any special dietary requirements were recorded on a notice board. Lunch was seen to be unhurried and the assistance given to service users at meal times was seen to be sensitive. It was concerning that care needs plans Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 15 were not being followed in regards to feeding. The inspectors observed a member of staff using a loaded dessertspoon when it stated in the care plan that a teaspoon should be used to prevent choking. This was brought to the attention of a trained nurse on duty. The puree food given to service users was well-presented at this inspection in individual portions. Feedback from Service users consulted indicated that the food is always good with a good choice. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Service users receive an appropriate level of support to meet their personal and health care needs. The home had improved in their procedures administration and recording of medication. 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. Feedback from service users consulted was positive and they indicated that the staff were kind and caring. Service users were well attired and appeared well cared for. Service users were seen using specialised equipment to enable them to maintain their independence. Physiotherapy is available on a daily basis and is conducted by physiotherapy assistants. A qualified physiotherapist is available for advice and assessments and has visited the home on a monthly basis. The home is advertising for a full time physiotherapist. This is required if the home assesses and admits service users with a specific physiotherapy need. 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 Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 17 for the management, the residents. This GP holds a ‘surgery’ in the home for four hours each week. Health care input was satisfactory. The service users in Wey House have a high level of physical nursing needs and these appeared well managed. At the last inspection concerns were identified in regard to the medication systems at the home and the pharmacist regulation inspector was asked to visit the home. The visit took place on 2nd September 2005 where two requirements were made as follows: • The home must ensure that all products are checked to ensure that are within the expiry dates set for them and that those products beyond these dates are disposed of appropriately. A system must be set up to ensure that this is done regularly. And the home must obtain appropriate authorisation and documentation for all medicines administered to service users in a different form to that supplied. • Evidence was seen that both requirements had been complied with. Medication Administration Records sampled indicated good practice. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Appropriate steps are taken to reduce the risk of harm or abuse to service users. EVIDENCE: The home had a complaints procedure, which was available to service users, staff, and visitors. It was seen displayed in the main entrance hall. It should also form part of the service user guide and be more detailed in the Statement of Purpose. Service users able and staff spoken with informed the inspectors that they would not hesitate in raising concerns should they have any. Two complaints had been received by the home since in the past twelve months both had been investigated and appropriately dealt with. The CSCI had received one anonymous complaint in regard to care issues and rights of service users, which the CSCI felt the previous manager and provider investigated appropriately and one anonymous concern into staffing levels, use of agency staff and replacement of chairs and equipment. The company had been made aware and were taking action to replace equipment and worn chairs. Staffing levels were maintained with the use of agency staff and staffing will be discussed with the company. Complaints records were maintained. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 19 Staff spoken to understood the lines of communication should they suspect any form of abuse. Abuse and challenging behaviour training is still to be provided and is required as at the last inspection. The home also had a ‘zero tolerance to bullying’ policy. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 29 and 30. Service users live in a homely, clean environment where they can enjoy the privacy of their own bedrooms or socialise in a variety of communal areas. Parts of the home are in need of refurbishment. A plan of refurbishment was requested at the last inspection by the CSCI with a timescale of 30 July 2005 and has not been received. EVIDENCE: All communal areas and at least four bedrooms were seen at this inspection. The majority of service users are accommodated in single bedrooms, which are fitted with en-suite wash hand basin and toilets. There is one shared room. Bedrooms are situated on the first and second floor and are accessed by two passenger lifts and stairs. A wheelchair lift has been installed to the stairs on the first floor, which access two rooms. This enables service users with mobility problems to access those rooms. Service users are encouraged to personalise their rooms and staff ensure that the privacy and dignity of service users is respected. This was evident at inspection. Service users rooms seen had accessible locks on their bedroom Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 21 doors. The majority of doors were seen to have doorknockers. Service users spoken with informed the inspectors that they liked their rooms. Specialist equipment was available to assist with maintaining independence. Many service users had their own specialist chairs, which had and were continuing to be replaced. During the inspection, service users were observed utilising all communal areas. At the last inspection it was agreed and required that many areas of the home were in need of re-decoration and that the company must provide the CSCI with a plan of action by 30 July 2005 as to when the outside of the building (in regard to paintwork), communal bathrooms, and individual bedrooms. At the time of this inspection this had not been received. Some individual bedrooms had been refurbished. The home had adequate specialist bathing and toilet facilities for service users however the downstairs facility used for showering must be refurbished and have new flooring laid as soon as possible. The flooring is torn and is at risk of harbouring bacteria, which would flourish in the damp and torn flooring. The company uses contract cleaners to maintain the cleanliness of the home. A housekeeper is employed to oversee this. At the time of this inspection all areas seen were clean and free from malodours. Infection control systems were in place. The laundry area was well organised, clean and tidy. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, and 36. Staffing levels were adequate and morale was good – however the high use of agency staff puts pressure on the core staff group, which could potentially lead to standards dropping. Staff were well supported by the acting manager. Staff had not received any supervision since the last inspection and specialist training pertaining to the service user group had not commenced. A full time physiotherapist is not available at the home. EVIDENCE: Staff spoken with were clear about their own roles and the roles and responsibilities of others. Feedback from service users consulted was positive about the support they received from the acting manager and staff. Staff morale appeared good and staff were positive regarding the support they received from the acting manager. The majority of staff had enrolled on an NVQ in care programme to level 2 or 3. There are two NVQ assessors and two more staff are enrolled for the course. The acting manager agreed that training in all areas including specialisms e.g. Huntingdon’s Disease and Picks Disease should be implemented. However Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 23 given her role had changed from deputy to acting manager in a matter of weeks training and supervision for staff was not being implemented and she felt was being neglected at this time. Support for the acting manager and training/supervision for staff will be discussed at a meeting with representatives of the providers on 3/11/05. Two Registered Nurses (RN) and ten care staff cover mornings at the home; two RN’s and eight care staff are on duty in the afternoon and two RN’s cover nights with three care staff. Access workers, who support service users to access leisure facilities and activities, are in addition to the care staff. Staffing appears adequate however is made up with agency staff. At the time of this inspection nine of the home’s staff were either off sick or on leave. There was no receptionist, administrator, activities co-ordinator or second physiotherapy assistant on duty. On the day of the inspection it was evident that in the absence of an administrator the acting manager would be answering the telephones as well as undertaking other management duties. The acting manager was on call 24 hours per day and 7 days per week and had been working long hours. The company must review this situation and have a strategy in place to ensure the acting manager gets full support at the home at all times including administrative staff. The inspectors were concerned that no recruitment had taken place since April 2005 when it was clear that staffing continued to be covered by agency staff, and there was not a qualified physiotherapist in place. The deputy role of a deputy manager was not in place would assist and support the acting manager until a further manager is appointed. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 and 43. The home does not have a registered manager. The home is generally taking appropriate steps to ensure the health and safety of service users, staff and visitors. The overall management of the service appears inadequate. EVIDENCE: The area manager regularly completes Regulation 26 visits and copies are sent to the CSCI. These should be more detailed and reflect what is happening in the home on that day to include audits and sampling of care plans, staff supervision and training. The registered manager recently resigned without explanation and the deputy Susan Whitlock is acting up at this time. The home has not retained a manager for any length of time in the past two years and will be discussed at a meeting with a representative from the company on 3/11/05. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 25 Fire records were examined and were found to be up to date. Weekly in house checks are recorded for the home’s fire detection system. Monthly checks are maintained for the emergency lighting. Servicing records indicated that all servicing of equipment including hoists was up to date. A record is kept of all portable appliances. The last test carried out was recorded as 11/04 so is due this month. A record of accidents and incidents in the home is maintained which were last analysed in September and should be monthly. As discussed all incidents must be recorded. One care plan sampled indicated on a daily record that the service user had had their leg trapped in a bedrail on two occasions – there was no incident record of this or risk assessment in place. Individual staff training files were sampled and evidence was seen of mandatory training and induction however manual-handling updates appeared overdue according to the records seen. Abuse and challenging behaviour training is still to be provided as mentioned previously. The home displays appropriate employers liability insurance, which expires, the end of September 2006. Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 26 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 2 x x x Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 2 1 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 x 3 1 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 1 2 x 1 1 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wey House Nursing Home Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score 1 x 1 x x 2 2 DS0000003310.V253648.R01.S.doc Version 5.0 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4; 5 and 6 Timescale for action The registered person 15/12/05 shall ensure an up to date Statement of Purpose and Service User Guide to the home is available in line with the matters listed in Schedule 1 and reflects the scope of the service to be provided at the home. The registered person must ensure that the home can meet all of the service users assessed physiotherapy needs before they are admitted to the home. 15/12/05 Requirement 2 YA2 14 3 YA6 15(2)[b] The registered person 15/12/05 must ensure that service users individual care plans are reviewed and updated and all current care needs are reflected. (A previous timescale of 1 July 2005 was not met) Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 28 4 YA8 12 and 16(2)[m][n] A system of ensuring service users are offered opportunities to contribute in the day to day running and development of the home must be reviewed and implemented. 30/12/05 5 YA9 13(4) The registered person 30/12/05 must ensure that all service users individual risk assessments are completed and reviewed. The registered person 18/11/05 must ensure that there are mechanisms in place to enable staff to know the care needs of a service user in regard to assistance with food and to prevent choking. And the fridge with a broken seal in the kitchen must be replaced. The registered person must actively ensure a qualified physiotherapist is employed at the home to meet the assessed needs of the service users. Evidence of advertising must be forwarded to the CSCI. 20/02/06 6 YA17 13(4) 7 YA18 14 Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 29 8 YA24 13(3);16(2)[c];and The registered person must continue to replace 23(2)[b] [d] worn furniture and send an action plan of redecoration and refurbishmant plans for the home to the CSCI. 30/11/05 9 YA30 13(3) (Previous timescale of 30 July 2005 was not met) The bathing facility 30/11/05 identified as being an infection control risk must be refurbished asap. The registered person must ensure that specialist training for staff in challenging behaviour and abuse is implemented without further delay. 30/12/05 10 YA32 18(1)[c] {i} 11 YA33 12 and 18 (Previous timescale of 30 August 2005 not met) The registered person 30/11/05 must ensure that the management structure within the home is robust and supportive to allow for an effective staff team. 12 YA35 18 The registered person must ensure that staff receive training, which meets Sector Skills Council workforce training targets, to include specialist training, to meet the assessed needs of the current service users. 20/02/06 Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 30 13 YA36 18(2) The registered person must ensure that individual formal staff supervision commences. (Previous timescale of 30 August 2005 not met) 30/12/05 14 YA37 8 The home must appoint 15/02/05 an individual to manage the care home to ensure the home meets its stated purpose, aims and objectives. Evidence of advertising must be sent to the CSCI. 15 YA39 24 and 26 The registered person must ensure that quality monitoring systems in place are implemented to include gaining views of service users, staff, and visitors on the conduct of the home. Visits by the provider must include matters identified in Regualtion 26 (4) and reflect what is happening at the home on that day. The registered person must ensure that all staff receive manual handling updates at least annually. 30/12/05 16 YA42 18 30/12/05 Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wey House Nursing Home DS0000003310.V253648.R01.S.doc Version 5.0 Page 33 - 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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