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Inspection on 09/06/05 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 9th June 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 6 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 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 appeared well cared for and were well attired. Some of the service users are involved in the re-designing of a secured garden at the back of the home. 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 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 a dedicated physiotherapy team to assist. 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. Relatives spoken to expressed their satisfaction with the care provision. Feedback from service users was positive with regard to all aspects of the provision of care at the home. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors to the home.

What has improved since the last inspection?

All heads of care have a meeting each Monday to keep abreast of any changes at the home. There is an open evening `surgery` for families to meet with the, manager to air their views on the conduct of the home and raise any concerns they may have. Bed rails are now labelled with the room number and audited on a regular basis as to their safety and records are maintained. Worn communal furniture has been replaced and there is a rolling programme of service users own chairs being replaced. Staffing levels had improved. There are now two registered nurses on duty 24 hours per day. Pureed food seen looked well presented in separate portions to make it look more appetising. Systems were in place to track financial transactions for each service user to prevent any risk of financial abuse. Hoists used had been identified in all but one of the service users individual care plans assessed, which enables staff to be able to use the correct hoist for the individual service user. One communal bathroom is being refurbished to provide a shower that the shower trolley can be used with. This will benefit many of the service users.

What the care home could do better:

Each prospective service user and current service user must have a service user guide to allow them to make informed choices.Care plans must be reviewed at least 6-monthly to ensure all current needs are reflected to enable care staff to deliver the care required. All but one of the care plans assessed at inspection had not been reviewed within the last twelve months. Some areas of the environment would benefit from re-decoration. The communal bathrooms were in need of refurbishment. Some of the individual bedrooms seen were in need of redecoration. The paintwork on the outside of the house is in need of attention. Some service users are still sitting in chairs with splits to the arms and foam exposed. These must be replaced as soon as possible. It is understood that the chairs are specially made and take time to be completed by the manufacturer. Implementing supervision and training for staff must be commenced in regard to specialist training and one to one supervision. This would ensure staff are developed in line with their personal training needs, which will benefit service users, by the provision of competent staff. Service users should be involved in the day-day running of the home and have an opportunity to air their views through minuted meetings with the staff and manager. Activities for those service users unable to join in should be developed and enhanced. The inspectors noted that service users nursed in bed appeared to miss out on an opportunity to join in and have stimulation from one-one activities. The activities co-ordinator appeared unsure of how to implement such activities. Registered nurses should examine their own practices in regard to medication administration, and recording in line with the Nursing and Midwifery Council (NMC) and Royal Pharmaceutical guidelines to prevent any potential risk to service users.

CARE HOME ADULTS 18-65 Wey House Nursing Home Norton Fitzwarren Taunton Somerset TA4 1BT Lead Inspector Caroline Baker Unannounced 9th June 2005 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 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 Stationary 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 D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Wey House Nursing Home Address Norton Fitzwarren, Taunton, Somerset, TA4 1BT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 337391 01823 326652 The Robinia Group Plc YA 37 Category(ies) of Old age (37) registration, with number Physical disability (37) of places Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 inlcude persons with brain injury and/or physical disablement. Date of last inspection 14th January 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 thirteenperson lift has been installed. The home is suitably adapted for the client group accommodated. The home has a large hydrotherapy pool and dedicated physiotherapy staff. There is a skill mixed team of professional staff and care workers. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was announced and took place on 14th January 2005. At that inspection four requirements were identified and three recommendations were made. At the time of this unannounced inspection evidence was seen that action had been taken to meet the majority of the requirements and the recommendations made. This inspection took place over one day (7.5 hours) by two inspectors Caroline Baker and Jane Poole. 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 eight service users were spoken with and four staff were interviewed. The manager designate 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, manager and staff for their help and time during the inspection. What the service does well: 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 appeared well cared for and were well attired. Some of the service users are involved in the re-designing of a secured garden at the back of the home. 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 that all service users have access to appropriate health care professionals and will offer support to attend appointments where appropriate. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 6 A hydrotherapy pool is available for those who would benefit, with a dedicated physiotherapy team to assist. 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. Relatives spoken to expressed their satisfaction with the care provision. Feedback from service users was positive with regard to all aspects of the provision of care at the home. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors to the home. What has improved since the last inspection? What they could do better: Each prospective service user and current service user must have a service user guide to allow them to make informed choices. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 7 Care plans must be reviewed at least 6-monthly to ensure all current needs are reflected to enable care staff to deliver the care required. All but one of the care plans assessed at inspection had not been reviewed within the last twelve months. Some areas of the environment would benefit from re-decoration. The communal bathrooms were in need of refurbishment. Some of the individual bedrooms seen were in need of redecoration. The paintwork on the outside of the house is in need of attention. Some service users are still sitting in chairs with splits to the arms and foam exposed. These must be replaced as soon as possible. It is understood that the chairs are specially made and take time to be completed by the manufacturer. Implementing supervision and training for staff must be commenced in regard to specialist training and one to one supervision. This would ensure staff are developed in line with their personal training needs, which will benefit service users, by the provision of competent staff. Service users should be involved in the day-day running of the home and have an opportunity to air their views through minuted meetings with the staff and manager. Activities for those service users unable to join in should be developed and enhanced. The inspectors noted that service users nursed in bed appeared to miss out on an opportunity to join in and have stimulation from one-one activities. The activities co-ordinator appeared unsure of how to implement such activities. Registered nurses should examine their own practices in regard to medication administration, and recording in line with the Nursing and Midwifery Council (NMC) and Royal Pharmaceutical guidelines to prevent any potential risk to service users. 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 D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, and 4. Service users should be provided with the information they need to enable them to make an informed choice about moving to the home. The home was able to demonstrate that service users are fully assessed prior to admission to ensure their needs can be met. The home would be able to introduce prospective service users to the home prior to admission. EVIDENCE: The inspectors were given copies of the current draft form of the Statement of Purpose and Service User Guide. The manager informed the inspectors that the service user guide has not readily been given to prospective service users. It was agreed that this would be feasible once the new draft was finalised. Two individual service user pre-admission assessments were examined. They were comprehensive and well written. The manager informed the inspectors that if the home could not meet the needs of prospective service users they would be declined. The home has an open door policy and encourages prospective service users and their families to visit the home at any time to aid in any decisions. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9, and 10. The home’s care planning system did not demonstrate that care plans are 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. The home demonstrates that it handles all information and records in line with the Data Protection Act 1988. EVIDENCE: The manager recognised that the care planning systems in place were in need of re-developing and was looking at introducing a new care planning system in the near future. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 11 Four individual care plans were examined and the individual service users were met. The care needs sheets were well detailed with actions to be taken by care staff to deliver the care. None had been reviewed in line with NMS 6.10. Risk assessments in regard to manual handling and pressure area care had not been completed in one of the care plans examined. The care plans did not have individual service user risk assessments carried out in regard to specialist and adjustable beds as required at the last inspection. The types of hoists in use for the individual were reflected in all but one of the care plans examined. Input by community health professionals was documented, such as G.P and dietician. The care plans demonstrated service user involvement and agreement to risk assessment intervention. The manager informed the inspectors that he wanted to develop the involvement service users have in the running of the home. There has not been any service user meetings held since the last inspection. The manager has held ‘surgeries’ in the evenings, so that families can have more opportunity to meet him and express their views. Service users who were asked said that they felt able to talk to the manager about their life in the home. Interaction seen between the manager and the service users was good. Service users’ individual care plans and all records were stored appropriately. Care plans were accessible to staff. All financial records were stored securely. Access to records is controlled by the homes policy guidance with regard to disclosure and confidentiality. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 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. EVIDENCE: During this inspection at least five service users were attending a local college - S.C.A.T. in the morning and at least three service users were 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 their classes. The manager is currently investigating the possibility of more in-house classes, to enable more service users to take advantage of education. No residents of Wey House are currently employed. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 13 During the afternoon it was pleasing to see the majority of service users enjoying the good weather and playing netball and other games in the garden with the staff. There is an Activities Co-ordinator, who leads specific interventions with service users. The manager agreed that intervention with those service users unable to join in with planned activities should be enhanced and developed further. There is no longer an in-house speech and language therapy, and this service is accessed via the NHS, on referral by the GP. 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. Service users would usually be supported to participate with the political process through postal voting or supported visit to the polling station. There is a hydrotherapy pool, which is used mainly for therapeutic activities and managed by a team of physiotherapists and assistants. The pool has recently been made 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. Families and relatives were seen visiting during the inspection. Those spoken to expressed their satisfaction at the provision of care at the home and indicated an improvement since Mr Breen had been in post. Service users were seen to be 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 was that they can spend their time as they wish. The kitchen at Wey House was seen to be clean and tidy and food stored appropriately, for example, food in the fridge was covered and dated. Cleaning records were up to date. All residents have nutritional assessment and those requiring PEG feeding have specialist community dietary support. The menu is on a two-week cycle and the choices are being reviewed at present. The cook spoken to had a good Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 14 knowledge of the service users personal preferences and any special dietary requirements. Lunch was seen to be unhurried and the assistance given to service users at meal times was seen to be sensitive. The puree food given to service users was well-presented at this inspection in individual portions. Feedback from Service users indicated that the food is always good with a good choice. A larger hot-trolley was delivered during the inspection which would assist staff to deliver the meals in a way that ensures food maintains its heat. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 failed in their procedures for the management, administration and recording of medication, potentially placing service users at risk of harm. EVIDENCE: Evidence was seen that service users are able to choose the way they are cared for, for example the clothes they wear, their preferred name, where they want to spend their day and how. Feedback from service users was positive indicating that they are happy at the home. 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 at the home is readily available on a daily basis. Community physiotherapists are on hand to give guidance and support. The home has the services of a local G.P to provide care for the service users at Wey House, if the service users so wish. This service is at no extra cost to the residents. This GP holds a ‘surgery’ in the home for four hours each week. Health care input was satisfactory. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 16 The service users in Wey House have a high level of physical nursing needs and these were well managed. Two service users had a pressure sore at the time of this inspection, which were being well managed. As part of this inspection seventeen out of thirty-four Medication Administration Records (MAR) were examined. The following issues were identified: • Nine MAR sheets had gaps in signing for administration of prescribed medications. • Six MAR sheets with hand transcribed medications did not carry two signatures. • On two occasions the amount of medication given for Variable Doses were not reflected. • On one occasion the prescribed medication (Paracetamol) stated give ‘1’ and administration signatures on 9 occasions stated ‘2’ given An immediate requirement notice was issued. Prescribed medications received were receipted appropriately with two signatures. Homely remedies are authorised and signed for by the G.P and Manager. Controlled drugs were stored appropriately. Storage of medicines was satisfactory. During the assessment of the premises it was noted in many rooms that prescribed creams were stored inappropriately and none were dated with an opening or expiry date. It was recommended that a thermometer be placed in each store cupboard to monitor the storage temperatures. Medicines are being crushed to administer via Gastric Peg feeding tubes. It has been agreed that the CSCI pharmacist inspector visit the home to review and monitor this practice to ensure medicines are crushed only within their product license guidelines. A copy of the homes medication policy was given to the inspectors. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 and forms part of the service user guide. Service users and staff spoken with informed the inspectors that they would not hesitate in raising concerns should they have any. The inspectors were informed that one complaint had been received by the home since the last inspection this had been investigated by the provider and appropriately dealt with. The CSCI had received one anonymous complaint in regard to care issues and rights of service users, which the manager and provider investigated the CSCI felt appropriately. Complaints records were maintained. The home had a whistle blowing policy and copies of Somerset’s policy on the protection of vulnerable adults. Staff spoken to understand the lines of communication should they suspect any form of abuse. Abuse and challenging behaviour training is being implemented at the home in the near future. The home also had a ‘zero tolerance to bullying’ policy. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 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. EVIDENCE: All communal areas and at least eight 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 is being installed to the stairs on the first floor, which access two rooms. This will enable 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. All service users had accessible locks on their bedroom doors. The majority of doors were seen to have doorknockers. Service users spoken with informed the inspectors that they liked their rooms. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 19 Specialist equipment was available to assist with maintaining independence. Many service users had their own specialist chairs, which were being replaced on a rolling programme. Many new communal chairs had been purchased since the last inspection. During the inspection, service users were observed utilising all communal areas and the pleasant gardens with the assistance and supervision of staff. It was agreed with the manager that many areas of the home were in need of re-decoration. The company should provide the CSCI with a plan of action as to when the outside of the building (in regard to paintwork), communal bathrooms, and individual bedrooms in need will be attended to. The home had adequate specialist bathing and toilet facilities for service users. 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. It was evident that new bed bumpers had been purchased since the last inspection. Some were still in need of replacement as pointed out to the manager. The radiator identified, as not working at the last inspection had not yet been repaired – the maintenance person informed inspectors that a part had been ordered. The extractor fan identified had been repaired. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, and 36. Staffing levels and the skill mix of staff at the home were adequate. Staff morale was good and staff were supported and competent to do the job they had been employed for. The homes recruitment procedures protect service users from the risk of abuse EVIDENCE: The Manager had been in post at the home for six months at the time of this inspection. Changes had already been made to enable him to lead the team in a way they understand. Staff spoken to felt supported by the manager and stated that morale had improved since he had been in post. An application for registration of the manager has been received and is being processed by the CSCI. Staff spoken with were clear about their own roles and the roles and responsibilities of others. Feedback from service users was positive about the support they received from the manager and staff. Staff morale appeared high and staff were positive regarding the support they received from the manager and training opportunities available to them. The Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 21 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. Formal supervision formats were in place and each staff member had a Staff Development File. Supervision had not been implemented and the manager stated that this would be. This will be followed up at the next inspection. Staff stated that the home was adequately staffed and that there were opportunities for quality time with service users. This was seen at inspection. 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. The manager works weekdays in addition to care staff and also provides cover where required. Agency staff are used to cover any shortfalls. The manager stated that due to a large recruitment drive, the use of agency cover was becoming less. Four staff recruitment files were examined as part of the inspection. Recruitment procedures were generally robust for the protection of vulnerable adults. The manager agreed that all documentation in regard to the staff in line with Schedule 2 of the Care Home Regulations 2001 must be kept at the home and not at Head office. The inspectors asked that evidence of CRB disclosures for the last four employers are sent to the CSCI from company Head Office. Staff spoken to, including recent employees, confirmed having completed CRB disclosures. Staff confirmed in discussions that they have a good range of statutory training, including Fire, moving & handling, First Aid and food hygiene. A file has been set up for each staff member to record his or her training and supervision. Plans are underway to provide challenging behaviour training and abuse training for all staff. This should happen shortly. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 40, 41, 42 and 43. The manager designate effectively manages the home and the management style provides an open and inclusive environment for service users and staff. The home is taking appropriate steps to ensure the health and safety of service users, staff and visitors. EVIDENCE: The manager designate is Mr Paul Breen. An application for registration is being processed by the CSCI. Staff and service users indicated an improvement at the home since Mr Breen had been in post as mentioned earlier. Records relating to staff meetings were not seen at this inspection. This will be followed up at the next inspection. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 23 Formal systems of Quality Assurance (QA) were seen at this inspection. The company actively sends out questionnaires to service users, social workers care staff and families to gain their views on the conduct of the home. Audits are recorded and displayed in a QA manual. The area manager regularly completes Regulation 26 visits and copies are sent to the CSCI. Mr Breen is hoping to enhance service user involvement and feedback within the home. The company has a good range of policies in place and these are accessible to staff when required and service users when required. The records required by regulation that were seen at this inspection were stored safely and appropriately. Access to records is controlled and there is policy guidance with regard to confidentiality and disclosure. At the time of this inspection, the home was taking appropriate steps to ensure the health and safety of service users, staff and visitors. 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 annual servicing is up to date. A record is kept of all portable appliances. The last test carried out was recorded as 11/04. A record of accidents and incidents in the home is maintained with monthly audits being carried out. The management of bedrails was much improved with regular audits being recorded and all bed rails being labelled with the room number. The home displays appropriate employers liability insurance, which expires, end September 2005. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 24 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 2 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 2 3 3 x Standard No 31 32 33 34 35 36 Score 3 2 3 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wey House Nursing Home Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x 3 3 3 3 3 3 D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 25 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. 2. Standard YA1 YA6 Regulation 5(2) 15(2)[b] Timescale for action The home must provide a service 1 July 2005 user guide to each prospective and current service user. The home must ensure that 1 July 2005 service users individual care plans are reviewed and all current care needs are reflected. The registered person must 9 June ensure that registered nurses 2005 adhere to the medication policy, pharmaceutical guidelines and An NMC medicine guidleines for the Immediate protection of vulnerable adults. requiment Notice was issued. The registered person must 30 July continue to replace worn 2005 furniture and send an action plan of re-decoration and refurbishmant plans for the home to the CSCI. The registered person must 30 August ensure that specialist training for 2005 staff in challenging behaviour and abuse is implemented without further delay. The registered person must 30 August ensure that individual formal 2005 staff supervision commences. Activities on a non-one basis for 30 August those service users unable to 2005 Version 1.30 Page 26 Requirement 3. YA20 13(2) 4. YA24 16(2)[c] plus 23(2)[b] [d] 18(1)[c] {i} 5. YA32 6. 7. YA36 YA 12 18(2) 16(2)[m] Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc join in must be further developed to suit their individual needs. 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. Refer to Standard YA8 Good Practice Recommendations The home should implement and record service user meetings to gain their views on the conduct of the home. Wey House Nursing Home D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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 D53 - D02 S3310 Wey House Nursing Home V 225321 090605 Stage 4.doc Version 1.30 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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