CARE HOMES FOR OLDER PEOPLE
Weymouth Care Home 21-23 Glendinning Avenue Weymouth Dorset DT4 7QF Lead Inspector
Amanda Porter Key Unannounced Inspection 13th September 2007 10:25 X10015.doc Version 1.40 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 Weymouth Care Home DS0000020502.V350185.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 Older People. 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. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Weymouth Care Home Address 21-23 Glendinning Avenue Weymouth Dorset DT4 7QF 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) 01305 784518 01305 206145 info@weymouthcarehome.co.uk www.altogethercare.co.uk Altogether Care LLP Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (10) of places Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: Weymouth Care Home is registered as a nursing home to accommodate fortythree service users, 33 in the old age (OP) category and 10 in the Physical Disability (PD) category including younger and older persons. The home is situated in a residential area close to local amenities. The home is easily accessible by bus or taxi to the town centre of Weymouth and beaches. Altogether Care LLP owns the home and Altogether Care (Weymouth) Ltd manages the home. There are twenty-five single and nine sharing rooms, the majority are en-suite with a toilet and washbasin. The home is set in two wings and first floor bedrooms are accessed by two passenger lifts that can accommodate wheelchair users. Residents’ bedrooms are attractively furnished and many are highly personalised. The communal rooms include a comfortable quiet lounge/library at the front of the house, a separate open plan dining room and lounge with views of a courtyard garden at the rear of the property. There is ample off street parking at the front of the home for visitors’ convenience. The weekly fees at the home at the time of inspection range between £595 and £800 per week, extra amounts are charged for chiropody services, hairdressing, daily papers /magazines. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 13th September 2007 over a period of approximately five and a half hours. The purpose of the inspection was to review the requirements and recommendations made at the last inspection and assess all of the key standards. The new manager, Ms Alison Blackledge, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • The annual quality assurance assessment completed by the home. • 2 questionnaires completed by residents, 7 by relatives and visitors, 1 by a care manager, 1 by a health professional and 2 by visiting GPs. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. During the course of the inspection four residents and five members of staff were spoken with and asked their views on the service provided at the home. Comments received in surveys and through discussion included: “The home provides a very caring and comfortable environment for residents.” “Staff are always helpful and accommodating to visitors and relatives.” “My Mother is always telling me how kind everyone is to her.” “I have placed a diverse group of service users in this home at various times and have observed individualised care plans and care services.” “The support offered to the families and previous carers of service users I have placed is greatly appreciated.” The residents and staff were all extremely helpful and welcoming to the inspector. What the service does well:
Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 6 Residents’ health needs are identified and met by staff and visiting health care professionals and medicines are managed well in the home in the best interests of residents. Staff at the home support resident’s rights to privacy in care routines and residents spoken with confirmed they are able to enjoy the privacy of their rooms when they choose without interruption. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents like the food provided and enjoy the choices offered at each meal. “The food is excellent.” The complaints procedure can reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff can easily follow. The house and gardens are maintained to provide residents with a comfortable place to live. Residents are encouraged to personalise their rooms with items of furniture, pictures and a variety of mementos. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Staff are generally well trained, which helps to ensure that a good standard of care is given to residents. A robust quality assurance system is in place to ensure that the home is run in the best interests of the residents. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at the Weymouth Care Home. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
As a result of this inspection four requirements and three recommendations of good practice have been made. The home does undertake an assessment of need prior to any resident being admitted. This needs to include social needs assessments so that a programme of activities can be arranged to meet those needs. There are some shortfalls in recording within the care documentation and there needs to be a consistent approach to care planning so that staff are given specific details of the needs of each resident and how to care for them, realistic goals must be set and care given monitored effectively. Some recruitment records were seen to be incomplete, resulting in the management not being able to guarantee that staff were being employed appropriately. The home needs to ensure that POVA first checks are received before the commencement of employment, a photograph is held for each new recruit and a full employment history is also held. The home has an ongoing training programme for staff, which means that residents will be cared for by skilled staff. However NVQ training needs to continue so that the home reaches the target of 50 of care staff holding this award. This training would provide the home with skilled and qualified carers at all times. The manager is committed to this training. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 8 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. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure enables prospective residents, and/or those acting on their behalf, to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: The home’s service user guide was reviewed and it contained sufficient information for prospective residents to be able to make an informed decision about whether they wish to stay at Weymouth Care Home. In response to the question in the survey “ Do you and/or your friend or relative get enough information about the care home to help you make decisions?” 4 people said “Always” and 3 said “Usually”.
Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 11 The files for three residents who had recently moved into the home were inspected. These showed that the home has a good procedure in place. Prior to anyone moving to the home the manager assesses his/her needs. Sufficient information was obtained so that a care plan could be drawn up and made available to staff. However the social interests and hobbies of prospective residents were not recorded. The manager confirmed in writing to the resident and/or chosen representative that needs could be met by the home. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The care files for four residents were reviewed. Files contained a variety of assessments and this information was generally used to formulate care plans. The care plans seen gave the basic information needed to care for each resident but did not always give specific details, which would have helped in caring for that individual. Examples of this included: • Care plans dealing with incontinence did not give details of incontinence pads used or toileting regimes
Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 13 • • One diabetic care plan did not give clear instructions about what this resident needed specifically. Some plans were not updated in a timely fashion. Instructions in one said that the resident needed to have their fluid intake monitored but on the day of the inspection this was not the case. The goals for care that were set were not always measurable nor did they give realistic expectations. Generally the daily written statements in the care files lacked detail about what sort of day the resident has had, how they have been occupied and whether they were in a state of wellbeing. Medicines were properly stored, being locked away and with a refrigerator for cold storage. Staff record fridge temperatures regularly and the records were seen to support this. Records were kept of the receipt, administration and disposal of medication and examination of these showed that all was well recorded and there was a clear audit trail available. It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, the district nurse, nurse specialists, dietician, chiropodists and opticians. Two GPs completed surveys and all were satisfied with the service provided at the Weymouth Care Home. Residents spoken with were happy with the care they received and staff treated them with respect and were supportive and kind. In response to the question in the survey “Do you feel that the care home meets the needs of your friend/relative?” 4 people said “Always” and 3 people said “Usually”. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are supported to maintain their life skills and are encouraged to make choices as far as possible. Social, cultural and recreational activities meet the needs of some residents. EVIDENCE: Since the last inspection the home has employed an activities organiser. Each resident is given a monthly programme of activities, which includes: • Gentle exercises • Trips out • Flower arranging • Boards games • Communion and church services • One to one sessions • Baking. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 15 These activities are enjoyed by residents but are not necessarily based on the assessed needs/wishes of the residents as these assessments are not routinely undertaken. It was clear through discussion with residents that some of them preferred to arrange their own social activities, which they were free to do and they could spend their days as they wished. “I prefer to stay in my room and I can please myself.” Residents confirmed that they could receive their visitors in private and that they were always made very welcome. One visitor said: “I am made welcome and always offered a cup of tea.” The menu continues to provide choice and the chef was aware of residents’ likes and dislikes. Residents confirmed they could take their meals where they wished and some preferred to eat in their rooms and most preferred to go to the dining room. They said they liked the food offered. Comments included “Excellent.” “Its catering service is very good.” “ Kitchen staff are always very obliging in providing extra meals for visitors.” Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. EVIDENCE: The home has a clear complaints procedure available to everyone. Residents spoken with during the inspection said that if they had any concerns they would feel confident about talking to the manager, knowing that she would listen to them. The home has not received any complaints since the last inspection. The home has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect and some staff have received training in this. In discussion they appear to have a general understanding of local procedures. It is the manager’s intention to pursue further training in this area. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at the Weymouth Care Homes is good providing residents with an attractive, homely and safe place to live. EVIDENCE: The home has a programme of routine maintenance and the home provides a comfortable environment in which to live. Since the last inspection several rooms and corridors have been repainted and refurbished. Records show that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation.
Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 18 • • Lift. Hoists. A call bell system is available in every room. All communal areas, inside and out, were accessible. All areas of the home were clean and there were no unpleasant odours. However the general bathrooms seen appeared untidy and were used to store some general items such as incontinence pads and manual handling slings. This made them uninviting to use. The laundry was well managed and adequate supplies of clean linen were seen to be available. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Sufficient nursing and care staff are employed to meet the needs of residents. Recruitment procedures are not sufficiently robust to protect residents from the risk of unsuitable staff working at the home. Training within the home is sufficient to enable staff to meet the needs of all residents. EVIDENCE: At the time of inspection staff rosters demonstrated that there are sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents and call bells were answered efficiently. However some people spoken with during the inspection said that they had to wait to have their call bells answered. The home has an ongoing training programme, which includes NVQ level 2 in care. The manager confirmed that at the time of inspection less than 50 of care staff held this award but there were further candidates who are working towards attaining it. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 20 Five staff recruitment files were reviewed and they contained most of the relevant information required. It was evident that the POVA first checks carried out were not always received before the member of staff commenced employment. Files did not routinely contain a photograph of the member of staff and application forms did not ask for a complete work history. Training files demonstrated that staff were receiving induction training. Records showed that staff had also received training in many different areas such as: • Fire safety • Food hygiene • Protection of Vulnerable adults • Venepunture • Male catheterisation and catheter care • Enteral feeding • Diabetes • First aid • Moving and handling. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 &38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Since the last inspection Ms Blackledge has been appointed manager. She has not yet submitted her application to register with the Commission for Social Care Inspection. Standard 31 cannot be fully assessed until her application has
Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 22 been processed and approved. However staff and residents spoken with confirmed that there was a good working atmosphere under her leadership. There is an effective quality assurance and quality monitoring system in place. The home takes steps to review its performance regularly and resident surveys are conducted and results analysed and action is taken as necessary. Residents spoken with during the inspection said that the management team did listen to what they had to say. Residents confirmed that they either deal with their own finances or have appointed a responsible representative to do so. This is frequently another family member. The home does hold some “pocket money” for any residents who request this. Clear records are kept of any monies held and how this is spent on behalf of the resident concerned. Records showed that staff had received recent training in fire safety and all had manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP3 Regulation 14(1)(a) (2)(a) Requirement Timescale for action 13/12/07 2. OP7 15 The registered person must not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so – Needs of the service user must be assessed by a suitably qualified or suitably trained person and kept under review (This must include assessment of social needs.) 13/12/07 The registered person must, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. (This must include all aspects of physical, psychological and social welfare and give accurate information to staff as to how needs are to be met. Records should also show whether goals set for the care are being met) The Registered Person must 13/12/07 consult service users about the programme of activities arranged by or on behalf of the care
DS0000020502.V350185.R01.S.doc Version 5.2 3. OP12 16(2)(n) Weymouth Care Home Page 25 4. OP29 19(4) home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. (This must include providing activities based on the assessed needs of the residents.) The Registered Person must not allow a person who is employed to work at the care home unless the employer has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2. (This must include obtaining a POVA first check before employment is commenced; including a photograph of the employee in the recruitment file and obtaining a full work history with the application form. 13/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP18 OP26 Good Practice Recommendations The service user guide should include relevant information about the new manager in post. The registered Manager should continue to seek places on adult protection courses for both management and staff. Bathrooms should be tidy and inviting for residents to use. Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Weymouth Care Home DS0000020502.V350185.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
