Inspection on 26/02/07 for Wick House

This inspection was carried out on 26th February 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wick House 26/02/09

Wick House 09/02/06

Wick House 28/09/05

Wick House 30/03/05

Wick House 26/01/05

Wick House 09/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Wick House Buttermere Liden Swindon Wiltshire SN3 6LF Lead Inspector Stuart Barnes Key Unannounced Inspection 09:00 26th February 2007 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 Wick House DS0000035463.V304824.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. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wick House Address Buttermere Liden Swindon Wiltshire SN3 6LF 01793 641189 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) Swindon Borough Council Valerie Timms Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any person outside the category of `Older People` who was receiving care and accommodation at the home as at 30th October 2003 may remain living in the home, subject to an assessment or review of their needs at least every 6 months that the home is able to satisfactorily meet their needs. That Intermediate care may only be provided for up to 9 people in the area known as the `rehabilitation unit`. That the home may provide care and accommodation for people aged over 55 years and under 65 years so long as they are receiving intermediate care or short term care and that not more than 2 people aged between 55 years and 65 years are accommodated in the home at any one time. For the purposes of this registration the definition of short term, or respite care, or intermediate care, is care and accommodation that does not exceed 8 weeks in any one care episode. 9th February 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Wick House is a single storey purpose built care home that provides care and accommodation for up to 48 older people over 65 years. The home includes a rehabilitation unit that accommodates up to 18 people for a period of typically less than 3 months, 4 crises care beds and 26 long term beds. Additionally there is a day care facility for people who live in the wider community that is integrated within the home. The home is situated in the Liden area of Swindon and is owned and managed by Swindon Borough Council. Those living in the home have their own single bedrooms and there is a large well maintained secure garden. Car parking is available. Typically the home is staffed by 10 care staff per shift covering the main house and 5 staff per shift in the rehabilitation unit. Additionally there are support staff who clean, housekeep, administrate and garden. At night, 4 awake staff cover the whole of the service who also have access to on-call staff if needed. The day centre is staffed separately. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place over two days of which the first day was unannounced and the second day planned. The main focus of the inspection was to benchmark all the core national minimum standards (NMS). The inspector spoke informally with five residents in communal areas and with three residents in private. He also spoke with two care workers in private as well as the manager, deputy manager, administrator and the maintenance manager. Twenty five ‘Have Your Say’ leaflets were left in the home to be distributed to 50 of the service users. However none have been returned before completing this report. The views of health care staff and care managers were also obtained in respect of two of the service users who were interviewed in private, along side the views of two relatives. These views inform the inspector’s findings. Time was also spent viewing various case documentation, policies and procedures and staff files. Due to the impending refurbishment programme about to commence the inspector did not major on the standards associated with the standard of accommodation. Instead it was agreed with the manager that currently some of the accommodation standards fall short of what is required. Fee levels are dependant on the type of care package received and are means tested. What the service does well: What has improved since the last inspection? Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 6 The service is getting better at providing consistently good outcomes for service users. The day activity programme is better focussed, more inclusive and well run. There is more service user satisfaction with the meal arrangements. Managing complaints and concerns about the welfare of service users is much improved. There are more face-to-face supervision meetings than before. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 7 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 Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. 2. 3. 4. 6. Overall the service is good at assessing and meeting people’s needs. There are a couple of very minor deficits with paperwork including people who receive rehabilitation not have any written terms and conditions of residency. The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home provides a detailed service user guide and statement of purpose but this will be need to be updated to take account of changes arising from the proposed refurbishment programme. It will also need to be updated to show the level of fees payable by the service users, the local authority and the primary care trust where applicable. Service users confirm that they are given copies of the service user guide. It was noted that service users in the rehabilitation unit do not appear to have any terms and conditions of residency or contract outlining services and fee levels while those receiving long term care do have such contracts in place. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 9 The Swindon Borough Council contract details what is provided and what is not provided, termination notice, insurance details, extra costs and fee levels. Examination of case documentation in respect of two newly admitted service users confirms the availability of a sufficiently detailed and comprehensive assesment of needs, though in one case a person’s contact and profile details were not fully recorded. Assesment details cover social history, medical history, personal care needs, manual handling and mobility needs, assessment of personal risk and daily notes. From such assessments it can be seen that the service promotes self care and independence within a risk management framework and the service seeks to involve family and others in a partnership of caring. Accidents, incidents, including falls are being recorded. However a person’s M.R.S.A. status was not recorded. There was also evidence on case files of relevant information being obtained from hospital staff when a person was admitted from hospital. The home continues to provide a dedicated intermediate care/rehabilitation service though at the time of this inspection the service was being temporarily reduced, pending the upgrade of the home. Those who receive this service continue to highly praise it. In one case the person’s multi-disciplinary assessment shows they made progress at maintaining skills in dressing, washing, eating, mobilising and communication over a 16-day period. Other files also indicate progress a view confirmed by those who use the service. Service users also report that the home is “nice and quiet where they can relax” but one complained about the “noisy budgies”. A relative described the home as being “excellent” saying that “the staff keep her informed of any concerns they have”. This person illustrated this with the example of the staff phoning her and asking whether they would like staff to go with her mother to buy a new dress or whether she would like to do this. This, the relative said, “showed proper consideration and respect by staff both for her and her mother.” A visiting doctor said that the service is “very good at showing respect, preserving dignity, accommodating personal wishes, and preferences and reporting when people are not able to follow thorough their rehabilitation programme.” They go on to say that the carer model of supervised community rehabilitation works well at Wick House due to the well motivated and trained care staff working in a team environment in partnership with health professionals.” Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7. 8. 9. 10. The service continues to meet most needs very well. People who receive rehabilitation highly praise the service. Assessment, care planning and reviews are being done quite well. Service users praise the staff for the way they respect their dignity and ensure their privacy. There is room to further improve the way medication is managed and administered. The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Examination of selected case documentation provides evidence of good care planning that links with the persons assessed needs. For example one person was encouraged to use hip protectors to reduce the risk of injury. Another person was to be supported with extra continence care. While another case file acknowledged needs arising from some cognitive impairment. The service is now confirming in writing the extent to which it can meet assessed needs. This enables the service user or their representative to feel more confident and to make an informed decision as to whether to take up a Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 11 place or not. Assessments and other case documentation also promote family involvement. In the rehabilitation unit it can be seen that personal goals are clearly identified and that the multi-disciplinary staff team carefully assess how well people are meeting these goals. Sometimes this is done daily. Care plans are being reviewed frequently, some times weekly in the rehabilitation unit and typically monthly in the long-term unit. There is also evidence of a community care or placement reviews occurring. In one review it was recorded that the person was happily placed at Wick House; a view endorsed by their son and the care workers. It was noted that in respect of another person their cognitive impairment was being sensitively and well managed, as was the distressing nature of coping with difficulties around continence, which were being sensitively handled by the service. Case files also show that where applicable service users are supported to access health care services such as the district nursing service, hearing and vision clinics, hospital consultants, specialist nurses and the general practitioner. All three of the service users who were interviewed by the inspector confirmed that they get sufficient respect and privacy when using the bathrooms and toilet. One service user went on to add that they could lock their bedroom door. A service user also recalled how well the home introduced a male carer, allowing her to decide whether she wanted him to bath her or not. Staff that work at the home confirmed that they are told when they first start how important privacy and dignity is. Care workers also emphasised the importance of telling the person what they were going to do before they start carrying out the task. Care workers also highlighted respecting cultural difference as a means of showing respect and being dignified. One service user was keen the inspector should know that staff in the home respond much quicker to the buzzer than hospital staff. Despite the service having a detailed drug administration policy and staff receiving medication training the arrangements for administering medication continue to challenge the home. Two medication errors have been reported in the previous 12 months and as a result some corrective actions were put in place. Care workers report that these changes are now working better but the current system of having two different medication systems one for the main house and the other for the rehabilitation unit continues to give some staff anxiety and worry. The inspector checked one person’s medication record and found an error in respect of the person declining a drug as this was recorded as having been taken by the service user. The manager explained that probably what happened was that one carer took the drug to the resident and another carer recorded it as having been given but the service user declined their medication and the record was not corrected. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 12 The local chemist has recently undertaken an inspection (Feb. 07) and according to the manager the verbal report raised no significant issues of concern. The written report from the chemist is still awaited. The fact that the service has reported two medication errors to the Commission shows that the home has an open error reporting system. The Commission is satisfied with the way the service dealt with both of these incidents. Records show more staff are undertaking medication training. It is policy that newly appointed staff do not undertake medication duties until they have successfully completed their probationary period and that Agency staff are not permitted to assume a medication lead. Medication appeared to be safely stored and records show that unwanted/unused drugs are returned to the chemist. A visiting doctor also confirmed that the staff tell them when their patient declines medication. When an incident of diarrhoea and vomiting occurred in the home this matter was dealt with in accordance with agreed protocols and in partnership with the local health protection agency. Service users report that they can access the medical services they need. One person said that a lady doctor called in on her not because she was ill but because the doctor was just keeping an eye on me-something the person found very reassuring. Another service user confirmed that they could access the optician and that both in an emergency and once a week the doctor calls. Another service user said, “though we are old we should not be treated like an imbecile and here we are not treated as imbeciles”. One of the social workers who provided their views on the service reported that two permanent staff have the right skills and experience to support individuals living in the home – but there are issues with bank staff [agency staff] who don’t always have the right skills”. They go on to say the service is good at supporting service users helping them to become more confident and secure. A visiting doctor commented that the “staff are very attentative and make good observations.” This doctor said that they had never seen any examples of any poor performance in respect for providing people with dignified or respectful care in either the rehabilitation unit or in main house.” Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11. 12. 13. 14. Service users report that they have quite a bit of choice in what they do and staff work hard to encourage residents to be as independent as their condition allows. Some, but not all, residents have the opportunity to attend a day activity programme. Some residents hint that on occasions they have to wait for a bath. Family involvement is both welcomed and encouraged and there is good service user satisfaction regarding the meal arrangements. The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 14 EVIDENCE: Service users report that they can exercise choice in a lot of what they do. They can for example choose what to wear, whether to take meals in the dining area or their room and whether to spend their time in the communal rooms or in their own rooms. Service users also confirm that they can go to bed at a time of their choosing, though closer examination of these options suggests that their frequency partly depends on the availability of staff and the degree of perceived risk. The home offers people who want it the opportunity to engage in craft and other activities. The inspector observed one of these sessions when approximately eight service users were making Easter cards. A feature of this session was that there were two workers who were able to the people attending support and encouragement quite unobtrusively. It was evident too that those taking this session were enthusiastic about the class and that the session had a club like atmosphere where social engagement and meeting for a purpose were interwoven into a happy and constructive environment. It was also noticed how those less able due to physical conditions such as arthritis were given extra support and help. While service users affirm there are things to do some also said that on occasions “they get a bit bored” or “I don’t do anything.” but in doing so they did not portion blame to any one. No service user made any comment about the lack of choice or autonomy though there were some hints that at times people might have to wait for a bath. The home is using a four weekly repeating rota that is adjusted to seasonal fluctuations and the weather. Service users report good and improving satisfaction levels with the meal arrangements. The kitchen is ideally situated so that service users pass it by on the way to the dining area and lounge. This provides them with an opportunity for informal contact with the chef and cooking staff. Information such a personal likes and dislikes, favourite menus and special diets are kept by the chef and displayed in the kitchen area. It also includes information as to where service users wish to take their meals. Service users mostly praised the food arrangements. Their comments included; • • We get a good variety – something different every day. It is pretty good, no cause to complain and today breakfast came to me with milk and tea in a pot and cereals. I am able to have to have the main meal in the dining room. I always have something different and staff come to collect me for my meals with a wheelchair. The food is very good, the menu is not too bad – several cereals to choose from in the morning and sometimes sausage or bacon or porridge – and cups of tea well almost every 5 minutes. I make my own. DS0000035463.V304824.R01.S.doc Version 5.2 Page 15 • Wick House Wick House DS0000035463.V304824.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. 17. Complaints and concerns about poor practice and alleged abuse are taken very seriously and acted upon. A recent increase in the number of concerns and allegations raised needs to be carefully monitored. The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 17 EVIDENCE: There were four complaints recorded in the register of complaints, including in one case an example where a care worker reported a concern about the competency of an agency staff member. This shows that staff are using the ‘whistle blowing’ policy to ensure the protection of the residents. All four complaints appear to have been concluded with the complainant advised of the outcome where appropriate. This is a service where any concerns about safeguarding adults are taken seriously and acted upon within the local safeguarding adult protocols. Issues dealt with under these protocols in the past year include allegation of poor care practice and alleged theft of monies belonging to service users. In total there were four recorded incidents (notified events) when service users’ alleged that some of their money was missing. As a result the police carried out an investigation. No charges were brought but according to the manager these incidents stopped following the police becoming involved. The police also investigated one person’s death but following their investigation they concluded there were no suspicious circumstances. Another incident occurred when a service user went missing from the home and was found unharmed in the local supermarket. Following this incident the service undertook a review of the garden security and no such incidents have since occurred. Discussion took place with the manager why at this inspection there was an increase in the number of reported events. The manager thought this reflected greater staff awareness of the reporting process rather than a reflection of anything sinister. One service user mentioned that, “[service users] are allowed to report staff if they are nasty.” Care workers report and staff records confirm that they are provided with awareness training in adult protection and preventing abuse. Copies of the local ‘No Secrets” protocols and the General Council of Social Care (G.S.C.C.) code of conduct were available in the home. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 26. The environment is looking tired in places but the refurbishment programme will address these concerns. There is a lack of certainty as to whether the way hot water is stored is safe. Care needs to be taken to ensure the home is kept clean at all times, especially toilets. The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home is about to be refurbished. This has resulted in the number of service users currently being accommodated being reduced for a temporary period. The manager was not able to verify whether the fire safety officer has been informed of the date of commencement of the building work though she was able to confirm that the fire officer knew of the plan to refurbish the home. The fire officer needs to be informed of the commencement date so they can clarify and confirm any expectations re fire safety during the building programme. The manager undertook to inform the fire officer of the date of commencement. Other systems appear to be in place to ensure that the refurbishment will be undertaken in a safe way and be appropriately risk assessed. There is a fire risk assessment in place, which when audited by the safety manager was said to be “excellent”. Records show that for the first two months of the year over 66 of staff had undertaken fire instruction. The requirement is 100 for each 3-month period so the service is on track to meet this requirement. Records show that annual servicing of the fire extinguishers was slightly over due. The manager undertook to chase up the contractor to carry out this work. It is accepted by the manager that some communal area areas such as the toilets and lounges need some refreshing. It is accepted that these matters will be addressed as part of the refurbishment of the home so the commission will not be making any requirements in relation to these matters. Generally speaking most areas were reasonably clean and tidy, though one toilet was left unclean for several hours. This suggest that staff were not checking toilets often enough. Some areas looked tired including some carpets. Discussion with the manager and the maintenance staff suggest that there is some confusion as to whether the home will ensure that water is stored at a safe temperature to prevent legionnaires disease and that water is distributed to baths and wash hand basins at a safe temperature to prevent accidental scalding. The service is praised for supporting housekeeping staff to undertake National Vocational Qualification (Level 2) training in infection control. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27. 28. 29. 30. The dependency on using agency staff to ensure sufficient staff cover has caused some concerns for permanent staff and for some service users. These concerns need to be addressed. Permanent staff are being well trained. While recruitment is quite well done there are three areas where this can be further improved. The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Examination of the rotas show that the home is adequately staffed but that this is dependent on the use of agency staff. The number of agency staff appears to be reducing with a figure of over 943 hours covered during a 4 week period commencing 25 Nov 06 and only 252.5 hours covered for the 4 week period commencing 20 Jan 07. While agency staff clearly make a valuable contribution to this service there are concerns about the impact of so many agency staff working in the home. Concerns have been expressed in staff meetings about the impact of so many staff shortages. In one care workers supervision record it was recorded that “high levels of agency staff … [were] resulting in unacceptable levels of stress to permanent staff.” A staff member commented that when they first started work in the home they got the distinct impression from residents and from Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 21 colleagues that, “here is another new staff member to get to know.” A care manager expressed their concern that there were not always enough staff on duty and as a result those staff working feel under pressure to get the job done – there by doing for the service users rather than encouraging the user to do for themselves.” One service user reflected that while they can have a weekly bath sometimes there is not enough staff to have two or more baths a week. Another service user commented that on occasions they are kept waiting too long – another indication of staff shortages. The manager’s view was service users can ask for a bath at any time but there are service users who think staff are too busy when they are not; though conceding that in the mornings people may need to wait. Another service user commented that there are so many staff changes they can’t remember their names.” All staff who provide personal care are aged over 18 years and all staff who have supervisory responsibilities are aged 21 years or over Staff training records confirm that nearly all permanent staff (35) excluding recent new starters, have successfully completed their National Vocational Qualification at level 2 or above. The system for recruiting staff is well established. It is underpinned by detailed equal opportunities policies, however since the application form does not ask for the dates when previously employed there does not appear to be a sufficiently robust system in place where those appointing staff can query whether there were any un-explained gaps between jobs. The manager said the reason for not asking for this information in the application form was to ensure there was no direct or indirect age discrimination in the short-listing process, as required by law. However at the point of interview there is an opportunity to verify the reasons why someone might have some gaps in their employment history as a further safeguarding measure. Neither was it clear in the records kept in the home as to the status of the persons criminal record bureau check (CRB) i.e. whether they were at the standard or enhanced level. In one case the council were relying on their own template reference request which means that they cannot be certain that the person completing the form are indeed a representative of the company employing the person and acting with the authority of the persons previous employer. However of the three staff files that were checked all references appeared to validate the person had suitable personal and professional qualities commensurate with the position. Staff confirm that they are provided with the G.S.C.C (General Social Care Councils) code of conduct, which they are expected to adhere to. Examination of training records show that care workers can and do access a range of awareness raising training courses relevant to their job role. This includes areas such as continence care, hygiene and infection control, dementia care and safeguarding adults. Records also confirm that care workers receive training in the key areas of first aid, fire safety, medication, moving Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 22 and handling and health and safety. However in a care workers supervision notes there was a comment that some agency staff are “inadequately trained in cleaning and catheter care” and while discussion with the manager said this comment related to an individual worker, concerns have been expressed that agency staff sometimes lack sufficient confidence or awareness in all that is expected of them. Where a home uses so many agency staff it is incumbent of the home and along side the agency to ensure that agency workers have the required experience; and that they can carry out the tasks expected in a competent manner. There is some evidence to suggest that there are barriers between the home and the agencies providing staff to work within a collaborative framework that ensures good outcomes for all service users. Recent new starters are being supported to undertake induction in accordance with the standards as outlined by the relevant skills council. Service users who were interviewed reported that the staff were, “gentle and kind” and indicated that they were satisfied with the personal and professional qualities of the care workers. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31. 33. 35. 36. 38. This is a well managed service where the management team are getting better and better at promoting good standards of care and protection. Systems for assuring quality and getting customer feedback is beginning to be translated into even better services. Care needs to be taken to ensure all staff have sufficient face-to-face meetings with a competent supervisor. There are effective systems of communication between staff at all levels and the management team. Managing service users money is well done. The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 24 EVIDENCE: The service benefits from having a suitable, qualified competent and experienced manager who is deemed a ‘fit person’ to manage this home. It also benefits from being part of the local authority, making it possible to access a variety of specialist or dedicated services that can support the homes main objectives. These include specialist departments for; customer care, finance and human resources. According to the manager there is no current quality assurance policy written for the service but the council have been awarded the Investors in People accreditation. Not withstanding the absence of a detailed written quality assurance policy the manager has actively developed better “customer care” initiatives. This included sending out questionnaires on a quarterly basis to service users, outside agencies and relatives and friends of service users to cover themes such as diversity, choice, equality. There are plans to follow up this work by sending questionnaires on aspects of health and personal care, staffing and finally the standard of accommodation and comfort. Examination of the responses received appear to show mostly positive comments along side a small number of suggestions for improvement. For example relatives said they would like the opportunity to eat a meal along side their family member and would like more information on how to complain. The manager said both these comments had already been actioned. Comments from service users were mostly complimentary but again some respondents asked for more information about how to complain. The results of these surveys are made known to the service users. Feedback from health care professional raised no significant issues of concern. The system for supervising staff appears quite well established. There is a dedicated staff supervision policy. The records of two staff selected at random were checked and both these found that structured face to face meetings between care worker and supervisor are taking place but not at the frequency of every 2 months. The manager explained that during the pre Christmas period it was not possible to provide all staff with a supervision meeting. Much better done is the opportunity for staff at all levels (including night workers) to periodically meet with a manager. Examination of the minutes of these meetings show that they are used to thank staff for their efforts and endeavours, to prompt staff to undertake specific tasks such as undertake laundry tasks, to discuss issues around health and safety or specific challenges arising from various residents care needs and for staff to share any concerns they may have. The manager has recently introduced a buddy system for new starters and this is said to be working well. There are well established procedures in place for reporting incidents and accidents. These include informing the Commission of any significant occurrences. It is policy to complete an accident/incident report if anyone has a fall. Records show that in the previous 12 months twenty two service users Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 25 were taken to hospital mainly as a result of having a fall or at the request of the general practitioner. The manager talked of her concern that some service users who have a fall may have to wait for an ambulance or are not being taken to hospital. However since this is a care home care workers cannot possible know if, following a fall, someone has a fracture; and it remains appropriate for the home to continue to seek medical attention at a hospital in such circumstances. Approximately half of the service users have arrangements in place to help them manage their moneys, including nominating a separate power of attorney. There are well established systems in place for the checking and recording of moneys held by the home of behalf of those service users who do not wish to hold on to their own money. Two such records were randomly checked and were found to be satisfactory. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 5(1)(C) Requirement Timescale for action 01/06/07 2. OP19 23(4) 3. OP19 13(4) 4 OP30 18(1) The service user guide must be updated to include a standard form of contract and recent changes to the service. The planned refurbishment 01/05/07 programme must not commence until the fire safety officer has been informed of the start date and been given an opportunity to comment on aspects of fire safety that might arise. The registered person must 01/09/07 ensure that any water stored must be at a temperature to prevent an outbreak of legionnaires disease but distributed to baths and wash hand basins at a temperature, which is safe to prevent accidental scalding. The induction process of agency 01/06/07 staff and checks on their competency must be improved to ensure that service users are not put at undue risk. Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 28 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. 4 Refer to Standard OP27 OP26 OP29 OP29 Good Practice Recommendations It is recommended that the service undertakes to review if the arrangements for providing service users with a bath or shower meets the needs of each service user. It is recommended that a review be undertaken of the cleaning schedule of the toilets used by residents. It is recommended that all staff that are interviewed for a post at Wick House be asked to explain any gaps in their employment. It is recommended that those recruiting staff for Wick House ensure that any reference provided received from the most recent employer is validated by a company stamp, letter head and confirms of the persons name and job title so as to ensure its authenticity. It is recommended that the number of face-to-face supervision meetings between care workers and their supervisors be not less than every two months. 5 OP36 Wick House DS0000035463.V304824.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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