Inspection on 28/09/05 for Wick House

This inspection was carried out on 28th September 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 but made no statutory requirements on the home.

Other inspections for this house

Wick House 26/02/09

Wick House 26/02/07

Wick House 09/02/06

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 Announced 28 to 30 September 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 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 DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Wick House Address Buttermere Liden Swindon Wiltshire SN3 6LF 01793 641189 01793 525199 timmsv@swindon.gov.uk Swindon Borough Council 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) Valerie Timms Care Home 48 Category(ies) of OP Old age registration, with number of places Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Any person outside the category of `Older People` who were 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. When the home has a vacancy after 1st April 2004, this vacancy must not be filled until such times as the home is able to recruit the full time equivalent of 22 care staff in substantive posts. Any such calculation must not include staff solely designated to work in the day care facility, the home manager and ancillary staff such as administrators, cooks, cleaners, housekeepers and gardeners. Full time is defined as 37 hours per week Date of last inspection 30 March 2005 Brief Description of the Service: Wick House is a single storey purpose built care home that provides care and accomodation for up to 48 older people over 65 years. The home includes a rehabilitation unit that accomodates up to 18 people for a period of typically less than 3 months, 4 crisis 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 rehabilitaion 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 DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The term resident and service users used throughout this report are interchangeable and mean the same thing. The home has a relatively newly appointed registered manager. This inspection, which was by appointment, was carried out over 3 days, totalling 20 hours. Prior to the inspection the Commission sent out questionnaires to the people living at the home and received 17 responses. They also received 5 responses from relatives/visitors and a detailed preinspection questionnaire from the manager. The first day of the inspection was spent mainly with the manager progressing plans to partly refurbish the home, progress the recommendations and requirements made at the previous inspection, checking on the staffing arrangements, sampling various case documentation including service users files; and examination of various policies and guidance. On the 2nd day the inspector continued with examination of documents relating to staff but most of the time was spent talking to service users and getting their views. On the 3rd day, time was mainly spent wandering the communal areas talking informally to groups of service users as well as talking to them in private. In total 11 service users were spoken to. Time was also spent talking to staff in private and getting their viewpoint. At the end of the inspection feedback was given to the manager. The inspector also observed 2 fire drills. What the service does well: What has improved since the last inspection? This is a much improved home, benefiting from having a new manager. Assessment of needs and care planning has further improved. The service now provides written terms and conditions of residency. More activities are now being provided; ones that the service users say they want. The way complaints Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 6 are handled is more effective. Staff morale is good. Supervision of staff is an improving area. The management of records has improved a lot. 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 DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 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 standard(s) 2, 3, 4, 5 and 6 Services users and their family are welcome to make pre-placement visits where they can get information about the service. Overall the assessment standards are mostly satisfactory but more attention is needed to ensure that people applying for a place are informed in writing the extent to which the service can or cannot meet their needs. Service users report good satisfaction levels with the care they receive. People who receive intermediate care continue to have very high satisfaction levels. EVIDENCE: Five case files were examined and each had up to date terms and conditions of residency detailing the services to be provided and period of notice required. Case files include personal profiles and daily care programmes. There is a range of relevant assessments in place including risk assessments, manual handling assessments as well as need assessments that inform the daily care programme. Those accommodated in the rehabilitation unit benefit from specialist assessments that include physiotherapy, occupational therapy or other specialist health care workers. Care programmes include where relevant; attention to personal care, safety issues, history of falls, issues around communication and general welfare. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 9 It was noted that Wick House staff had not reassessed several residents who were admitted from another council care home when it closed down and that these residents had not been told in writing whether Wick House could meet their care needs. Sixteen out of 17 service users who sent in comment cards said they felt well cared for. The one person who did not agree said that only sometimes did they feel well cared for. All 17 respondents indicated that the staff treated them well and all 17 said that they felt safe in the home. Several service users praised the staff for the caring qualities. For example one person said, “ The staff are very helpful.” Another said, “The carers are very good and will do anything” [for you]. A relative also affirmed the quality of the care provided to their grandparent by saying, “ I am happy with the care provided.” Another resident who had lived in the home for over 8 years said, “The staff are very caring - they give you tea in bed and if you want a book they will find it for you and they will take you for a walk sometimes”. Two resident qualified their compliments by saying that; “staff are too caring – they will stay with you in the bathroom but you don’t want them to do this all the time.” Another person simply exclaimed that the staff were, “wonderful – except for one person….” Records show that potential applicants have the opportunity to visit the home before accepting a place. A recently admitted service user confirmed this was so. Relatives also confirm that they are invited to visit the home before someone takes up a place. However people who are admitted from hospital and are placed for rehabilitation can miss out on getting introductory visits. This needs to be guarded against. Those placed for rehabilitation benefit from having specialised facilities and specialist staff who can support them through their rehabilitation. Relatives also confirmed they are appropriately informed of any changing circumstances and that they were satisfied with the care provided; though a couple of relatives queried whether there was always sufficient staff on duty. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 The way certain interventions are recorded is not fully satisfactory since it is not always obvious from the daily records if the care plan has been carried out as prescribed. This said, care planning has improved. Satisfaction levels with access to health care workers is high and residents confirm staff show them respect. EVIDENCE: Daily care records and individualised care programmes show what care is needed. For example in one case file it shows that when a person’s physical condition deteriorates staff respond by giving extra care and attention. Other examples include comments such as the service users, “ likes her hair done weekly” or “needs prompts with eating and drinking,” or “ [staff to] encourage person to do as much as is possible for themselves,” or “staff to stay with the person throughout any personal care tasks.” There are examples when records indicate when and where service users like to take their meals and their preferences for being mobilised. Records also show staff report any unusual conditions such as, “ face [appears] strained one side, or “[noticed] small rash. Less well evidenced is the frequency and manner in which care staff provide the care required or prescribed. For example for one person assessed as needing hourly checks at night the daily record does not Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 11 record that these take place. In another example a record was made that a person was, “very depressed and wanting to take some tablets to end it all,” but it was not clear from the records how the staff responded to this. A record reported that a person’s dentures were missing but there was no record to show they had been found or how to reduce such occurrences happening again. Notes also show that on occasions the manager has to chase up staff to complete incidents reports. According to the manager these cameos indicates a recording deficit more than a failure to provide the care or support needed. This may be so, but some comments from service users suggest some inconsistencies and these need to be eradicated. It was suggested by one care worker that on occasions some residents get a delayed bath due to changes in the system of giving out medication. This concern was discussed with the manager and other staff. It was felt that the home needed more time to bed the new medication system down and to monitor any delays in personal care that occur as a result of the change. No service user made any negative comment about the way personal care is provided, except one person hinted they might want to be left alone in the bath. Examination of one of the randomly selected case files shows that staff support service users to access health care staff. To illustrate for one person in one month they were twice referred by staff to their GP, assisted to attend a hospital appointment, seen by a occupational therapist and by a physiotherapist. There is also evidence in many case files of good networking with the local continence advisor. A policy on tissue viability was not in place. Staff report there are good working relationships with community nurses, dieticians and GP surgeries. Service users confirm that they can access their GP when they need one and that they are satisfied with the medical care they receive. The records also show that staff give appropriate attention to some of the fears and anxieties expressed by older people. For example in one file it reports the person has, “reoccurring bouts of depression” and in another person’s file it states; “person feels low in mood and [is having] disturbed sleep.” It was also noted from a survey of the home recently undertaken by the manager and from daily notes that residents talk to staff about their wider concerns such as feelings of loss and detachment from their families or wanting more [emotional] contact time with the care staff. The fact that such issues are acknowledged and bought out into the open suggests this is a caring home and a care home where staff are sensitive to peoples feelings. To further illustrate this it was noted that for one recently admitted person care staff went out of their way to check on the person two or three times each day in the first few days to give reassurance. The service user guide and statement of purpose underline the requirement of staff to promote privacy and dignity. Staff report that these areas are covered in their induction/training. Except for one comment by a service user that it is not nice having to share toilets the service users confirm the staff respect their privacy and dignity. Two service users spoke about their feeling that on occasions staff might be too Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 12 intrusive. For example person felt they did not need staff to assess their capability to dress themselves and another commented about staff being always present throughout their bath time. Examination of the respective case files and discussion with the manager indicates that such responses were appropriate to the circumstances. However these residents concerns suggest more needs to be done to help residents understand and accept the need for such intrusive care. It is policy in the home that any mail is given to service users is unopened. Staff are wiling to help people read mail if asked to do so. Case files indicate each person preferred form of address. Residents may have their own telephone line installed in their room, if they are willing to pay for it. Alternatively calls can be taken on a payphone, which offers a degree of privacy or in an office, which is less private. The arrangements for administering medication in the rehabilitation unit were checked and were found to be satisfactory. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 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 standard(s) 12, 13 and 14 There have been recent improvements in the amount of activities provided but some residents say they still want more activities or different activities. The introduction of a film and craft club has been uplifting. Relatives appear well received when they visit the home. Policies and practice promote privacy, dignity and independence. Service users can be involved in the running of the home. This is an area where the home is improving. EVIDENCE: Five out of 17 respondents who returned comment cards said that they would sometimes time prefer to be more involved in the running of the home and the same number said they would like more or different activities. Several people said, for example; “They like the company they find at Wick House” or “I have made good friends here.” Several service users said they would like to go to the shops occasionally or to a garden centre. In practice these options are dependant on staff good will as they typically fall outside normal duties. Since the last inspection staff have given more attention to the promotion of activities. The homes own quality survey reports quite good satisfaction levels by service users in respect of activities and involvement. Resident meetings indicate that staff are trying very hard to meet these needs. One of the staff has been innovative and established a film club. This is something several residents said they would like and they confirmed that they can suggest suitable films for watching. An opportunity to do craft has been extended. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 14 The service is quite good at taking into account the views of residents about things such as food preferences, redecoration of rooms preferred use of names. Resident meetings are held from time to time, typically every other month. Minutes of these meetings show that a wide range of issues are put forward and followed up. For example there was a suggestion that instead of having individual times for meeting the chiropodist the chiropodist should have an open surgery. Another matter raised by a service user was that the toilet tissues were packed to tight to easily extract the tissue – so the manager has arranged a different supply. One recently admitted service user said they would like to be more involved in the home and attend the day centre but that they didn’t know how to become more involved. They said that they did not feel “fully integrated” into the home. This suggests more needs to be done to support integration through activity sharing. Paradoxically discussion with staff suggests that their attempts to involve residents more in activities and in the running of the home are not always successfully. Those accommodated in the rehabilitation unit were much more likely to confirm that there was plenty to do with some of them saying that to do more would make them rather tired. Feedback from relatives confirm that they are well received at the home with comments such as; “staff are very approachable” or “I can talk to the staff at anytime if I want.” The policy of the home is to encourage service users to be as independent as possible and to exercise choice. Service users confirm that they can go to bed and get up when they want to and that they can choose between staying in their own room or sitting in one of the communal lounges. Care plans indicate people’s personal preferences for getting a bath and their preferred routines including where to take meals and whether an early morning drink is required. Almost without exception service users personalise their rooms with memorabilia and if want they can and do bring with them small furniture items. Residents are encouraged to manage their finances or to have a family member (or advocate) to do this for them. If necessary the service can offer help in this area. There are well established protocols in place to ensure proper accountability and record keeping if the home handles resident’s money on their behalf. Residents can manage their own medication but only if they are assessed as being safe to do so. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 15 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 standard(s) The new manager shows a commitment to addressing residents concerns and especially their complaints. The manager shows that dealing with any expressed complaints is an opportunity to improve the care provided. This is refreshing and reassuring. It shows a big improvement. EVIDENCE: Service users are informed of the way to make a complaint in the service user guide. All the service users who completed a comment card confirmed that they knew who they could contact if they were unhappy with the care they receive. The home keeps a register of complaints. It shows 2 recent entries. One alleges that an unnamed care worker was rude and impatient when a resident used their alarm call. The other was a resident wanting the menu to be more varied. The response to these complaints appears appropriate to the circumstances and in the first example included involving a relative in the solution. Evidence was found of the service making staff accountable for (any) poor practice through management review including disciplinary action and routine supervision. It was evident from discussion with the manager that she will ensure complaints are followed up. There has also been an improvement in following up any expressions of minor niggles or concerns by recording these in daily notes and given them more attention than before. The home also keeps a record of compliments received. These are mainly from relatives of residents or residents who have left Wick House and returned home after a period of rehabilitation. The number of compliments far outweighs the number of complaints. Compliments typically state; “absolutely wonderful treatment and love and care by all the staff” or “[I] have been very Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 16 pleased and satisfied….” Another thanked the home for the; “outstanding care and compassion shown to their father.” Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: On this occasion none of these standards were fully inspected. However it is noted that parts of the home have been upgraded and improved since the last inspection and that more upgrading and refurbishment is planned in the next 6 months. This will include some re-carpeting and redecoration, installation of an improved fire prevention system and call bell system. The fire safety measures were inspected by the fire safety officer of Wiltshire Fire Brigade in July 2005 and were assessed satisfactory. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. It appears that increasing the number of rehabilitation beds, all be it temporarily, is putting a strain on the service. The number of current staff with National Vocational Qualification level 2 or above exceeds the standard. EVIDENCE: Some relatives and some residents indicate that on occasions there may not be enough staff on duty. Several residents said that staff were [often] very busy, but more said there was enough staff on duty. Staff also commented that on occasions there was a shortage of staff or insufficient staff. They cited weekends sometimes being a problem especially if someone fails to turn up at short notice. Staff in the rehabilitation unit expressed their concerns about the impact of the home having increased the number of rehabilitation beds from 9 to 18. They said there are problems when there is a person being admitted and discharged on the same day. They also said that when the rehabilitation unit is full or nearly full, “it is not always possible to get everyone to complete their therapy goals” and that, “rushing people to complete therapy was counter productive and could set back peoples recovery.” It was also said that the practical difficulties of ‘spring cleaning’ the bedrooms that were used by a departing resident (so as to prevent cross infection) in time for the new resident was getting more difficult because of having more admissions and discharges closer together. Paradoxically it was reported that recent changes in the way staff were deployed in the long term unit was beginning to improve the way personal care was being delivered, though one person expressed a contrary view. Examination of the rotas shows that to provide adequate staff cover the home Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 19 is dependent on using agency staff. Records show that 39 different agency staff were deployed in the home for a 2 month period i.e. 7/05/05 to 2/07/05 though not all of these people provided direct care to residents. At the time of the inspection the home had vacancies for daytime care staff (75 hours), night staff (15 hours) housekeeping and kitchen staff (47½) hours. The home deploys 4 people at nights. The 4th person is an extra person to take account of the increase numbers in the rehabilitation unit. This level of night staffing is considered adequate. Staff confirm that they are encouraged to attend training courses and impress as wanting to learn and to improve their skills. The home exceeds the current standard for the number of staff who have successfully obtained a relevant National Vocational Qualification level 2 or above. Records show that in total 21 staff have obtained level 2 and 5 staff have attained level 3. Records also show that in the past 12 months selected staff have either undertaken training in; basic food hygiene, deaf awareness, dementia awareness, equality awareness, fire safety, first aid, managing medication, moving and handling and stoma care. All care staff are aged 18 years and over and all supervising staff are aged over 21 years. The staff group shows a good mix of age and experience and includes male staff as carers. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37 and 38 A feature of this inspection is the noted improvement in managerial and professional accountability evident throughout the home. There is scope to further improve the effectiveness of the current quality assurance system by increasing the range of views obtained. Staff impress as wanting to keep the residents free from harm but safety measures would be further improved by having a better templates for recording risk. The communication link between staff at all levels appears to be effective. EVIDENCE: An experienced and competent manager manages this improving service and is deemed by the Commission as a ‘fit person’ to manage such a home. They have completed their National Vocational Qualification level 4 managers award. More spot-checking is taking place, systems seem better organised and offices are better working environments. Places are tidier and staff verify that the new manager is improving the home. The manager periodically meets with her staff including night staff and examination of the minutes of these meetings show a Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 21 good balance between staff matters and matters concerning the care and welfare of the residents. Care staff report that the manager is supportive. One area where there is some inconsistency is the opportunity for care staff to regularly meet in private with their supervisor. Some staff described it as being; “ regular and concentrating on training and development [of skills] and being quite structured and helpful.” Another person recalled the last one to one meeting as being 5 months previous. Records do show that since July 05 a regular and fairly consistent pattern of one to one meetings has been established. Prior to this it was less so. Records show that 12 different people provide on to one supervision; a number, which in the opinion of the inspector makes it harder to ensure a consistent approach. There is evidence to show that the manager periodically and systematically checks that supervision meetings do take place. Questionnaires are used to formally obtain the views of service users and/or their families; the response to which are taken seriously and acted upon. The current development plan for the home focuses on the need to refurbish the home and to increase the range of care provided. It is evident that current service users are beginning to benefit from the development plan being actioned. Since the last inspection there has been an overall improvement in record keeping. For example it was observed that files and documents are kept tidier and are better organised. It was also observed that the standard of record keeping in the rehabilitation unit is better than in other parts of the service. Minutes of staff meetings and supervision notes indicate that care staff are reminded of the importance of accurate record keeping. This said, there is still room for improvement. The following records were selected at random and were found satisfactory; accidents and incidents, fire prevention log, terms and conditions of residency and hot water temperatures. The following records were not satisfactory; there were no monthly management reports as required under Regulation 26 of the Care Homes Regulations 2001 for the previous 3 months. Comments concerning record about residents have been detailed elsewhere in this report and will not be repeated here. The service benefits from a comprehensive list of policies and procedures including best practice guidance in key area such as; safeguarding older people from abuse, complaints, fire safety, infection control including MRSA, missing persons,’ whistle-blowing and numerous policies in relation to staff matters. One policy not found was a policy on tissue viability. Details about the experience and qualifications of agency staff are inadequate. Matters of safety appear to be taken seriously. Fire safety measures are satisfactory. The inspector observed a fire drill. It appeared to be well managed and well rehearsed. The service provides training in health and safety, fire prevention, first aid, managing medication, and in the moving and handling of people. It can be seen action is taken to reduce cross infection and awareness of MRSA has improved. Written assessments of risk appears a little muddled and a bit ‘hit and miss’ with some documentation not being up to date or missing on some residents. Residents report feeling safe at the home. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 22 It was observed that service users had difficulties recalling the name of key staff; and that staff do not wear any name badges. Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 2 3 3 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 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 3 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 2 x x 2 2 2 Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14(1)(d) Requirement Timescale for action 30/12/05 2. OP27 16(1) 3. OP38 26(2) 4. OP28 18(1)(a) The registered person must ensure that all residents recently transfered to the home receive in writing confirmation as to whether the home can or cannot meet their care needs. The current number of 30/11/05 rehabilitation beds must be reviewed. Any such review must take into account the concerns of staff about having 18 such beds in the home. The responsible person must 01/11/05 ensure that for each calendar month a suitable person undertakes an unannounced visit to the home and writes a report as to the conduct of the home; a copy of which must be left in the home and sent to the Commission. The person in control must detail 01/11/05 to the Commission what protcols are in place to ensure that the manager of the home has verifiable information as to what relevant training has been sucessfully undertaken by each named person deployed by agencies, including the date such training was undertaken. (Note Version 1.30 Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Page 25 this requirement is carried over from the previous inspection where a timescale of 30/05/05 was set. 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. Refer to Standard OP7 Good Practice Recommendations It is recommended that where residents require supervison of their personal care consideration is given as to how best to explain why such supervison is needed and to get the view of the resident as to whether they regard it as intrusive or not, and if so how best to limit such feelings. Further consideration should be given as to the best way to help newly admitted residents fully integrate into the home and how staff can promote friendship through activity sharing. It is recommended that the number of staff who are delegated to provide one to one supervison is significantly less than 12. It is recommended that there is a policy and/or guidance on tissue viability which relevant staff can reference. It is recommended that all assessments relating to each service user is kept in the same place on that persons case file and that a consistent format is used throughout. In the interest of helping service users to get to know staff, consideration should be given as to the staff wearing name badges. 2. OP7 3. 4. 5. 6. OP36 OP37 OP38 OP38 Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 Page 26 Commission for Social Care Inspection Suite C, Avonbridge House Bath Road Chippenham Wiltshire 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. Extracts may not be used or reproduced without the express permission of CSCI Wick House DD51_D01_S35463_WICKHOUSE_V233254_280905_STAGE4.doc Version 1.30 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. 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