CARE HOMES FOR OLDER PEOPLE
Wickmeads Thornbury Road Southbourne Bournemouth Dorset BH6 4HR Lead Inspector
Trevor Julian Unannounced Inspection 11th October 2005 10:30 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 Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Wickmeads Address Thornbury Road Southbourne Bournemouth Dorset BH6 4HR 01202 427144 01202 427144 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) Care South Care Home 38 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (38) Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 38 in the category OP (Old Age) including up to 6 in the categories DE(E) and/or MD(E). The home may accommodate one named service user (as known to the CSCI) under the age of 65. 16th June 2005 Date of last inspection Brief Description of the Service: Wickmeads is a care home providing personal care and accommodation for 38 older people, 6 of whom can be people with mental disorders or dementia. The home, which is part of Care South – a not for profit organisation - was being managed by Mrs Maureen Anderson who had transferred from another home to fill the vacant post. A registered manager’s application was in progress at the time of the visit. The home is located in the Tuckton area of Bournemouth close to the shops and the river. There is on street parking available outside the home. Public transport is accessible with buses travelling to both Bournemouth Town Centre with all its amenities and beaches, and Christchurch. Accommodation is provided in single bedrooms located on the ground and first floors. None of the rooms have en suite facilities but there is ample bathroom and WC provision on both floors. Two lounges and a sun lounge / conservatory are situated on the ground floor. The décor in the home is attractive and the rooms are comfortably furnished. There is a separate dining area and seating in the spacious entrance hallway. The home has a passenger lift to enable easy access to both floors. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 11th October 2005 between 10:30 – 15:30. The total inspection time was 14 hours, this included travelling, preparation, inspection and report writing. During the visit information was gathered through discussion with residents, visitors and staff, inspection of records and the premises. The manager was not available; senior staff and a manager from another Care South home were covering the role temporarily. This was the second of two visits carried out in the inspection cycle. For information on the key standards not covered in this report please refer to the previous inspection. For the purpose of this report the terms service user and resident are interchangeable. What the service does well:
During the visit the residents and visitors were very positive about the standard of care provided. They felt they were able to follow their preferred choice of hobbies and pastimes. One person was setting up a computer with internet access another enjoyed watching historic action movies. People said they had no unmet spiritual needs. The staff were seen to be supportive and patient with the residents. One resident was overheard saying to a member of staff that the carer was always happy and that helped to keep her bright. Staffing levels were appropriate to the needs of the residents. Staff felt the shifts were busy but manageable. Recruitment systems were robust, no recruit was appointed until all the required checks and references had been received. The organisation had a training programme which staff accessed through the supervision system. There were core training courses which all the care staff undertook. Staff helped most residents by managing their personal allowances which was used to cover expenditure for hairdressing, toiletries, etc. The records seen showed that transaction records were audited against the monies held. Those seen were up to date and matched the balances held by the resident. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 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 Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 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): Not assessed on this inspection please refer to the previous report. EVIDENCE: Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 9 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, 9 The care plans did not fully show the revised needs of the residents’, therefore there may be occasions when staff would not know how to meet those assessed needs. Medication systems in the home provided safe administration and storage of medication, however one area of record keeping needed to be addressed EVIDENCE: The care plans showed good levels of recording and appropriate levels of detail. One of the files seen showed that the resident had been assessed as needing particular equipment. The senior member of staff on duty said the equipment had not been required for sometime but there was no record of this change. The files seen showed no evidence of resident or their representatives’ involvement in the development of the care plans. The care plans were accessible to the care staff. The senior member of staff managed the medication system while on shift. The records were up to date and showed any medical allergies. The
Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 10 handwritten items added to the medication records were checked by a second person. However, when medication was repeated, but no stock ordered, the entry was handwritten this was not verified by a second person so there could be a risk of transcription errors. The stock was held securely. Residents said the staff took great care when handling the medication. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 11 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): Not fully assessed on this inspection. Please refer to the previous inspection EVIDENCE: Two residents said they enjoyed the quiet in the home neither had unmet religious or spiritual needs but felt it would be arranged as needed. Another person said that they were supported to follow their preferred activities including watching war movies. One person had her computer and was waiting for someone to help with an internet connection. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 12 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): Not assessed during this visit. Please refer to the previous inspection. EVIDENCE: Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 13 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): Not fully assessed in this inspection please refer to the previous inspection report. EVIDENCE: Since the last visit a new call alarm system had been introduced. The staff were getting used to the system which gave staff information about the source of the call and allowed them to prioritise their response. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 14 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 Staffing levels were appropriate for the level of care provided. The residents were in a safe environment as the organisation had robust recruitment procedures and staff received good levels of training. EVIDENCE: At the time of the visit the home was staffed as follows: 07:15 – 14:45 4 carers including 1 agency 14:30 - 22:00 4 carers including 1 agency 21:45 - 07:30 2 carers including 1 agency There were 2 senior staff members on duty during the daytime reducing to 1 at night who also provided sleep-in cover between 23:00-06:30. The above figures did not include the activity organiser nor domestic staff. The home covered vacant shifts by offering extra hours to their own or bank staff; those hours still not covered were allocated to agency staff. A check of agency cover over a two week period showed that agency staff covered 13 of the available hours. A check of three staff files showed two had completed NVQ 2 in Care the other person was part way through. They also showed that the recruitment process made sure that new recruits had appropriate checks and references before
Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 15 starting work. The records contained information from supervision meeting and the individuals’ training records. Two members of staff said the standard of training provided by the organisation was very good; one had completed NVQ 3 the other was nominated for level 2. Both had completed courses on a range of topics including Dementia, First Aid, Catheter Care, Adult Protection, Safe Moving and Handling, Induction and Foundation. Training needs were considered during their supervision meetings. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 16 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): 35 The systems in place protected the residents from the risk of financial abuse within the home. EVIDENCE: The home did not manage the finances for any of the residents. However, most people had cash deposited at the home for personal expenditure e.g. hairdressing, toiletries, etc. A check of records and balances for three of the residents showed the transaction records matched the monies held. The staff carry out their own internal checks. The organisation was in the process of recruiting a deputy manager.
Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 17 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations The care plans should reflect the assessed needs of the resident. It should identify any equipment used to meet those needs. When handwritten alteration or additions are made to the medication records they should be checked by a second person to reduce the risk of transcription errors. Wickmeads DS0000003904.V257675.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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