CARE HOMES FOR OLDER PEOPLE
Wickmeads Thornbury Road Southbourne Bournemouth Dorset BH6 4HR Lead Inspector
Trevor Julian Unannounced Inspection 28th July 2006 10:00 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.V306118.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. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wickmeads Address Thornbury Road Southbourne Bournemouth Dorset BH6 4HR 01202 427144 01202 427144 wickmeads@care-south.co.uk www.care-south.co.uk Care South 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) Mrs Maureen Beatrice May Anderson 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.V306118.R01.S.doc Version 5.2 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. 11th October 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. Weekly fees ranged between £425-£540 dependent on level of care and the accommodation offered. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced visit took place on Friday 28th July 2006 between 10:00 and 15:30. During the visit discussion took place with 10 residents, six visitors, staff and management. Further information was gathered by inspection of records and procedures and a tour of the premises. Since the last inspection comment cards had been received from residents and visitors giving their view of the home. This was a key inspection looking at compliance with specific standards and to monitor progress made with recommendations made previously. What the service does well:
The comment cards showed high levels of satisfaction of the service provided. Comments included: “Excellent care is provided…” “An absolutely lovely home…” “All the staff are very pleasant, supportive and caring. They work hard and are always cheerful. “I thoroughly enjoy living at Wickmeads”. The senior staff at the home visit all prospective residents before offering a placement at the home. This is to ensure that the home is able to meet the assessed needs. The home maintains good communication with the local healthcare services to ensure health needs are met. Residents confirmed that their GPs’ are called as needed. There was a range of specialist equipment in use to aid staff with safe handling of residents. Medication was safely stored and administered and there were checks in place to ensure that any transcription errors were rectified. Residents continue to enjoy the activities and outing organised by the home. All those spoken to confirmed that there were enough activities to keep them occupied. One new resident was enjoying living at the home and was taking the opportunity to gradually sort through his collection of travel books. People found the food was of good quality and varied. Information on the meals offered was posted on the white board in the dining room each day. Some residents needed assistance with their meals this was handled sensitively and in an unrushed manner. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 6 Residents said they were able to discuss concerns with the staff or management but those spoken to had not needed to make a formal complaint. The premises were well maintained and presented. The home was clean well aired and there were no unpleasant odours. The home was staffed according to the needs of the residents. The training programme ensured that the staff were competent to provide care for the residents. The home is well managed and the organisation has reporting systems in place to ensure standards are maintained. Personal cash was held for most residents for incidental expenditure. The monies were safely held and the balances matched the transaction and receipts records. The home has good systems for health and safety. All staff receive regular fire safety training and the equipment is properly serviced and inspected. Accident reports are used to monitor for trends. What has improved since the last inspection? What they could do better:
The choices for meals should be made clearer; in particular, residents should be made aware that salads are available on request. Several vacancies exist at the home due to promotions and staff movement. This has resulted in an increase in the use of agency cover for vacant shifts. Staff were aware of their responsibilities regarding adult protection however, the action that should be taken should be periodically reminded to staff. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 7 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.V306118.R01.S.doc Version 5.2 Page 8 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.V306118.R01.S.doc Version 5.2 Page 9 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No resident is offered a placement until an assessment has been completed to ensure the home has the capacity to meet the assessed needs. EVIDENCE: The file of one new resident was examined it contained a Social Services care plan and a pre–admission assessment completed before a place was offered. In discussion with the family and friends of the resident they had visited the home on two occasions before accepting the placement, they also confirmed that the home had advised them that the home was able to meet his assessed needs at that time. The home had a copy information about the services provided on the main entrance of the home. The manager said that a second copy was placed in the bedroom of any new resident.
Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 10 Residents and visitors commented that they felt the home gave very good levels of information about what they could expect. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are in place to inform the staff how assessed needs are to be met. The home maintains good links with local healthcare services to ensure that health needs are met. The medication procedure helps to protect the residents from the risk of errors. The staff treat the residents with dignity and respect in order to protect the residents’ rights. EVIDENCE: The pre-admission assessment was used to develop the residents’ care plan. The plan included risk individual assessments. The files seen showed that the resident or their representative had signed the document to agree the proposed care. Where changes occurred a short term care plan was introduced to reflect the change.
Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 12 The daily care records showed good levels of recording. Information included any GP or other healthcare visits and social interaction. As part of a nutritional assessment the residents’ weight were recorded once a month to identify any weight gain or loss. There were copies of any accident reports to ensure that trends were identified during monthly reviews. Comment cards showed there was good communication between the home and local doctor surgeries. Residents and visitors were aware of the need to keep records and had seen their care plans none had requested to see their daily reports. Medication was securely stored stock levels were good and there was a clear audit trail although it could be improved by the dating of when bottles of liquid medication are opened. There were no apparent errors on the medication record sheets for individual residents. Any known allergic reaction to medication was recorded and there were photographs on file to aid the identification of residents. Only senior staff who had been trained and assessed as competent were permitted to distribute the medication. None of the residents used in the sample self medicated. One resident commented that the staff took the administration and distribution of medication very seriously and she was happy to let the staff manage her tablets. The bedrooms were fitted with appropriate door locks allowing residents to lock them if needed. Staff were observed knocking bedroom and toilet doors before entering. Whilst in the lounge, staff were seen chatting to the residents. Where one person was being assisted, the member of staff was explaining her actions to the resident. Wickmeads DS0000003904.V306118.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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes good levels of resident choice in their daily lives. The food provided was of good quality and attractively presented to encourage the residents to maintain a good nutritional intake. EVIDENCE: Residents said they were able to get up whenever they liked as breakfast was served between 08:00 until 10:00 and they could also have it on a tray in their room on request. People felt they were encouraged to make decision and choices wherever possible. The home had an activity co-ordinator and there were sufficient activities available to help them pass the time. The home had a visiting library service offering a range of typefaces to help people with sight problems. A programme of activities was displayed in the hallway leading to the dining room. Several people said they enjoyed the minibus trips out during the summer. The home has an attractive garden that was being enjoyed by some of the residents and visitors; sunshades and sun hats were provided. Visitors
Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 14 said they were always made welcome one person said she enjoyed the cakes offered during the afternoon tea round. In the dining room the daily menu was displayed on a white board there were two main courses or alternative as needed. Some residents said that they would prefer salads during the warmer months; the chef said that salads were always available on request and several people did ask. The sweet trolley had a range of fresh fruit but is was not a popular choice for most of the residents. The midday meal seen was well presented and appetising. During the afternoon tea round residents were offered a choice of homemade cakes. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The organisation’s procedures allowed complaints to be raised without fear of recrimination. Adult protection procedures were in place to help protect the residents from abuse. EVIDENCE: The commission had not received any complaints or adult protection referrals relating to the home. There were systems in place for recording and investigating complaints within the home; compliments were also recorded. Residents and visitors said the staff were very approachable and they could discuss any concerns with them. No one spoken to had felt it necessary to make a formal complaint The organisation had a procedure for responding to allegations or signs of abuse. Staff were aware of their responsibilities however, they were not clear on the lead role of Social Services in all cases. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 16 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, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents at the home enjoy a clean, hygienic, comfortable and well maintained environment. EVIDENCE: The home was well maintained. Major works were prioritised with the annual budget. During the tour of the premises, the rooms seen had been personalised by the individual occupant using photos and other mementoes. Some rooms were carpeted others had non-slip vinyl flooring. There were a variety of specialist baths in the home providing residents with further choices. The home was heated by conventional radiators. Not of all the radiators were covered, instead individual risk assessments had been completed to consider the risk of burns.
Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 17 The home was clean and well presented it was observed that staff had access to protective gloves and aprons in order to assist hygiene and infection control. Several of the residents commented that the staff worked hard to maintain a clean environment. One visitor said it was a lovely home although she would have preferred the rooms to have had en-suite facilities. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 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 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were adequate for the needs of the residents. The organisation’s recruitment procedure helps to ensure that only suitable staff are appointed. Initial and ongoing training programmes ensure the staff have the skills to deliver good quality care. EVIDENCE: The staffing of the home was appropriate to meet the needs of the residents. Staff said the shifts were busy but manageable. There had been some promotion of carers this had resulted in an increased dependence on agency staff to cover vacant shifts, this did affect the continuity of care for the residents. The manager said that there was never an occasion that all care staff on the shift was agency and that gender sensitive care was always considered. Staff said they were able to voice their ideas through supervision and staff meetings. Supervision was used to identify any training needs, the staff spoken to said the training provided by the organisation was good and it was easy to get on the courses. The staff training file showed the training
Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 19 completed by the staff included core and specialist topics. One new member of staff said she had completed her induction and Manual Handling training and was looking forward to starting NVQ level 2 in care. A new Care Team Manager said she had just started her NVQ level 3 in care. Files seen during the visit showed that the new staff had the appropriate clearances and references before starting work at the home. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 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 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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was managed by a competent team who were accessible to the residents. The organisation’s quality assurance system ensures that residents and others involved with the home have the option of giving their views on the way the home is run. The system for managing personal allowances helps to protect the residents from financial abuse. Heath and Safety systems and training help promote a safe environment for the residents and staff. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager holds a management qualification at level 4. A new deputy had recently been appointed to support her. Recording systems, staff roles and general procedures are defined and well organised, supporting residents to live in a home in which they feel secure and well cared for. There is a clear organisational structure with duty allocation, and tiered responsibility, which from the running of the home and feedback from residents, work well. Representatives from the organisation carry out internal monthly visits to the home to ensure that standards are being maintained. A quality assurance audit is conducted annually and had recently been completed so the outcome was not known but would be used to inform the business development plan for the service. The manager nor staff manage finances for the residents. Most residents deposit personal spending allowances with the admin staff. A check of three accounts showed that the transaction records and receipts matched the balances held. The monies were held separately for each person. The manager confirmed that an ongoing programme of training supports staff members to receive induction and regular updates in mandatory areas of safe working practice. Fire records confirm that fire precautions and staff training was up to date. The home’s fire risk assessment was reviewed in February 2006. There was an accident record and register to allow an audit trail. The reports were reviewed to monitor for trends. The home used some generic risk assessment these had recently been reviewed. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 2 3 X X X X X 3 3 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 3 X 3 X 3 X X 3 Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 23 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 OP15 OP18 Good Practice Recommendations Residents should be made aware of the choice of meals offered. Staff should receive regular reminders of the adult protection procedures and the role of Social Services as lead body in any investigation. Wickmeads DS0000003904.V306118.R01.S.doc Version 5.2 Page 24 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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