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Inspection on 25/01/08 for Wilbraham House Residential Home

Also see our care home review for Wilbraham House Residential Home for more information

This inspection was carried out on 25th January 2008.

CSCI found this care home to be providing an Adequate service.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Attention to details of resident choice and lifestyle. Flexibility of routines adjusted to allow choices. Residents are treated with respect and dignity protected. Warm, friendly atmosphere. Good engagement between residents and staff. Visitors are made welcome (confirmed by visitors seen during inspection). Visitors confirmed that they were kept informed of residents progress and informed of any areas of concern. Statement of Purpose/Service Users Guide gives detailed information about the services offered at Wilbraham House. Good working relationships with GP, District Nurses and other local healthcare professionals. Many residents are from the local village and surrounding areas promoting a positive identity. The home has a positive identity in the local community which is easily accessed.

What has improved since the last inspection?

Positive and significant changes to the environment: Radiators and pipe-work in all areas of the home are now covered ensuring safety. Two bathrooms have been refurbished including new bath-lifts, upgrading and redecoration. Six toilets have been upgraded/redecorated. Stored items have been removed from bathroom/toilet areas. Redecoration/re-flooring of dining area. Lounges recarpeted. Most areas have been recarpeted over the past year and the remainder planned. The medication system is more secure. A new Monitored Dose system (blister packs) has been provided and new medication trolleys obtained to allow easier access and greater flexibility in medication delivery. Storage is more secure with bars to windows installed and medication trolleys fixed to the wall when not in use. Fire doors were not wedged open, as seen on the last inspection. New doorguards have been installed to allow some doors to be left open whilst not compromising fire safety. A new commercial stainless-steel serving table has been purchased for the kitchen area. A fridge/freezer replaced and new dishwasher provided (none previously). The staff training programme has continued since the last inspection with training in - First Aid, continence care, food Hygiene, Moving & Handling, tissue viability, infection control, medication administration, fire awareness and equality & diversity training.

What the care home could do better:

Staff training is required in Food Hygiene for all catering staff. Medication training is required for all staff administering medication. Movinng & Handling training is required for all staff providing personal care to residents. There is a target date form completion of all statutory training by 31st March training will either be completed by this date for all staff or dates firmly booked. Falls risk assessments must be completed for all residents. All residents must be weighed upon admission and thereafter monthly unless there are concerns about weight loss when they must be weighed weekly.All creams should be obtained on prescription and must bear the name of resident with clear instructions for use. Creams must not be stored in communal areas. Regular fire drills are required for all staff and must be recorded with names of staff involved. The outstanding issues on the improvement plan should be completed including carpeting of the first floor corridor, completion of assisted bathing or shower facility, refurbishment of one toilet area and refurbishment of the kitchen area. The completion dates for this work is given by the providers for 30th April 2008.

CARE HOMES FOR OLDER PEOPLE Wilbraham House Residential Home The Old Vicarage Church Street Audley Stoke On Trent Staffordshire ST7 8HL Lead Inspector Peter Dawson Key Unannounced Inspection 25th January 2008 08:30 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 Wilbraham House Residential Home DS0000005035.V358358.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. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilbraham House Residential Home Address The Old Vicarage Church Street Audley Stoke On Trent Staffordshire ST7 8HL 01782 720729 01782 720729 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) Wilbraham Limited Mrs Susan Elizabeth Cameron Care Home 33 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (33), of places Physical disability over 65 years of age (6) Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation (without nursing) for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 33 Physical Disability over 65 (PD)(E) 6 Physical Disability over 55 (PD) 2 Dementia over 65 (DE) (E) 6 The maximum number of service users to be accommodated is 33. 2. Date of last inspection 15th May 2007 Brief Description of the Service: Wilbraham House is a privately owned residential care home, registered to care for up to 33 elderly residents with a variety of dependency needs. The home has been under the present ownership since October 2001. Sue Cameron has been the Registered Manager since October 2006. She has clearly made improvements to the home and quality of care during since that time. The extension to the home was finally completed in 2006 - providing 6 additional bedrooms, each equipped with an en suite, as well as a separate adapted bathroom and shower. Many improvements to the environment were needed. A programme of improvement over the past year has taken place and almost complete. Other areas such as staff training and care practice have also improved. Wilbraham House is well located in the village of Audley, opposite the Church and convenient for a wide range of local amenities including shops, pubs, post office, community centre and health centre. There are plans to further develop the external space to provide more user friendly and safe areas for residents to enjoy during the better weather. Weekly charges at Wilbraham House state in the Statement of Purpose are £335- £390. The Manager states that current maximum fees are £400 per week. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection was carried out on one day by one inspector from 08:30 – 18:00. The last key inspection took place on 15th May 2007 at that time the service had moved forward by addressing many urgent issues that were highlighted on the previous inspection. Most of the requirements had been addressed. The objective of this inspection was to assess the progress made since the key inspection in May and particularly the progress outlined in the improvement plan following that report. It was pleasing to see that the majority of the stated planned improvements to the environment had taken place and also some progress in areas of staff training, medication, food provision and risk assessments. A further Annual Quality Assurance Assessment was not requested for this visit and feedback forms from residents were also not requested. It was however possible to speak to a significant number of residents both together and separately who expressed very positive comments about the care and life at Wilbraham House. One lady summarised this by saying “ I am very happy here – this home surpasses everything”. The present Manager has been in post for 15 months and worked hard to achieve results in most areas of care. She has supported and motivated staff and together they have made considerable progress in addressing many previous shortfalls in the home. There has been close working with the Providers who have made considerable improvements to the environment. What the service does well: Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 6 Attention to details of resident choice and lifestyle. Flexibility of routines adjusted to allow choices. Residents are treated with respect and dignity protected. Warm, friendly atmosphere. Good engagement between residents and staff. Visitors are made welcome (confirmed by visitors seen during inspection). Visitors confirmed that they were kept informed of residents progress and informed of any areas of concern. Statement of Purpose/Service Users Guide gives detailed information about the services offered at Wilbraham House. Good working relationships with GP, District Nurses and other local healthcare professionals. Many residents are from the local village and surrounding areas promoting a positive identity. The home has a positive identity in the local community which is easily accessed. What has improved since the last inspection? Positive and significant changes to the environment: Radiators and pipe-work in all areas of the home are now covered ensuring safety. Two bathrooms have been refurbished including new bath-lifts, upgrading and redecoration. Six toilets have been upgraded/redecorated. Stored items have been removed from bathroom/toilet areas. Redecoration/re-flooring of dining area. Lounges recarpeted. Most areas have been recarpeted over the past year and the remainder planned. The medication system is more secure. A new Monitored Dose system (blister packs) has been provided and new medication trolleys obtained to allow easier Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 7 access and greater flexibility in medication delivery. Storage is more secure with bars to windows installed and medication trolleys fixed to the wall when not in use. Fire doors were not wedged open, as seen on the last inspection. New doorguards have been installed to allow some doors to be left open whilst not compromising fire safety. A new commercial stainless-steel serving table has been purchased for the kitchen area. A fridge/freezer replaced and new dishwasher provided (none previously). The staff training programme has continued since the last inspection with training in - First Aid, continence care, food Hygiene, Moving & Handling, tissue viability, infection control, medication administration, fire awareness and equality & diversity training. What they could do better: Staff training is required in Food Hygiene for all catering staff. Medication training is required for all staff administering medication. Movinng & Handling training is required for all staff providing personal care to residents. There is a target date form completion of all statutory training by 31st March training will either be completed by this date for all staff or dates firmly booked. Falls risk assessments must be completed for all residents. All residents must be weighed upon admission and thereafter monthly unless there are concerns about weight loss when they must be weighed weekly. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 8 All creams should be obtained on prescription and must bear the name of resident with clear instructions for use. Creams must not be stored in communal areas. Regular fire drills are required for all staff and must be recorded with names of staff involved. The outstanding issues on the improvement plan should be completed including carpeting of the first floor corridor, completion of assisted bathing or shower facility, refurbishment of one toilet area and refurbishment of the kitchen area. The completion dates for this work is given by the providers for 30th April 2008. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1-5 were inspected on this visit Quality in this outcome area is good. Information provided to prospective residents has been updated and improved. All have a copy of the information and also contracts. Pre-admission assessments and procedures are good. Pre admission visits the preferred option. There is now written confirmation of homes ability to meet needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A recommendation at the time of the last report to update the Service Users Guide and provide a copy to all residents has been met. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 11 A new Guide has been compiled with pictorial prompts to provide a comprehensive but very readable document. All residents have a copy in their bedrooms and there is a copy available in the home for visitors/prospective residents and their families allowing them to make a choice about the home in knowledge of the service provided. A short well-presented home brochure to supplement this has also been provided. All files sampled had a contract/statement of terms/conditions whether funded or self-funding. Assessments are always carried out prior to admission. The homes preadmission assessment documents contains all the required information and the samples seen were completed fully and accurately. It is now the homes practice following that assessment to notify the person in writing that the home is able to meet the assessed needs of the person. This complies with Regulation 14(1)(d) . Where possible prospective residents are invited to spend time in the home prior to admission. In two instances of recent admissions – one was in hospital and unable to visit prior to admission, in the other visits had been made for 4/5 hours and then for the day prior to making a decision about admission. The latter is the homes preferred option. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 –10 were inspected on this visit Quality in this outcome area is adequate. Care planning information has improved but risk assessments must be improved. Health care needs are documented but there are some shortfalls for those nutritionally at risk. Regular weighing is required to ensure better monitoring of residents health. Security and administration of medication has improved, although two further shortfalls are identified. Residents are treated with respect and privacy upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 13 A sample of care plans were seen including recently admitted and long-term residents. These were based upon assessed needs and information from the homes pre-admission assessments and also Care Management Assessments from Social Workers. The number of shortfalls identified in the last report have been addressed/improved. There was evidence of regular monthly review of care plans. Risk assessments are in place but require more detailed information on the risks and the control measures in place to reduce/eliminate the risk. An example was a recently admitted resident with a history of falls, this was stated on the risk assessment but there was no information detailing the history or risk or assessment of the risk in the new setting. This must always be completed. Many areas of healthcare were inspected/reviewed. There was some good information but also some shortfalls. The home complete Waterlow assessments and nutritional risk assessments. There is one currently bedfast resident with minor pressure damage being monitored by the District Nursing Service with 2 hourly turns by staff. Relatives, District Nurse and GP are all involved in the person’s care and Airwave pressure relieving mattress provided for this and another person. There was evidence that residents had not been weighed regularly. One person with low weight, poor diet and on supplements had not been weighed for 3 months. In another instance a person had not been weighed since admission one previously. All residents should be weighed upon admission and monthly thereafter. Where there are concerns about weight loss/nutritional deficits they should be weighed weekly. There is a positive working relationship with the GP practice across the road at the Health Centre. Currently there are regular reviews of medication and close monitoring by GPs of residents healthcare needs. There is a reported good relationship with the Nursing Service and there have been past meetings with the GP Practice Manager to resolve any issues regarding medication supply. In one instance seen not all interventions by health care professionals were recorded. One resident has daily insulin injected (Pen) by staff. Training has been provided and documented by the District Nursing Service to ensure named members of staff have received appropriate training. Nursing staff have provided Stoma Care training and the Community Matron been involved in other health care training with staff. The Continence Nursing Specialist has also provided training. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 14 CPNs visit the home irregularly although this service is not satisfactory at this time. A resident with challenging behaviours and a dual diagnosis of dementia and mental health needs is currently being re-assessed. A decision is to be made whether the home are able to meet the persons needs. The resident has physically assaulted staff. The Manager was advised to press for a domiciliary visit by Consultant Psychiatrist to provide a pertinent assessment and possible support to the home in continuing to care for this person. A person with dementia care needs left the home recently through an exit door. She was swiftly located an returned safely. The home carried out an immediate assessment of the security of the premises. Alarms were installed on all exit doors and risk assessment completed. This also includes a daily description of what she is wearing and heightened awareness of staff to monitor closely at all times. At the time of the last inspection there were serious concerns about the medication system. Requirements were made and improvements have taken place. A new blister-packed system is now is use with two new medication trolleys to improve security. These are now secured to the wall and the security of all medication including controlled drugs storage has improved. There has been medication training for staff since the last inspection, although it is clear that one person administering medication has not had accredited training. This must be arranged before she is able to continue this task. It was noted that Sudocrem was present in a bathroom area and without a prescription label. All creams must be prescribed and have labels clearly stating ownership and usage. Creams must not be left in communal areas. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12- 15 were inspected on this visit. Quality in this outcome area is good. A range of activities are provided by staff to meet social, cultural and religious needs. Contacts with family/friends are part of the philosophy of care. Residents observed to be enjoying their chosen lifestyles. Food provision has been improved with greater choice and variety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are encouraged to take part in activities which are recorded individually with care planning information. There was evidence of residents involved in some gardening activity. Social events are organised internally, residents and families invited/encouraged. On the day of inspection a relative Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 16 was playing the piano to encourage participation. This is a regular weekly event with other external entertainment provided also. A resident who has a learning disability enjoys being in his room writing, playing music etc and rarely visits the lounge. His chosen lifestyle is supported and he is taken out each week for 2 half-days by a social work resource team to access community facilities, additionally he goes to church weekly. There is a regular input from clergy to the home from the church facing the home. There are 3 lounge areas where residents can choose and move between particular groups. It was refreshing to note the TV was not on in one lounge where residents were engaging with each other and readily socialising. Residents spoke about chosen lifestyles for example late rising, returning to their bedrooms throughout the day as they wished, receiving visitors in the communal areas or privacy of bedrooms. Many residents in this home are from the local village and community and feel a strong bond with that community. Requirements were made in relation to food provision in the last inspection report. There were no recorded alternative choices at all mealtimes. Menus were seen and this has been addressed – there were choices at all mealtimes from the menus seen. A requirement to provide a vegetarian resident with a sample menu has now been provided. Fridge temperatures were high, food not labelled in fridges and a fridge/freezer not operating correctly. These issues have been addressed. Fridge/freezer temperatures were satisfactory. The defective fridge/freezer replaced with a new one and a dishwasher provided improving handling and infection control. Residents spoken with said that they were happy with the choice, quantity and presentation of food. A new Breakfast Bar has been installed allowing residents to make greater and informed choices about their breakfast choices which also include cooked breakfast too if required. The Manager is considering the provision of a trolley for hot food which would allow greater and more meaningful choice of food at other mealtimes including type, quantity and greater individual choices. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16- 18 were inspected on this visit Quality in this outcome area is good. The complaints procedure is readily available to residents and visitors. There has been some staff training in Adult Protection. Some updating is needed to ensure greater awareness and protection of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a clear and concise complaints procedure in place. All resident have a copy with the Service Users Guide and there is a copy in the reception area of the home for visitors. No complaints have been received by the home or the Commission since the last report. There is also a suggestion box located in the home but apparently little used. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 18 Training records showed that 60 of staff have received training in Safeguarding (Adult Protection). The Manager & Deputy have completed a course as trainers in protection. Senior staff have recently completed a course on the new Mental Capacity Act which is being cascaded to other staff. Good recruitment procedures protect staff against potential risk of abuse. Residents spoken with said that they felt able to speak to the Manager or a member of staff if they had any concerns. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 – 26 were inspected on this visit. Quality in this outcome area is adequate. Many serious shortfalls identified in the environment on previous inspections have been addressed with a planned improvement/replacement programme which is nearly complete. This has improved most areas of the home and the facilities for residents. Toilets/bathrooms have been refurbished with plans to complete the final bathroom by 30th April 2008 Residents bedrooms are well furnished, comfortable and well personalised. Standards of hygiene have been improved throughout the home improving infection control. This judgement has been made using available evidence including a visit to this service. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 20 EVIDENCE: Aspects of the environment have not been satisfactory on recent inspections – requirements have been made under Regulation and an improvement plan required from the providers. It was pleasing to see on this inspection that the majority of the environmental improvements needed have either been completed or are in the process of being completed. A requirement that all radiators and pipe-work must be guarded has been met. All areas of the home including communal and bedroom areas now have covered radiators and pipe-work to ensure the protection of residents. A requirement for all bathrooms to be cleared of all stored items and to be redecorated and fitted with appropriate assisted facilities has been addressed. Two of the 3 bathrooms have been fitted with new bath-hoists, redecorated and cleared of surplus items. Their presentation has been vastly improved. One further bathroom for refurbishment is presently being planned – the provision of either a bath hoist or alternative walk-in shower area is being considered. The home presently has 3 assisted bathrooms, one with a shower facility. Completion of the fourth bathroom is planned for completion by 30th April 2008. Six toilet areas have required upgrading with redecoration/new flooring and these have been completed. One further toilet refurbishment is planned. The kitchen area needs improvement and there are quotations for refitting units, replacing flooring and tiling this area. The completion date is planned for 30th April 2008 The lounge areas have been recarpeted and one still needs redecorating which is planned. Redecoration and re-carpeting of the hallways is in process. Stair carpet has been replaced. One area of recarpeting on the first floor is needed and will be completed. 24 new lounge chairs have been provided since the last inspection. Security of the medication area has been improved with security bars to the window and new medication trolleys fixed to the wall in a locked area. The above improvements have vastly improved the presentation of the home in general. Shortfalls mentioned above are planned in the improvement plan made available for the inspection. There is a large lounge area part-divided by a wall which naturally divides into 2-3 smaller groups. This is a good use of this large lounge area. It is Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 21 recommended that the lighting in this area is reviewed to provide better and brighter lighting in this important area. The wall mentioned reduces the light to the opposite part of the lounge giving little natural light. Bedrooms seen were well-furnished and well personalised reflecting individuality. One room that was carpeted had an area of the floor laminated to improve continence management. All bedrooms are for single use at this time and it is envisaged that shared rooms will not be used. Additional electric sockets have been installed as needed. There was a portable heater in bedroom 7 which should be removed to ensure safety. The carpet on the first floor landing is badly stained and will be replaced soon. All areas of the home were clean and hygienic with no mal-odours. To improve infection control all bathrooms and toilets have had dispensers fitted to ensure a constant supply of gloves, aprons and wipes. Alcohol hand-wash dispensers have been fitted at strategic points in the home including the reception area. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27-30 were inspected on this visit. Quality in this outcome area is adequate. Numbers of staff are adequate. Staff training has improved but there are still shortfalls in some areas. Progress has been good and needs to continue to improve staff skills. Recruitment procedures protect residents. More than 50 of staff are trained to NVQ standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current staffing levels are 4 carers on early shift and 3 on the afternoon shift – Plus the Manager. There are 2 waking night staff. An additional carer has been provided on the early shift from 6.30 a.m. (prior to night staff completing their shift) to enable additional help at the busy time and ensure that there are no pressures to get people up early for breakfast to time with the shift change. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 23 The number of night staff was discussed with the Manager and appeared adequate for the numbers and present dependency levels of residents. The Manager has (and does) provide additional night staff in the even of illness etc and keeps the staffing levels under review. The overall number of care staff appeared adequate for the numbers and dependency levels of residents. Care staff are supported by catering, housekeeping and some laundry hours. Staff training has been an area of concern in this home for sometime. Prior to the present Manager appointment 15 months ago there was little statutory or other training. A training matrix was provided during this inspection showing improvements in this area. There are, however still shortfalls in some areas including Moving & Handling, Health & Safety, Fire Safety and Food Hygiene. Further requirements are made in this report for this training and also Medication training. Since the last inspection there has been training as follows: 4 People have received Fire Awareness update. 11 people have received Infection Control Training 11 people have received First Aid Training 9 people have received updated training in Moving & Handling (the home are pursuing a possible trained moving & handling trainer) There has also been training in Continence Care, Stoma Care, COSHH, CPR, Abuse, Equality & Diversity and dementia awareness. Whilst considerable progress has been made it is still necessary to maintain the momentum in the area of staff training. 11 out of 17 staff have now obtained NVQ2 training, some progressing to Level 3 and Level 4. The Manager feels that improved training has led to greater individual commitment and improved staff retention. Dates for further training are subject to current negotiations with Newcastle College and SARCP. The anticipated target date for completion of staff training in Fire Awareness, Adult Protection, Infection Control, Manual Handling and Food Hygiene is 31st March 2008. Recruitment procedures have become more robust ensuring greater protection of residents as highlighted in the last report. Staff files seen evidenced that all checks and references had been obtained prior to employment. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 24 Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31-33 and 36-38 were inspected on this visit. Quality in this outcome area is adequate. The Manager has the experience, qualification and skills to run the home. The home is run in the interests of residents evidenced by changes made to routines. Requirements are made in relation to staff training, risk assessments, aspects of health care and the environment where there are still some shortfalls which need to be addressed to improve the safety and well-being of residents. Providers, Manager and staff have made progress in many areas since the last report. This judgement has been made using available evidence including a visit to this service. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager has been managing the home for the past 15 months. She has a number of years experience in care and achieved the Registered Managers award in September 2007. There was an open, relaxed and homely atmosphere in the home throughout the inspection. The Manager takes a positive lead in the home and engaged openly in a relaxed way with both residents and staff. The Manager has worked hard to arrange a necessary programme of training for staff which has been successful but must continue. She has been instrumental in changing practices in the home with the cooperation of staff who seem well motivated and are clearly responding to new ways of working and the ongoing training programme. Residents confirmed that they were consulted about the running of the home and their individual preferences. All spoke highly of the commitment of staff and the support given to them. Issues of safety, infection control and training identified in the last report have been positively addressed, some remain ongoing. Six staff have received Food Hygiene training since the last report. This does not include one of the catering staff. Training for this person must be arranged as soon as possible. Fire records showed that there were regular tests of the system and equipment. Shortfalls in the last report had been addressed. Most staff have had external fire training. Although there had been an actual evacuation of residents as a fire drill there had been no other regular drills. There was some confusion about the actual drills and required regularity. This was clarified and it is important that night staff have 3 monthly fire drills and day staff 6 monthly drills. There are only 2 waking night staff on duty and it is important that they have at least 3 monthly drills. The Manager was confident that night staff could effect a phased evacuation of residents to the next fire compartment in the event of a fire. There is a smoking room. Currently 4 residents smoke, all have been risk assessed and are closely supervised. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 27 The practice of fire doors being wedged open identified on the last inspection has ceased. Several door-guards have been purchased to allow doors in the communal areas to be left open but to self-close in the event of fire. PAT testing had been carried out on 11/12/07 and there was evidence of public liability cover for the premises. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 18 3 2 3 2 3 3 3 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 2 Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 13(4) Requirement Falls risk assessments must be completed for all residents at risk improving safety in the event of fire. All residents must be weighed upon admission and regularly thereafter. Those at nutritional risk must be weighed weekly to closely monitor progress Accredited medication training must be provided for all staff administering medication increasing awareness and safety for residents All creams must be prescribed & labels clearly state ownership and usage. Creams must be removed from communal areas. Outstanding environmental improvements in the improvement plan must be completed to the timescales agreed. All staff preparing food must have Food Hygiene training. All staff must have Moving & Handling Training. Night staff must have 3 monthly fire drills and day staff 6 monthly DS0000005035.V358358.R01.S.doc Timescale for action 31/01/08 2 OP8 12(1) 31/01/08 3 OP9 13(2) 29/02/08 4 OP9 13(2) 31/01/08 5 OP19 23 30/06/08 6 7 8 OP38 OP38 OP38 16(2)(j) 13(5) 23(4) 29/02/08 29/02/08 29/02/08 Wilbraham House Residential Home Version 5.2 Page 30 fire drills to protect residents in the event of fire. 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 OP25 Good Practice Recommendations Lighting in the large lounge must be reviewed to provide a brighter environment in the area where there is little natural light. Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wilbraham House Residential Home DS0000005035.V358358.R01.S.doc Version 5.2 Page 32 - 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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