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Inspection on 29/06/05 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 29th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

During the past three years Wilbraham House has significantly improved the quality of care afforded to residents. Health and personal care needs are well addressed and more recently some improvements have been made in the provision of social care activities. Wilbraham House is located in a very close-knit village community and as such provides a valuable resource to many local elderly people who wish to remain in the village. The home provides a homely and relaxed setting; many of the staff live locally and have a very good rapport with residents and visitors alike, which contributes to the friendly and pleasant ambience.

What has improved since the last inspection?

Care planning has improved steadily during the past year. Social care has improved by the provision of an Activity Assistant. Afternoon care hours had just been increased prior to this inspection, enabling the Registered Manager to be supernumery each afternoon. Management meetings had just been introduced to include the Registered Manager and the senior team, along with the Responsible Individual and the Operations Manager. The Inspector sees this as a very positive step forward and an opportunity to improve relations and establish a more cohesive action plan for continued improvements.

What the care home could do better:

The most important improvement needed is for better, supportive and mutually respectful professional working relations to be established between the Registered Manager, the senior team and the Responsible Individual and the Operations Manager. The Registered Manager could delegate some appropriate areas of responsibility to members of the senior team. Improvements could be made to the way in which the home responds to shortfalls identified during inspection. Some areas raised by the Inspector more than three years ago have still not been fully addressed, nor is the Inspector clear when these matters will be fully addressed as agreed timescales are repeatedly unmet. While the home has submitted an application to increase its registration following the conversion of the basement, aspects of the physical environment of the current registered premises remain in need of improvement and priority should be given to these areas, notably bathrooms and toilets, radiator guards, thermostatic valves and replacement flooring. The domestic arrangements in place for the home could be much improved. The provision of just 17.5 hours each week for cleaning the entire home, including four communal areas, 25 bedrooms, corridors as well at bathrooms and toilets, is inadequate to maintain satisfactory levels of cleanliness and hygiene throughout the home.

CARE HOMES FOR OLDER PEOPLE Wilbraham House Residential Home The Old Vicarage Church Street Audley - Stoke on Trent Staffordshire ST7 8HL Lead Inspector Norma Welsby Announced 29 June 2005 9:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Wilbraham House Residential Home Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Old Vicarage Church Street Audley Stoke-on-Trent Staffordshire ST7 8HL 01782 720729 Wilbraham Ltd Elaine Bailey CRH 27 Category(ies) of DE(E) - 6 registration, with number OP - 27 of places PD(E) - 6 Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 2 PD over 55 Years Date of last inspection 11 January 2005 Brief Description of the Service: Wilbraham House is a privately owned residential care home, registered to care for up to 27 elderly residents with a variety of dependency needs, including 6 residents with a mental frailty and 6 residents who are physically frail. At the time of this Announced Inspection, 23 residents, including two older people on short stay, occupied the home. Two residents were also in hospital receiving treatment. While the primary purpose of the home is to provide long-term care, short stay visits are also catered for if there is a suitable vacancy. The home came under new ownership in October 2001 and the Registered Proprietors are Mr Pargan Dhadda and Mr Sukhinder Singh Kandola. The Registered Manager is Mrs Elaine Bailey, who has been in post for three years. There are plans to convert the basement to provide additional bedrooms and other facilities and an application to increase the registered numbers, possibly to 33, has recently been submitted. The inspector was able to examine details of the plans on site during this inspection and gave some initial feedback. 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. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Announced Inspection took place on the 29th of June 2005. It found that many of the standards inspected were either partially or satisfactorily met. However, there remain several outstanding matters, which are highlighted in detail in the main body of this report, including guarding of radiators, the provision of a safe and accessible garden for residents and the continued review of staffing levels to ensure that the needs of all residents are met appropriately. Other shortfalls were also identified during this inspection and these included the over heating of parts of the home due to radiators not being fitted with individual thermostatic controls and the need for the boiler to be operational to supply hot water, the continued poor appearance of bathroom and toilet areas and the omission of important written procedures. Of particular concern to the Inspector was evidence that the professional relations between the Registered Manager and management team and the Responsible Individual and his representative the Operations Manager, continue to be uneasy, with little evidence that these have improved much during the past three years. Throughout the period of the inspection the Inspector received helpful assistance from all present including the Responsible Individual, the Registered Manager, the Operations Manager and all staff on duty. Observations of staff carrying out a range of duties confirmed to the Inspector that staff were caring and competent. Consultation with many residents conveyed a very positive impression to the quality of care afforded to them and their satisfaction with the service they receive at Wilbraham House. Two visitors to the home were also very complimentary about many aspects, including the provision of meals, the friendly and caring staff team and the homely atmosphere. Pre admission assessment procedures and care planning were found to be satisfactory. Personal and health care needs were being appropriately met and the Inspector commended staff on their continued good standards. Social care provision has improved a little with the appointment of an Activity Assistant who works 6 hours in the home each week, (3 x 2 hour sessions), but this could be further enhanced by increasing these dedicated hours. The complaints procedure has recently been updated and amended and should be displayed in the home. Wilbraham House provides a homely and attractive environment, but there are several shortfalls, summarised above. Observations of staff at different levels and performing a range of tasks confirmed their competence and commitment to providing a caring service. While some shortfalls have recently been addressed, other specific areas require improvement, notably floor domestic hours. The Registered Manager has been in post now for three years and while there is evidence of steady improvements, the professional relations of senior management, as detailed Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 6 above must be improved if the home is to make positive progress in the future. What the service does well: What has improved since the last inspection? Care planning has improved steadily during the past year. Social care has improved by the provision of an Activity Assistant. Afternoon care hours had just been increased prior to this inspection, enabling the Registered Manager to be supernumery each afternoon. Management meetings had just been introduced to include the Registered Manager and the senior team, along with the Responsible Individual and the Operations Manager. The Inspector sees this as a very positive step forward and an opportunity to improve relations and establish a more cohesive action plan for continued improvements. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 7 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. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 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 standard(s) 1,3 & 5. Standard 6 is not applicable as Wilbraham house does not provide intermediate care. The home has revised its Statement of Purpose and Service User Guide, which was satisfactory. The home has an established pre admission assessment procedure. Prospective residents and their relatives/friends are always invited to visit the home prior to admission and once agreement has been reach to offer a place, this is initially for a trial/assessment period. EVIDENCE: The Inspector had been provided with a copy of the Statement of Purpose and Service User Guide prior to this inspection and was found to be satisfactory. This information should be distributed to all prospective residents and others with an interest in the home. Discussions with the Registered Manager and senior staff confirmed that pre admission assessments continue to take place with usually two people being involved, which is good practice. Appropriate documentation is maintained on file, evidence of which was seen during this inspection. Prospective residents and their relatives/friends are always encouraged to visit prior to admission, to meet other residents and staff, view the vacant bedroom and the environment and facilities generally. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 10 Confirmation of this good practice was gained via discussions with staff, residents and a visitor to the home. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 & 10 Care plans were found to be satisfactory. Appropriate arrangements were in place to meet the health and personal care needs of residents. The management and administration of medication was found to be satisfactory, with the exception of the need to improve security. Respect for residents and promotion of their privacy was apparent to the inspector. EVIDENCE: During the period of this inspection, the Inspector examined a 20 sample of care plans, which were found to be satisfactory. The Inspector was aware that the Registered Manager takes responsibility for reviewing all care plans and discussed with her the possibility of delegating some responsibility to the senior staff/keyworkers. In doing this there would be a need to set up a system of auditing so that the Registered Manager could ensure that satisfactory standards are maintained. Health care arrangements were discussed and remain satisfactory. The home has a good rapport with local health care professionals and reports a very supportive service. An examination of care notes confirmed to the Inspector that a wide range of services, including specialist services, is accessed. When asked several residents also confirmed to the Inspector that they were very Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 12 satisfied with the provision of health care services and felt their concerns were positively responded to by the home. The management and administration of medication was found to be satisfactory, including records and signatures. In general storage facilities were also satisfactory. However, due to the close proximity of a opening window the Inspector recommended that a door be fitted to the small room used for storage. By fitting a door lock, this would improve security, ensure medication was out of view from outside and would also resolve the issue of doubly locking controlled medication. Throughout the period of the inspection, the Inspector saw several examples of residents being treated with respect and their privacy promoted. Discussions with staff confirmed a respectful and caring attitude towards residents. Residents also confirmed to the Inspector that they felt that they were treated with respect and that their privacy was promoted. The Inspector was advised that all residents have a lockable facility in their bedroom, and have also been consulted about a bedroom door lock. While the majority of residents choose to spend time during the day in one of the communal areas, some elect to spend time privately in their bedroom and their choice in this is respected. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 &15 Wilbraham House provides a satisfactory level of social care activities. The home is very well located in the village of Audley, providing excellent access to a wide range of local facilities. Choice is promoted in day to day routines and activities. The provision of meals was found to be satisfactory. EVIDENCE: Consultation with residents confirmed that the Activity Assistant continues to provide a good range of social activities, including one to one and small group sessions, which include reminiscence, music sessions, games and quizzes. Access to local community facilities is also promoted, including shops, the community centre and church. Currently the Activity Assistant works 6 hours each week, providing three two hourly sessions. Given the size and occupancy of the home, an increase in these dedicated hours would further improve provision of social care opportunities for residents and should be considered especially in view of the impending increase in registered numbers. Flexible daily routines were being promoted and on the day of the inspection several residents were observed to be rising at different times and taking breakfast accordingly. Residents confirmed to the Inspector that they were encouraged to pursue personal daily routines and exercise choice. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 14 The provision of meals remains satisfactory. Copies of menus were provided to the Inspector. Food stores were seen and contained a very good variety, with lots of smaller items to provide a greater degree of choice. Extensive consultation with residents, visitors and staff confirmed that the standard and variety of meals provided remains consistently good. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Wilbraham House has a complaints procedure, recently reviewed and found to be satisfactory during this inspection. Protection policies and procedures were found to be in place. EVIDENCE: During this inspection the Inspector consulted with residents and felt that there was a general awareness of the complaints procedure, but this should be further enhanced in residents’ meetings and one to one discussions. Certainly there was a clear feeling that staff were always willing to listen to any concerns and several residents told the Inspector that staff were very approachable. The amended complaints procedure should be displayed in a conspicuous place where residents and staff will easily see it. A recent incident in the home necessitated action under the vulnerable adults procedure. A thorough discussion was held about this during the inspection. While there were issues still to conclude, along with lessons to learn as a result of the experience, from the information available to the Inspector, it was concluded by the Inspector that the Registered Manager took appropriate action. Specifically it was identified that the home’s internal communications systems in the event of a serious incident needed to be improved and the Inspector recommended that the home establish a written procedure to clarify and confirm expectations of who should be notified and in what timescales. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 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 standard(s) 19,20,21,25 & 26 Wilbraham House provides a homely and attractive environment that is very well located in the busy village community of Audley. While there have been improvements made to the physical environment since the change of ownership in October 2001, there remains a number of shortfalls which must be addressed. During this inspection the Responsible Individual and the Operations Manager agreed to forward to the Inspector an action plan outlining their timescales for compliance. EVIDENCE: During this Announced Inspection, the Inspector carried out an inspection of the physical environment of Wilbraham House. Each of the communal areas were in use and were comfortable and attractive in appearance. There is a programme of routine maintenance in operation, with the home having a handyman contracted to work 6 hours each week. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 17 The absence of a safe, enclosed garden remains an issue that needs to be addressed as a priority, but the Inspector is aware that the home does not intend to do this until the building work planned for the basement has been completed. Other health and safety shortfalls were also identified, including the completion of the programme to guard all radiators. While some radiators have been guarded, those fitted with wooden guards are very attractive and suitable, many others, particularly in bedrooms have been fitted with a wired frame many being too small and have been left unsecured. The timescale for the completion of this programme is to be notified to the Inspector in the action plan to be forwarded to the CSCI. On the day of this inspection, which was a warm summers day, many radiators were very warm, resulting in some bedrooms being unpleasantly hot. The Inspector was aware that this had been an issue raised by residents during the recent warm spell of weather. When the Inspector raised this finding, it was ascertained that in part of the home the boiler would not allow hot water to be heated separately to the radiators. This situation was worsened by the fact that radiators were not fitted with individual thermostatic control valves and so residents were not able to adjust the temperature of the radiator to suit their particular preference. The Operations Manager advised that he had been in consultation with a plumber and work was scheduled. The Inspector requests confirmation of the completion of this work, which is requirement of this inspection. A sample of bedrooms was viewed during this inspection and each of these was found to be satisfactory. Bathrooms and toilets were also inspected. These remain unattractive and bland in appearance and some were congested with the storage of inappropriate items. The Inspector also highlighted the underneath of bath hoist chairs, which need to be resealed to ensure a satisfactory level of infection control. Attention must also be paid to window dressings to provide privacy. The Inspector advised that the improvement in the appearance of bathrooms and toilets was a requirement of this inspection and should be included in the aforementioned action plan to be submitted to the CSCI. The Inspector found the home to be clean and well presented during this Announced Inspection. However, it was ascertained that the weekly floor domestic hours remain unchanged at just 17.5 hours each week. This provides 3.5 hours from Monday to Friday, with no provision made for weekend. Given the size and layout of this home, the Inspector feels that in order to maintain a clean, pleasant and hygienic environment and without impinging upon the role of the care staff, the arrangements for domestic cover must be increased. This was discussed during the inspection and again should be detailed in the action plan. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Recent improvements had been implemented in respect of staffing hours in order to enable the Registered Manager to be supernumery. The care staffing ratio provided for 5 staff on duty each morning, 4 until 6pm, (including the Registered Manager), 3 from 6pm until 10pm and 2 waking night care assistants. In addition satisfactory arrangements were in place for catering services, but a shortfall, as highlighted under the previous set of Standards was identified in respect of adequate domestic cover for the home. Staff recruitment procedures were in place and the Inspector was told that all staff have had a CRB check. EVIDENCE: Observations of staff on duty conveyed a very positive impression of their competence and care of the residents of Wilbraham House. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. The home now has a much improved staffing structure, providing a manager or senior carer on duty on each shift. Discussions with residents and visitors to the home also conveyed a very positive impression of staff conduct, staff being referred to a ‘friendly’ ‘helpful’ and ‘caring’. While NVQ training was progressing well, the recent staff turnover has led to a significant drop in the number of staff with NVQ qualifications. There are plans in place however for several staff to pursue training in September 2005. The Inspector raised with the Registered Manager the issue of staff retention and Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 19 the home should look positively at ways of retaining qualified and experienced care staff. Staff recruitment procedures were found to be satisfactory. The Inspector examined a sample of staff files, which were very well organised and evidenced that appropriate procedures had been followed. The need to improve the floor domestic hours has already been raised. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 & 38 The Registered Manager of Wilbraham House is Mrs Elaine Bailey, who is a qualified nurse with many years of experience. Mrs Bailey is part way through the Registered Managers Award and hopes to complete by August 2005. The Registered Proprietors are Mr Pargan Dhadda and Mr Sukhinder Singh Kandola, who purchased the home in October 2001. Mr Kandola is the Responsible Individual for the home. The company Wilbraham Limited employ Mr Bobby Dhadda as the Operations Manager. The Inspector has identified a need for improvements in the professional working relations of the aforementioned senior staff and this was discussed during the inspection. The Inspector again clarified the procedure and records required in respect of the management of residents’ monies. The Inspector was satisfied that the health, safety and welfare issues of residents and staff were being promoted, with exception to the specific examples already highlighted, namely: radiator guards, thermostatic valves on radiators and the provision of a safe garden for residents to access. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 21 EVIDENCE: Mrs Bailey has been in post for approximately three years. During that time there have been several improvements at Wilbraham House. For example, the day to day care of residents has improved significantly, care planning has made good progress and the structure of the care team has been developed to include several senior posts. Running alongside these developments has been the steady improvements the proprietors have made to the physical environment. However, the Inspector was disappointed to find that there were still tensions in the relations between the Registered Manager, the Operations Manager and the Responsible Individual. The establishment of a monthly meeting also to include the deputy/assistant managers will hopefully help to develop a more cohesive team with a shared vision, which is needed if Wilbraham Hose is to made real progress in the future. There was some confusion about the management of residents’ personal monies and the Inspector clarified this. The Registered Manager must assume overall responsibility, but the other three managers can also access monies when required and maintain contemporary records. The Responsible Individual should audit records regularly to satisfy himself that monies are being used appropriately and accurate records are being maintained. Throughout the period of this inspection, the Inspector observed sensible procedures being followed in respect of health, safety and welfare. Staff have access to disposable aprons and gloves and suitable hand washing facilities. COSHH information is updated and staff advised that they were given appropriate guidance and advice. The home now has a shaft lift as well as two stair lifts, all of which were described as being in good working order. With the exception of the radiator guards and the overheating of some parts of the home, already raised in this report, the Inspector did not note any other issues of concern in respect of the internal environment. It was noted however that throughout this warm day none of the residents were sitting outside and this relates to the lack of provision of a safe garden area, which must be addressed. Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 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 2 3 2 x x x 2 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x 2 x x 2 Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 25 Regulation 13 & 23 Requirement Radiators and pipework must be guarded or have guarented low temperatures surfaces. THIS IS AN OUTSTANDING REQUIREMENT. Timescale for action The Responsibl e Indiviudal to notify the CSCI in writing of timescale for compliance The Responsibl e Individual to notify the CSCI in writing of timescale for compliane With immediate effect and to remain on going. 2. 19 23 The home must provide a suitable and safe garden to meet the needs of all residents. THIS IS AN OUTSTANDING REQUIREMENT. 3. 27 18 & 19 4. 35 16 & 20 All staffinglevels must be kept undet constant review to ensure the changing needs of residents are met and that good standards of hygiene and cleanliness are maintained throughout the environment. THIS IS AN OUTSTANDING REQUIREMENT. A written policy and procedure in respect of the management of 31 July 2005 Page 24 Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 5. 38 37 6. 9 13 residents personal monies must be developed, which must incorporate the necessary safeguards. A copy of this policy/procedure should be forwarded to the Inspector. A written policy and procedure in respect of serious incident must be developed, which must include notification in writing of the incident to the CSCI. A copy of this policy/procedure should be forwarded to the Inspector. Medication must be securely and safely maintained. Controlled medication must be doubly locked. The Insepctor advised that a lockable door be fitted to the medication store room. 31 July 2005 31 July 2005 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 19 19 Good Practice Recommendations Stained carpets should be replaced to improve appearance. The fire officer should be consulted about reintroducing the kitchen/diner serving hatch which would provide a useful facility and help reduce conjestion along the adjacent corridor. Consideration should be given to implementing stategies to promote better staff retention. 3. 29 Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wilbraham House Residential Home E51-E09 S5035 Wilbraham Hse V228169 29.06.05 Stage 4.doc Version 1.40 Page 26 - 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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