Inspection on 05/06/06 for Wild Acres Rest Home

This inspection was carried out on 5th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wild Acres Rest Home 06/12/07

Wild Acres Rest Home 16/01/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wild Acres Rest Home 440 Finchampstead Road Finchampstead Wokingham Berks RG40 3RB Lead Inspector Stephen Webb Unannounced Inspection 5th June 2006 10:15 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 Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wild Acres Rest Home Address 440 Finchampstead Road Finchampstead Wokingham Berks RG40 3RB 0118 973 3670 0118 936 1862 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) Harbhajan Surdhar Mrs Lynne Valerie Cotterell Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Wild Acres provides 24-hour care and accommodation for up to 18 people aged 65 and over. The home is a large bungalow set back from a residential road overlooking countryside, and enjoys a large mature garden to the front with a patio, and parking for several vehicles. Communal space within the home consists of a lounge and dining room; all 18 bedrooms are for single occupancy and five of these have en-suite facilities. The home is close to local amenities and is within a short drive to the town of Wokingham; public transport is available. The home provides care only for service users needing care solely as the result of old age, and is not registered to admit service users who have dementia or other needs outside the Old Age category. The fees at the time of inspection were from £450 to £500 per week. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to this service was undertaken unannounced on the 5th of June 2006. The site visit included time spent with service users, a relative, the manager and some of the staff. The inspector also toured the premises and examined key records, and had lunch with service users. Evidence was also gathered from various documents supplied to the inspector by the service, including the pre-inspection questionnaire, copies of menus, training records and an activities plan. There were eight returned service user questionnaires, some of which were completed by relatives in consultation with the service user. The home had a welcoming but busy atmosphere, on the day of the site visit and the staff were busy meeting the needs of the service users. It was positive to observe care staff effectively engaged with the service users. Several of the service users were able to give verbal feedback in some detail, to the inspector. The inspector also met with one relative during the site visit. What the service does well: Service users have appropriate opportunities to visit the service prior to admission. The manager and staff are described as welcoming, supportive and helpful. Staff have received a range of training though some gaps remain. Staff demonstrated good awareness of the needs of individual service users and there was evidence of a good relationship between them and the service users. The home is well supported by local external professionals when required. Most of the staff, including the night staff, have received medication training, which is good practice. Untrained staff do not administer medication. Privacy is maximised by the provision of all single-occupancy bedrooms. The home has an effective complaints procedure, of which service users were aware, and felt they would be able to raise issues with the manager if necessary. The manager holds regular residents meetings, which relatives can also attend, in order to obtain improved feedback on the care provided. This would be a good vehicle for the necessary survey regarding meals improvements. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Further development of risk assessments is required in some areas, and the initial assessment could be improved by the development of a single core assessment record. The manager needs to establish a complete audit trail for medication coming into the home, and written confirmation should be obtained of any changes to prescribed medication before these are made. There is a need to actively offer a bedroom door lock to service users unless they are assessed as unable to manage this, rather than relying on a service user to ask if they want a door lock. Further development of a range of activities, entertainment and community involvement is necessary. There is a need for more consultation with service users on the food provided as this was the most consistent criticism levelled at the home. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 7 There is a need for all staff to receive “Vulnerable Adults” (POVA) training as a priority, and some improvements to recruitment procedures are needed. Some additional staff also require food hygiene training. There remains a need for further improvements to and completion of elements of the internal environment of the home, and the garden is in need of significant work to render it safe for use, and increase accessibility. Current staffing levels are minimal, for a home of this size. However, they appear to meet the needs of service users from the feedback obtained. The staffing levels should be kept under regular review by the manager, to ensure staff have sufficient time available for providing activities and to meet the changing needs of service users. Guidance should be sought from the fire authority and environmental health department regarding the health and safety aspects of the accommodation provided for one live-in staff member. Some improvements to the records of the management of service user finances would be beneficial, though there is no suggestion of inappropriate expenditure. 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. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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 Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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): 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There remains some room for improvement of the assessment systems in terms of the development of a core assessment document to address the major aspects. Standard 6 is not applicable as this service is not provided. EVIDENCE: The manager visit the prospective service user where they are living, speak to relatives and other parties if appropriate. The prospective service user visits the unit at least once and service users move in initially for a one-month trial period. The home has recently adopted the Standex recording system, but has a range of assessment documents in place, both from this system and from previous practice. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 10 The records examined included a dependency profile, a questionnaire on likes and dislikes, risk assessments on nutrition, moving and handling, and pressure areas but some aspects, such as mental health history, were not thoroughly addressed and the variety of different documents was confusing. The manager indicated that a lot of information was recorded on a blank notepad during the assessment visit rather than within an assessment format. It is recommended that the manager reviews the various elements of the assessment process and devises a single unifying assessment document, which contains prompts for the core information and links, where appropriate, to the various peripheral documents. Any elements of the Standex system which the home elects not to use, should be removed from the format to avoid confusion. A relative spoken to during the inspection confirmed that they had had opportunities to visit the unit prior to admission, and been visited at home, and added that the staff had been very open, welcoming and helpful, and “put themselves out” to support the move. It was also confirmed that the care needs of the prospective resident had been discussed, and a care plan devised. The majority of service user questionnaires returned (8), indicated that service users had received sufficient pre-admission information about the home (7 respondents), and that a contract had been provided (7 respondents). Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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. There is some room for further development of the care plans, though these have been improved since the last inspection, a risk assessment should be undertaken whenever cot-sides are proposed, and a medication audit trail needs to be in place. EVIDENCE: Each service user has a care plan within the new system adopted by the home. The overall plan comprises the care plan document, and also a social activity plan, but might benefit from the inclusion of an individual profile to include more detail on the day-to-day provision of care. Longer-term staff demonstrated their familiarity with the needs and wishes of service users during the inspection, and clearly know them well. Service users confirmed their awareness of their care plan, and one added that their next of kin could also see it if they agreed. A relative also confirmed their Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 12 awareness of the care plan, and having been consulted on the care needs of the service user by the manager. The manager had also explained to the relative that she could access the CSCI inspection report via the Web, which is good practice. The manager reported that care pans are reviewed with the local authority contracts manager where relevant, but these documents were not available at the time of inspection having been placed in temporary storage during the extensive building works. Evidence of the ongoing review of care needs was found in the review of the pressure area risk assessment for one service user, within a month of writing, owing to the service user ceasing to mobilise independently. Following previous concerns regarding the safety of cot-sides in one case, these had been provided with appropriate covers. However, whenever cotsides are used, a risk assessment should be undertaken, and none was in place. The manager must ensure that an appropriate risk assessment is put in place whenever the use of cot-sides is considered, and the support of next of kin and GP should be obtained, ideally in writing. The care records on each service user include a range of formats addressing the individual’s healthcare needs, including a medication profile, pressure area and nutritional risk assessments and medical records. The home has a range of hoists and other equipment to meet the needs of service users. Service users receive support from a range of external professionals including GP, district nurses, CPN, chiropodist and eye clinic as required. The home has a written medication procedure and all but three of the staff have received medication training. These three staff do not administer. The night staff have also received the training, which is good practice. Observation indicated satisfactory administration practice. However, there is a need to record and countersign the quantities of medication received into the home as the start of the audit trail. The driver collecting medication returns should also be asked to sign for these. In one case a change had been made in administration frequency for one medication without the home having written confirmation of the change from the GP. The home must always obtain written confirmation of any medication changes before these are made. Discussion with service users and feedback from returned questionnaires, indicated that most service users feel that the staff usually treat them with Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 13 respect and dignity. One service user confirmed that they are enabled to bathe by themselves, as they remain able to manage this. Service user comments included “ the staff are very kind and helpful” and “the staff do their best” and one relative said “the staff… are always very pleasant and caring”. However one service user commented that some staff are not as approachable as others. All of the bedrooms are single occupancy, which provides for basic privacy though none of the doors is currently fitted with a lock. The manager stated that one would be fitted if a service user wanted this. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in activity planning and provision but there remains a need for further expansion of the activities provision and community involvement in the home, and for improvements in the consultation process about meals and the provision of these in the home. EVIDENCE: Several service users were critical of the level of available activities, and one suggested that the opportunity to go out sometimes, for a drive and perhaps a pub lunch, was limited by lack of funds being made available, but the manager felt this was not the case and that few such requests had been received. There had been some trips to local garden centres/cafes. Service users referred to quizzes and occasional garden parties. One indicated that there were few outside entertainers and that they would like more. Another indicted that they were not really interested in activities and tended to amuse themselves. Four of the eight respondents to the inspection questionnaire to service users were critical of the level of activities, two made positive comments. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 15 It was noted, that there was no TV available in the lounge. Whilst it is very important that a TV is not always on, reducing opportunities for conversation and other activity; the option to watch TV communally should be available. In its absence, service users have no option but to watch TV in isolation in their bedroom, which may not necessarily be their preference. The manager stated that the provision of activities had improved since the last inspection, and had produced a written activities programme. However, she acknowledged that further development was possible, and that this would be undertaken now that the distractions of the major building works have reduced. Further discussion with service users or surveying of their views might be beneficial. A relative of one service user has undertaken to explore further activities options, especially art and craft ideas, on behalf of the home. This is good partnership working, though the home should not rely solely on her efforts. The home is visited monthly by a local vicar who holds Holy Communion for the service users who wish to take part. (Seven service users). None of the other service users is reported to have spiritual needs which require addressing. Although one service user originates from the Ukraine, she identifies herself as British. It was evident that a number of service users enjoyed regular contact and visits from family. Several relatives visited the unit during the inspection. Visitors can see service users in the lounge or in private in their bedroom. At present, the home does not make the best use of possible local community links, and perhaps these could be developed further. The manager stated that service users are asked their preference regarding times for baths, getting up etc. This was confirmed by some, but not all of the service user feedback obtained. Service users confirmed that they were able to make choices in a number of areas of day-to-day life, such as getting up and going to bed, meal options and whether you wanted to take part in activities. Two service users indicated that they maintained control over their own finances. The menus indicated some processed foods, such as pies, but there was a good balance of home-made meals which the manager stated were made from primarily fresh ingredients. Menus also indicate the availability of choices at each meal. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 16 The menus are on a four weekly seasonal cycle and laminated copies have been produced to give to service users to enable them to make choices each day during the morning. This is an improvement since the previous inspection. One service user indicated that if you didn’t like the options on a particular day, then a further alternative was offered. One confirmed that menus and food were discussed at residents meetings. However, verbal feedback from service users about the meals was primarily negative, with most expressing some criticism, and only a few making positive comments. Two felt that the food had improved, while others stated that it was not as good as it had been in the past. Several felt that the preparation of English meals was not the chef’s forte. One suggested that the quality of some items was not as high as in the past. Service users confirmed that additional snacks were available from staff on request. A number of service users bemoaned the lack of home-made cakes since the home changed hands. It was also commented that the evening tea was rather small at times and failed to satisfy individual’s hunger. From the service user questionnaires returned, eight made negative comments about the food. Given that the teatime meal needs to satisfy service users until breakfast the next morning, the quantity and content of the teas should be reviewed by the manager. The manager agreed to review the tea menu. The home caters for the needs of one vegetarian service user to her satisfaction. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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 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. Residents indicated an awareness of the complaints procedure, and an appropriate recording system was in place. Some improvements in staff recruitment practice and training would be beneficial in improving the level of protection to service users. (See Staffing section for more detail and resulting requirement/recommendation). EVIDENCE: The home has a written complaints procedure, which the manager reported to be shown to new staff and residents. The complaints log indicated two, connected complaints since the last inspection. The complaint related to a food issue, and was made by the service user directly, and then a relative, on behalf of the service user, on the same issue. The matter was appropriately resolved. Several of the service users that the inspector spoke with, indicated they would take any issue to the manager. All of the respondents to the service user questionnaire indicated they were aware of the procedure, with several confirming they would first take any issue to the manager. The home has a policy on the protection of vulnerable adults. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 18 Some minor improvements to staff recruitment practice would provide improved protection for service users. See staffing section for details. (Recommendation made under Standard 29, below). The training record indicates that only three of the staff have received recent vulnerable adults training, and this was in 2003. All staff should be provided with POVA training from a suitably qualified trainer as a priority, in line with Regulation 13(6). (Requirement made under Standard 30, below). Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is coming to the end of a major refurbishment, which has led to improvements in the standard of accommodation, but a significant number of issues remain to be addressed, in order for the potential to be maximised. EVIDENCE: The premises have been subject to a major refurbishment over the past few months, which has proved quite disruptive to the life of the home. The majority of the internal building works are now complete or close to completion and where areas have been finished, considerable improvements in the environment are evident. Work is still being carried out in some areas, including the creation of a new staff room, and improvements to the office. Three service users said that the redecoration of their rooms had been an improvement, although the disruption of having to move out while work was Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 20 carried out had been difficult. One commented that their pictures had been rehung in their bedroom today, and now it felt like their room again. The en suite bedrooms are particularly attractive, and each opens out onto the raised terrace in the garden. The new radiator covers were seen as a positive addition, with adjustable thermostatic valves also being fitted to each one, and one service user said they had been told that new curtains were also coming. At the completion of the works there will be three bathroom/toilets and a further separate toilet, which was still under construction, and five of the bedrooms will have en suite facilities. All of the bathrooms are fitted with hoists, though in future, some consideration should be given to the provision of height adjustable baths on staff health and safety grounds. A number of service users were looking forward to an end to the disruption and noise from the building works. One indicated that she had not found the noise too disruptive and had had a good relationship with the builders. Some of the staff had found working during the building works to have been stressful, and were relieved that internal work was nearly completed, though all recognised the necessity for the improvements to bring the premises up to standard. Several service users and a relative commented that the manager and staff had coped admirably during the building works. Two service users commented verbally about the need to make the garden safer and more accessible. The home has had new boilers installed as the previous ones were inadequate, and the commissioning certificates were awaited. Thermostatic safety valves were being installed on all hot water outlets, including bedroom hand-basins, over the two weeks following the inspection. A fire contractor had visited the home the week prior to the inspection. His report indicated the need for adjustment of some fire door self-closers and for the provision of additional smoke/heat detectors. This work must be addressed as a matter of urgency. The low level of ambient lighting in the new dining room had been reported to the inspector by a relative and was commented upon by a number of service users during the inspection. The inspector concurred that there was insufficient lighting in this area. The proprietor undertook to address this matter. The lounge is a bright room, with plenty of natural light from the large windows. The new curtains were said to be on order. However, there remains insufficient communal space for service users, particularly in terms of the number of available armchairs. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 21 The proprietor plans to remove an ornamental fireplace in the lounge, to enable additional seating. He also plans to convert a small area of the dining room into a second lounge space with armchairs. This area will need to be provided with additional lighting and flooring consistent with a lounge, if it is to be considered appropriate, and should not be provided at the expense of sufficient dining space. In the long term, there are plans for a possible conservatory to further extend available communal space. At present none of the bedroom doors is fitted with a lock, which is not in accordance with Standard 24. The manager indicated that a door lock would be fitted if requested by a service user. In future, the option of a bedroom door lock should be positively offered to all service users unless their assessment indicates they would be unable to manage one. The offer and the service user’s decision should be recorded on each individual’s file within their care plan. Examination of the new kitchen indicted that there may be a need for a flyscreen to be fitted at the back door. The advice of an Environmental Health Officer should be sought on this matter. The kitchen door also required a selfclosing device. If it is felt necessary for this door to be held open during the serving and clearing of meals, a detailed risk assessment must be carried out, in consultation with the Fire Authority, before fitting an approved device to enable this. It was of some concern that a member of the domestic staff was living on the premises and did not have her own self-contained facilities. She had only a small, un-ventilated room without a window, and with no dedicated toilet, bathing or cooking facilities. The advice of both the Environmental Health Department and the Fire Officer must be sought, in writing, on the health and safety aspects of this arrangement, and a clear written agreement should be drawn up and signed, which makes clear the position re external visitors, who have not been CRB checked, given that this accommodation is not self-contained with its own, separate entrance, and can only be accessed from within the home. Examination of the garden indicated an area of great potential, with pleasing views across open fields, which was yet to be realised. The garden was mainly given over to lawn, with few paths. There was a raised patio/terrace area, which presented hazards from uneven and loose paving and crumbling low walls, which could be a trip hazard. There were no effective railings or other boundaries around raised areas and level changes, to reduce the risk to service users, and on one side, where a tall fence had been removed there was no boundary to prevent a service user wandering off. None of the current service users was said to be at risk of Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 22 wandering, but it was agreed that an appropriate boundary was needed to secure the garden and maximise the freedom of movement of the service users. The proprietor agreed to provide this. This had been discussed with service users at a residents meeting. The garden afforded some natural shade beneath mature trees, which the manager reported was utilised by service users at times, but the terrace itself had no shade provided and would therefore be unusable on a sunny day. In discussion, the manager and proprietor agreed that this area was their next priority. Their plans included raised beds, sensory planting and possibly growing some vegetables. Given the approach of summer, it will be important to make the garden safe for use and provide some additional shade, as a matter of priority. Whatever longer-term plans may be being considered. At the front of the home was a full skip and a quantity of other builders refuse awaiting removal. This detracted from the appearance of the home and should be removed as soon as possible. The new laundry had suitable equipment, including a sluice cycle washing machine, but was inappropriately accessed via the dining room. During the inspection the possibility of creating an alternative access from the corridor was identified in discussion with the proprietor. This should be pursued as a priority, while builders are still on site, to reduce the risk of cross infection. It was noted that a number of holes remained in the laundry ceiling from the fitting of the new boiler therein. These must be filled to maintain the integrity of the ceiling as a fire barrier. This was commenced immediately during the inspection. It was also noted that the cover fitted to the smoke detector during the boiler installation remained in place. This was immediately removed. It is important that such matters are checked thoroughly on completion of work in each area. The home was clean, for the most part, given the ongoing building works, and free from offensive odours. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 23 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 Good. This judgement has been made using available evidence including a visit to this service. The home has a stable staff team, with a satisfactory level of NVQ achievement. Some improvements to recruitment practice and the provision of POVA training are necessary to maximise the protection of service users. The provision of training in other areas is improving. EVIDENCE: The home has a stable team with a core of long-term staff. Standard staffing during the daytime is two care staff, plus the manager is on duty until 6pm, with one staff member on waking nights each night from 8pm to 8am. This is considered to be absolutely minimal in a home of its size. In their written responses to inspection questionnaires, five out of eight respondents were happy that staff were usually available to meet their needs, and three said they were always available when needed. Three service users did comment verbally that they felt that only one staff member at night might not be sufficient as some service users had a tendency to wander at night. They also commented that the staff could be stretched at times, and were often very busy, though it was also said that staff usually responded quickly to call bells. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 24 It was reported that the night staff got some service users up in the mornings. It is not considered appropriate for night staff to do this, (especially where when they are the sole person on duty), unless it is genuinely the recorded preference of the individual service user. One service user confirmed that she did not require a lot of support from the staff at the moment as she could manage by herself for the most part. Staff indicated that they could generally manage during the daytime, but there was some suggestion that one night staff was not always enough. The manager should keep the staffing levels under regular review in response to the changing needs of service users, and in order to provide for an increase in available activities. Five staff have NVQ level 2 and one has level 3. Four staff do not have an NVQ, though two of these are completing their SRN training. The manager has obtained her NVQ level 4 and registered manager’s award. There was room for some improvements in recruitment checks. For example the application form does not require a complete employment history for even the past five years. It is strongly recommended to include this as it helps to provide evidence of suitability and may indicate gaps in employment history, which need to be pursued. The reference request form does not ask for any history of disciplinary action and does not encourage the provision of an employers official stamp or a response on headed paper. This can be helpful in the case of references from a previous employer, as it would normally provide contact details in order to verify the reference, if there is any doubt about it. The manager has a training spreadsheet indicating the recent staff training, which had included fire safety (all), moving and handling (all), medication (1, others have received this previously), nutrition (correspondence course)(7), infection control (7), and a correspondence course on health and hygiene (all). Eight staff had a current first aid certificate. Hoist training had been provided to all staff in February. The manager also indicated that some training on bereavement and Parkinson’s disease had also been provided. However, training on the protection of vulnerable adults (POVA), had not been provided to several staff and only three had received this in 2003. All staff must be provided with POVA training from a competent source as a matter of priority. Also additional care staff require food hygiene training as they are responsible for some meal preparation and serving. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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 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 is managed effectively and the manager has commenced a cycle of quality assurance, review and development planning, which will help the home continue to develop in the future. A system for regular ongoing consultation with service users is in place. There is room for some improvements in the recording and management of service users’ funds, in terms of their greater individualisation, though there was no evidence of any inappropriate use of these monies. Health and safety related matters were being addressed effectively by the service, for the most part and works to improve health and safety were ongoing, including the installation of thermostatic safety valves and radiator covers throughout the home. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 26 EVIDENCE: The manager is suitably experienced and qualified to manage the home. She has attained NVQ level 4 and the Registered Manager’s Award. The manager is usually present in the home Monday to Friday. The feedback from service users and relatives is complimentary about her approach and accessibility as well as her supportive attitude to service users. She attends some training to maintain her awareness of current practice. The manager had recently undertaken a round of quality assurance questionnaires to service users, (some were completed on their behalf by next of kin), relatives, and key professionals, for which the closing date was said to be the 9th of June. She undertook to compile a summary report to make available to participants. Following this the manager will undertake an annual review and produce a development plan for the ensuing year, and will provide a copy to CSCI. The manager carries out regular monthly residents meetings, which are minuted. This was confirmed by service users, and also by a relative who had also attended one of them. It was stated that most service users attend these and that the manager goes round individually to any who do not attend, to obtain their views. Financial management systems, where the home manages small amounts of funds on behalf of service users (currently for nine service users), should be improved by the provision of separate storage for individual’s funds and receipts for any expenditure on their behalf, as discussed during the inspection. The records of each individual’s funds should also be maintained separately so as to maintain privacy. The manager or senior already check and sign individual balances. In most cases service users have family members who manage their money on their behalf. One service user confirmed that they still managed their own financial affairs. The health and safety of service users was stated to be a priority for the manager, though the manager and proprietor acknowledged there had been difficulties during the extensive redevelopment process. Appropriate health and safety-related certification was in place for the most part, though the commissioning certificates for the new boilers were awaited and the thermostatic safety valves for all hot water outlets were due to be Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 27 installed over the two weeks following the inspection. The installation of radiator covers throughout the home, was almost complete. Staff receive appropriate training on medication, health and safety, moving and handling, first aid and the use of the hosts. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 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 X 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 29 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. 1. Standard OP7 Regulation 13(4) Requirement The manager must ensure that a written risk assessment is in place wherever cot-sides are to be used. The manager must address the identified shortfalls in the system of medication recording in line with Royal Pharmaceutical Society guidelines. The manager must make further improvements to the diversity and frequency of activities provision to service users. The manager must consult effectively with service users on the issue of food, and ensure that the quality and quantity of food provided meet the needs of service users. The proprietor must ensure that the remedial works identified by the fire contractor and inspector, are completed promptly. (Smoke /heat detectors, self-closer adjustment and installation, fire risk assessment and filling of holes in laundry ceiling). The proprietor must seek written approval from the local fire authority and environmental DS0000065935.V292264.R01.S.doc Timescale for action 05/07/06 2. OP9 13(2) 05/07/06 3. OP12 16(2)(m) & 16(2)(n) 16(2)(i) 05/09/06 4. OP15 05/08/06 5. OP19 23(4) 05/08/06 6. OP19 23(4) & 23(5) 05/08/06 Wild Acres Rest Home Version 5.1 Page 30 7. OP19 23(2)(o) 8. 9. OP20 OP20 23(2)(P) 23(2)(g) 10. OP26 13(3) & 13(4)(c) 19 & Schedule 2 13(6) & 18(1)(c) (i) 18(1)(c) (i) 11. OP29 12. 13. OP30 OP30 health department, for the current accommodation provided for a member of domestic staff within the premises. The proprietor must provide a written plan to indicate how the external grounds are to be improved in terms of safety, security and usability. The proprietor must ensure that the lighting levels in the dining room are improved. The proprietor must ensure that the communal lounge facilities are improved such that sufficient comfortable seating for all service users is provided. The proprietor must provide appropriate access arrangements to the new laundry room, in accordance with Standard 26.2. The manager must ensure that the recruitment system and records thereof, conform to Standard 29 and Regulation 19 and Schedule 2. All staff must be provided with POVA training to maximise the protection of service users. The manager must ensure that all staff who handle food, have a current food hygiene qualification. 05/08/06 05/08/06 05/08/06 05/08/06 05/07/06 05/08/06 05/08/06 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 OP3 Good Practice Recommendations The manager should consider developing a core assessment format which contains the necessary aspects, to ensure consistent and thorough assessment. DS0000065935.V292264.R01.S.doc Version 5.1 Page 31 Wild Acres Rest Home 2. OP7 3. 4. 5. 6. 7. OP13 OP19 OP19 OP24 OP35 The manager should consider the development of an individual profile within the care plan format to provide readily accessible details of the day-to-day support needs and wishes of each service user. The manager should consider ways to increase the level of community involvement in the home. The manager should confirm when the commissioning certification for the new boilers has been received. The manager should consult with the environmental heath department regarding the possible need for a fly-screen at the kitchen back-door. Service users who are assessed capable of managing a bedroom door lock, should be offered this facility. The manager should consider making the identified improvements in the management systems for service user finances. Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 Wild Acres Rest Home DS0000065935.V292264.R01.S.doc Version 5.1 Page 33 - 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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