Inspection on 10/05/05 for Wilmington Manor Nursing Home

This inspection was carried out on 10th May 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.

Other inspections for this house

Wilmington Manor Nursing Home 02/05/08

Wilmington Manor Nursing Home 10/05/07

Wilmington Manor Nursing Home 06/09/06

Wilmington Manor Nursing Home 15/11/05

Wilmington Manor Nursing Home 26/10/04

Wilmington Manor Nursing Home 13/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Wilmington Manor Nursing Home Common Lane Wilmington Dartford Kent DA2 7BA Lead Inspector Elizabeth Baker Unannounced 10 May 2005 9:30am 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. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Wilmington Manor Nursing Home Address Common Lane Wilmington Dartford Kent DA2 7BA 01322 288746 01322 284403 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) BUPA Care Homes Limited Mrs Patricia Anne Wakefield CRH Care Home 50 Category(ies) of OP old age (50) registration, with number PD Physical disability (5) of places Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Staffing Notice dated 3 October 1997 Date of last inspection 26 October 2004 Brief Description of the Service: Wilmington Manor is a care home providing nursing care for 50 Older People. Within that total the home may admit upto five Older People with a physical disability. BUPA Care Homes Limited is the registered provider. The home is a large converted property. Accommodation is provided on the ground, first and second floors. Bedrooms comprise 50 single rooms with ensuite WC facilities. There are two sitting rooms and two dining rooms. All bedrooms have a TV and telephone point. All rooms used by service users are connected to the nurse call alarm. There are two seven-person passenger lifts, one of which accesses all floors. There are well-maintained gardens, which are accessible for people with a physical disability. Access to the home to shared with the neighbouring but unconnected care home. The home is located in a rural area and public transport is limited. The home is approximately one mile from the A2 Dartford Heath junction. Dartford and Bexley town centres are approximately two and three miles away respectively. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over seven hours on the 10 May 2005. Lead Inspector Elizabeth Baker carried out the inspection. A partial tour of the home took place. Records were inspected as part of case tracking and to assess progress on requirements and recommendations made at previous inspections. At the time of the visit 44 service users were resident at the home. Nine service users were spoken with, of which six were formally interviewed. One visitor and four members of staff were also spoken with. The inspection was carried out with assistance from Deputy Manager Mrs D Catchpole. What the service does well: What has improved since the last inspection? What they could do better: More information about the home and its facilities must be available so service users and their representatives can make a informed choice. All service users must be provided with written information about terms and conditions of residence so they are aware of rules, costs and responsibilities. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 6 Registered Nurses must maintain care records as required by their professional body as evidence of care being delivered. Prescribed medicines must not given or applied to other service users. In order for service users to be satisfied their concerns are taken seriously, the home must keep detailed complaint records, including subsequent action taken to rectify the matter. Special nursing beds must be provided to service users whose assessed needs require them. The current arrangements for transporting “hot” meals to service users bedrooms must be improved to ensure food is served at the appropriate temperatures. The standard of cleaning throughout the home must be improved for service users’ protection. A replacement and repair programme must be initiated. The programme must include carpets, bed linen, bedroom doors and the driveway. All rooms used by service users must be kept at temperatures, which meet their needs and preferences. For the safety of service users and staff, environmental risk assessments must be carried out on all bedrooms to identify and reduce potential hazards. Care staffing levels must be reviewed and increased to reflect the assessed needs of the current service users. 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. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 3 The home’s Statement of Purpose is inadequate and does not provide prospective Service Users with sufficient information for them to make an informed choice. Not all service users are aware of terms and conditions of residence as only privately funded service users are provided with such details. EVIDENCE: The Commission recently received a revised copy of the home’s Statement of Purpose. The document is intended to inform prospective service users and their representatives about the services and facilities provided at Wilmington Manor. However the revised document does not provide sufficient information for such a decision to be made. The home has now been provided with a copy of the Commission’s Policy Document on the content of Statement of Purpose to assist the Manager in developing the home’s document further. Privately funded service users are provided with a contract setting out terms and conditions of residence. There is no equivalent document for service users whose care is paid fully or partly by other agencies. This prevents these Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 9 service users being adequately informed of current rules, rights and responsibilities of staying at this home. Registered Nurses assess prospective service users in their own homes or hospital prior to a decision of admission being made. A form is used to record the information gathered at these visits. However the form does not adequately cover all the relevant care aspects described in standard 3.3 to ensure a complete plan of care is devised. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 10 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 and 10 Service users are at risk as care records are not adequately maintained and medications are not stored in hygienic conditions. EVIDENCE: For case tracking purposes, care records of three of the six service users interviewed were inspected. Only one of the care plans had been signed by the service user. The service users interviewed were aware of their care needs and problems. However the records inspected were not reflective of the current needs and problems including sleep, pain, mobility and skin condition. A GP had prescribed a particular skin cream for a service user. The cream seen in the service user’s room was not that prescribed and had been prescribed for another service user. A particular service user described how they now have trouble standing and their legs sometimes feel like jelly. The respective care plan made no mention of this change. The home uses a range of clinical risk assessments to monitor the effectiveness of treatment plans. Some of these assessments were Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 11 incomplete. Daily records are maintained but contain minimum information on service users’ quality of day and social experiences. Service users receive input from other health care professionals, including dentists, chiropodists and opticians, on an assessed needs basis. The home has a clinical room in which medications are stored. The standard of cleaning in this room was unacceptable. The skirting wall/floor junctions were dirty, the stainless steel sink was badly stained and the light de-fuser contained dead insects. The sink unit cupboard had been stuffed full of nursing aids. The sharps box contained re-sheathed sharps. Part of the interior enamel roof lining of a large metal medicine cupboard was missing and requires replacement or repair. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 12 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 and 15 Service users are supported in exercising their lifestyle preferences with regard to activities. Service users are offered a choice of meals and where to eat, but the quality of some meals taken in bedrooms is unsatisfactory because of transporting arrangements. EVIDENCE: Organised activities are available for service users who prefer group activities. Service users are encouraged to continue with activities they previously enjoyed prior to entering the home, including art and crafts, knitting, tapestry and model making. Service users said they like sitting in the garden, but are reliant on staff having the time to take them out and bring them back and so cannot do this as often as they would like. The home does not have a facility for service users to buy small items such as sweets, toiletries, cards, pens etc. One service user said although staff willingly carryout errands in their own time, it would be nice to be able to buy such things in-house. Service users said the food is very good and choices are offered. Full English breakfasts are available. Most service users like to eat breakfast in the privacy of their own bedrooms. The distance between the kitchen and some bedrooms is quite far, resulting in service users receiving cold cooked breakfasts. Menus are displayed at various points around the home. However not all service users are able to access and/or read the menus, which prevents them from making an informed choice prior to the meal being served. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 13 The home provides service users with alternative meals if the menu selection is not to their liking. Details of these meals are not recorded, which could present a problem in the event of a food investigation having to be carried out. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 14 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 and 18 The recording of complaints is selective and does not demonstrate the home listens to and takes all service users’ concerns seriously. EVIDENCE: Care staff are trained in Adult Protection issues. The home’s complaint’s procedure includes contact details of the Commission. Service users described the action they would take if they had a concern or complaint. The complaint book could not be found at this visit. However the Deputy Manager said the two specific concerns/complaints mentioned during the inspection had not been recorded in the book. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 15 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, 23, 24, 25 and 26 The current environmental state of the home does not create a safe, comfortable and pleasing place to live. EVIDENCE: A Technical Officer of the local Environmental Health Department inspected the kitchen in April 2005. A number of matters required attention. The home has a number of adjustable beds. However, such a bed had not been supplied to a service user whose current assessed needs required this. Carpets throughout the home are showing signs of wear and tear. An old odour lingers in the reception area. Some carpets are heavily stained and others have started to fray. Many internal doors have been contact damaged. Some bedrooms require redecorating. Bedrooms sizes conform to the minimum requirements of a pre-existing home providing nursing care. Some rooms are cluttered with furniture and personal possessions, presenting a hazard to both service users and staff. Suitcases and black sacks containing Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 16 personal possessions were seen stored on top of a wardrobe and under the bed. The standard of cleaning in bedrooms was poor. The floor in the visitor’s toilet was dirty, particularly along the skirting/wall junctions and under the radiator. The laundry room required a thorough clean behind the washing and drying machines. The laundry only has one sink. This sink is used for soaking soiled items. There is no separate hand wash sink for staff use. The dual use of this sink does not promote safe infection control practices. Threadbare and frayed bed linen was seen in the laundry. This was to be used on service users’ beds. The home shares its driveway with a neighbouring care home. There are holes in the driveway, making walking access hazardous and ambulance transfers uncomfortable. The home was warm, apart from the large sitting room, which was noticeably colder. Service Users commented on this and some had been supplied with leg blankets to keep warm. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 17 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, 28 and 30 Care staff numbers are not adequate to meet current service users’ assessed needs. EVIDENCE: The home continues to use the staffing notice issued in 1997 as the basis to determine its current staffing levels; a time when dependencies of service users receiving nursing care were considerably lower than today. Dependency assessments are also used, although not all the care records inspected contained such an assessment. Service users said staff response to call bells is generally good but they have to wait sometime for actual assistance. One service user said it is not unusual to have to wait a couple of hours in the morning before they are assisted with washing and dressing. Another said having to wait to be assisted to the toilet causes them distress The staffing levels are not adequate for the assessed needs of the current service users. Staff are employed for cooking, cleaning, laundry, administration, activities and maintenance. New members of staff are required to complete a comprehensive induction programme. Care staff receive foundation training relevant to their roles. One Healthcare Assistant is qualified to NVQ level III care and six to NVQ level II. A number of Healthcare Assistants are working towards to this qualification. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 18 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 and 38 The home’s management is satisfactory overall, but records are not adequately maintained. Some practices do not promote and safeguard the health, safety and welfare of service users and staff. EVIDENCE: The Registered Manager is appropriately qualified and experienced to manage the nursing home. The organisation’s representative visits the home on a monthly to support the Registered Manager. Care records contained moving and handling assessments. The assessments were incomplete of the type of lifting equipment to be used. Care records also contained risk assessments. The assessments did not adequately describe the specific environmental risks to service users and staff in respect of a number of bedrooms visited, with particular regard to the size and content of the rooms. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 19 The clinical room is near to the nurse’s station on the ground floor. For staff to hear the phone when preparing medications, a wooden wedge is used to prop the door open. This practice damages the fire integrity of the door as well as reducing the room’s security. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 20 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 2 2 3 x x 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 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x 2 2 2 2 STAFFING Standard No Score 27 2 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 x x x x x x 2 Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 21 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 1 Regulation 17 Requirement The statement of purpose should be completed as per the Policy Guidence provided at the time of this inspection. (Timescale 31/01/05 not met) Sponsored service users must be provided with a written statement of terms and conditions of residence. Service Users must receive actual medicines and preparations as prescribed by their GP. Service users prescribed medications must not be administered or applied to other service users. The clinical room and associated equipment must be kept clean and in a good order. Sharps must not be re-sheathed. Timescale for action 30/09/05 2. 2 5 30/09/05 3. 9 13 10/05/05 4. 9 13 10/05/05 5. 6. 7. 8. 9. 9 9 15 15 19 13 13 16 16 23 31/05/05 10/05/05 Meals must be served to service 15/06/05 users at appropriate temperatures. A record of meals actually 31/05/05 provided must be maintained. (Not adequately met) The Manager must inform the 30/06/05 Commission as to the compliance progress in respect of the Environmental Health H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 22 Wilmington Manor Nursing Home Departments visit requirements. 10. 11. 12. 19 24 24 23 16 16 The driveway must be repaired. Carpets and bedlinen must be replaced. Adjustable beds must be provided where assessed as necessary. (Time scale 31/01/05 not met). Rooms used by service users must be appropriately heated for their needs and preferences. The standard of cleaning throughout the home must be improved. The cause of the lingering odour in the reception area must be eradicated. A separate hand wash sink must be installed in the laundry. Staffing levels must meet the assessed needs of current service users. Detailed assessments must be carried out for those bedrooms presenting risk due to size and contents. (Timescale 31/01/05 not adequately met). The clinical room door must not be kept wedged open. 31/08/05 31/07/05 10/05/05 13. 14. 15. 16. 17. 18. 25 26 26 26 27 38 23 23 23 23 18 13(4) 10/05/05 10/05/05 30/06/05 15/07/05 31/05/05 31/07/05 19. 38 13 10/05/05 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. 3. 4. 5. Refer to Standard 7 7 8 8 12 Good Practice Recommendations Care plans must be complete and current of all needs and problems. All service users should be encouraged to be involved in their plan of care. Clinical risk assessments must be complete. Daily records should provide quality of day statements as well as health and personal care information. Service users should be able to go to the garden when H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 23 Wilmington Manor Nursing Home 6. 7. 8. 12 16 28 they request. A facility to enable service users to purchase small items such as toiletries, pens, sweets at the home should be available. All complaints must be recorded and be readily available for inspection. 50 of unregistered staff must be trained to NVQ level II care or equivalent. Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Wilmington Manor Nursing Home H56-H06 S26214 Wilmington Manor Nursing Home V226236 100505 Stage 4.doc Version 1.30 Page 25 - 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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