Inspection on 15/11/05 for Wilmington Manor Nursing Home

This inspection was carried out on 15th November 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 10/05/05

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 Announced Inspection 15th November 2005 09:45 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 Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wilmington Manor Nursing Home Address Common Lane Wilmington Dartford Kent DA2 7BA 01322 288746 01322 284403 wakefiep@bupa.com 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) BUPA Care Homes Limited Mrs Patricia Anne Wakefield Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50), Physical disability (5) of places Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2005 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 up to five Older People with a physical disability. The home is a large detached 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 residents 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 is shared with the neighbouring but unconnected care home. Wilmington Manor 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 DS0000026214.V254092.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over seven hours on the 15 November 2005. Lead Inspector Elizabeth Baker carried out the inspection, with support from Pharmacy Inspector Jane Vaughan. A partial tour of the home was carried out. Some residents were spoken with including three who were interviewed in private. One visitor and a Social Worker were spoken with. A number of staff were spoken with and two were interviewed in private. At the time of the visit 46 residents requiring nursing care were residing at the home. The inspection was carried out with assistance from Registered Manager Mrs P Wakefield. Some judgements about the quality of care, life and choices were taken from conversations with residents, as well as direct and indirect observations. Some records were seen as part of case tracking and to assess work on the requirements and recommendations made at the last inspection. In response to the announcement of this inspection the Commission received a total of 47 comment cards from residents (42), relatives/visitors (two), health and social care professionals (two) and care manager (one). Some of their comments have been incorporated into this report. This is the second inspection of this home for the year 2005/06. Not all key standards have been inspected on this occasion, where they were met at the first visit. This report should therefore be read in conjunction with the inspection report dated 10 May 2005. What the service does well: What has improved since the last inspection? 13 of the 19 requirements made at the last visit have been complied with. As part of the home’s upgrade and refurbishment programme, the furniture in both dining rooms has been replaced, the main dining room has been redecorated and re-carpeted, the visitor’s toilet facility has been revamped, most of the ground floor corridor carpets renewed and the driveway reWilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 6 surfaced. The standard of cleaning throughout the home had significantly improved. This all makes the home a better place for residents to live. The number of unregistered care staff now trained to NVQ level II has increased and more staff are about to commence NVQ training. Care records are now kept in a better order making the auditing of care assessed and that delivered easier to follow. 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. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 the following standard(s): 1 and 2 The home’s statement of purpose is still inadequate and does not sufficiently provide prospective residents with specific information about this home. Sponsored residents are still not provided with terms and conditions of residence. EVIDENCE: A revised Statement of Purpose has been developed since the last inspection visit. Although this generally follows the principles set out the Commission’s guidance, some aspects do not adequately reflect the individuality of Wilmington Manor. These include admission criteria, social activities and size of bedrooms. There is also a reliance to referring to the organisation’s (BUPA) policies and manuals for additional information. Prospective residents and their advocates may not have these documents readily available for explanation. These matters have subsequently been discussed with the manager. At the last inspection it was noted that only privately funded residents are provided with a contract. At this visit the manager said the organisation is Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 9 currently developing such a document. This is important as all residents, whether privately or publicly funded, need to know the rights and responsibilities of both parties for staying at the home. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9 and 11 The health needs of residents are met with evidence of good multi-disciplinary working taking place on a regular basis. Residents are potentially at risk because the medication management system is not totally satisfactory. EVIDENCE: Residents are provided with a care plan. Four care plans were inspected as part of case tracking. Where appropriate residents are encouraged to sign their care plans. In support of the care plans the home uses a range of clinical risk assessments, including pressure sores and moving and handling. Such documents assist staff in monitoring the progress of the care planned. However three of the four pressure sore assessments inspected had been incorrectly scored. Another document relating to moving and handling had been ticked to indicate the resident suffered with pain. The comment added next to the tick said “sometimes”. The resident had reported that they are continually in pain. During a conversation with a resident it transpired the resident had asked for the duvet to be removed from their bed during the night because the weight of it increased their pain discomfort. Sadly neither the night entries of the ‘daily’ records nor the care plan had been recorded to reflect this important point. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 11 Care plans were deficient of the level of detail some residents require with their personal hygiene needs. There was some confusion as to the number of baths residents could have a week. Whilst one care plan said a resident was to be offered one bath a week, another had no information about the frequency. This matter was important to this resident who clearly stated they would prefer more baths. None of the four records had any information in respect of the residents’ wishes and preferences in respect of death and dying and last rites. Whilst recognising this is a sensitive issue, this is an important aspect of care and must be addressed. To assist the home in finding a way in obtaining this vital information, contact details were provided to the manager. A separate inspection of the administration, storage and handling of medications was carried out by Pharmacy Inspector Jane Vaughan. This found medicines, which were stored correctly. However one cupboard was badly damaged and files of blistered medication would be better stored on hanging brackets. Good systems were in place for ordering medication. Medication administration charts (MAR) produced in the home were poor and lacked synchronisation. Some MARs were signed prior to administration. The home had no guidance for the administration of “when required” medication to ensure appropriate and consistent care. Variable doses were not recorded. Staff were unclear about the correct storage of medication. Storage and recording of Controlled Drugs complied with current legislation. The home had no arrangements for the disposal of waste medication to comply with current legislation. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 the following standard(s): 12, 14 and 15 The home provides a good selection of meals, although some residents are not receiving hot drinks, as they would like. EVIDENCE: A resident described how he enjoys walking around the home’s gardens and being escorted to the nearby high street for a look around. Residents are encouraged to bring in small personal items so that they can individualise their bedrooms. Indeed many residents are appreciative of this as it helps them in settling in to their new environment. Residents interviewed were very complimentary about their meals. One resident said they are always offered a soup, which they particularly like, with their teatime meal. However 15 returned comment cards from residents indicated they only sometimes like the food. There was some confusion as to the availability of hot drinks between suppertime, which is around 8pm and breakfast, which is around 8.30/9am. Although tea-making facilities are available for staff to access at any time, not all residents receive a drink between the time they wake up and their breakfast. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 13 Residents have a choice of meals and menu records are kept for auditing purposes. However, where a different “one-off” meal is provided it has not been the home’s practice to record this information. This could be a problem in the event of a food investigation being carried out. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 the following standard(s): 16 Residents cannot be assured that their complaints and comments are listened to and acted upon. EVIDENCE: The home maintains a record of formal complaints. However, this system does not ensure that all residents’ concerns or complaints are recorded and dealt with. This included a particular matter, which was identified during the inspection and had been made by the complainant to the home a little while ago. It has not been the home’s practice to record details of informal complaints such as verbal concerns and adverse comments. Having such would enhance the home’s quality assurance system. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 The home’s environment has greatly improved making it a cleaner and nicer place to live. EVIDENCE: The home was considerably cleaner on this visit. The visitor’s toilet has been refurbished, the majority of corridor carpets have been replaced, dining room furniture has been renewed and the driveway has been resurfaced. Although bedrooms and communal areas were warm, it was noticeably cooler in the sitting room nearest to the main entrance. Indeed one resident commented it could be draughty in this room. A similar comment was picked up at the last inspection visit. This matter needs to be monitored and addressed to ensure residents are kept comfortable whilst using this room. The home continues to increase its number of adjustable beds. Indeed a resident described their new bed as “really lovely and smashing”. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 16 The home has a range of hoists for the safe transferring of residents. Following a previous recommendation, the home arranged for an environment assessment to be carried out by a Registered Occupational Therapist. This was to ensure that the environment is appropriate for current and future residents. The bathrooms and sluice rooms visited were clean and tidy. However the plastic coating was coming away from racking used to store continence aids in a sluice room. This situation does not allow for effective cleaning. A separate hand sink has now been installed in the laundry room. This minimises cross infection risks. Although the laundry was in better state on this visit, cobwebs were seen high up and an area of the wall had been damaged by damp. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 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 and 29 There is a good complement of staff ensuring good quality care and support. EVIDENCE: Staff were seen carrying out their duties in an unhurried manner. Residents said staff usually respond quickly to their calls. However the two comment cards received from visitors/relatives indicated it is their opinion that there are not always sufficient staff on duty. One of the respondents included the additional comment “staff work hard, but I do feel they are under pressure sometimes, ie shortage of staff has knock on effect for [residents], ie waiting periods for toilet etc”. Management is committed in ensuring all care staff are appropriately trained. Indeed thirty percent of unqualified care staff are now trained to NVQ level II care and another six are ready to commence on their course. Two staff files were inspected and identified that systems are in place and generally followed for vetting and recruiting staff. However it was noted in one file that a complete employment history had not been obtained and employment dates did not correspond in another. There was no evidence that the matters had been investigated or clarified. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 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): 33, 34, 35 and 38 The manager has a good understanding of what needs to improve in the home and has resources to carry these out. EVIDENCE: Residents, staff and visitors spoke freely about their experiences at the home during the inspection visit. The home endeavours to obtain the opinions of residents and relatives as to the services provided at the home and facilitates meetings as a means to obtain this information. Each bedroom has an information pack. This now includes a quarterly newsletter. A resident said this is very useful, particularly as it contains matters relating to staff. The organisation is about to survey the home as part of its quality assurance programme. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 19 Records of monies held by the home on behalf of some residents showed they are appropriately maintained. During the inspection frayed carpet was noted in a couple of areas. This poses potential trip hazards to residents, staff and visitors. All residents have been provided with risk assessments with regard to their bedrooms. It was of a concern that a potential “scalding” hazard identified in a particular bedroom had not been included in the resident’s records. The pre inspection questionnaire indicates the home regularly services and maintains its equipment as is required to keep them in good working order. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 3 3 3 3 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 3 X X 2 Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 17 Requirement The statement of purpose must be individualised to reflect Wilmington Manor. (Timescale not completely met) Sponsored residents must be provided with a written statement of terms and conditions of residence. (Time scale 30/09/05 not met) The damaged medication cupboard to be replaced. (Timescale 31/05/05 not met) Arrangements are made for the disposal of waste medication to comply with current legislation. Medication administration record charts to be signed immediately after the medication has been administered, not before or at a later time. Handwritten medication administration charts to be synchronised for clarity. Dispensing labels should not be attached to charts. A record of all meals actually provided must be maintained. (Timescale 31/05/05 not met) All complaints (written, verbal, DS0000026214.V254092.R01.S.doc Timescale for action 31/03/06 2 OP2 5 31/03/06 3 4 5 OP9 OP9 OP9 13 13(2) 13(2) 31/01/06 31/12/05 15/11/05 6 OP9 13(2) 15/11/05 7 8 OP15 OP16 16 17(2),Sch 30/11/05 30/11/05 Page 22 Wilmington Manor Nursing Home Version 5.0 4(11) 9 OP25 23 10 11 OP29 OP38 19 13(4) informal and formal) must be recorded and acted upon. All rooms used by residents must 15/12/05 be approximately heated for their needs and preferences. (Timescale 10/05/05 not met) Complete employment histories 31/12/05 must be obtained and any gaps or discrepancies investigated. Detailed assessments must be 31/12/05 carried out for those bedrooms presenting risk due to size and contents. (Timescale 31/07/05 not completely met) 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 Refer to Standard OP7 OP8 OP9 Good Practice Recommendations Care plans must be complete of all details relating to residents individual needs and wishes, including frequency of baths. Clinical risk assessments must be accurate and complete. The home to produce guidance for the administration of “when required” medication to ensure effective consistency of care. Administration of “when required medication and variable doses to be completely and accurately recorded. Consideration to storing files of medication on hanging racks should be given. A minimum/maximum thermometer to be used to monitor the temperature of the fridge and procedures to be produced to ensure medication is stored at the correct temperature. Arrangements to be put in place to accommodate those residents wishing to self-administer. Care records must be complete of details of resident’s individual wishes and preferences in respect of death, dying and last rites. Staff must ensure all residents are offered and receive hot drinks as per their individual choice. DS0000026214.V254092.R01.S.doc Version 5.0 Page 23 4 5 OP9 OP9 6 7 8 OP9 OP11 OP15 Wilmington Manor Nursing Home 9 10 OP26 OP28 The cause of the damp area in the laundry room should be investigated and made good. 50 of unregistered care staff must be trained to NVQ level II care. Wilmington Manor Nursing Home DS0000026214.V254092.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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 DS0000026214.V254092.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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