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Inspection on 02/05/08 for Wilmington Manor Nursing Home

Also see our care home review for Wilmington Manor Nursing Home for more information

This inspection was carried out on 2nd May 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

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

What the care home does well

What has improved since the last inspection?

CARE HOMES FOR OLDER PEOPLE Wilmington Manor Nursing Home Common Lane Wilmington Dartford Kent DA2 7BA Lead Inspector Mrs Susan Hall Unannounced Inspection 08:20 2nd May 2008 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.V361155.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilmington Manor Nursing Home Address Common Lane Wilmington Dartford Kent DA2 7BA 01322 288746 01322 284403 bazeleym@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd 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) Vacant 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.V361155.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2007 Brief Description of the Service: Wilmington Manor is a large detached property, which has been extended and altered during the 1990s to provide additional facilities. It is owned by BUPA, who are well known providers for delivering care. Accommodation is provided on the ground, first and second floors, with two large passenger lifts providing access between floors. All bedrooms are for single use, and have small en-suite toilet facilities. The home is provided with two lounges and two dining rooms, one of which overlooks the rear gardens. Front and rear gardens have been designed to enable people in wheelchairs to get around easily, and are pleasantly set out, and well maintained. The home is located adjacent to Dartford Heath, about one mile from the A2. The setting is quite rural, and there are limited places to access locally, as there are few suitable pavement areas for wheelchair users. Public transport is limited. Dartford and Bexley town centres are approximately two and three miles away respectively. The current fee levels range from £593.40 to £955.00 per week. They are assessed according to residents’ individual needs. Additional charges are payable in respect of hairdressing, newspapers, chiropody and escorting residents to appointments. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which includes assessing information since the time of the previous inspection. Most of the National Minimum Standards were assessed. The visit was carried out by one inspector, and lasted for over eight hours. Nine completed CSCI survey forms were received back from residents, staff and one health professional. These included very positive comments such as “Wilmington Manor is a very happy, comfortable home, and the staff do their best to make life as good as possible” (from a resident). During the course of the visit, we (i.e. CSCI) viewed most areas of the building, examined documentation, observed every day staff practices, and talked with six residents, four relatives and ten staff. These included different staff roles such as nursing and care staff, housekeeping and laundry staff, chef and maintenance. The manager was present throughout the day. The manager has been in post for over a year, and the home has undergone changes consistent with new management since the last inspection. This has included new ways of working with staff, and has been a settling down period. The home provides a comfortable and homely environment, and staff are friendly and easy to talk to. Relatives commented that “the staff are all good and caring, and you can talk to any of them about anything”. The manager ensures that any complaints or concerns are taken seriously and acted on. She appropriately refers any serious allegations to the Social Services Safeguarding Adults team, and co-operates fully with them in any investigations. They investigated one referral during the past year, and the allegation was not substantiated. What the service does well: The home provides good information for prospective residents. Detailed preadmission assessments are carried out, to ensure that the home can meet the needs of the person. Health care needs and medication are well managed. Residents and relatives expressed confidence in the nursing and care staff in delivering personal care. Residents are treated with respect and dignity. For example, staff are careful to address residents according to their preference – by their first name, or Mr. Mrs. etc. Care needs and doctors’ visits are carried out in the privacy of residents’ own rooms. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 6 Visitors are made welcome in the home at any time, and are actively invited to take part in meal times and activities. Residents said that the food is good, and there is plenty of choice. There are good programmes in place for ongoing and effective staff training. Recruitment procedures and inductions are very well managed. What has improved since the last inspection? What they could do better: Two points in the home’s “Statement of Purpose” need to be amended to clarify the information given. The nursing staff write the daily records. Some of these records are in poor handwriting, which is difficult to read. Nurses must be aware that these are legal documents, and all entries must be clearly legible. Detailed forms are completed for end of life care and preferences. However, some of these are signed only by relatives and nurses, and do not take into account that the resident has the mental capacity to make their own decisions. All information about end of life decisions must be checked against the criteria of the Mental Capacity Act, ensuring that this legislation is being met. Although there is a good activities programme in place, there is only one person to deliver most of the activities. Care staff help where possible, but there are insufficient staff to always deliver an effective programme (especially one to one input). Shared toilet facilities are inadequate. This is especially important on the ground floor for residents who are in lounges/dining rooms and who want to Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 7 use the toilet. Only one toilet is sufficiently large enough to accommodate a wheelchair and a hoist. Most residents require hoisting facilities. This problem must be addressed. Bedroom en-suite toilet areas are too small for most residents to access, so these cannot be included as viable toileting facilities where residents cannot use them. Shared bathroom and shower facilities are inadequate. Although there is a sufficient number, most of these are poorly designed, and do not meet the needs of residents. All of these must be reviewed, to ensure that there are sufficient numbers of useable bathrooms/showers, including space for hoisting, toileting, and for getting in and out of baths/showers appropriately. Sluice floors need replacing for effective management of infection control. The laundry floor has broken tiles and must be reviewed to check if this can be effectively cleaned to meet infection control standards. Two carpets need replacing. The large lounge on the right of the entrance hall has a carpet with stained areas, and smells of urine, in spite of regular cleaning. The company should review carpet cleaning products, as well as replacing this carpet. Another identified bedroom carpet is severely “rucked” and needs replacing for safety reasons. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 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 Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (Standard 6 does not apply in this home). Quality in this outcome area is good. The home provides sufficient information to enable prospective residents to make an informed choice. Pre-admission assessments are reliably carried out, ensuring that the home is suitable to meet the needs of each resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a “Welcome Pack” in the entrance hall, which is always available for enquirers. This includes the home’s statement of purpose, the service users’ guide, and the complaints procedure. The statement of purpose sets out the aims and objectives of the home. Two points made (numbers 3 and 7), need to be amended to ensure that the information is clarified, and is accurate. The manager said she was aware that this document needs some adjustment, so this has not been made as a requirement. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 10 The service users’ guide is set out in large, easy to read print, and contains clear and relevant information, such as “there are always two nurses on duty”. It includes meal times and sample menus, and gives information about items such as weekly hairdressing, and chiropody visits. Costs for these are invoiced in arrears. The home has a GP who is the visiting medical officer, and who visits weekly. The guide states that a nurse will discuss care planning with new residents; and that residents and relatives meetings are held in the home. The guide also explains the colours of different uniforms to help residents and relatives to identify staff; and gives a resume of activities available. All residents have a contract which includes the terms and conditions of residency. Pre-admission assessments are usually carried out by the manager, and a resident said that “the manager was very helpful with pre-admission information, and visited me in hospital”. We read four pre-admission assessments. These had all been comprehensively completed with information such as previous and current medical history; social and cultural needs; medication; and mental state. Residents and relatives are invited to visit the home prior to admission, whenever possible. All admissions are for a trial period of four weeks, after which there is a review to check that the placement is suitable. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Quality in this outcome area is good. Residents can feel confident that their health care needs are being met and that their medication is well managed. The home needs to ensure that decisions about end of life care are consistent with the Mental Capacity Act, so that residents are included in decision making wherever possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The nursing staff have worked hard to ensure that all care planning is now being recorded using BUPA’s “Quest” documentation. This is a method of care planning which ensures that nursing and care staff are prompted to complete the details for all aspects of care. We viewed four care plans, two from the ground floor, and two from the first/second floors. These include well completed admission information, and ongoing assessments. Care plans are reviewed on a monthly basis, and the manager and deputy manager audit a number of care plans each month. Any Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 12 parts not filled in correctly are brought to the attention of the named nurse, so that they are becoming increasingly aware of the new Quest system, and ensuring that all information is well recorded. Plans viewed demonstrated clear and detailed information, such as (re a resident’s ability to communicate) – “wears glasses for reading and TV. No problems with hearing. Can verbally communicate well”. Life “maps” are well completed, showing that staff are considering all aspects of the person’s life and preferences. There is clear evidence of resident and relative involvement with care planning, and a record is kept of phone calls and conversations with relatives to update them about the resident’s condition. Care plans include photographs and consent for taking these. Any wounds, bruises or injuries are photographed (with permission). Wound care management was checked in two care plans. These showed each wound as having separate documentation; and a charted assessment for each time the dressing is changed. Some of these had a written record as well as the wound assessment chart, and these records were very good. However, not all wound care included a written account of the dressing change. This was discussed with the manager, who said she would point this out to the nursing staff, and she would instigate this as a clear practice. Risk assessments are well completed, and include data for items such as risk of falls; risk of using bed rails; risks of having hot drinks placed nearby; risks associated with bathing; risks of using a wheelchair; and use of electrical equipment. There are good details such as ensuring people who can walk are wearing properly fitting shoes/slippers. Mobility assessments show if a resident needs a hoist, and the type of sling to use; and include details of all moves, such as getting in and out of bed, moving from armchair to wheelchair, or moving from wheelchair to toilet. Other ongoing assessments include dependency assessments, pain assessments, continence assessments and nutritional assessments. The home has a stock of pressure relieving equipment, and care plans indicate the type of pressure-relieving mattress in use. There is good evidence of input from other health professionals such as GPs (the home has a GP who is a visiting medical officer and who visits weekly), Speech and Language Therapist and diabetic nurse. Daily records are written day and night, and are appropriately signed, dated and timed. These contain some good data, such as “ pain well controlled today”; “peaceful day walking around the home” etc. but some of the handwriting was poor in these records, and there is a recommendation to remind staff that these are legal records which must be clearly legible. Medication is stored in a clinical room, which would benefit from some upgrading, but was seen to be generally clean and well organised. The deputy Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 13 manager oversees medication management, and carries this out well. She has instigated good systems for checking controlled drugs every week, and “as necessary” drugs every day. This ensures that if there are any discrepancies, they are immediately evident. Nursing staff have competency checks as well as updates in medication training. Any resident who wishes to self administer medication is assessed to ensure that they are able to do this effectively, and understand that the medication must be kept locked up when not in use. There are lockable facilities in all rooms for this purpose. The GP always carries out a review of medication for any residents who have been in hospital. We viewed all Medication Administration Records (MAR charts) for the ground floor, and these were well completed and in good order. The drugs fridge had a broken lock. The manager had already ordered a new drugs fridge, so this has not been made a requirement. Care plans have good details in regards to discussing residents’ preferences with end of life care. Decisions have been recorded in regards to possible resuscitation in the event of sudden illness, and we expressed concern that some of these have been signed by relatives and nurses, but without reference to the resident and GP/consultant. Checks must be made to ascertain if the resident has the mental capacity to make their own decisions or not. Any decisions made about end of life input/care, must be decided by the criteria of the Mental Capacity Act, ensuring that this legislation is being met. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is good. The activities co-ordinator works hard to provide sufficient activities and items of interest for the residents. Additional staffing to assist with this would be of benefit to the residents. The residents are confident that food is well managed in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service Users’ Guide gives a clear indication of the sort of activities which are available. These include arts and crafts, gardening, bowls, skittles, ball games, music and movement, walks in the grounds; board games, discussions, quizzes, card games, videos, reminiscence, jigsaws, bingo (with prizes), music sessions, trips out, and entertainers. One to one time includes manicures, hand massage and use of the sensory garden. The home employs an activities co-ordinator full time, and she is committed to checking that residents’ individual preferences and abilities are taken into account. There are many in the current group of residents who prefer one to one time, although there are some who like to get together to watch films or listen to music. A weekly activities programme is drawn up and given to each resident, and relatives are Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 15 invited to join in. During the afternoon of the inspection there was a quiz held in the large dining room, and approximately ten residents and several relatives joined in with this. Planned activities are carried out on five days per week, with the weekends quieter for family visits and to provide a change. Outings are sometimes arranged and the manager said they are planning a trip to a local garden centre soon. Residents are sometimes taken out on a one to one basis for walks in the grounds or shopping trips. A good number had recently attended a dress rehearsal at a local grammar school for the musical “Oliver”. Residents and relatives had thoroughly enjoyed this. They have also recently arranged a Community tea, when students from the local grammar school visited and brought their grandparents in. Some relatives said that the home is sited in an area which does not provide many local walks, as there is insufficient paving for pushing wheelchairs safely. However, there is a nearby pub, and that provides an additional place to take residents out for a drink. The activities co-ordinator writes a brief report about each resident each day, stating if she has spent time with residents, and writing their response to activities in which they have joined in. She is helped where possible by care staff, but there are not sufficient numbers of care staff always available for this. The activities co-ordinator bases herself in one of the lounges as much as possible, so she can also keep an eye on any residents who are restless. Residents are enabled to bring in their own items, and some rooms were seen to be personalised with their own photos, ornaments, small pieces of furniture etc. Residents are encouraged to maintain their own financial affairs where possible, otherwise advocacy is arranged as needed. Residents and relatives said that the food is generally good, and there is plenty of choice. The kitchens were seen to be generally clean and well organised. The chef on duty explained the daily and weekly cleaning schedules. Colour coding labels are used for opened food items which are put back in the fridge, so that it is easy to see which day they must be discarded if not used. The menus are drawn up by the chef and the manager, and are sent to BUPA Head Office where they are checked by a nutritionist for their nutritional content. A new head chef has been recruited, and was due to start work the next week. The home has a “Night Bite” system in place, ensuring that snacks are available throughout the 24 hours. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Residents know that their concerns are listened to, and that appropriate action is taken to address these. Residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is set out in a BUPA leaflet, and this gives clear directions on how to make a complaint, and how to take things further with senior BUPA management if unsatisfied with the initial outcome. The manager keeps a complaints record, and this shows there have been six complaints since January 2008. The records demonstrate that all complaints are taken seriously, and that they are dealt with appropriately. Residents said that if they have any concerns, they can talk to any of the nurses or care staff, or to the manager, who has a visible presence in the home. There are good staff training records, which show that all staff are trained in the recognition and prevention of adult abuse. This training is commenced at induction, after which there is further training and updates. The home cooperates fully with the Social Services Safeguarding Adults team in the event of any referrals. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is adequate. The residents benefit from living in a home in which the day to day maintenance is satisfactory. Toilet and bathroom facilities are inadequate, and must be reviewed, so that residents benefit from improved facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All communal areas of the home were viewed, and many of the bedrooms. The home employs a full time maintenance man, and as this is a large, spread out building, there is lots of ongoing maintenance to be carried out. The original building is quite old, with a more recent extension added during the 1990’s. Most of the décor is generally satisfactory, and there is an ongoing programme to redecorate bedrooms as needed. Corridors could be improved with Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 18 redecorating fairly soon. There are two lounges at the front of the home, which are decorated in a style consistent with the age of the premises. One has a fish tank and a television. The other (larger) lounge is used more for activities. The carpet in this lounge smells of urine, in spite of frequent cleaning, and needs replacing. The home has two dining rooms, a small one (which is good for meeting with relatives), and a large dining room adjacent to the kitchen and overlooking the rear garden. This is airy and spacious, and a very pleasant area for sitting in. The home has recently employed a gardener, who is working hard to provide pleasant outdoor areas for residents to sit out in summer months. She was busy potting up seedlings for flower tubs on the day of the inspection. There are two separate patio areas, as well as lawns and trees. A sensory garden is being developed, and the gardener is going to make a squirrel run, so that residents can watch these more easily. Toilet facilities are generally unsatisfactory. Most residents are unable to access their small en-suite facilities, and many of these areas are just used for storage. There are only two communal toilets on the ground floor, and neither of these is easily accessible for wheelchair users. These need to be reviewed and altered as needed. (e.g. putting in a ceiling hoist may be sufficient to enable one of these to be used). Only one of them will take the large hoist, which is the hoist that many residents need for transferring from wheelchair to toilet. Bathroom facilities are also unsatisfactory. A ground floor bathroom is not used, as it is too small. A first floor bathroom has a Parker bath in it, but there is no toilet in this bathroom, no overhead hoisting, and the flooring is damaged and is very unsightly. The second floor has a shower unit in one room, which is impractical for most clients to use. All bathroom and shower facilities need to be reassessed, and an action plan put into place to ensure that there are adequate bathing facilities to meet the changing needs of residents. The home has sufficient hoisting equipment, with hoists kept on each floor. Another standing hoist would be helpful. All doors are fitted with suitable closures in the event of fire. The call bell system is a pager system. Some residents said they do not have to wait long to have their bells answered; however, there is only one call bell point in each lounge, so residents are dependent on another resident to ring the bell for them. More than one point is needed. We observed that the resident with the call bell in one lounge was asleep when another resident wanted attention. Bedrooms are quite small for the amount of equipment which is needed for effective nursing care, and en-suite areas are too small for most residents to access. There is a recommendation to review these for long term future planning, for providing suitable facilities for residents. Residents can bring in their own items, and many rooms were seen to be attractively personalised. Twenty bedrooms have been redecorated during the past year. One identified Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 19 bedroom has a carpet which is becoming dangerously creased, and “rucked,” and this needs replacing. The maintenance man keeps clear ongoing records. These include checks for water temperatures, wheelchair checks, bed rail checks, fire equipment checks and drills and fire tests. All bedroom doors are linked into the fire system or have fire safety fitments. The laundry facilities are on the lower ground floor, and include two commercial washing machines and two tumble dryers. The flooring is cracked in places, and uneven. The sluice floors are also damaged. These should be replaced for good management of infection control and cleaning purposes. There is a second laundry area for clean clothes and ironing. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is good. The safety and well being of residents is satisfactory because the home’s recruitment procedures are well managed, and staffing levels are satisfactory. The care of residents is enhanced because there are good programmes in place for staff training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing numbers include two nurses throughout the 24 hour period, which is important, as this is a very spread out building, with three floors. In the mornings there are eight care staff, (in addition to the nurses) and in the afternoons there are six. There are three night care staff. Staffing levels need to be kept under review, due to changing needs of residents, with many having high dependency levels. There are currently sufficient care hours to meet personal care/hygiene/nursing needs, but they do not allow much time for care staff to take part in assisting with activities and one to one input with residents. Carers are allocated to assist with breakfasts each morning, which leaves four care staff on the first/second floors and three care staff on the ground floor for the first part of the morning. The home currently has over 50 of care staff with NVQ level 2 training or higher, and BUPA actively encourages care staff to undertake this training. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 21 We viewed three staff recruitment files, and these are excellently maintained. They showed that all recruitment requirements are met, with CRB and POVA first checks, ID confirmation, two written references (with one from last employer), and confirmation of training. Each applicant also completes a medical questionnaire, and a record is kept of the interview. Nurses’ PIN numbers are checked. We viewed four staff training files, and two induction files. These are very well completed, and show clear records of different training undertaken. The training co-ordinator has a good system in place to highlight when any member of staff has a specific training subject due, and books them on to the next arranged training course. Induction courses include all mandatory training, with written questions and answers to ensure that staff understand the subject concerned. Training courses are included for the prevention of adult abuse, and understanding dementia, for all staff. Nursing staff are enabled to maintain their nursing skills and competencies. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-38 Quality in this outcome area is good. The home has experienced a period of settling down in the last year with a new manager in post. She provides effective management, with day to day control of the delivery of care. Residents benefit from her visible presence in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for nearly 18 months. She is a trained nurse, and has completed the Registered Managers’ Award. She is not yet registered with CSCI as the manager for this home, but has applied for this. Residents and relatives spoke highly of her commitment to good care, and said that she is easy to talk to and speaks to them regularly out of the office. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 23 Having a new manager has undoubtedly brought about significant changes for many staff, as they have developed new ways of working together. The evidence in this report shows that the manager has brought about improvements in the home, and provides a good leadership model to other staff. BUPA has a system of “Personal Best”, whereby staff can be nominated each month (by other staff, residents or relatives) for the quality of their work. If several of these are obtained there are monetary rewards as well as a certificate each time. This provides an additional incentive for staff to work to the best of their ability. The home has an ongoing system in place for identifying residents’ views, using a customer satisfaction survey at least once per year. The results from the last one showed that there was an increase of residents who are “satisfied with the quality of the service” from 12 in 2006, up to 67 in 2007 – an increase of 53 . There was a 96 response rate to the last survey. This statistic alone shows that more residents are satisfied with the level of care they are receiving. The manager was on the point of arranging another survey. Residents and relatives meetings are held from time to time. The manager stated that she had not had one yet this year, and acknowledged that this was too long a gap since the previous one. She said she would ensure that these are held more frequently in the future. As she has an open door policy, and is a visible presence on the floor, residents and relatives expressed their confidence in being able to speak with her about any concerns. Relatives are invited to join in with activities, and “themed” meals, and these are good opportunities for informal meetings. BUPA has been assessed as being financially viable by the CSCI Finance Department. Residents’ own finances are managed by themselves or their chosen representatives. Accounts for items such as hairdressing and chiropody are invoiced in arrears each month. The home only oversees “pocket money” for a few residents, whose finances are handled by the Social Services Client Financial Advisor. Each person’s money is held individually, and records are kept of all transactions, including receipts. Systems have now been put into place for carrying out one to one staff supervision, with nurses delegated to carry this out with other staff. Informal one to one talks are recorded as well as formal meetings, to ensure that items raised by staff are properly handled and dealt with. Records are generally well managed, with up to date documentation. Policies and procedures are reviewed yearly. Maintenance records are well kept, with clear details of dates for servicing and checking equipment. There are monthly Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 24 maintenance audits. Records of fire training, fire testing and fire equipment showed that there is good fire awareness and prevention. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 1 3 X 2 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 3 3 3 3 Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 26 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 OP11 Regulation 12 (2,3) Requirement To ensure that residents are consulted about their own wishes in regards to end of life care, and the decision for possible resuscitation in the event of an emergency. Directions given in regards to this must show compliance with the Mental Capacity Act 2005. To replace the carpet in the identified lounge. To carry out a review of all communal toilet and bathing/showering facilities. To provide CSCI with an action plan by the given date for showing how these facilities will be altered to meet the needs of residents. To replace the carpet in the identified bedroom. To ensure the sluice and laundry floors are reviewed, and are repaired or replaced as necessary for the effective management of infection control. Timescale for action 30/06/08 2 3 OP20 OP21 16 (2) (c) 23 (2) (a,j) 30/06/08 31/08/08 4 5 OP24 OP26 16 (2) (c) 13 (3) 02/06/08 30/09/08 Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 27 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 6 Refer to Standard OP7 OP8 OP12 OP19 OP27 OP33 Good Practice Recommendations To ensure that staff understand the importance of writing daily records in clear, legible, handwriting. For wound care to have a separate written account for each dressing change, as well as a completed wound assessment chart. To ensure that sufficient numbers of activities staff are available, so that all residents can be included in the programme of activities and one to one input. To check that the call bell system meets the needs of residents. To keep numbers of care staffing under review, ensuring that there are sufficient numbers of care staff at all times to meet the assessed needs of residents. To hold meetings for residents and relatives more frequently, to enable them to have input into the running of the home. Wilmington Manor Nursing Home DS0000026214.V361155.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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