Inspection on 09/01/08 for Wilsmere House

This inspection was carried out on 9th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Wilsmere House Wilsmere Drive Harrow Weald Middx HA3 6BJ Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 9th January 2008 10:00 DS0000069362.V355882.R01.S.doc Version 5.2 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 DS0000069362.V355882.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 and Care Homes for Adults 18 – 65*. 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. DS0000069362.V355882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilsmere House Address Wilsmere Drive Harrow Weald Middx HA3 6BJ 020 8420 7337 020 8420 7496 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) Barchester Healthcare Homes Ltd Diana Hilary Patricia Parry Care Home 94 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places DS0000069362.V355882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 64 places for younger people with physical disability (PD). No less than 30 places for older people (E). 12th February 2007 Date of last inspection Brief Description of the Service: Wilsmere House Care Centre is owned and operated by Barchester Healthcare, a national provider of care homes across the country. It is situated in a quiet cul-de-sac in a residential area of Harrow Weald. It is accessible by car and there is a large car park for in excess of twenty cars in the grounds of the home. Buses served the Uxbridge Road which is about ten minutes walk away. People have to be aware, in case that this has not been rectified, that in the past the pavements on the road from the bus stop to the home have been uneven and might have created difficulties for people with mobility problems, including wheelchair users. Underground and railway links are an approximate ten-minute bus ride away. The home is a large detached building spread over three floors: the basement, ground and first floors. Residents are accommodated in four units. There are two units on the ground floor and two units on the first floor. Each unit is run semi-independently with its own team of staff, a kitchenette and communal areas. There is a physiotherapy room on the ground floor in one of the units, and a computer training room in another unit. The kitchen, dinning room, laundry, hotel manager’s office and psychologist’s office are located in the basement. Access to each floor is via lifts and stairs. Bedrooms are mostly single and are of varying sizes. There are a few double bedrooms but these are currently used mostly as single rooms. All bedrooms have en-suite toilets and wash hand basins. Showers and bathrooms are for communal use. There is a large car park, some lawn areas and mature trees to the front of the home and well-maintained gardens to the rear and sides of the building. The home accommodates a majority of younger adults with some older people. The younger adults are admitted with a variety of needs following neurological conditions and brain and spinal injuries. To meet their needs the home benefits from a multi-disciplinary team, which consists of nurses, carers, GP, psychologist, physiotherapist, catering and cleaning staff. The registered manager is Diana Parry and she runs the home with the support DS0000069362.V355882.R01.S.doc Version 5.2 Page 5 of a deputy manager and a hotel services manager. The home charges fees from £1,100 to £3,200 per week dependent on the complexity and level of residents’ needs. The fees do not include hairdressing, dry cleaning, toiletries, newspapers and other personal expenses. There were 81 residents in the home at the time of this inspection. DS0000069362.V355882.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced inspection started on the 9th January from 10:15-17:15 and continued on 14th January from 10:15-18:45. This was the first inspection for the period 2007-2008. The findings in this report are based on an inspection of a sample of records, a partial tour of the premises and conversation with residents, some visitors to the home, the manager and some members of staff. 40 comments cards were sent to residents and the same amount were sent to relatives of the residents to get their views about the service. Out of this 16 comment cards from residents and 13 comment cards from relatives/visitors were returned. These have been used to inform this report where possible. The manager also completed an Annual Quality Audit Assessment (AQAA) to tell us about the quality of the service that the home provides. The content of the AQAA has been used where possible in this report. I would like to thank all the residents and all the relatives/visitors who provided feedback about the service and I am grateful to the manager and all her staff for their support and assistance during the inspection. What the service does well: People receive information about the service and are invited to visit the home to find out more about the services that it offers prior to them deciding to move into the home. The home accommodates older people but the majority of people who live in the home are younger adults. The younger adults tend to have complex needs following brain and spinal injuries and neurological and debilitating illnesses. It generally provides a good standard of care and residents (old and young) are on the whole well looked after taking into consideration the complexity of the needs of residents who live in the home. There is evidence that they or their relatives are involved in the care planning and risk assessment process. To meet the complex needs of residents, the home secures the input of a range of healthcare professionals such as the physiotherapist, dietician, psychologist and occupational therapist to provide a continuous and consistent service to residents. As a result resident receive the services that they require in-house and do not have to travel to hospitals and there is no significant time delay from the point of referral to a particular healthcare professional to the DS0000069362.V355882.R01.S.doc Version 5.2 Page 7 point of delivery of the service. Nursing and care staff can feel confident that they are supported by the various healthcare professionals in meeting the needs of the residents. One relative said, “I am on the whole very satisfied with the care Wilsmere House has given to my relative”. Another said “I cannot commend the home enough, I am grateful to Wilsmere for making the stressful times (of looking after my relative) so much easier to deal with”. The home promotes the rights and independence of residents and values their contribution on running the home. There is a residents’ association, which is entirely run by residents, which then refer significant issues to the management of the home to consider addressing. One relative commented in a comment card “it (the home) has supported residents to be more vocal and independent”. Feedback about the management of the home, nursing and care staff was mostly positive. 11 residents said that staff always listen and act on what is said. One relative said, “It employs some very caring staff”. Another said, “Staff are polite and patient with my relative”. Good feedback was also given about the medical support given to residents. 10 out of 16 residents said the medical support is always good and five say that it usually good (one person did not respond to this section). The management structure of the home allows for a flexible service, which meet the needs of residents. The manager is supported by a team of people who each has a clearly identified role and who is responsible for an aspect of the service. As a result there is confidence that the home will address any issues that may arise promptly. The home has a quality assurance procedure, which is consistently applied to monitor the quality of the service. Part of this includes getting feedback from people who use the service. What has improved since the last inspection? What they could do better: The home accommodates residents with a variety of needs. A few of the residents may have had brain injuries, which may have resulted in cognitive DS0000069362.V355882.R01.S.doc Version 5.2 Page 8 and executive functions of the brain being affected. As a result information may have to be provided to some residents in a simpler form for them to be able to make an informed decision based on the information that they understand. That is why it is recommended that the home explores ways of providing information to residents in a manner that they can understand such as in an easy to read format or with the use of signs and symbols. The home offers a contract/statement of terms and conditions to all residents. Residents who are self-funding sign the contract but residents who are publicly funded do not always sign to say that they have received a contract/statement of terms and conditions, which contain information about their rights and responsibilities. The contract/statement of terms and conditions apply to all residents except that the arrangements for paying the fees may differ from residents to residents. Although most care plans are comprehensive, the needs assessments tend to address mostly physical and nursing needs of residents and do not tend to address the mental health needs of the residents in a comprehensive manner. Younger adults who have become physically disabled after illness or trauma may exhibit mental health needs such as unsocial and/or aggressive behaviour or depression and low mood. Care plans and risk assessments tend to address residents needs and do not always address areas where residents are being encouraged to develop living skills and independence. The care plans while containing notes made by the various healthcare professionals do not exhibit a multi-disciplinary approach, with involvement of the relevant healthcare professional in the area where the resident is being encouraged to develop skills and independence. Comments cards from residents showed that the provision of activities is an area, where they are relatively less satisfied as compared to other areas such as staffing, meals and support that they get. The home should look at improvement in this area to increase the level of satisfaction. Medicines management is an area where the home did not perform as well as in other areas. All medicines received in the home must be recorded and the instructions for the administration of medicines on the MAR sheet must be changed as required to reflect changes in the prescription. Good records in all areas of medicines management must be kept to enable tracking of residents’ medicines to make sure that the administration of medicine is being safely carried out. Feedback from residents and their relatives about staff was on the whole positive, but there were a few comments that the standard of care on a few occasions varied with the calibre of staff on duty, that a few members of staff have a poor command of English which affects communication and that at times staff are so busy that they do not always have the time to attend when residents call for help. The home should monitor these issues to find out how relevant these are and address as required. DS0000069362.V355882.R01.S.doc Version 5.2 Page 9 Health and safety issues are on the whole appropriately attended to as required. It was noted that the home did not have at least quarterly fire drills and monthly in-house emergency lights test. There were a number of wooden wedges and beanbags, which were in use to prop bedroom doors open. These must be subject to the fire risk assessment and consideration must be given to the use of automatic door closing devices, which would automatically close the doors should the fire alarm be activated. 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. DS0000069362.V355882.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) DS0000069362.V355882.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides enough information to people, for them to decide if they want to use the services that the home provides. People who live in the home are given a contract/statement of terms and conditions but they do not always sign these documents to show that they have received these and that they have agreed to them. EVIDENCE: The home has a service users’ guide (SUG) and a statement of purpose (SOP). The SUG is available in all residents’ bedrooms. A brochure is also provided to all prospective residents or their relatives to provide them information about the service prior to them deciding to move into the home. The manager stated that residents and/or their relatives are encouraged to visit the home to see DS0000069362.V355882.R01.S.doc Version 5.2 Page 12 the facilities that it has to offer, meet staff and other residents and to ask questions. It was noted that the SUG is not available in an easy to read format, such as signs and symbols, to enable those who may have a cognition impairment following brain injuries, understand this document to be able to make an informed decision about moving into the home. 10 out of 16 residents who responded to comment cards sent by the inspector stated that they had enough information about the service to decide about moving into the home. 2 said that they were placed in the home by their local authority and were not offered any choices. This however is not the remit of the home. The AQAA says on page 7, under standard 5, “All prospective clients are provided with a contract, that itemises all terms and conditions relating to service they may expect. They are requested to peruse and sign this prior to admission, and in the case of emergency admission as soon as possible, and no later that 5 days, following admission”. Inspection of residents’ files showed that people who are privately funded are provided with a contract/terms and conditions that they sign. 2 recently admitted residents who were publicly funded did not have a signed copy of the home’s contract/statement of terms and conditions in their files. The manager said that people who are publicly funded normally receive the terms and conditions of the placement in the SUG as well as copies of the agreement made between the home and the local authority. They however do not always sign to show that they have received the home’s contract/statement of terms and condition of the placement. 8 people who returned comment cards stated that they have not received a contract/statement of terms and conditions. 5 have received these and 3 were not sure whether they have received the home’s contract/statement of terms and conditions. As the contract/statement of terms and conditions is an important document which describes the terms and conditions binding the home and the resident/relative and makes the resident/relative aware of his/her obligations and rights while living in the home, it is required that people sign these to show that they have received and agreed to the contract/statement of terms and conditions. While the arrangements for paying the fees may vary, all the other terms and conditions such as the arrangements for laundry services, care plans, provision of meals and meeting healthcare needs apply to all residents, irrespective of the source of funding. I was able to check that all new residents to the home have a preadmission assessment of their needs and noted that these were in the main comprehensive. The home has a preadmission format to records the findings of the preadmission assessments, which are normally carried out by the manager DS0000069362.V355882.R01.S.doc Version 5.2 Page 13 or the deputy manager. Copies of the care plan, needs assessments or risk assessments of prospective residents by the placing authorities, are also available on file to provide information about the needs of the prospective residents before the home decides to offer a place to the residents DS0000069362.V355882.R01.S.doc Version 5.2 Page 14 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service Care plans generally address the physical, nursing and health needs of residents. These can be more comprehensive if issues about mental health needs and the development of living skills and independence are also addressed within a risk assessment context. EVIDENCE: I looked at the care records of 5 residents. It was noted that these were on the whole completed to a good standard. They were in good condition and were kept in a filing cabinet by the nurses’ station. DS0000069362.V355882.R01.S.doc Version 5.2 Page 15 All residents have an assessment of their needs on admission to make sure that all their needs are identified for care plan purposes. The home accommodates residents with complex and varied needs. While the physical needs of residents are on the whole appropriately assessed it was noted that the psychological and mental health needs of residents are not always addressed to clearly identify these. These are particularly valid for younger residents who used to lead an active life in the community with their families and friends and who have now become physically disabled because of illness and trauma, and for those who have sustained brain injuries, which might have resulted in cognitive, behavioural or executive impairments. Following the assessment of residents’ needs, care plans are formulated to reflect the needs of residents. In a few cases this could have been more comprehensive. For example a resident who was assessed, as having a shooting pain did not have a care plan reflecting this. In another case a resident with a brain injury was discharged from hospital with a plan for him to have a diary to support him with remembering and with developing his level of cognition. This was not addressed in his care plan. Another resident had an assessment, which said that he could not make decisions, but one of his care plans said that he was able to make decisions Care plans and risks assessments were reviewed at least monthly. However in a few instances the care plans were not amended when they required changing as a result of a change in residents’ needs. For example a resident who could not have any showers still mentioned that he should be showered twice weekly. Another resident who was walking with an aid still had a manual handling risk assessment, which said that the resident should be transferred with a hoist. One resident who had an operation more than 4 months ago still had a care plan for post-operative pain It was also noted that a number of residents have the input of some healthcare professionals such as the physiotherapist, occupational therapist and psychologist. While these professionals were keeping good records about their input, it would have been good if they were more involved at the stage of writing care plans depending on the area that they cover. For example the physio could be more involved in drawing out and reviewing the care plan about mobility to reflect her input and make sure that nursing and care staff can support her in this process. Similarly, the psychologist could be involved in drawing up care plans about behaviour and cognition and the occupational therapist could be more involved in drawing up care plans and risk assessments about developing living skills. The care plans seen were in most cases reviewed with residents or with the relatives. While staff were clear that care plans should be reviewed with the residents or their relatives, they were not so clear as to whether they should include the residents or their relatives when drawing up the care plans. Some care plans were signed on admission to show that they have agreed to the care DS0000069362.V355882.R01.S.doc Version 5.2 Page 16 plans but others were not. Two ‘younger adults’ stated that they have seen their care plans. Two ‘older’ residents who have been admitted to the home a few weeks ago, have not signed their care plans when these were drawn up to show that they have agreed to these. They stated that they have not seen their care plans. One relative said that she has not seen the care plan for her husband, who was admitted to the home a few weeks ago. All risk assessments seen, were drawn up with the residents or their relatives. These were on the whole appropriate and addressed areas where the safety of residents might be compromised. For example risk assessment included areas such as risks of falling, use of bed rails, risk of developing hypo or hyperglycaemia and residents not being provided with a call bell. However as noted during the previous inspection, the risk assessments did not always address areas where residents are being encouraged to develop independent living skills and independence. In these cases a certain amount of risk is inevitable but plans must be in place to minimise these risks as far as possible while promoting the independence of residents as far as possible. I noted that a number of residents stayed in their wheelchairs during the course of the day. They had seat belts around them and I was told that this was to maintain the safety of the residents while wheeling them around the home. I checked the care records and noted that risk assessments were not in place about the use of a seat belt. While the safety of residents is paramount it must also be noted that seat belts are a form of restraint, which limit the freedom of people and at the same time pose a risk to people who might struggle to get out of their chair or who might slip out of their wheelchairs. DS0000069362.V355882.R01.S.doc Version 5.2 Page 17 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. DS0000069362.V355882.R01.S.doc Version 5.2 Page 18 Residents are supported to have lifestyles that match their expectations, choices and needs as far as possible. A variety of nutritious meals are provided to residents and the home makes real efforts in ensuring that the selection of meals provided meets residents’ tastes and choices. EVIDENCE: 5 comment cards from relatives/visitors said that they think that the home always supports people to live the life that they choose and 5 said that the home usually does that. One said that the home meets the needs of residents in a major way but not the minor things. 4 residents said that there are always activities that are arranged by the home that they could take part in, 2 said usually, 5 said sometimes, 3 said never and 2 did not respond to this section. Compared to all areas in the comment cards the result seems to suggest that activities is an area, which scores less than other areas. One person said that there should be a better focus on resources and one said that there is not enough support by care staff for residents to take part in activities. The care records showed that an assessment of the social and recreational needs of residents are carried out for residents. These were on the whole comprehensive and describe the things that residents enjoy doing. It was noted that these records, which included some form of life history of residents, were normally found at the back of the care records. The home employs a full time and two bank activities coordinators. A programme of activities is produced weekly and includes a number of group and one-to one activities. The manager states in the AQAA that residents are supported with attending classes and day centres if it is possible for them to do that. She added that the home has arranged some classes for those who are interested in astronomy and history. The home has a computer room, which can be used by residents. For those who are not fully conversant with computers there is a computer class every Friday. There are other opportunities for residents to develop skills. These include art classes and a number of group discussions, which are facilitated by the psychologists. Residents have their own discussion group which meets once a week. This is totally for residents and run by residents. Issues that need to be brought to the attention of management or need to be addressed are taken to the manager by the chair of the discussion. DS0000069362.V355882.R01.S.doc Version 5.2 Page 19 I was informed that the home organises outings on a regular basis. There are two mini buses, which are adapted for wheelchair users and have tail lifts. As the home has a considerable number of residents, outings are planned to give the opportunity to all residents to go out. Outings tend to concentrate on visits to places of interest and to the shopping centres. The home has an open visiting policy and a number of visitors were observed in the home during the inspection. A hot drink machine and a water cooler are found in the reception area for visitors to help themselves. Visitors stated that they are made to feel welcome to the home by the home’s staff. The care records have a section on the fears for the future and address to some extent the hopes and expectations of residents. The section on sexuality in the care records mention issues about supporting residents to maintain a relationship with their partners. This part also takes into account the changes that people who fall ill or become physically disabled have to face and come to term with. The manager stated that one of the bank activities coordinators’ main duty is to find out the traditions, celebrations and observances of the various cultures and religions of residents and support them in practising their religions, observe their traditions and maintain cultural links with their community. I noted that some residents had their DVD/video player in their rooms and music systems. They could therefore watch movies and listen to music that is culturally appropriate to them. 11 out of 16 residents who responded to comment cards say that staff listen and act on what they say. The comments cards and people who spoke to me during the inspection indicated that most staff in the home respect residents’ privacy, dignity and choices. 2 residents said that this also depends on the individual member of staff and that the standard of service is at times variable. I observed that on the whole staff interacted appropriately with residents. They were dressed appropriately and their clothes were appropriately ironed. I visited the kitchen on the second day of the inspection. It is located in the basement. I noted that on the whole the kitchen was well equipped, clean and tidy. The chef was on duty with at least 3 kitchen assistants. The home employs a head chef, a chef and a number of kitchen assistants. The Environmental Health Officer of the local Borough inspected the home in July 2007 and as a result the home was awarded 4 out of 5 stars. This is a good result and the home is commended. I checked that the home kept all the necessary records such as the records of the temperature of the fridges and freezers and records of all meals cooked into the home (the menu choices sheets were kept). DS0000069362.V355882.R01.S.doc Version 5.2 Page 20 Menu sheets completed by care staff are sent to the kitchen and the meals are sent to the floors according to the choices of residents. On the first day of the inspection there were three residents in the dining area in the basement. I was told that very few residents choose to come to the dining area and that most prefer to remain on their wings for their meals. The meals are sent to the various wings on hot trolleys. At the time of the inspection the home had a 4 weekly menu. There used to be a 2 weekly menu, which has been changed to reflect Barchester’s policy and approach to the provision of meals, after consultation with residents. I noted that there were always choices on the menu and that in addition to the two choices on the menu there was an additional alternative menu for those who did not want any of the two main choices. I observed the meals being served on wing 3 on the first day of the inspection. There was homemade carrot and coriander soup and liver pâté on toasts for entrée. The main meals consisted of roast beef, Yorkshire pudding, roast potatoes, beans and carrots and fisherman pie. There was bread and butter pudding for desert. With regards to desert one resident who was a diabetic, said that she was tired of eating ice-cream and yogurts, as he/she always got these deserts and not the other deserts on the menu. It is recommended that sugar-free deserts be prepared for residents who are diabetic to provide them with greater choice. It is difficult to comment on portions of meals without knowing the individual preferences of residents as some people like small portions and other like bigger portions. One person said, “Portions sizes of meals are fairly small and as dinner is served early residents are hungry in the evening”. Meals are normally served at 13:00 and at 18:00. The issue about the sizes of meals can only be addressed appropriately by having clear records of the meals and the amount that residents take, the likes and dislikes of residents and by making sure that care staff have a good knowledge about residents’ needs. Most residents that I spoke to during the inspection said that the portion of meals were appropriate for them, but one said that she received a big portion for her lunch which put her off eating it. The menus are a live topic in the residents’ discussion meetings and any suggestions are then passed on to the manager of the home or the hotel services manager for action. One respondent to comment cards said “ It (the home) has tried hard to produce appetising menus-and been successful”. The complexity of meeting the choices of all residents is summed up by this comment made in a comment card “the home should take more note of the real requirement of individuals and all age groups. Older people tend to want simpler meals”. Despite this, the evidence seems to suggest that the home does a relatively good job in trying to meet the needs of residents in this area. DS0000069362.V355882.R01.S.doc Version 5.2 Page 21 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 17-21 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The personal and healthcare needs of residents are on the whole met to a good standard. Medicines management is not that robust to make sure that residents are safe at all times. EVIDENCE: The residents presented as appropriately dressed and clean. Men were appropriately shaved and female residents wore make up if they wanted to. On the day of the inspection the hairdresser was in the home and number of people went to have their hair done. DS0000069362.V355882.R01.S.doc Version 5.2 Page 22 Personal care of residents was provided in the bedrooms or bathrooms and it was noted that residents were getting up at various times of the day according to their preferences. Some residents who wanted to stay in bed were found in bed according to their wishes. When commenting on whether the care home gives the support and care that is expected, 5 relatives said always and 7 said usually and one said sometimes. 4 said that staff always have the skills to care for people properly and 5 said usually. So while residents and their relatives seem to be pleased with the attitude of staff, they say that residents do not always receive the care that they expect because at times the skills and experience of staff seems to be lacking. The following comments were made: “It depends who is on duty”, “lack of key worker who has knowledge of the resident”, “high turnover of staff”, “English is not the first language”, “shortage of staff”, “low staffing”. 11 relatives who responded to comment cards said that they are always kept informed of important issues, such as acute illnesses and admission to hospital. 1 did not respond and another said that they are usually kept informed of changes. The home benefits from the services of a range of therapists, which are purchased and financed by the home as part of the services that it provides. The services may include physiotherapy, psychology and occupational therapy. The manager stated in the AQAA that the home was bringing in services from a speech therapist and a dietician from January 2008 to make the package of care that it provides, more complete. The services provided by the GP has been rated as excellent by some relatives and staff said that they are very well supported by the GP and that they all work as a team. I also noted that the podiatrist was attending to residents on the day of the inspection. Records showed that the optician visits the home on a regular basis. Services to the home by a dentist are not that regular due to difficulty in the provision of NHS dental services. However in emergency, the home would seek to contact a dentist. Medicines management was inspected on wings 2, 3 and 4. Most records were kept as necessary. There were records of medicines received into the home except on one unit when the records of medicines received was not always recorded particularly when a new medicine was started within a 28 days cycle. On one occasion the amount of one medicine that was prescribed was to the tenth of a millilitre. This amount is difficult to be measured with a normal medicine container and a syringe must be used to get the amount as accurate as possible. Changes were not always made in the medicines chart when the instructions for administering a medicine have been changed. For example the frequency for administering a medicine was reduced to once daily from twice daily but the changes were not made on the chart. As a result there is a DS0000069362.V355882.R01.S.doc Version 5.2 Page 23 danger that a new person administering the medicine might not be aware that the instructions for that medicine has changed. I noted that the strength of medicine had been changed on the medicine chart of a resident. I made an attempt to find out more about this issue, but was unable to track the changes and to balance the amount of medicine that should be in place with the amounts that were in place because of a lack of appropriate records such as dates when changes were made, dates and amounts of medicines that were received. The home has a number of residents who were diabetics. I noted that an inappropriate lancing device was being used for the testing of blood sugar levels for people who were diabetics. A lancing device for personal use (selftesting) was being used by the nursing staff when a professional device should be in use to prevent cross infection as per Medical Device Alert MDA/2006/066 (www.mhra.gov.uk) As mentioned previously in this report the care records contain some information about the hopes and the fears for the future of residents. Some of the care records also contain information about the wishes and instructions of residents or of their relatives and about the arrangements that may have been made with regards to death and funeral. I was informed that staff have been having training on managing end of life care and that there are plans to look at the implementation of the Gold Framework for end of life care in the home. DS0000069362.V355882.R01.S.doc Version 5.2 Page 24 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The home takes all complaints and allegations of abuse seriously and deals with these to make sure that residents are safe. EVIDENCE: The complaints procedure can be found in the SUG and is also available in the reception area of the home. It seems that most people who use the service and their relatives know how to make a complaint and who to complain to, as shown by the comments cards. 11 respondents out of 13 relatives/visitors said that they were aware of the complaints procedure. One person said that he/she was not aware of the above and one person did not respond to that section. 13 residents out of 16 knew how to make a complaint and the majority of residents always or usually knew who to speak to if they were not satisfied about the service that they received. DS0000069362.V355882.R01.S.doc Version 5.2 Page 25 One relative commented that even if they approach the Head Office with issues for a more independent approach to their complaints, these are still passed on to the home to investigate instead of the head office investigating the issues. The home has received 13 complaints. 4 of these were not directly related to the provision of the service, but to the grounds of the home on the part of neighbours. Most of the complaints were appropriately investigated and addressed within the appropriate timescale. Out of the 13 complaints 10 were substantiated. The AQAA showed that there have been 4 safeguarding adults referrals to the local Borough and 1 was investigated through this process. The referral, which was investigated by the safeguarding adult team, showed that the right procedure was not followed at the time, in alerting the relevant authorities. The home has however learnt from this case as I noted during the inspection, by talking to the manager and trained members of staff. The training records showed that most members of staff have had training in safeguarding adults and that new members staff receive this training as part of the induction. Inspection of the management of personal money of residents in the home showed that good procedures were adhered to and that residents are safeguarded from financial abuse on the part of the home as much as possible. The home in the first instance keeps personal money for only a few residents. The relatives of the residents or the placement authorities are mostly responsible for this role. The home keeps some of the personal money of residents in cash if residents want to buy something and there is also a residents’ bank account, where the rest of the money is kept. I sampled the records of 2 residents and noted that receipts were kept as required and all expenditures were logged. There was also monthly reconciliation to account for all money that has been received or spent. This was good practice. DS0000069362.V355882.R01.S.doc Version 5.2 Page 26 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The home has the potential to provide a higher quality standard of accommodation and facilities to residents, but the planned renovation of the home must take place for this to happen. EVIDENCE: DS0000069362.V355882.R01.S.doc Version 5.2 Page 27 The home is situated in a quiet and pleasant residential area of Harrow Weald and is easily accessible by car. There is about 10 minutes walking distance to the nearest bus stop. Wilsmere benefits from extensive grounds both in the front, rear and on the sides of the building. These are maintained to a good standard. A large parking area is found in the front of the home and the rest of the grounds is mostly laid with lawn, mature trees and bushes. The exterior of the building seems to be in good condition. The reception area is warm and welcoming. Entry to the home is by a code-pad for staff and those who are regular visitors to the home. Other visitors ring the bell. The front door of the home was not closing properly during the inspection and the manager stated that she would get the door repaired. While most of the residents and relatives were satisfied with the quality of the environment, 2 relatives commented that the home was due for a refurbishment and one said that the refurbishment, which has been promised for some time has not yet taken place. The manager clarified that home has plans for a major refurbishment. I was informed that Barchester has agreed the plan for this. The main aim is to develop current facilities in the home to make full use of the environment that the home provides. Primarily the plan is to use the area, which accommodates the dining room, as this area is underused. It was noted during the inspection that even though the dining room was appropriately decorated and prepared for residents to have their meals, few people used that area. The refurbishment plan involves making part of the dining room into a gym/physio room and erecting a conservatory for more communal space. The plan includes refurbishing the lounge areas in wings 3 and 4 on the first floor to make these into one area with a sitting facility and a dining facility. This is a summary of the plan and does not exactly represent what the home aims to do. While touring the premises I observed that the communal areas were appropriately furnished and decorated. I noted that residents tend to use the communal areas in the home. On wing 3 where there was little use of the lounge area, as residents preferred to stay in an open area along the corridor or in their bedrooms. All bedrooms are en-suite and personalised to a good standard. Residents brought pictures, photographs and items of decoration to make their rooms more homely. There are a few double bedrooms but these were empty or occupied by only one resident. There are two rooms on wing 3 which can be reached by a small set of stairs from the first floor. These were not occupied at DS0000069362.V355882.R01.S.doc Version 5.2 Page 28 the time of the inspection. The manager stated that there are plans to put a small platform lift to serve this area and improve wheelchair access. The home has adequate number of baths and shower facilities, which provide access to wheelchair users. Residents with poor mobility or those who cannot use their limbs as a result of spinal injuries are provided with items of equipment to promote their independence according to their needs. Most younger adults who live in the home have some form of physically disability as a result of their illness/condition, and some have electric wheelchairs to assist them with mobility. One resident was noted to have a special adaptation/remote control to activate the lights, TV, nurse call bell etc… 10 out of 16 residents stated that the home is always fresh and clean, 5 said usually and 1 said sometimes. One relative stated that there tends to be an odour along the corridor on wing 2. I noted that the home was on the whole clean and free from odours except along the main corridor on wing 2 where there was an odour and a bedroom on wing 3 where there was also an odour. There was evidence that the carpet in the bedroom, where there was an odour, was regularly shampooed to address this problem. These findings seem to match the comments by residents as few of them noted an odour in the area where they live. There were a few residents who had a particular infection. There were antiseptic hand wash, paper towels and I noted that appropriate infection control practices were adopted with laundry and clinical waste. The home used to leave alcohol hand rub in the bedrooms of residents and in corridors for all to use including visitors, but this practice has been stopped by the home. I was told that this was because of the risk that the alcoholic hand rub posed to some residents, who may ingest this. Two residents and a relative voiced concerns about this issue during the inspection and mentioned that this practice should not have stopped. There has also been one anonymous complaint made to the commission about this matter. While it is clear that the alcohol hand rub do pose a risk to some people it is recommended that appropriate risk assessments be carried out if necessary, based on an individual basis to determine where the alcohol hand rub can be used. I observed that alcohol hand rub was available at the nurses’ station. DS0000069362.V355882.R01.S.doc Version 5.2 Page 29 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The home on the whole provides appropriate numbers of staff, who are appropriately trained to meet the needs of residents. EVIDENCE: There are varying number of care staff on each wing depending on the number of residents and their needs. There is however always 1 trained nurse on each wing day and night. For example there were 1 trained nurse and 4 carers on wing 3 for 15 residents and in addition one of the residents had a one to one carer. Wing 1 DS0000069362.V355882.R01.S.doc Version 5.2 Page 30 accommodated 22 residents and there was 1 trained nurse throughout the day and 6 carers in the morning and 5 in the afternoon. When commenting on what the home does best 6 relatives said that staff in the home are its main strengths. 11 residents said that staff always listen and act on what they say but only 2 said that staff are always available when they need them with 8 saying that staff are usually available and 4 saying sometimes. 3 said that staff do not listen to them. One resident commented that “It depends on the staff on duty”, two said that some care staff have a poor command of English. 3 relatives mentioned that language could be an issue with regards to communication. Another relative said “more one to one contact could improve the quality of the service.” To summarise the above it seems that the attitude of staff towards residents are mostly good and that the majority of nursing and care staff would always help residents, but it also seems that staff are not always easily available when residents need support and that on occasion the ability of a few care workers to communicate in English may cause some frustration on the part of residents and relatives. The point that staff are not always available when a resident need support may very well be true on a few occasions. I observed that the call bell rang for about 5 minutes on a wing while I was on another wing. Trained nurses commented that they are very busy with everything that they have to do. The home indeed accommodates highly dependent residents with complex needs that in some instances can only be met by nursing staff. The nursing staff also have to make sure that all the care records are up to date and that the management of medicines is being carried out safely. I looked at the personnel records of 6 members of staff. There was evidence that some members of staff who have been in the home for some time did not have all the records that are required. All new members of staff however have all the relevant records including appropriate references and a full employment history. The manager stated that she was aware of the need to make sure that all applicants have the relevant records before they are offered employment in the home. It is noted that the staff composition is not always representative of the residents’ composition and that English is not always the main language of some members of staff. Some residents and relatives did express some concerns about staffing and the difficulty in communication, as above. The manager stated all members of staff have to speak relatively good English before they are offered employment. Recruitment of care staff is particularly difficult in some areas of London and there is a reliance on people from abroad to work in this sector. There is also a need to comply with the relevant DS0000069362.V355882.R01.S.doc Version 5.2 Page 31 employment legislation. With the right training and support most of the care workers will turn out to be very good care workers. The home has 31 care staff out of 91 trained to NVQ level 2 or above. It also has 8 carers working towards an NVQ level 2 or above. The home therefore does not yet have 50 of its care staff trained to NVQ level 2 or above. There is however evidence of ongoing training that is provided to staff in the home. The home benefits from a training manager who organises training, ensures that all staff are trained as required and responsible for the induction of new members of staff. The home uses an induction package, which is based on the common induction standards from Skills for Care. New members of staff are supernumerary during the first few days of the induction. Barchester also has training packages that are offered to staff on CD-rom/DVD. I noted that staff were being supported with their training and that they had individual training profiles in place. Most staff were up to date with statutory training in fire, health and safety, manual handling and food hygiene. Staff have also had training in infection control and safeguarding adults. DS0000069362.V355882.R01.S.doc Version 5.2 Page 32 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and42 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The home has an effective management arrangement with clear lines of responsibility, which ensures a smooth running of the home. DS0000069362.V355882.R01.S.doc Version 5.2 Page 33 The quality system in use is appropriate to assess the quality of the service that the home provides and to ensure continuous improvement. Most issues with regards to health and safety are attended to except for few issues, which needed attended to, to ensure the safety of residents, visitors and staff. EVIDENCE: The home has a registered manager who has now been in post for about 2 years. She is a trained nurse and has many years experience managing care homes. She has a qualification in management. The home benefits from a good management structure. There is a hotel services manager and a deputy manager, who is mostly responsible for clinical issues and for liaising with health and social care professionals. The manager is also closely supported by the regional operations manager and other Barchester services such as the clinical support nurse. The running of the home promotes the rights and independence of people who use the service. The residents’ discussions group is one of the ways where residents’ contribution to the running of the home is being promoted. There are also three monthly residents and relatives meetings and three monthly staff meetings. Comments cards were all positive about the management of the home. One person’s feedback about head office mentioned that head office tends to pass everything back to the home and does not always address issues appropriately, particularly when complaints are made directly to head office. One relative said “I cannot commend the home enough”. Another said, “I am glad that my husband is in Wilsmere and not somewhere else”. A third said, “generally speaking Wilsmere is well run and my mother is well cared for”. Comments cards seem to suggest that although residents and relatives thought that there are some areas where improvement could be made, all thought that Wilsmere runs a good service and that they did not want to move to another care home. The home uses the Barchester Healthcare quality assurance procedure. Quality control systems used include stakeholders survey and quality audits. The satisfaction surveys are carried out yearly and the feedback is used to compile a report. The monthly audit system is a self-monitoring tool, which addresses various aspects of the service such as care, social and recreational activity, administration and health and safety. The audits which are carried out by the manager or by a person who has been delegated this duty, are also validated DS0000069362.V355882.R01.S.doc Version 5.2 Page 34 by head office staff such as the regional operations manager, divisional nurse, maintenance manager and catering manager. Monthly visits as per regulation 26 of the Care Homes Regulations 2001 are carried out by the operations manager and the reports are regularly sent to the Commission. The management of health and safety was inspected. The home had up to date gas safety certificates for the gas appliances in the home, a portable appliances test certificate, a wiring test certificate and evidence that the water system in the home was being maintained. All equipment including hoists and lifts were maintained as required. The home has a fire risk assessment and a fire emergency plan. There is evidence that fire fighting equipment and fire detection equipment are maintained, as required. It was noted that the fire emergency lights test have not been carried out monthly and that there has been only two fire drills in 2007 and that night staff have not been involved in one of them. Some fire doors were held open by small beanbags but a few were held open by wooden door wedges. It is understandable that some residents want to have their bedrooms’ doors open, but there must be appropriate risk assessment about the devices to use to maintain fire doors open. Consideration must also be given to the use of automatic self-closing devices such as electromagnetic door closing devices or door guards. The home has had problem, on and off, with the supply of hot water. 3 relatives mentioned that the supply of hot water in the home is unreliable. The manager has in the past informed the commission of poor supply of water to the home as a result of work on the water system by the local water company. This affected the supply of hot water, but I cannot be certain if it was the water company, which was responsible on every occasion when there was no hot water in the home. DS0000069362.V355882.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 4 38 X 39 3 40 X 41 X 42 2 43 X 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 DS0000069362.V355882.R01.S.doc Version 5.2 Page 36 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 YA5 Regulation 5(1)(b)(c) Requirement The responsible individual must ensure that all residents receive a copy of the contract/terms and conditions of the home to ensure that the residents are aware of their obligations and of their rights while living in the home. Care plans must be drawn up to reflect all the needs of residents and must be kept updated as and when changes occur. That residents or their relatives be involved not only when the care plans are reviewed but also when they are drawn up. To make sure that residents are safe when they are seated in wheelchairs with the seatbelts on, risk assessments must be drawn up to address this issue. The amount of all medicines received into the home must be recorded. When administering exact doses of medicines (such as when a tenth of a millilitre is prescribed) a syringe must be used to make sure that the actual amount is being DS0000069362.V355882.R01.S.doc Timescale for action 31/05/08 2 YA6 15(1,2) 31/03/08 3 YA9 13(4) 31/03/08 4 YA20 13(2) 31/03/08 Version 5.2 Page 37 5 YA20 13(2) 6 YA20 13(2) 7 YA20 13(2) 8 YA30 16(2)(k) 9 YA35 18(1)(c) 10 YA42 24 accurately measured and administered. Changes in the instructions for the administration of medicines must be recorded on the MAR sheet to make sure that all people who administer medicines will be able to read the changes. There must be a clear audit trail of all medicines that have been prescribed to make sure that residents always receive the right dose of medicines at the right frequency and at the right time, as prescribed. That the appropriate lancing devices for professional use, is used for blood sugar testing in diabetics to prevent the risk of cross infection. That all areas of the home be free of odours as much as possible to make sure that the environment remains pleasant for all people who use these areas. The home must have 50 of its care staff trained to NVQ level 2 as soon as possible, to make sure that they are fully competent to care for the residents. There must be monthly emergency lights test to make sure that the system is working properly and at least quarterly fire drills, including one at night to make sure that all staff are aware of the action to take if there is a fire. That the devices to keep bedrooms doors open (particularly wooden wedges) be subject to a risk assessment to make sure residents safety is being maintained at all times. Consideration must be given to the use of automatic self closing DS0000069362.V355882.R01.S.doc 31/03/08 31/03/08 31/03/08 31/03/08 31/12/08 31/03/08 Version 5.2 Page 38 devices, such as electromagnetic door holders and door guards, to close the doors should the fire alarm be activated RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations It is recommended that the home explores the use of easy to read format for the production of the service users’ guide, care plan, complaints procedure and other documents that may be relevant to residents who may have a cognitive impairment, to make sure that they understand the information that is contained in these documents. That the care plans and risk assessments, particularly for younger adults address not only areas of avoiding risks but also areas of risk taking where residents are being supported to develop independent living skills and independence. It is recommended that sugar-free deserts be prepared for residents who are diabetic to provide them with a greater choice of deserts. That the use of alcoholic hand rub in the home be determined by a risk assessment taking into consideration the individual circumstances of the residents. 2 YA9 3 4 YA17 YA30 DS0000069362.V355882.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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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