Inspection on 30/07/09 for Wilton House Nursing And Residential Home

This inspection was carried out on 30th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wilton House Nursing And... 11/08/08

Wilton House Nursing And... 16/10/07

Wilton House Nursing And... 09/05/07

Wilton House Nursing And... 30/10/06

Wilton House Nursing And... 31/10/05

Wilton House Nursing And... 19/05/05

Wilton House Nursing And... 14/10/04

Wilton House Nursing And... 03/06/04

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Claremont House

Oak Ridge

Sun Court Nursing Home

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Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Wilton House Nursing And Residential Home 73-77 London Road Shenley Hertfordshire WD7 9BW Lead Inspector Sheila Knopp Key Unannounced Inspection 30th July 2009 08:15 DS0000019620.V376666.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wilton House Nursing And Residential Home Address 73-77 London Road Shenley Hertfordshire WD7 9BW Telephone number Fax number Email address Provider Web address Name of registered company Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 858272 01923 856760 Wilton House Limited Manager post vacant Care Home 51 Category(ies) of Dementia - over 65 years of age (51), Old age, registration, with number not falling within any other category (51), of places Physical disability over 65 years of age (31) Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The home may accommodate up to 25 older people who require personal care. The home may accommodate 25 people with physical disabilities who require personal care. The home may accommodate up to 26 older people who require general nursing care or who are elderly mentally infirm and require nursing care. The home may accommodate up to 25 older people with dementia who require personal care. The home must ensure a minimum of 5 suitably qualified and experienced staff work at night within the home. 11th August 2008 Date of last inspection Brief Description of the Service: Wilton House Nursing & Residential Home opened on 3 June 1987. The home is currently registered to admit 51 older people who are physically frail and may have dementia. The home can also accommodate twenty-six older service users within the overall capacity of the home, who require nursing care. Wilton House is a purpose built home in a village location. Residents have single rooms with en-suite facilities. Assisted bathing and toilet facilities are provided. The village shops and pubs are a short distance from the home. Extensive car parking is provided to the rear of the building for visitors. The home is on a sloping site. There is pedestrian access from the main road or residents/visitors can enter the home from the rear car park via the lower ground floor taking the lift to the ground floor. Although there are extensive grounds at the back of the building there is only a very small garden accessible to service users. The Statement of Purpose, Service User Guide and previous inspection reports are available on request from the manager. A copy of the Service Users Guide will be provided to prospective service users by the home. The current fees per week are in the range of £590 for personal care, £621 for dementia care and £842 for nursing care (correct on 30/7/09). Extra is payable for toiletries, hairdressing, chiropody and newspapers. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes. The information in this report is based on an unannounced inspection to the service and a review of information we have received between our key inspections. This includes information from an unannounced random inspection we carried out on 15/4/09. This inspection took place between 08:15 and 17:40. Two inspectors were present for part of the visit as we carried out a period of intensive observation to look at the experience of people who have dementia and how staff respond to them. We also met residents, visitors, staff and members of the management team who made themselves available. Relevant information about the service was reviewed. To make sure we include a range of views in this inspection we made survey forms available to 15 residents and their relatives, 10 staff and 4 community health and social care professionals who are regular visitors to the home. We received completed surveys from 5 residents, 4 relatives, 8 staff and 3 health & social care professionals. We have reviewed the notifications about events in the home that services are required to send us and the manager’s annual quality assurance self assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This visit gave us the opportunity to meet with the new manager of Wilton House, Monika Gilice, who took up her post on 1/6/09. To improve the quality of life for the people who live at Wilton House the company have continued to implement the action plan they provided us with following our inspection on 11/8/08. This inspection identifies that progress is being made but there is still work to do. As a result of this inspection the company have responded positively to the requirements and recommendations we have made and identified the action to be taken. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 6 What the service does well: People are assessed before they come to stay at Wilton House to make sure their needs can be met and any specialist equipment they need arranged before they arrive. One person who completed a survey told us ‘‘we decided on Wilton House because it is near to our home. I’m very pleased with it. My relative is well looked after’. The 5 people living at Wilton House who completed our survey and described what they felt the home did well added the following comments, I ‘feel at home in a nice safe environment. Staff very kind’, ‘most staff are friendly’, ‘takes good care of me’, looks after my welfare and needs quite well, ‘home is clean’. A relative told us ‘I’m more than pleased with my relative’s treatment at Wilton House they are always clean and looked after’. People are monitored for their risk of developing pressures sores and provided with the equipment they need to protect them. People are encouraged to take part in activities and things that interest them by an enthusiastic activities organiser. However the ability of one person to spread themselves across the whole home are limited and care staff must follow her lead and be encouraged to develop their skills in this area. People tell us they enjoy their meals and are offered choices. What has improved since the last inspection? People’s experience of moving and handling procedures will have improved through the provision of new equipment, staff training and monitoring. People’s dignity and comfort has been improved now that there are new lounge chairs. People who need assistance to make sure they get the food and drinks they need are being closely monitored. A care summary has been provided for the care staff so that information about people’s daily care needs is more accessible to them. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 7 The activity organiser has completed a course in activities for older people and is enthusiastically using her knew knowledge to provide people with more opportunities for stimulation and occupation. What they could do better: People living in the home, who have dementia, need to be confident that staff will provide meaningful interaction throughout the day, to enable them to lead fulfilling lives, based on maintaining their skills and provide a sense of wellbeing and comfort. People will experience a routine task based approach to providing their care that is not centred on their individual needs and preferences. This is because managers use the allocation of tasks to monitor that basic care needs are being met within a changing work force that at times lacks the skills to manage work for themselves in a more person centred way. People using wheel chairs need risk assessments in place to record the safe use of lap belts where these are needed for safety. People who have dementia and need staff to interact with them during the day to provide stimulation and comfort, need to be assured that staff will be provided in sufficient numbers to support this. People living in the home need to be assured that any staff employed will be able to communicate with them. This is to protect residents and make sure they receive consistent and dignified care from staff who are able to communicate effectively and understand the home’s policies and procedures and training materials. Many areas of the home need upgrading to improve the quality of the furniture, furnishings and decoration. Following discussions during our visit we have been advised by the director, who acts as the responsible individual for Wilton House that ‘a general refurbishment of Wilton House will commence in September 2009 and will be completed by 1st March 2010’. We have been advised that reports on the progress being made will be available to us and have requested that quarterly reports are provided. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 9 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 Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (standard 6 does not apply to this service) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People looking to move into Wilton House will be involved in an assessment of their needs to make sure that it is a suitable place for them to live and that staff will be able to support them. EVIDENCE: We spoke to a resident who had recently moved into Wilton House to see how they have found the experience and whether they were involved in an assessment of their needs. Specialist equipment they needed had been put in place before they arrived. A health & social care professional who completed a survey told us assessments were carried out quickly following referrals. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 11 The new manager makes sure she sees people shortly after their admission to check that everything is in place and they are happy with the arrangements made for them. Admissions to Wilton House are made within the categories described on the home’s registration certificate. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 7, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and nursing needs will be monitored but staff do not currently demonstrate they have the skills to provide people who have dementia with the support and comfort they need. EVIDENCE: The 3 residents who completed surveys had different views on the quality of care they are receiving. One person said they ‘always’ receive the care they need. The others said this was ‘usually’ or ‘sometimes’ the case. Two out of three people said they ‘usually’ receive the medical care they need. Relatives who completed our surveys and those we spoke with during our visit confirmed that staff were good at keeping them informed about important health matters. All the relatives (5) who completed our survey said their relative always had the care they needed. One person added ‘I’m more than Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 13 pleased with my relative’s treatment in Wilton House they are always clean and looked after’. The people we met on the day of our visit had received good attention to their personal care but staff need to take care to ensure people’s hair styles are maintained after the hairdresser has been, rather than washing sets out. We observed improvements in moving and handling procedures with staff taking their time and talking to the person about what was going to take place. Staff made sure that the people’s dignity was protected when people were being transferred in public areas. Following our last inspection the company have provided details of the training provided by staff to promote people’s dignity and good moving and handling techniques. The new manager is continuing to monitor this area of care. Staff were observant in knocking on people’s doors before they went into their rooms. Each person has plan of care detailing their needs and the actions required by staff to meet them. The care plans had been regularly reviewed and now contain more details from other health care specialists, such as dieticians, who are involved in providing advice on specific needs. A significant improvement has been the introduction of a care profile that makes information for carers on each persons daily care needs more accessible. Staff allocation systems are used to plan and deliver the daily care of residents. This means named staff are accountable for specific tasks to ensure people receive; the personal care, fluids, assistance with meals and management of incontinence they need regularly throughout the day. These systems are in place to ensure that the daily delivery of the physical care people require is achieved. However the management team need to improve the continuity and skills of the staff employed to achieve a more person centred approach. This is particularly evident when looking at the staff approach to people who have dementia. We followed up notifications we receive about events in the home, such as accidents and hospital admissions, with an unannounced random inspection on 15/4/09. A random inspection focuses on specific areas rather than reviewing all the standards covered at a key inspection. We looked at the systems in place to make sure people were receiving the food and fluids they need and the prevention and management of pressure sores. The visit confirmed that suitable systems were in place to monitor these areas. None of the residents at that time were reported to have a pressure sore. This visit confirmed that peoples’ food and fluid intake continues to be closely monitored. Where people are known to have problems with their nutrition staff encourage them to eat the main meal but then offer supplement drinks and desserts to boost their nutrition where necessary. Nutritional shakes are taken around on the drinks trolleys and people have drinks to hand in their rooms. The nursing staff are currently managing the care of one person admitted from hospital with a Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 14 pressure sore. Specific plans of care showing the treatments provided and the person’s response to the care they are receiving are recorded. Pressure relieving equipment had been arranged before the person moved in. There are no reports of any of the current residents developing pressure sores in the home, which is a positive indicator of care, given the high dependency and lack of mobility of some of some of the residents. The manager reported that, following discussions with the general practitioner (GP) who visits the majority of residents, new systems to reduce the effects of accidental knocks and bruises are being introduced. We have advised the manager to look at how tubes of cream applied to skin, as a homely remedy, can be identified for individual use to promote good infection control practices. Risk assessments are in place covering key areas such as prevention of pressure sores, management of nutrition, risks associated with the use of bed rails and moving and handling. However we observed three people left unattended in wheelchairs with lap belts in place. Their care plans did not provide details regarding the reason for their use, when they should be used and safety instructions for staff on how to check they are fitted and adjusted correctly. Incorrect use can be restrictive and lead to accidents. Our observation of the experience of people with dementia and the interaction staff have with them concluded that there is little meaningful contact from staff other than when they are carrying out tasks such as providing medicines or drinks. On the ground floor there was no social interaction from the carer assigned to the lounge during the observation period. They sat and observed and responded to people when they moved or indicated assistance was needed. We also noted that this carer had difficulty communicating with residents because of language differences. We looked at the systems for managing people’s medicines and found that the ordering, storage and systems for administering people’s medication were well organised. We have advised the manager to clarify the details on one administration chart with the GP or pharmacist, so there is clearer guidance for staff. Following our random inspection we asked the company to make sure that the procedures and equipment used to monitor blood glucose levels were in line with Medicines and Health Care Products Regulatory Agency guidance and designated for single patient use, to prevent infection. This has been achieved. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are able to make decisions for them selves will be able to take part in a range of activities. However people who need staff contact to help them engage meaningfully with the world around them and provide comfort, need more support. People are offered a choice of meals that they enjoy and assistance is available to people who need help. EVIDENCE: There is a very enthusiastic activity organiser who has recently completed a course in providing activities for older people. She is developing ideas, based on the information she has learnt, that encourage people to be independent with specific aspects of their lives. A programme of activities and events is organised that includes opportunities to go out into the community, visit local events, have lunch or coffee out and attend church services in the community Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 16 or those provided in the home. A mini bus can be arranged for trips further a field. To keep people up to date with the local news the local talking newspaper is available and provides opportunities for conversation and discussion. As we observed and have previously reported, unless staff are engaged in specific tasks with residents there is very little interaction and contact. There are times when people are left on their own in the lounges. A resident commented to one of the inspectors as a member of staff entered the lounge ‘look she’s going to wake up the one person who was asleep’. Some staff go through the motions of trying to engage with people but don’t look as though really know what to do or feel comfortable with it. On our arrival there were people sitting in the lounges on their own without anything to occupy them. Staff allocated, to spend time with people in the lounges later in the day were passive, just sitting with them and only responding when someone moved or indicated their needs. Staff need to be provided in sufficient numbers to extend and develop the work of the activity organiser throughout the home. The care records have details of how staff can interpret people’s feelings of ill being or well being but these and the social histories and personal profiles vary in detail. One person’s monthly review listed, over a 5 month period, that they were ‘noisy, restless and physically and verbally abusive at times’, but did not refer to whether the actions required by staff were effective or what other strategies to try. People in their rooms receive very little social support. The activity organiser told us she tries to spend time with these people providing music and hand massage but understandably her time is limited. Residents we spoke to seemed pleased with the meals served. One said, “The food is very good. I enjoyed it.” Another said, “The food is good. No complaints.” Lunchtime was unhurried. There was a choice of two hot dishes. One resident was served a late lunch. Members of staff were generally helpful and gentle with the residents. The managers self assessment (AQAA) tells us that following our visit last year a meeting with the chef was organised to discuss the presentation of meals and a menu choice book was started so residents are offered a choice of meals each morning. To make sure people’s dignity is supported when eating and drinking staff need to make sure that spills and splashes on walls and furniture from food, are cleaned up. Melamine jugs should be cleaned so they are stain free and not brown from the build up of tannin deposits. Place mats should be pleasant to look at and have intact surfaces. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are able to raise issues with the manager can be confident that they will be taken seriously and addressed. Some people may experience an inconsistent approach from some staff, that may leave them feeling vulnerable. EVIDENCE: The relatives who completed survey forms confirmed they knew how to make a complaint if they needed to. One person added ‘no complaints-very satisfied with the care at Wilton House’. Four residents, who completed the survey question on who to speak to if they had a concern or how to make a complaint, were not so sure of the process or who to talk to. While we have received positive comments about the approach of staff there are times when residents experience inconsistencies in the way they are looked after. We are aware of 2 incidents, one reported by senior staff in the home for investigation under the Hertfordshire multi-agency safeguarding vulnerable adults procedure and one reported by a relative to the manager, who carried out an investigation. In both incidences concerns have been expressed by Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 18 residents and or their relatives about the approach of staff that have not been able to be fully verified because the people concerned have a degree of memory loss. One resident told us that they felt a member of staff had been rough. A relative who completed a survey told us ‘the staff have at times been a bit abrupt, but when we complain it is usually sorted out’. This tells us that people may not always be experiencing a positive approach from staff. Information other agencies have shared with us about the service indicates that senior staff have made appropriate referrals under the procedures for reporting adult protection issues and worked with out-side agencies to review the concerns. People making complaints about the service have received feedback about their concerns. Arrangements are made for staff to receive training in safeguarding of vulnerable adults but some may have limited understanding of this area leading to the inconsistent approach we have reported. People’s capacity to make decisions about their lives is being assessed in line with guidance related to the Mental Capacity Act. We have been told staff training is planned. While the issues of restraint in relation to the use of bed rails is understood and recorded as part of an individual risk assessment, we noted that people in wheelchairs with lap belts in place did not have assessments of risk recorded in their care plans. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are living in a home that is regularly maintained to make sure it is safe but has become shabby over time. People will be reassured to know that the company have told us of plans to improve the environment. People need to be confident that staff will recognise the lack of dignity experienced when cleaning and hygiene standards are not maintained. EVIDENCE: People are able to add personal possession to their rooms, including hanging pictures and photographs on the wall, to make them feel more at home. Each person has their own room with ensuite toilet. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 20 Wilton House has become very shabby, in terms of decoration, flooring and furniture. As managers have changed the use of facilities has altered over time. For example there is a bright reception area and office space for administrative staff to support the functions of the home on the lower ground floor. There are no administrative staff as this role is carried out in the company head office in Hemel Hempstead. Therefore this area is rarely used and there is no welcome when people come to the door. People not able to use the key pad have to wait for staff to come down from the upper floors. This also takes staff away from their duties. On the day we visited a relative of a resident, who was just coming to stay, had been let in by staff but was walking around the home on their own looking for some to help them move in. This does not encourage a positive or reassuring first impression. New lounge chairs have been provided to improve the quality of seating since our last visit. The fitted wardrobes and vanity units in many of the rooms have seen better days. Some of the laminate surfaces had blistered making them difficult to clean. In one room the door of the bedside cabinet was falling off. Repairs have been carried out over time with little thought for matching existing colour schemes or tiles. The bathrooms are bare and unwelcoming which may not provide the necessary cues to their functions and feeling of comfort needed by people with dementia. Some of the bathrooms are internal rooms with no windows. One bathroom with a frosted window had the blind missing which made the room look cold, neglected and institutional. Baths with seat hoists are available to help people but there are currently no shower facilities. The dining room furniture is looking worn where the wood has become bleached over time with cleaning. Blistered table mats need to be replaced to promote people’s dignity. We found worn bed linen in cupboards ready for use, a dish washer out of action when we visited in March had still not been replaced and broken / fragile garden furniture. Since our visit we have been informed that these items have now been replaced. Window restrictors are in place to prevent accidental falls from height. One on a lounge window had broken but was fixed before we left. Regular checks need to be carried out and recorded to make sure they remain effective. The home was fresh and odour free on the day we visited. Residents and relatives have also made positive comments about standards of cleanliness. However we observed dried on food spills in individual rooms and splashes in the dining room. A room vacated in March still hadn’t been cleaned. A social care professional who visits Wilton House told us ‘on more than one occasion I Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 21 found dried congealed food (mashed potato) on legs of tables and tray tables’. The AQAA refers to cleaning as an area that needs monitoring. There is a laundry on the lower ground floor and the laundry assistant is currently studying for a related NVQ qualification. In response to feedback the manager received from relatives she is going to purchase large net bags so each person’s laundry is kept together through washing process. This is to reduce the number of missing items. Staff have access to disposable personal protective equipment such as gloves and aprons. One of the staff surveys raised issues about the quality of gloves being used as they were sticking to the resident’s skin when being used. The manager reported new supplies are now in place. Liquid soap and paper hand towels, to promote good hand hygiene, are in place in individual rooms and shared bathrooms and toilets. The treatment room used for storing medicines and medical supplies does not have a sink. The area is very small and would benefit form a review at some stage to make it more accessible to staff. We have asked the manager to look at suitable hand cleansing systems for this area. Staff should also have access to a blood spillage kit to use in the event of an accident to reduce the risk of infection. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home experience inconsistent approaches to their care depending on the attitude experience and skills of the staff they have contact with. People cannot be confident that they will receive care according to their individual preferences because staff are not provided in sufficient numbers to move beyond a routine approach to care, which sees people having their needs met in turn with others. People can be confident that references and criminal checks are carried out to check staff are suitable to work with vulnerable people but need to be assured that the company’s recruitment procedures will make sure staff have the language skills they need to communicate effectively as they start work. EVIDENCE: This report refers to our concerns regarding the interaction of staff with residents who have dementia and their language skills. Residents and relatives have told us staff are gentle and kind. A social care professional said staff seem happy and caring. We observed during lunch time that staff were Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 23 generally helpful and gentle with the residents. We asked residents if staff were kind and gentle. One person said they had told a member of staff who had provided their personal care ‘you’re the roughest person I know’. They said this was not the case with others. In addition to the comments in the complaints and protection section of this report a relative told us ‘the staff at times can be very rude but most of the time we are pleased with how our relative is being looked after’. Frequent changes of staff and constant skilling of new staff means the home doesn’t move beyond a task based approach. This also has resource implications for the company as they are not seeing the benefits that would be achieved from having a stable work force. We were concerned to find a member of staff, recently been employed as a cleaner, who is not able to converse with residents and needed to have the health & safety training videos interpreted by a manager. This member of staff is not able to respond to residents and has access to information about cleaning products they are not able to read. The manager has told us translations will be made available and staff are encouraged to attend language courses. A reliance on specific numbers of staff to attend to people’s physical needs each day is not enabling the home to develop a person centred approach to dementia care, which needs more staff time and quality interaction. Following our last visit the staff files have been audited to make sure all the required information is available. We looked at the recruitment process applied to 4 new members of staff. Criminal records checks are confirmed before people start work and 3 references are obtained. The manager also follows the good practice of confirming the last employer’s reference by telephone. We have advised that references that are provided by overseas staff with their application need to be verified and ‘to whom it may concern references’ not accepted unless authenticated. The personal identity numbers of the registered nurses are checked to make sure they are currently registered to practice with the Nursing & Midwifery Council. An external company provides training to cover induction skills, statutory H&S training, safeguarding vulnerable adults, dementia care and National Vocational Qualifications. We have been advised that 15 carers have NVQ 2/3 in care. Staff are not paid to attend all the training they are required to do. Two staff feel that training is hampered by the language skills of some of the staff present, which does not enable subjects to move on in more depth. A health & social care professional also raised concerns about the ability of residents to understand some of the staff. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33,35 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home need to be assured that the company responsible for Wilton House will make resources available to provide a stable staff team with sufficient training and skills to provide a person centred service. EVIDENCE: Wilton House has had two people managing the service since our inspection on 11/8/08. The new manager started on 1/6/09 and is being supported by the area manager and Director, Dr Selimyan, who acts as responsible individual for the company, Wilton House Ltd). Dr Selimyan completed the annual quality assurance assessment (AQAA) when we asked for it. The assessment was very Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 25 detailed and referred to the action taken to address issues we raised at our previous inspection. We will need an application from the new manager so we can assess her suitability for the role under the Care Standards Act. This report refers to key areas of strategy and resources that have implications for the quality of the service and are the responsibility of senior managers and the board. The company need to look at their approach to recruitment and work force planning. They are putting resources into training but as staff leave and new staff need training neither the residents or the company are seeing the benefit of a consistent well trained team. This is commented on by health & social care professionals responsible for funding people at Wilton House. One person told us the care staff are helpful but don’t always know clients’. Another person commented about the approach to dementia care and the difficulty residents have understanding some staff. Wilton House is recognised as a resource for people living in the area. A social care professional said ‘the location of the home is an ideal place but it needs good leadership to run the home, organise staff etc’. The new manager has prioritised areas for improvement that she has identified. These include promoting people’s health & dignity and health promotion, to reduce urinary tract infections. There are systems in place to enable people to deposit money so they can have access to their finances for day to day expenditure. Details of deposits and withdrawals are recorded so transactions can be audited. The views of staff and discussions about working practices take place at staff meetings and through regular one to one supervision. Records to support this are kept and minutes circulated. Opportunities are made for residents and relatives to give their views through meetings and surveys. There is a training plan in place to make sure staff are up to date with the health & safety training they need. Service records for safety equipment and services within the home, including fire safety equipment and regular fire alarm checks are kept up to date to make sure people are protected by having safe systems in place. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 3 x 3 Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(7)(8) Requirement The registered person must record individual risk assessments for the safe use of wheelchair lap belts where these are in use; detailing the reason for their use, circumstances under which they are to be used and instructions for staff. This is to make sure there are no inappropriate limitations on people’s freedom and safety measures are in place. The registered person must ensure that all areas are kept clean: 1. There should be no food spills or splashes on the walls. 2. Stained melamine jugs must be cleaned or replaced. 3. Replace damaged and stained place mats. This is to promote people’s dignity. The registered person must: 1. Review the organisation’s DS0000019620.V376666.R01.S.doc Timescale for action 30/09/09 2. OP26 23 30/09/09 3. OP27 19 30/11/09 Page 28 Wilton House Nursing And Residential Home Version 5.2 recruitment and assessment procedures to make sure only staff who have the skills necessary to be able to communicate effectively with residents and read and understand the home’s policies, procedures and training materials, are employed. 2. Provide CQC with details of the review, language assessment used and level of competency necessary to be offered employment. This is to make sure people’s dignity and safety is protected. The registered person must: 1. Review the support needed to meet the needs of people in the home, including those with dementia and people looked after in their rooms, so that sufficient numbers of staff are provided to support people’s social needs. 2. Provide CQC with a report on the review and action taken. This is to enable people to experience a person centred approach based on achieving their goals and aspirations rather than a task based approach based on meeting basic care needs. 4. OP27 19 30/11/09 Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP19 OP19 Good Practice Recommendations Regular safety checks on window restrictors should be carried out and recorded to make sure they are effective. Provide quarterly updates on the refurbishment programme to include steps to make sure people do not have damaged or broken furniture in their rooms. Wilton House Nursing And Residential Home DS0000019620.V376666.R01.S.doc Version 5.2 Page 30 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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