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Inspection on 30/10/06 for Wilton House Nursing And Residential Home

Also see our care home review for Wilton House Nursing And Residential Home for more information

This inspection was carried out on 30th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

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

What the care home does well

At the last inspection many of the homes internal management systems and paper work had been reviewed, and a date for some of these reviews are just becoming due. Policies and procedures had been recently reviewed just prior to the last inspection and the induction process and new paperwork was fully up and running. Adult Protection training has been provided to staff and plans are in place to include new and remaining staff on the next training places available. All staff receive in house abuse awareness training prior to attending the external course; abuse awareness training provides safeguards for service users. Wilton House is currently awarded accreditation for Dementia Care through Hertfordshire Adult Care Services. To gain accreditation, the staff and the management of the home further developed many of the internal systems to ensure that care plans were specific and contained all the required information to support each individual service user. Staff are robustly recruited and training and supervision is in place. Various areas of the home have recently been redecorated and shared facilities such as bathrooms have signs in place. Service users and relatives gave positive feedback about the manager and staff and said they were very pleased that there is a new activities person in post to provide more activities. Service users said that the food was generally good and that there were ample portions of food and plenty of beverages served.Medication is well managed and appropriately stored; medication records were observed to be accurate. Other records pertaining to care and the running of the business were also found to be accurate and up to date.

What has improved since the last inspection?

Since the last inspection care plans have been reviewed to ensure they contain a full record of health, social and personal care needs including a nutritional assessment. The activities co-ordinator was in the process of completing the social history and current recreational preferences for all service users. A COSHH (Control of Substances Hazardous to Health) cupboard had been repaired for the safe storage of substances hazardous to health. The newly appointed activities co-ordinator was in the process of co-ordinating a structured activities programme including activities for people who have dementia care needs. An entertainer had been booked for November 2006. The complaints procedure had been amended and a copy of this posted in the hallway near the visitors signing in book. The activities room was accessible to service users following a requirement at the last inspection to render all communal shared facilities as accessible. Showerhead hoses had been replaced. Adequate staff supervision arrangements had been put in place. A risk assessment had been completed for managing risks to service users accessing kitchenettes on the units.

What the care home could do better:

The side entrance needs to be redecorated. External lighting to the side entrance of the building needs to be installed to render it safe for access as service users, visitors and staff use this entrance. The laundry room needs to have locks fitted to both doors to prevent access to hazardous substances. All areas of the home need to be safe; an ill-fitting fire door required immediate attention. The housing for the lift machinery must be kept locked at all times; an immediate requirement was made during the inspection. Toilet facilities need be well maintained, clean and fit for use. A toilet seat needed to be removed and replaced immediately and an immediate requirement was made. The laundry room needed cleaning and redecorating in the interest of safety and infection control. The clothing storeroom also needs cleaning. Requirements were made in respect of the laundry facilities. All areas of the home need to be kept clean and hygienic. Sharps must not be left accessible and must be disposed safely. A used razor had been left in a bathroom. Bar soap must not be left in bathrooms in the interest of infection control; an immediate requirement was made for their removal and safe disposal during the inspection. Attention needs to be given to staff changing facilities. Whilst it is noted that the hours for the maintenance person had been increased within the past year, these still do not appear to be sufficient and further consideration should be given to the increase of the maintenance hours provided within the home.. The provision of a computer for the manager`s office is recommended to assist various aspects of management.

CARE HOMES FOR OLDER PEOPLE Wilton House Nursing And Residential Home 73-77 London Road Shenley Hertfordshire WD7 9BW Lead Inspector Hazel Wynn Unannounced Inspection 30th October 2006 2:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.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 provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 858272 01923 850019 Wilton House Limited Linda Fuller 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.V317835.R02.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. 31st October 2005 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. Following a variation application, the home may now accommodate twenty six older service users for nursing care within the overall capacity of the home. Wilton House is a purpose built home in a village location. Resident accommodation is 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 CSCI inspection reports are available at the mangers office at Wilton House (a copy of the service users guide will be provided to prospective service users by the home) CSCI inspection reports are also available on the CSCI web site. The fee range is £510.00 to £750.00 depending on assessed level of need. Beds funded by Hertfordshire County Council are £400.00 to £550.00). Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection visit took place during the day and evening of 30th October 2006. One inspector carried out the inspection and met with several service users to gain their views and to observe care provision. The requirements made during the inspection of the 31st October 2005 had been met. A tour of the premises was undertaken and records relating to fire safety checks were inspected. During the inspection, feedback was given to the manager regarding both the positive and negative outcomes of this inspection and requirements made from issues arising after the registered manager had left work were fed back by telephone the following morning (31st October 2006). What the service does well: At the last inspection many of the homes internal management systems and paper work had been reviewed, and a date for some of these reviews are just becoming due. Policies and procedures had been recently reviewed just prior to the last inspection and the induction process and new paperwork was fully up and running. Adult Protection training has been provided to staff and plans are in place to include new and remaining staff on the next training places available. All staff receive in house abuse awareness training prior to attending the external course; abuse awareness training provides safeguards for service users. Wilton House is currently awarded accreditation for Dementia Care through Hertfordshire Adult Care Services. To gain accreditation, the staff and the management of the home further developed many of the internal systems to ensure that care plans were specific and contained all the required information to support each individual service user. Staff are robustly recruited and training and supervision is in place. Various areas of the home have recently been redecorated and shared facilities such as bathrooms have signs in place. Service users and relatives gave positive feedback about the manager and staff and said they were very pleased that there is a new activities person in post to provide more activities. Service users said that the food was generally good and that there were ample portions of food and plenty of beverages served. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 6 Medication is well managed and appropriately stored; medication records were observed to be accurate. Other records pertaining to care and the running of the business were also found to be accurate and up to date. What has improved since the last inspection? What they could do better: The side entrance needs to be redecorated. External lighting to the side entrance of the building needs to be installed to render it safe for access as service users, visitors and staff use this entrance. The laundry room needs to have locks fitted to both doors to prevent access to hazardous substances. All areas of the home need to be safe; an ill-fitting fire door required immediate attention. The housing for the lift machinery must be kept locked at all times; an immediate requirement was made during the inspection. Toilet facilities need be well maintained, clean and fit for use. A toilet seat needed to be removed and replaced immediately and an immediate requirement was made. The laundry room needed cleaning and redecorating in the interest of safety and infection control. The clothing storeroom also needs cleaning. Requirements were made in respect of the laundry facilities. All areas of the home need to be kept clean and hygienic. Sharps must not be left accessible and must be disposed safely. A used razor had been left in a bathroom. Bar soap must not be left in bathrooms in the interest of infection control; an immediate requirement was made for their removal and safe disposal during the inspection. Attention needs to be given to staff changing facilities. Whilst it is noted that the hours for the maintenance person had been increased within the past year, these still do not appear to be sufficient and further consideration should be given to the increase of the maintenance hours provided within the home.. The provision of a computer for the manager’s office is recommended to assist various aspects of management. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 7 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. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 5 Standard 6, does not apply to this home because it does not provide intermediate care services. Service user’s needs are assessed before the move into the home and are assured that their needs will be met. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An assessment is carried out prior to the offer or acceptance of placement and the original assessment was maintained on the four files seen during this inspection; the registered manager stated that an offer of placement would not be given to a prospective service user whose needs could not be met by the home. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 11. An individual plan of care for service user’s health, personal and social care needs is in place for each service user and the service users’ health care needs appear fully met. Medication is managed appropriately in accordance with the homes policies and procedures. Service users are satisfied that they are treated with respect and feel that there is no infringement to their privacy. The home supports service users and their families/friends well during the last phase of life and provides support in a sensitive manner to relatives and friends when their family member has died. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Samples, of four, service user’s care plans were seen during this inspection and these did contain the individual service users health, personal and social Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 11 care needs. The care plans have been expanded to include nutritional needs; meeting a requirement made at the last inspection. The inspector discussed with the registered manager that the progress notes need to be expanded in order to evidence exactly what care has been given in relation to meeting the needs as detailed in care plans (it is not sufficient to make an entry of ‘all care given’. The community nurse visited on the 11th October 2006 for the purpose of giving influenza protection to those service users who had consented to this vaccine. A new activities person has been employed by the home and had just commenced work. During the inspection the activities person was meeting with service users to obtain social histories and to review their current needs and wishes regarding their social care. Since the last inspection took place action has been taken to ensure that medication no longer required is struck from the record and properly disposed; staff have been made aware of the need for proper recording and disposal procedures to ensure clarity and transparency. There are arrangements and policies and procedures in place for the administration/self administration of Medication and a check on the system and records evidenced that this was being appropriately managed, stored and administered. A pharmacy provides an auditing system. Proper procedures were in place for the management of controlled medicines and the storage and recording of this were checked during this inspection and were in order. All staff who administer medication have received training and certificates were seen on file. A new medicationtraining course is awaited through New Barnfield via Hertfordshire Adult Care Services. There were no gaps on the Medication Administration Record. The inspector met with service users individually and also met with a small group of five service users; all service users spoken with provided good feedback stating the they felt that they were treated with respect and dignity and that their right to privacy was upheld. A requirement made at the last inspection and published in the report of 31st October 2005 regarding all service users needs, preferences and wishes in the event of death had been met in that care plans do now contain the relevant personal information regarding personal wishes. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 –15 Action has been taken to improve the lifestyle experienced in the home and improvements were apparent regarding the provision of social and leisure needs. Religious and cultural needs are provided for. Very satisfactory arrangements are in place for service users to maintain their family relationships and their contact with the local community. Service users are supported to stay in control of their own lives and choices. The home provides a wholesome and appealing diet; the dining arrangements are comfortable and mealtimes are well spaced; arrangements can be made for service users to eat at a later time if needed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new activities person has been employed by the home and had just commenced work. During the inspection the activities person was meeting with service users to obtain social histories and to review their current needs and wishes regarding their social care. It had taken some time to recruit a Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 13 person for the post; the inspector met with the activities person who appeared to be keen to properly organise and structure a programme to benefit the service users. Service users spoken with provided the inspector with positive feedback regarding their care and experience of life in the home and said they were looking forward to an increase in activities being provided by the new activities co-ordinator. A ‘sing-along’ entertainer had been booked for the 23rd November 2006 and the service users said they were looking forward to this. The inspector met three relatives who said they had no complaints, they felt their relative was well looked after and that staff were “nice”. A letter from a relative was seen by the inspector, and a quote from this read “during the last few days everyone at the home supported me with such tenderness and such care”. “Mum slipped away with dignity, surrounded by family and her carers at Wilton House”. As part of quality assurance, a questionnaire is given to service users to obtain their feedback and provide them with the opportunity to have their say in how the home is run. A service user told the inspector that he was planning a birthday celebration and would probably book a taxi to take his wife out for a meal; this was an example of a service user exercising choice and control over his life. The menu seen during this inspection appeared to be providing a nourishing and varied diet. The evening meal looked appetising and service users who needed assistance with eating their meal were observed to be supported in an appropriate and sensitive manner. Service users gave positive feedback about the food served and choice of menu and staff said a meal would be kept for service users who were not able to take their meal at a given time. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18: The home has comprehensive complaints procedure in place at the home with guidance on making a complaint published in the service users guide. Measures are in place for the prevention of abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Hertfordshire Adult Protection Procedure and guidance was available in the office and the staff training records showed that adult abuse awareness training was being provided to staff. The complaints procedure had been amended as required at the last inspection to provide updated advice on the stages of making a complaint. The registered manager stated that there had been one complaint received in the year since the last inspection and this had been responded to within 48 hours in accordance with the homes policies and procedures. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 26: Action is needed to ensure that service users live in a safe and wellmaintained environment including shared indoor facilities. There is access to a small garden area but the side entrance needs to be lit. Action is needed to ensure that the lavatory and washing facilities are well maintained and kept clean and hygienic. There were some areas of the home that needed decorating and cleaning although lounge areas, hallways and service users room were clean and pleasant. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activities room had been redecorated and there was open access for service users; the requirement made at the last inspection was met. The entrance to the side of the building, which is used by visitors, service users and staff needs redecoration; lighting is also needed to the outside of Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 16 this entrance which was very dark from approximately 6pm. A requirement is made. During the last inspection of 31st October 2005, a requirement was made that communal space in the home, must be made available to service users; this pertained to the locked activities room but during this inspection, this was observed to be accessible and the requirement had been met. Toilets on the upper and lower floor were observed to be lacking good hygiene standards and a cleaning cloth had been left on a mobility rail; this was discussed with the manager who said she would take action. A toilet had a very blistered wooden seat (which posed a risk of cross infection); this was also discussed with the registered manager as an immediate requirement. Used bars of soap and a used wet shave razor were left in a bathroom; the inspector requested staff to dispose these safely and immediately; an immediate requirement was made. A requirement was made at the October 2005 inspection for showerheads to be replaced; it was observed during this inspection that the requirement had been met in all accessible bathrooms. One bathroom was locked and the registered manager informed the inspector that this was out of use pending refurbishment and conversion to provide accessible showering facilities. There was very heavy dust on the laundry windowsill where service users clean clothing is stored awaiting return and the laundry room had dust debris between and behind the machines. Requirements were made in the interest of improving hygiene standards, ensuring safety where heavy electrical equipment is in use, and to ensure that infection control is in place. The laundry room was accessible through a door that is not able to be locked; this door has a notice on that states for access by personnel only but this is not sufficient; in the interest of the control of substances hazardous to health the laundry room must be kept locked when not in use and a requirement was brought forward; a previous requirement for a lockable COSHH cupboard for none laundry items had been met and other COSHH items were observed to be appropriately stored. The laundry room has holes in the décor and requires repair and redecorating. The door to the lift machinery (lift maintenance door) was unlocked and an immediate requirement was issued. The fire door leading to the stairs on the ground floor at the main entrance does not close properly leaving a large gap and on opening it becomes wedged open by its weight on the floor; an immediate requirement was issued. The linen cupboards were well stocked on the day of inspection. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 17 The staff room walls were very dirty and in need of cleaning and decorating; clothing was trailing on to the floor from chairs and proper facilities must be provided for staff. Other areas of the home did present as fresh, clean and pleasant. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27- 30 There are adequate trained staff to meet the assessed needs of the service users and service users were observed to be consistently in safe hands. The homes recruitment polices, procedures and practices provide support and protection to service users. The staff induction programme is completed to ensure staff competence. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were adequate staff on duty during the day and night shift of this inspection and the current rota reflected consistent staffing levels over one month. The night shift has one staff nurse, one senior carer and 3 care assistants. All of the night staff were well experienced and provided a good skill mix. There were adequate staff on duty and very good progress was being made with NVQ (National Vocational Qualifications in care); two staff have just completed NVQ level II, three night staff were making progress at this stage and 5 day staff were enrolling for NVQ level II. One senior staff member was enrolling for level NVQ III and one senior was commencing an assessors course to enable the home to assess their NVQ candidates. Two senior staff at the home have already achieved level III certificates and this equates to the home achieving a position of having over 50 staff with or undertaking an NVQ. Seven staff hold a Nursing qualification and update their training requirements in line with the requirements of the professional register. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 19 Staff attended a 3-day dementia-training course and gained accreditation in July 2006. The registered manager explained that plans are in place to provide this course to other staff. Staff confirmed that they receive formal supervision every two months and find this supportive. Staff interviewed by the inspector stated that the staff team are very supportive and registered manager has an open door policy and is also very supportive. Staff were observed to be getting on well together and providing a good atmosphere for service users. A sample of four files staff files were checked as part of the inspection visit and These provided evidence that robust recruitment practices are in place and provide safeguards for the service users. An application form with employment history is maintained on file, gaps in employment are explored, a minimum of two references had been obtained, criminal records bureau checks and the protection of vulnerable adults register is checked. Staff changing facilities are discussed under environment in an earlier section of this report. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 A registered and experienced manager runs the home. Action is needed regarding running the home in the best interests of the service users. There are safeguards in place for the financial interests of service users and staff are appropriately supervised. The progress notes (the record pertaining to the service users care plan) should be expanded to explain more fully the care provided. The concerns raised regarding environmental hazards, mentioned earlier in this report, must receive urgent attention in order to ensure that the service users and staff’s health, safety and welfare are safeguarded. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 21 The manager is registered by the CSCI, which means that robust checks were carried out as part of the process for her registration as manager at Wilton House. Linda Fuller is a first level nurse of long standing experience, who is also N.V.Q. trained at level 4 and undertakes periodic training in line with PREP, as do the other qualified nurses at the home. The home has policies and procedures in place to ensure that the health, safety and welfare of service users and staff are promoted and protected; however these had not been fully adhered to in relation to issues arising concerning the environment (see requirements and also the environment section of this report). These records are accessible to all staff. All accidents and injuries are recorded in the accident book and RIDDOR forms are completed where applicable. Fire drills have been held. Fire safety equipment has been serviced and a log of routine checks carried out in the home was seen during this inspection. Regular checks on hot water temperatures and moving and handling equipment were observed to be recorded. All chemical items that pose a risk to service users were locked away with the exception of the laundry room which was accessible (see environment section where a requirement was made). A fire door required attention. The lift machinery was accessible and an immediate requirement was made. Better facilities were required for the staff changing room and the room required cleaning and redecorating. Some areas of the home required redecoration and attention (especially in relation to toilet facilities (see environment section where requirements were made). External lighting was required for a side entrance that is used by service users, visitors and staff. An action plan is required in respect of requirements arising from this inspection. The home provides safe procedures for holding up to £50 for each service user, requiring support, for the payment of chiropody and hairdressing, toiletries and any personal requisites. The money is held in the office safe and was observed to be transparently managed, with receipts maintained for each transaction entered. Service users nominate a member of the family or a representative not connected with the home to act on their behalf in the management of their finances, where they require this support. Progress notes pertaining to the care given should be more explanatory and provide better details for reliable evaluation of the care plan and a recommendation is made. The provision of a computer in the manager’s office would prove invaluable for various aspects of management; this was discussed with the manager is strongly recommended. As recommended in the inspection of 31st October 2006 (when a recommendation was brought forward) it remains recommended that consideration needs to be given to increase the home’s maintenance hours; Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 22 especially in light of the fact that there are so many environmental issues arising from this inspection with requirements being made. A risk assessment had been completed with regards to kitchenette areas in November 2005 following a requirement made during the October 31st inspection and the registered manager stated that this would be reviewed in November 2006. A call point system is available throughout the home and call bells were observed to be suitably located for all service users. Evidence was seen during this inspection that regular meetings with staff, quarterly meetings with service users, relatives and advocates take place. The manager stated that she operates an open door policy and meets with relatives frequently; staff also stated that Linda is very supportive and approachable. Members of staff and visitors spoken to during this inspection stated that they feel supported by the manager and staff. The manager explained that there are staff hand-over meetings at the start of each shift to discuss service users care and progress; a staff handover had commenced as this inspection was drawing to a close at the commencement of the day shift to night shift handover. Staff interviewed during this inspection verified that they receive regular one to one supervision and support. The supervision arrangement record was seen during this inspection. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 1 X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 3 2 1 Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 24 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. 2. Standard OP19 OP19 Regulation 23 23 Requirement The side entrance must be redecorated. External lighting to the side entrance of the building must be installed to render it safe for access. The laundry room must have locks fitted to both doors to prevent access to hazardous substances. All areas of the home must be safe; the ill-fitting fire door must be attended to immediately. The housing for the lift machinery must be kept locked at all times. An immediate requirement was made during the inspection. Toilet facilities must be fit for use. A toilet seat must be removed and replaced immediately and toilet facilities must be properly cleaned. The registered manager stated that this would be addressed with the cleaner the day following this inspection. The laundry room requires cleaning* and redecorating in DS0000019620.V317835.R02.S.doc Timescale for action 30/01/07 31/12/06 3. OP19 & OP38 13 30/12/06 4. 5. OP19 OP20 & OP38 OP19 & OP38 24 13 & 39 31/10/06 30/10/06 6. OP21 23 31/10/06 7. OP26 12 (1)(a) 16(1)(2) 30/01/07 Wilton House Nursing And Residential Home Version 5.2 Page 25 (j)(k) 8. 9. OP26 OP26 & OP38 23 2(d) 13.4 10 OP33 2(d).4(a). 23(3)(a) (i) 11. OP38 3(i) the interest of safety and infection control. The clothing storeroom also needs cleaning*. *The timeframe for cleaning is by 31.12.06* with a longer timeframe for redecoration. All areas of the home must be kept clean and hygienic. Sharps must not be left accessible and must be disposed safely. A used razor had been left in a bathroom. Bar soap must not be left in bathrooms in the interest of infection control. An immediate requirement was made for their removal and safe disposal during the inspection. The registered manager must ensure that the home is run in the best interests of the service users and that immediate requirements resulting from this inspection are immediately actioned and that other requirements are met within the given timescales. Staff changing facilities require cleaning, redecoration and adequate storage for staff clothing must be provided. 31/10/06 30/10/06 30/10/06 30/01/07 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 OP19 Good Practice Recommendations Consideration should be given to the further increasing of the maintenance hours provided within the home. It is noted that a previous recommendation for an increase in hours did result in an increase being made, however this DS0000019620.V317835.R02.S.doc Version 5.2 Page 26 Wilton House Nursing And Residential Home 2. 3. OP37 OP38 still does not appear to be sufficient to meet the needs of the home.. Progress notes pertaining to the care given should be more explanatory and provide better details for reliable evaluation of the care plan. The provision of a computer for the manager’s office is recommended to assist various aspects of management. Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Hertfordshire Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Wilton House Nursing And Residential Home DS0000019620.V317835.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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