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Inspection on 09/05/07 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 9th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The activities provided at the home have been based around the choices of those living there. The recently appointed activity co-ordinator has spent time getting to know their needs. Some of the care plans provide staff with the detail on the action required to meet individual needs. Discussions with some of the people who use the service and some of their visitors on the day felt that they were reasonably well looked after.

What has improved since the last inspection?

There has been little improvement since the last inspection. Although some of the requirements made had been met further requirements were made at this inspection showing that the improvements that had been shown at the last random inspection had not been maintained by the service.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Wilton House Nursing And Residential Home 73-77 London Road Shenley Hertfordshire WD7 9BW Lead Inspector Alison Butler Unannounced Inspection 9th May 2007 10:00 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.V340669.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wilton House Nursing And Residential Home DS0000019620.V340669.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 provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01923 858272 01923 856760 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.V340669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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. 30th January 2007 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. The fee range is £510.00 to £750.00 depending on assessed level of need. For up to date information contact should be made with the provider. 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. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection. Time was spent talking with the people who use the service, the manager, the two new directors of the company and staff on duty. Care records and other related records were also examined. This inspection report has been written with information known to the Commission, plus visits to the service in November 2006 & January 2007. Where information has remained the same this has been brought forward into this inspection report. A number of immediate requirements were made at the inspection and the home must write and confirm the action taken to address these. What the service does well: What has improved since the last inspection? What they could do better: Initial assessments need to be fully completed, as this will ensure then home is able to meet the needs appropriately of new residents. Staff must be appropriately trained to meet the needs of the residents admitted into the home. Any review of needs should provide an audit trial on how needs are being met by providing more detail of what is being provided instead of the current practice of stating ‘on-going’. Risk assessments must be consistent and detailed to show choice is being offered and reduction of risk where possible is demonstrated. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 6 Staff must treat all individuals with respect and dignity at all times (see sections on health, personal care, daily life and social activities, environment, staffing and management for further details). To ensure the safety of those in the home medication procedures must be adhered to and medication should not be left unattended at any time. There must be adequate staff on duty at all times – deployed to meet the needs of the people who use the service at all times (see health, personal care and staffing sections for further information). Residents have not got regular access to transport, which would enhance the lives of the individuals living at the home to enable them to access the community more spontaneously and more regularly. The manager does not have access to a computer with Internet access. Internet access now provides a valuable source of information from professional bodies – including CSCI and aids management tasks. The manager must be able to demonstrate that complaints are acted upon and the policy is followed. The environment is in a poor state of decoration and maintenance. A number of risk were identified during the inspection in regard to infection and hygiene control measures and these must be addressed to ensure that all people who live in the home are provided with a safe, well-maintained and homely environment. Staff should all take responsibility for ensuring that health and safety is managed proactively at all times for the safety of all who live, work and visit the service. 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.V340669.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard (6 is not applicable to Wilton House). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs assessed prior to admission but the information recorded is limited and does not demonstrate that their needs can be met. EVIDENCE: From the care plans examined the in-house assessment are brief and do not give full details of the person needs. However, there was also an assessment completed by social workers giving a little more detail. The manager confirmed that they would not offer a place to someone whose needs they were unable to meet. However, people are not provided with written confirmation that their needs can be met at Wilton House. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 9 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, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs set out within an individual plan but the related records do not always demonstrate these care needs are being met. Medication procedures have improved but there are still some issues that need to be addressed to ensure that people are fully protected at all times. Some practices seen did not uphold people’s dignity and could leave people at serious risk. EVIDENCE: Four care plans were examined during this inspection, these showed that whilst some of the plans on managing individual’s needs such as continence, personal care were detailed they were not consistent. The nutritional care plan was a standardised template in which just the name of the individual and a date had to be completed. One person’s care plan noted they regularly go on hunger strike but the records did not include details of how the staff need to manage this, or when/how often it occurs. Records included instructions that a Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 10 named service user was to be encouraged to drink 2 litres a day. But a fluid intake chart had not been maintained to ensure that this assessed need had been met and monitored. Although reviews of care are recorded monthly these do not provide an audit trail of the care as every month as these just state “on going” and no further detail is recorded. Information is contradictory and could lead to choices of individuals not being met. One persons risk assessment refers to them using a shower, although the manager stated there is no shower facility available and the information recorded about the individuals choice states they prefer a bath. Important information that affects the quality of peoples lives was not easily available, it was noted by the inspectors that one of the people spoken to wore a hearing aid but on checking their care plan it was difficult to identify what ear it was to be worn in. Risk assessments are completed although not all the questions had been answered for example it asks have they had a history of falling out of bed? A positive response had been recorded but under the frequency there was no detail. A high number of the residents seen during the inspection were seen not to be wearing socks or stockings/tights. The manager reported that this was the choice of the individuals concerned but not one care plan examined had recorded this information. Another person had track suit bottoms on that were too short and the inspectors questioned if they were appropriate for the individual as they had wording across the bottom. Another person had a badly stained and damp top on which staff did not appear to have any concerns about, whilst assisting them to the lunch table. A pharmacy inspection was carried out in November 2006 and the overall judgement was adequate. Handwritten changes or additions did not always state by whom and when they occurred. Where an eye is being treated details of which is being treated must be recorded on the record sheet to avoid mistakes, where a dose is prescribed as one or two the actual number administered must be recorded this allows for a check and an accurate reconciliation of medications to take place at any time. A person who lives at the home was receiving a double dosage of medication via an inhaler, as staff were administering two puffs twice a day instead once a day as prescribed. Disposed of medication must be recorded. At this inspection a spot check was carried out and all of the above issues had been dealt with. However, one person had not received their medication from the supplying pharmacy and therefore had not been given their night time medication. The pharmacy had provided details that this medication was outstanding but no further information was available within the home that contact had been made to chase it up to ensure people do not go without there prescribed medication. On arrival at the home the inspectors walked into an open room with crates containing old blister packs, which were waiting to be returned to the pharmacy. However, a full blister pack of medication was found amongst them. This could potentially put the people who live at the home at serious risk Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 11 should they have been discovered or an individual may have gone without them if they had been returned. An immediate requirement was made. People spoken with during the inspection felt they were looked after well by staff. Visitors, on the whole, were happy with the care that the staff provide. However, after lunch the inspectors stayed to observe a group of 13 frail people in a lounge who were not checked or supported by staff for over ten minutes, another person was left unattended for over fifteen minutes in a toilet. The two staff that were covering the unit whilst the others were on their lunch break were assisting others who require two people for moving and handling and therefore leaving the rest at risk. An immediate requirement was made. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.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, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service have a variety of activities offered to them. Mealtimes are not the pleasurable experience that they could be and individual choice is not offered. EVIDENCE: The activity co-ordinator has made some great progress and provides activities for the people who live at Wilton House; she is knowledgeable about the people and their history. There is a reliance on the goodwill of the part-time activity co-ordinator as some of the activities she provides are outside her allocated hours. She has the people who live at home at the heart of what she offers to them. She has met with the activities co-ordinator from the sister home next-door (Wilton Lodge) and is hoping that by sharing ideas the residents will benefit. She is working at involving the local community and families to provide some volunteers to get them out and about. At the moment they have access to a minibus from the local church who also provides a driver, unfortunately they can only take one wheelchair out at a time and have to book in advance. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 13 A regular outing used to be made to the pub across the road but this has recently closed for refurbishment and it understood that it is going to reopen as a restaurant rather than a pub. Relatives were spoken to during the inspection and were reasonably happy with the care that is provided, but stated that the environment was in need of updating (see environment section for further details). The inspectors observed lunch being served and noted that the drinks had already been poured so people were not offered a choice. There were also insufficient condiments on the tables – some tables had salt only whilst others had pepper and some none. Staff served the food from the hot trolley without discussing with people what they might like, what the meal was, what vegetables were on offer or what size portion they would like. A member of staff was assisting one person with eating and stood at the side and did not once speak to them, even when placing the food in their mouth. The meal of the day smelt and looked reasonably appetising. A high number of meals on one of the floors had to be puréed and although the chef had provided each item individually staff when serving did not present nicely as the cauliflower and green vegetable were placed on top of each other instead of separately. One of the hot trolleys was out of action as it had broken down, they made a decision to stagger the lunch times to ensure all received a hot meal as the trolley needed to be used for both floors. This was managed well and did not appear to have an affect of those living at the home. It was reported that by the end of the inspection a new trolley had been ordered and would be at the home shortly. Some staff have some problems communicating as English is not their first language and were unable to answer some of the inspectors questions when first asked. Accepting that an inspection may make some people nervous questions had to be asked in several different ways, several times, until an answer could be given. This could be daunting for those living at the home if the care workers are unable to answer their queries or provide care that is being asked of them. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place. Residents are not always protected from abuse. EVIDENCE: The Hertfordshire County Council Adult Protection procedure is available on the wall and training is offered. Members of staff whose first language is not English had difficulty in answering the inspector’s questions about adult protection. This is a concern as it was not possible to verify that they would know what to do if an allegation of abuse was disclosed to them or if they observed an abusive situation. Other staff were aware of the adult protection and knew the procedure to follow. The inspectors on arrival gained free access to the building even after ringing the bell. It was reported that a previous visitor had not made sure the door was closed although there are signs asking you to ensure the door is closed behind you. The home must be secure at all times. An immediate requirement was made. The complaints file was examined which showed that a complaint had been made but no evidence of the investigation or the outcome was available to the inspectors so were unable to verify if it had been dealt with inline with the company policy and resulting in a satisfactory outcome. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.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, 23, 24, 25 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people who live at Wilton House do not live in a safe and well-maintained environment. Their own rooms are not safe, pleasant or comfortable to promote their dignity and independence. EVIDENCE: The requirements that were made at the inspection in October and the follow up visit in January showed that these requirements had been met. These were the side entrance had been decorated, external lighting had been installed to provide safe access, the laundry room had been fitted with locks to prevent access to hazardous substances, an ill fitting fire door had been attended to, the housing for the lift machinery had been locked and a notice put in place to keep it locked at all times, toilets had been made fit for purpose with the replacement of cracked and unhygienic seats being replaced, the laundry room had been cleaned and redecorated in the interests of safety and infection control, no sharps had been left in bathrooms, no bars of soap had been left in Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 16 the bathrooms, staff changing facilities had been cleaned and additional storage facilities provided. During this inspection a tour was conducted and it was extremely disappointing to see there were many areas that need to improve, to bring the environment up to a reasonable standard to provide a safe, well-maintained and homely environment for those who live there. The activities room was extremely cluttered and untidy, clothing of recently deceased people were in large blacks sacks waiting disposal although they had died over two weeks ago. There was also seating and furniture (drawer units) belonging to another deceased person within the room limiting the space available. The access to the small garden area was locked and staff reported that it can only be accessed if the key is asked for or if staff open it as the garden area was not secure. The inspectors asked some of the people who live at the home if they would access the garden if they could and they said it would be nice. Individual bedrooms that were inspected showed that the bedroom furniture was in a poor state of repair with shelves missing, bedside tables had drawers missing and were damaged, the surfaces were badly chipped and had patches of bare wood, walls had been repainted but these were patchy. The paintwork throughout the home is in need of being re-painted as it looking extremely worn and chipped. This does not provide for a safe, homely environment. A number of bars of soap were seen during this inspection in communal bathrooms and a used razor had also been left. Both of these issues had been reported at previous inspections. Windowsills were seen to be dusty and dirty especially in the lounges. Many of the extractors in bathrooms and en-suites were not working and needed a good clean. Seals around sinks were in need of replacing, waste bins were seen to be rusty or did not have lids, soap dispensers were of the refillable kind which do not promote good infection control/hygiene protection. Bathrooms were being used for storage such as footplates, continence pads in open baskets, slings for hoists. This does not provide a safe and pleasant environment. Some of the en-suite floors were in need of a good clean and there splash marks or badly stained surfaces. Some bathroom accessories were missing but brackets had been left behind. A double glazed window had become misty as the seal had obviously broken, so did not provide a clear view through the window. Some lounge seating and the tables are in need of replacing, as they are looking tired and worn. On arrival at the home the waste bins were overflowing in the bin area and wild animals/birds had managed to open the bags and food waste had spilled all over the floor. Two open clinical waste bins had been left in the car park Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 17 which could pose a health and hygiene risk. It was reported by the management that this had occurred because refuse collection was running late due to the bank holiday. An immediate requirement was made. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.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, 28 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The needs of the people are not met at all times and are placed at risk due to the inefficient deployment of staff. EVIDENCE: The inspection indicated that whilst some staff were knowledgeable about the needs of those living at the home, some had difficulty communicating with them as English was not their first language. Whilst there were enough staff on duty for most of the day, after lunch when staff take a break, it left 2 staff on duty to care for approximately 24 people on one floor, 6 of those were in reclining chairs in the small lounge and 13 frail people were in the main lounge. The inspectors stood near to the lounge for over 10 minutes and no member of staff came to check or support those people and one person had been left in the toilet for over fifteen minutes. When the inspectors found the staff on duty they were assisting with the toilet needs of individuals who required 2 people to manage the moving and handling. An immediate requirement was made to ensure that adequate numbers of staff are on duty at all times to meet the needs of individuals. The pre-inspection information stated that they have 11 carers with an NVQ level 2 or above equating to 50 holding the qualification. There are 5 first registered nurses. Training held during the past 12 months has included fire training, moving and handling, COSSH, protection of adults, dementia Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 19 awareness, and food hygiene. Staff training details indicated training (including induction) is conducted in the main by video training. The registered manager stated that training in dignity and respect was to be provided in the near future. As staff files were checked at the last inspection and found to be in order they were not examined during this inspection. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.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 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not run in the best interests of those who live at Wilton House. Health and Safety procedures are not followed to protect everyone who lives, visits or works at the home. EVIDENCE: The manager is a first level nurse, who has trained at level 4 in the NVQ award and undertakes periodic training and PREP. The home has been admitting people who have a diagnosis of Mental Disorder. However, not all service users with a diagnosis of mental disorder e.g. depression have a care plan to address any specific mental health needs. Additionally at the time of this inspection the registered manager and Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 21 Responsible Individual confirmed that no staff had received any training specific to caring for people with mental health needs. Health and safety procedures are not fully adhered to. As previously discussed, on arrival to the home, the inspectors gained free access through the main door, waste bins in the care park were overflowing and bags had been broken causing waste food to be scattered over the floor, two open clinical waste bins had been left by the side of the large clinical waste bins in the car park, a cleaning trolley containing COSSH materials had been left unattended in a corridor, two tins of air freshener were left on a windowsill in a lounge, a full blister pack of medication was discovered in an unlocked room, the fire door at the bottom of the stair well was not closing effectively (although this had been rectified by the end of the inspection), a used razor and bars of soap were found in bathrooms, the deployment of staff was not adequate to meet the needs of the people who live at the home, this puts those that use the service at risk in regards to their health, safety and welfare. These areas are detailed in various sections throughout this report. The environment of the home is in a poor state (see environment section for more details). This does not provide a welcoming and homely environment for those living there. Previous inspections have shown that there are safe financial procedures in place for ensuring the people who use the service are safeguarded in regards to monies. Progress notes do not contain enough detail to evidence that peoples care needs are being met. Computer Internet access is not available within the service which would benefit the staff and the people who use the service. Much of the information from professional agencies – including CSCI is now cascaded via the Internet. The activity person has to do research on activities in her own time as Internet access has proved a valuable resource to support her in providing for the needs of the service users. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 2 X 1 1 1 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1)(a)(d) Requirement The assessment process must demonstrate that individuals needs can be met they must be confirmed in writing to the individual. Risk assessments must be consistent, fully completed and be meaningful to the individual. All who live at the home must have their dignity and respect promoted and protected at all times. Prescribed medication must not be allowed to run out. Medication must be kept safe at all times. An immediate requirement was made. All complaints must be fully investigated and recorded in line with the policy. Access to the building must be kept locked at all times. An immediate requirement was made. The ill-fitting fire door must be attended to immediately. An immediate requirement was made Timescale for action 30/06/07 2 3 OP7 OP8 OP7 OP8 OP10 OP15 OP9 OP9 OP16 OP18 OP19 13(4)(b) & (c) 12(4)(a) 30/06/07 15/06/07 4 5 6 7 8 13(2) 13(2) 22 13(4)(a) 24 30/06/07 09/05/07 30/06/07 09/05/07 09/05/07 9 OP19 OP23 OP24 23(2)(b)( d)(e)(h) & (p) The decoration of the home must 31/10/07 be brought up to an acceptable standard DS0000019620.V340669.R01.S.doc Version 5.2 Page 24 Wilton House Nursing And Residential Home 10 11 OP25 OP20 OP21 23(2)(o) 23(2)(m) 12 OP26 16(2)(k) & (j) immediate requirement was made Access to the external garden must be available at all times. Appropriate storage facilities must be provided so that bathrooms are not used inappropriately as storage rooms. Appropriate infection control measures must be in place and followed at all times. (e.g. liquid soap, clinical waste) . An All areas of the home must be kept clean and hygienic. COSHH products and sharps must not be left accessible (e.g. razor blade and cleaning products) An immediate requirement was made 30/06/07 30/06/07 09/05/07 13 14 OP26 OP26 23(2)(d) 13(4) 09/05/07 09/05/07 15 16 17 OP27 OP28 OP30 OP7 OP10 OP33 18 (1)(a) 7 12(1)(b) 18(1)(a) (c) (i) 10(1)(3) 12(1)(a)( 2)(3) (4)(a) immediate requirement was made Appropriate numbers of staff must be on duty at all times. An Staff must receive training in dignity and respect. 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. 09/05/07 30/06/07 09/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 25 1 2. OP12 OP13 OP7 OP8 OP38 OP38 Access to transport should be increased to enhance the frequency of community outings. 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 and the use by the people who live at the home is recommended to assist various aspects of management and to provide a resource of useful information via the internet. 3. Wilton House Nursing And Residential Home DS0000019620.V340669.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Team 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.V340669.R01.S.doc Version 5.2 Page 27 - 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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