Inspection on 18/04/07 for Winchester House

This inspection was carried out on 18th April 2007.

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

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

Other inspections for this house

Winchester House 09/09/08

Winchester House 22/08/06

Winchester House 07/02/06

Winchester House 28/09/05

Winchester House 10/03/05

Winchester House 12/07/04

Similar services:

The Shelley

Thorndene

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Winchester House 180 Wouldham Road Rochester Kent ME1 3TR Lead Inspector Marion Weller Key Unannounced Inspection 18th April 2007 09:30 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 Winchester House DS0000026204.V335406.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. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winchester House Address 180 Wouldham Road Rochester Kent ME1 3TR 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) 01634 685001 01634 661030 winchester@barchester.com www.barchester.com/oulton Barchester Healthcare Home’s Limited Susan Watson Care Home 123 Category(ies) of Dementia (65), Old age, not falling within any registration, with number other category (38), Physical disability (15) of places Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service may from time to time admit service users under the age of sixty five (65) 22nd August 2006 Date of last inspection Brief Description of the Service: Winchester House is a care home for older people with nursing needs and includes a Dementia Care Unit. The home also provides services to those under the age of 65 who have a Physical Disability. Accommodation is provided on two floors with access by shaft lift to the first floor, many of the rooms have en-suite facilities. All areas are accessible to both residents and visitors. The home is situated in a rural area of Wouldham some distance from local shops and approximately 2 miles from the City of Rochester. The home provides some transport and a local taxis are available. There is ample car parking around the home. Current fees for services users over 65 range from £950 to £1010 per week. Fees for service users under 65 range from £1250 to £3000 per week, according to identified assessed need. More information can be obtained from the manager. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector between 9:30 am and 4:45 pm. During that time the inspector spoke with some residents, relatives, the home’s deputy manager and some of the staff on duty. The home’s new manager was on leave on the day of the site visit and therefore the inspector spent some time speaking with her the following day. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Residents and relatives indicated they were very satisfied with the standard of care the home provided. Statements made during the visit included: “This is the Rolls Royce of care home’s!” “Very satisfied and happy with the care here” “Staff are very kind, I can depend on them” And “Very happy with the care provided, some concerns about the home’s laundry service however” The Deputy Manager and staff gave their full co-operation throughout the inspectors visit. What the service does well: Winchester House is welcoming and has a relaxed and pleasant atmosphere. Information about the home and the service it offers people is easily accessible. The home provides a modern and comfortable environment. Rooms are decorated to a high standard and meet with the minimum requirements for size and furniture required by regulation. Communal areas are comfortable, well decorated and provide leisure and therapeutic facilities for residents use. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 6 The people who live in the home confirmed that food provided is of a high standard and a choice of meal is always available to them. Dining areas are very pleasant and laid up with fresh linen and flowers. Menus are on display for residents and visitors to read. Residents’ visitors are made welcome and can be accommodated in the home if an individual’s health is of concern. The home is sensitive about issues surrounding illness and death. What has improved since the last inspection? The home has recently been through a difficult period in regard to criticism concerning poor practice and quality of care issues. During this time the manager and staff gained considerable insight into particular areas of weakness and formulated robust plans for improvement. There was clear evidence on this unannounced inspection that planned improvements have now been consolidated to the benefit of the resident group. Following the home’s pre admission assessment the manager now confirms in writing to the prospective resident that having regard to the assessment the home is suitable to meet their identified needs. Residents care plans have greatly improved. They are now much more detailed and comprehensive. They accurately inform staff how to care for the individual. They are regularly reviewed and involve the resident or their representative in their formulation. Where indicated additional observation and monitoring tools, which benefit the health and welfare of the individual are used. Daily records are now completed to a good standard and evidence that staff follow the demands of residents care plans. They also provide sufficient information on which to base the monthly review of care provided. Communal bathrooms are free of the home’s stored items of equipment and provide full access to people who live in the home. The home continues to effectively work with overseas staff to overcome language and cultural barriers to ensure that people who live in the home have their choices; needs and preferences in relation to daily living understood and complied with. The manager has fulfilled her stated intention to eliminate the use of agency staff. This provides for greater continuity of care to the people who live in the home and ensures that they know and trust the staff that care and support them. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 7 Residents benefit from a delivery of care that is closely monitored by the Manager and her deputy. Senior staff responsible for a specific service unit in the home are held accountable for the quality of the care provided. Sufficient staff are now employed on a permanent basis to ensure that the staff compliment is appropriate to meet the needs of the people who live in the home and they receive regular formal supervision and identification of their training needs. Access to staff training has significantly improved and is now at a level where residents can be assured that suitably qualified and competent people are caring for them. The home has regained the ‘Investors in People Award’ and assessors made very positive comments following the process of assessment. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 8 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. Winchester House DS0000026204.V335406.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 Winchester House DS0000026204.V335406.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. JUDGEMENT – we looked at outcomes for the following standard(s): 123456 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have all the information about the home they need to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned before they move into the home which ensures individuals are appropriately placed and the home confirms this fact in writing to them. Residents or their representatives are given a contract that clearly tells them about the service they will receive. EVIDENCE: The home has a new manager who is now registered with the Commission. In relation to this and the recent reorganisation of the staffing structure, the statement of purpose, service user guide and resident welcome pack has been Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 11 revised to inform potential and existing residents. The documents are accurately descriptive of the home’s aims, objectives and philosophy of care and include explanations of the services, facilities and the conditions found at Winchester House. The content of information documents fully met the requirements of regulation. Copies were provided to each resident or their representative and were accessible in bedrooms and in reception. The manager visits all prospective residents prior to admission to make a decision as to whether the home can meet the individual’s needs. Assessments inspected were seen to contain good detail and included personal preferences. To meet the demands of regulation the home now confirms in writing to the resident that with regard to the assessment made, the home is suitable for the purpose of meeting their identified needs in respect of their health and welfare. Residents or their representatives are encouraged to visit the home before deciding to move in. Each resident or their representative is provided with a contract or a statement of terms and conditions between the home and themselves. Documents inspected include the fees charged and statements regarding the responsibilities of the organisation and the rights of residents. Access to staff training has significantly improved and is now at a level where residents can be assured that suitably qualified and competent people will be caring for them upon their admission. The home does not provide intermediate care. Winchester House DS0000026204.V335406.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has worked hard to change the previous care planning system and develop an improved format that provides good quality individualised care plans, which clearly show peoples health; personal and social care needs and which benefit from regular review and the use of additional monitoring tools. People who live in the home benefit from a delivery of care that is closely monitored by senior staff, which makes sure their health care needs are fully met and care is offered in a timely manner. Residents are largely protected by the home’s policies and procedures regarding medication. They can be confident that where shortfalls exist the home will review its arrangements and facilities in light of good practice advice to secure their safety and protection. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 13 EVIDENCE: Each resident has a care plan. Three were inspected in detail. These were found to be comprehensive in their approach and contained consistent detailed information based on sound assessment. Care plans were signed by the resident or their representative to show their involvement with the formulation of the plan and their agreement to it. Care plans were seen to have been regularly reviewed and changes made to the main plan where necessary. The home’s revised care plan format includes details of residents’ social care needs and their choices and preferences in daily life. A lot of work has been done in changing and developing the care planning system since the last inspection; the effort has paid dividends for the people who live there. Residents daily records were being maintained appropriately and reflected care plan demands. Care plans also included residents’ wishes for end of life care and arrangements to be made after death where that information was known to the home. Death and dying in the home was found to be handled with care, sensitivity and respect. Accommodation can be provided for relatives and friends during times of illness and the death of residents. Risk assessments were in place for a variety of aspects of care. Attention was paid to the prevention of falls, maintaining skin integrity and the moving and handling needs of residents, amongst others. Discussions with the deputy manager and nursing staff clearly indicated that residents’ health needs are being closely monitored and responded to. Some individual’s health care needs are quite complex; care plans evidenced timely input from other health care professionals involved with their care. Residents are weighed regularly and this is recorded as part of their ongoing assessment and review procedure. Some residents who have specific dietary and support requirements had these needs clearly noted on care documentation and staff explained how they offer assistance in the way and at a time the resident prefers. The deputy manager stated that staff had received training in care planning and risk assessment recently. The requirements awarded at the last inspection in relation to care plans have been met on this inspection. A monitored dosage system for dispensing medication is used. Only trained nurses administer medication in the home. Temperatures were regularly taken of medication storage areas, including cold storage and records were maintained. The home has designated lockable medication fridges on each service unit. One fridge inspected evidenced some build up of ice, which may have caused the fluctuations in recorded temperatures seen. On occasions these had been at the upper end of the optimum range. The fridge was also Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 14 found to be unlocked. The fridge was however situated in a locked room, which was not accessible to residents. Some medication administration sheets were inspected. No gaps in recording administration to residents were found. The home had a current medication policy and nurses have access to additional guidance documents. Residents prescribed medication is reviewed by their GP regularly or upon request. The home has a contract for the disposal of all waste medicine. The home has a homely remedy list, agreed with GP’s which was recently reviewed and updated. The home’s signature list for those staff designated to administer medication still contains an example signature of the previous manager. The list needs to be revised. Some sluices and a kitchenette had notices to people still in place signed by the home’s previous manager. This can be confusing, information or requests detailed on notices need to be current. Apart from the minor issues noted, medication in the home was handled competently and professionally. The deputy manager spoke of her intention to address shortfalls immediately. Staff were observed to be respectful when speaking to residents and good interaction was seen between staff, residents and their visitors. Residents’ privileged and sensitive personal information was kept securely and handled appropriately. Residents and visitors spoken with on the day of the visit were very happy with the care provided and were largely content except for some dissatisfaction in relation to the home’s laundry service. Residents clothing was on occasions being lost or spoilt. This was discussed with the manager and her deputy. The manager spoke of her intention to form a working party to look at the issues causing concern and to seek resolution. The manager felt that on the whole and in relation to the size of the provision, the home made every effort to provide a good laundering service to residents. Winchester House DS0000026204.V335406.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and opportunities for mental stimulation are regularly offered to residents. These diversions provide variation and interest for people. Residents are enabled to exercise choice in their everyday lives and receive a varied and healthy diet. People with specific dietary and support requirements now benefit from having their identified dietary needs clearly identified in care plans and met in full. Residents are enabled to maintain contact with friends and family who are made welcome in the home. The home continues to improve the difficulty experienced with language and cultural barriers between some overseas staff and residents to ensure that the people who live in the home have their choices, needs and preferences in relation to daily living, understood and complied with wherever practicable and staff fully understand what is expected of them. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 16 EVIDENCE: Activities and opportunities for stimulation within the home are considered an important part of residents’ lives. To this end they offer an activities programme and employ a dedicated activities organiser. The deputy manager stated that opportunities for the activities organiser to spend time with individual residents on a one to one basis are built into the programme where possible. On the day of the site visit containers of bedding plants were seen to have been purchased and were waiting for some residents interested in gardening to be involved in planting them up. The home has raised flowerbeds to accommodate this. Information about residents past work, interests and hobbies are noted on care plans. Routines in the home are flexible and varied to suit residents’ wishes where it is practicable to do so. The home operates a key worker system, which enables closer but not exclusive relationships to be formed between residents and staff where likes, dislikes and needs can be shared. There was a plentiful supply of leisure/recreational amenities available to residents such as TV’s, videos, books, jigsaws, board games, music cassettes, radios etc. Some residents’ chose not join in formal actives or were to frail to consider it, others preferred to keep to their rooms and staff respect the decision. Family and friends felt welcome and knew they could visit the home at any reasonable time, which ensures residents continue to receive stimulation and emotional support. There are regular residents/ relatives meetings. The manager emphasised how important maintaining good communication was to consistently improve the service. Said it was, “a 24/7 necessity to ensure everyone is listened to and issues of concern are acted upon immediately.” The food provided at lunch on the day of the site visit looked and smelt good. The home’s catering staff are experienced in cooking for older people and considered to be important members of the care team. Residents were aware of their right to make menu choices and how to organise that with staff. The home’s menus offer a balanced and varied selection of food. Residents with specific dietary and support requirements now have their needs met in full. The kitchen provides food to service units that are consistent with residents care plan demands. The home has no plans to vary their policy of recruiting some staff from overseas when it is necessary. The home’s new manager is aware of the potential communication difficulties this can sometimes create for residents. In relation to this issue she has made a genuine effort to provide regular Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 17 sessions for existing overseas staff designed to offer them the opportunity to improve their verbal and comprehension skills and their understanding of English cultural matters. This appears to have been well received and is of benefit to residents whose ability to exercise choice and control over their lives in the home has previously been compromised by poor communication with some staff. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure. People who live in the home and their relatives and friends can be confident that concerns and complaints once raised will be acted upon without delay. Outcomes from adult protection referrals have been satisfactorily managed and the home continues with robust plans for continuing improvement. The home’s records detailed accurate and clear reasons for the use of physical means of restraint when it is necessary, which ensures peoples welfare is protected. EVIDENCE: The home has a clear complaints procedure in place, which explains how people can make a complaint about any aspect of the facilities and services provided. Copies of the complaints procedure are included in the home’s information documents and are displayed on notice boards The deputy manager said as a senior team they are effective in resolving any dissatisfaction at an early stage and any concern, however minor, is dealt with quickly and to the complainant’s satisfaction wherever possible. The new Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 19 manager has an ‘open door’ policy; her reorganisation of the home and her problem solving approach at an early stage of discontent is working well. Residents spoken with said they felt safe and secure in the home. The home’s complaints file was well maintained. Since the last inspection there had been three complaints recorded. Records kept included details of investigations, outcomes and actions taken. Outcomes from the previous adult protection referrals have been satisfactorily managed and the home continues with robust plans for improvement. There have been no new Adult Protection issues raised. There was clear evidence on this inspection of firm progress being made to improve the overall quality of the service to the benefit of the resident group. An informal review of the home’s action plan with Social Services is due to take place in June 2007. Kent and Medway’s Adult Protection Policy has been adopted by the home. Most staff has now received Adult Protection training. The majority spoken with had a good understanding of the procedure to follow; they knew when to act and who to report to. Some residents had bed rails fitted for their protection. The home records their use in care plans, undertakes risk assessments and has a system which records agreement and authorisation for the use of equipment that presents a form of restraint for individuals. On this inspection it was clear that no other practicable means of securing the individuals welfare was possible and records gave the full circumstances of the decision being made and by whom. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 20 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 21 22 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from a generally safe, well maintained and clean environment in which good standards of décor and furnishings are provided. Residents would further benefit from all staff adhering to the home’s infection control policy. EVIDENCE: A full tour of the building was undertaken with the deputy manager. No defects in the general presentation of the building were seen. The home offers a very pleasant environment, which was found to be clean, and odour free. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 21 Communal bathrooms evidenced no items of stored equipment on this unannounced inspection. All areas of the home were easily and fully accessible by residents. The Requirement awarded at the last inspection to ensure that residents’ bathrooms and toilets remain free of the home’s stored items has been met. One bathroom evidenced two small bars of soap left on the edge of the bath. These were disposed of immediately by the deputy manager. This issue was discussed. Staff are to be remind about adherence to the home’s infection control policy to fully protect residents from any potential for harm. The home continues to give high priority to maintenance and servicing of equipment. All equipment-monitoring records were seen to be up to date. The laundry facilities in the home are generally well organised and are designed to control the spread of infection. Relatives spoken with on the day of the visit raised some dissatisfaction in relation to the home’s laundry service. Residents clothing was on occasions being lost or spoilt. This was discussed with the manager and her deputy. The manager spoke of her intention to form a working party to look at the issues causing concern and to seek resolution. All communal bathrooms were fully functional on the YPD Unit. No residents or their relatives raised any issues about having insufficient access to bathing facilities on this inspection. Staff spoken with said they now manage the situation better. At the time of the last inspection the unit had only been opened for a short period and one bathroom was out of use due to plumbing problems and blocked pipes. This may have added to peoples concerns about access to facilities at times that suited them. This matter is now resolved. Residents and relatives spoken with liked the home’s environment. They found it comfortable, bright and modern. Residents’ had personalised their own bedrooms to reflect their taste and interests as much as possible. Winchester House DS0000026204.V335406.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A dedicated staff team who are well supported and supervised cares for people who live in this home. The home demonstrated a clear commitment to training their staff. Commendable progress has been made in providing a comprehensive programme of training, which addresses the shortfalls evidenced at the last inspection, and ensures that residents’ needs are met. Residents can be confident that they are protected by the home’s robust recruitment procedures. EVIDENCE: Staff training was discussed with the deputy manager. The home’s electronic training matrix was viewed for compliance with statutory and basic training. This is a comprehensive database that lists staff training completed; training planned and alerts senior staff when mandatory training updates are due. Staff training had been addressed as scheduled in the home’s improvement plan and continues to be developed still further. Very good progress was evidenced on this inspection and it is clear that training staff is now taking a high priority in the home. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 23 The home’s Cook had almost completed the Intermediate Food Hygiene certificate. Fire training is complete for most staff. The last course is arranged for May 2007. Moving and Handling training is now regularly arranged. The deputy manager has completed a moving and handling ‘trained trainers’ course and updates all staff. Dementia training was arranged via the Alzheimer’s Society. Eight staff had completed a comprehensive course, a further four were due to attend on the 23/4/ 2007. The remaining staff that work on the Dementia care unit have training scheduled. The deputy manager had completed Tissue Viability training. A very positive outcome of this course was evidenced; Her increased knowledge had reduced the incidence of pressure areas occurring amongst the resident group. The manager is proposing to train another Registered Nurse later this year. Infection Control training had been arranged, twenty staff attended. Another course for the remaining staff is booked on 30/04/07. Care planning and risk assessment training was arranged for all staff and delivered by Blanchester’s Clinical nurse/ trainer. A revised care planning system for residents is in place and working well. The home is hosting a seminar for families of Dementia sufferers on the 11/06/07. All relatives/ friends and representatives of existing residents on the Dementia unit will be invited to attend. The manager had fulfilled her stated intention of recruiting to substantive posts and had recently eliminated the use of all agency staff. Many residents and their relatives had previously complained of a dislike of agency staff used by the home to cover vacant roster hours as they had little confidence that they understood their needs. The home evidenced that it currently exceeds the Dept of Health staffing formula guidelines. A review of staffing levels had taken place. A senior nurse is now responsible and held accountable for the quality of care offered on each service unit. The deputy manager oversees daily operational business and supports the senior nurses. This close monitoring approach appears to be working well and occupancy continues to rise as confidence in the service returns. The home has no plans to vary their policy of recruiting some staff from overseas when it is necessary. The home’s new manager is aware of the potential communication difficulties this can sometimes create for residents. In relation to this issue she has made a genuine effort to provide regular sessions for existing overseas staff designed to offer them the opportunity to improve their verbal and comprehension skills and their understanding of English cultural matters. This appears to have been well received and is of benefit to residents whose ability to exercise choice and control over their lives in the home has previously been compromised by poor communication with some staff. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 24 The home follows Barchester’s Recruitment procedures, which are comprehensive and robust and seek to protect residents from any potential for harm. Staff files inspected contained all the elements required by Regulation. CRB and POVA checks are being made before staff commence work. The home’s induction process for new staff is sound and meets ‘skills for care’ standards. The home has evidenced compliance with the requirements awarded in this outcome area at the last inspection and these will be removed from this report. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 25 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 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an experienced and competent manager who is able to discharge her responsibilities fully and provides an excellent role model. Residents further benefit from a permanent staff team that receive regular formal and informal supervision and identification of their training needs. Residents’ financial interests are protected and their welfare promoted through regular maintenance and equipment safety checks. Policies, procedures and systems of work are in place, which support the best interests of residents. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 26 EVIDENCE: The home’s new General Manager is registered with the Commission having completed the ‘fit person’ process in January 2007. She is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The manager has reorganised the management structure in the home in light of the growth in registered beds. A deputy manager has been appointed. Her title in the home is ‘Matron’. Service unit heads have been appointed to lead the nursing team on each service unit. It is intended that the revised structure will ensure accountability for the quality of service delivered and will support and improve communication amongst staff, residents and other stakeholders. Formal staff supervision is now taking place regularly and records are kept. There is a sheet in each staff file ticking the main elements of discussions held and recording the date and time of the event. Discussions were said to cover identification of training and development needs for individuals. Staff compile their own notes of the discussion and actions to be taken. These are kept off site. Although sufficient evidence was found to remove the statutory requirement awarded at the last inspection in relation to staff supervision it was recommended that supervision notes be kept in the home and maintained in a confidential manner. The home has regained the ‘Investors in People Award’ and assessors made very positive comments following the process of assessment. Data Protection in the home is sound. Records were seen to be kept in a manner that preserved confidentiality and safeguarded residents’ rights and best interests. There are administrative staff that support the management role. Residents’ financial interests are safeguarded. The home has comprehensive details recorded. Regular residents and relatives forums have been held. One relative spoke of their attendance at a recent meeting and was pleased to have had the opportunity to have a say in the day-to-day running of the home. The home also holds regular relative/ representative ‘drop in’ meetings during evening hours, which are more appropriate to some individuals who are working during the day. Barchester undertakes regular quality assurance and monitoring exercises. Results are collated and used to inform plans for service development. The home has a wealth of Barchester Healthcare policies that are known to the CSCI. The deputy manager stated they had been reviewed in line with the Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 27 Providers timetable and were current. These were not inspected on this occasion. Records of maintenance and safety checks were up to date in the home. The health, safety and welfare of people who live in the home is generally promoted and protected. Minor shortfalls exist in the home’s medication administration procedures however and residents would benefit from all staff adhering to the home’s infection control policy to fully protect them from any potential for harm. The management could evidence that clear and commendable progress had been made to ensure that improvement plans agreed with the Commission and Social Services have taken place as scheduled. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 4 X 3 3 X X X 2 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 4 X 3 X 3 3 X 2 Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 29 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations Some dissatisfaction exists in relation to the home’s laundry service with residents’ personal clothing on occasions being lost or spoilt. It is recommended that the responsible person seek to improve this aspect of a resident’s personal care to residents and relatives’ satisfaction. It is recommended that the responsible person review the medication administration practices and storage facilities in the home in line with good practice advice to secure residents safety and protection. It is recommended that staff adhere to the home’s infection control policy to fully protect residents from any potential for harm. It is recommended that staff supervision records be kept in the home and maintained in a confidential manner. Inspectors do not routinely read staff supervision records but as there was a requirement awarded in relation to staff DS0000026204.V335406.R01.S.doc Version 5.2 Page 30 2. OP9 OP38 3. 4. OP26 OP38 OP36 Winchester House supervision at the last inspection these should be better evidenced. Inspectors have the right under Regulation to inspect such documents if necessary. Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Winchester House DS0000026204.V335406.R01.S.doc Version 5.2 Page 32 - 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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