Inspection on 22/08/06 for Winchester House

This inspection was carried out on 22nd August 2006.

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

Other inspections for this house

Winchester House 09/09/08

Winchester House 18/04/07

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 Unannounced Inspection 22nd August 2006 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.V308911.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.V308911.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 Homes Limited Vacant Care Home 67 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (51), Physical disability (8), of places Terminally ill (5) Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 65 DE with the provision for up to 10 of those beds for early onset dementia from 50 years. Total number of beds to be accommodated to be a maximum of 118 beds. The double room in the YPD unit to return to a single room when either one of the current residents vacates (DOB`s 8.12.49 and 15.12.41. Residents in rooms 11-16 to be informed in writing of the limited access to daylight within those rooms. 7th February 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 £800 to £1050 per week. Fees for service users under 65 range from £1250 to £3000 per week, according to identified assessed need. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key unannounced inspection. Regulatory Inspectors, Marion Weller, Lisbeth Scoones and Sue Mc Grath were in Winchester House from 9:30 am to 5:20 pm. The main focus of the inspection was to monitor progress of the homes action plan for improvement and the meeting of requirements made at the last inspection. During the time spent in the home the inspectors spoke with some residents and visitors, the manager and her deputy and some of the staff group. Parts of the general environment, some records and documents were inspected. Some judgements about the quality of life and the safety and well being of residents within the home were taken from observations of care practice and from conversations. Some information that informed judgements was received prior to the inspection. Due to the nature of some of the services provided it is difficult to reliably incorporate accurate reflections of all the resident groups views of the service in the report. Some resident surveys and comments were received prior to the inspection. The majority indicated they were generally satisfied with the standards of care. There were comments however that indicated staff are not always available when they are needed and there were some criticism of the care currently provided to certain individuals. Statements included. • • “Staff usually available, sometimes a bit thin on the ground” “The carers are all nice and kind to me and I am generally satisfied, but not everything is perfect” “Staff shortages are our main concern with the home” “The ability of an ageing resident population with declining physical or mental health to get the best from the facilities this home offers them is wholly dependent on the level and standard of care provided. On occasions, I have observed a lack of attention from staff to peoples needs”. • • Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Some residents would be better informed of their choices and options before moving in if information concerning some bedroom light limitations was given to them in writing and was mentioned in information provided by the home. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 7 Residents would further benefit from written confirmation that the home can meet their needs, including any specialist needs of the individuals admitted to the home. Residents care plans and daily records must be more comprehensive. Care plans would benefit from timely review and the use of additional monitoring tools. Daily records must accurately reflect an individuals care plan requirements. Residents would benefit from a delivery of care that is closely monitored by senior staff that have a delegated area of responsibility and are held accountable for the quality of care provided. Staffing levels must be reviewed to truly reflect residents’ individual care needs versus numbers and competencies of staff on duty. Staff must receive regular formal supervision, appraisal and identification of training needs. Although firm progress is being made in the organisation of staff training, not all staff can currently evidence they have the skills, knowledge and experience to deliver the services and care the home offers to provide. Agency staff must receive a shortened form of induction when used in the home to ensure they understand what is required of them in regard to residents’ needs and their welfare. 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. Winchester House DS0000026204.V308911.R01.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 Winchester House DS0000026204.V308911.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4.5.6. Quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit to this service. People who use this service have most of the information about the home they need to make an informed decision about whether the service is right for them. Some residents would be better informed of their choices and options before moving in if information concerning some bedroom light limitations was given to them in writing and briefly included in information provided by the home. The personalised needs assessment means that individual’s diverse needs are identified before they move into the home, which ensures residents are appropriately placed and the home can meet their needs. Residents would further benefit from written confirmation that the home can meet their needs, including any specialist needs of the individuals admitted to the home. Residents cannot be confidant that their needs can be fully met at all times. Not all staff evidence they have the skills, knowledge and experience to deliver the services and care the home offers to provide. The home has insight into particular areas of weakness in this outcome group and has in place an improvement plan monitored by the Commission. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 10 EVIDENCE: The homes statement of purpose, service user guide and residents welcome pack has recently been revised to reflect changes in the homes registration and to better inform potential and existing residents about the range of services the home now offers. The documents are accurately descriptive of the homes aims, objectives and philosophy of care and include explanations of the services, facilities and most of the conditions found at Winchester House. The contents met all the requirements of regulation. Copies were seen to have been provided for each resident or their representative and were accessible in bedrooms. Contents of all information documents will need to be further revised to include details of the new manager of Winchester House who takes up post in September 2006. The manager or a trained senior member of staff visits all prospective residents prior to admission to make a decision as to whether the home can meet the persons needs. The assessments inspected were seen to contain good detail and the included personal preferences. To meet the demands of regulation the home intends in future to confirm in writing to residents 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 were able to visit the home before deciding to move in. Each resident or their representatives were provided with a contract or a statement of terms and conditions between the home and themselves. Documents included the fees charged and statements regarding the responsibilities of the organisation and the rights of residents. It is a condition of the homes current registration that service users in bedrooms numbered 11-16 are informed in writing of the limited access to daylight within these rooms prior to taking up residence. The homes compliance with this most recent condition of registration could not be evidenced on the day of the site visit. The homes Operations Director has since confirmed that a document is being prepared that will ensure future Compliance with requirements. The homes statement of purpose does inform prospective residents that bedrooms vary in size, shape and outlook. However, the statement needs to be more explicit in relation to this issue. The home was seen to be making firm progress in addressing shortfalls in staff training to ensure that all staff individually and collectively have the skill and experience to deliver the services and care the home offers to provide. The home has in place an improvement plan monitored by the Commission. The home does not provide intermediate care. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.11. Quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit to this service. Whilst care plans contain most of the information staff need to provide appropriate care to residents, these would benefit from timely review and the use of additional monitoring tools. Residents do not benefit from staffing levels that reflect their assessed needs and known preferences. Residents would benefit from a delivery of care that is closely monitored by designated senior staff that make sure care is offered in a timely manner rather than residents or their relatives having to request help. Residents’ quality of care and safety may be compromised by some staff that are unaware of their needs and preferences. Residents were largely protected by the homes policy and procedure for administering medication. Where medication systems were in need of action the registered person was working towards improvement. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 12 The home has insight into particular areas of weakness in this outcome group and has in place an improvement plan monitored by the Commission. EVIDENCE: Each resident had a care plan. Some individuals whose quality of care had been raised with the Commission as being of particular concern prior to the site visit had their care plans and daily records analysed in detail. The care they receive in the home was also discussed with them, where that was possible. The inspectors’ aim was to determine whether the homes documents and records provided a coherent and consistent picture of the care assessed, planned and provided. Concerns as to the homes policy and procedures in relation to accessing emergency treatment for residents were also closely looked at. The conclusions drawn from the work undertaken was thus: • Observation charts (‘seizure and falls charts’) would have been useful monitoring tools in some individuals care. A clear protocol must be established to ensure consistent practice. In some instances care plans had not been reviewed as the individuals needs had changed or it was not sufficiently clear as to the level of assistance currently required. i.e. daily assistance with fluids and diet. Risk assessments were completed and reviewed. The use of pressure relieving equipment for individuals should be better kept under review and updated on plans of care to reflect a residents changing needs. Staff must be more proactive in offering assistance to residents rather than waiting to be asked. Some residents spoke of needing more help than staff realised. Daily records were seen to be maintained, although in some instances difficult to read. The amount of detail in daily record entries was still inconsistent and dependent on the staff member completing the record. Evidence was seen of entries that recorded ‘All care given’ which is not helpful or adequate and should be avoided. DS0000026204.V308911.R01.S.doc Version 5.2 Page 13 • • • • • • Winchester House Daily records when well written, help senior staff to audit the care being provided and ensure that staff follow guidelines in the care plan. It is in the home interests to be able to illustrate what they have done for a resident and provides evidence on which to base reviews and to record that they are following the assessment of residents needs. • • The involvement of families and representatives were noted frequently in residents’ daily records. There was some improvement noted in the involvement of residents and their families in relation to the formulation and review of care plans. Some care plans were signed as evidence of involvement and agreement to the plan. Staff must not routinely rely on visitors to assist with meals and to complete fluid charts for them, as was evidenced in discussion with relatives. Staffing levels in some areas are of concern and must reflect the assessed needs of each individual resident. Dependency levels particularly in the Dementia Care unit and the Younger Adults Physical Disability unit was observed to be high. There was clear evidence that medical help, in relation to staff accessing emergency treatment for residents, was being sought by the home in a timely manner. • • • Some staff spoken with had a sound understanding of residents needs. Some agency staff spoken with on the day of the visit were unaware of residents’ names; another was unable to identify residents’ surnames. None said they had read the residents care plans they were looking after. This was discussed with the senior nurse on the unit. It was established that a simple induction process for agency staff at the start of a duty period is not currently undertaken. The nurse spoke of her intention to rectify this situation. The manger spoke of her intention to eliminate the use of agency staff in the home. Trained nursing staff administers medication. An appropriate policy and written procedures are in place for the storage and administration of medication within the home. Medication records are generally completed appropriately and kept with photos of residents. One missed signature was noted on the Younger Physical disability unit. The senior nurse spoke of her intention to rectify this. Medications for disposal were stored in a large box and records kept. Making arrangements for timely return and destruction of Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 14 such medicines was discussed with the manager at feedback who will address this issue. Facilities are available for the proper storage and administration of controlled drugs. From observation and discussion with residents and their relatives it was clear that staff treated residents with respect and promoted their privacy and dignity. Death and dying in the home were handled with care, sensitivity and respect. Accommodation could be provided for relatives and friends during times of illness and the death of residents. Winchester House DS0000026204.V308911.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15. Quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit to this service. Some residents enjoy organised activities arranged by dedicated staff on some days of the week. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The dietary needs of most residents are well catered for with a balanced and varied selection of food that meets their tastes and choices. Residents with specific dietary and support requirements may not have their identified needs met in full. Poor verbal communication with residents may compromise their ability to exercise choice and control over their lives in the home. The home has insight into particular areas of weakness in this outcome group and has in place an improvement plan monitored by the Commission. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 16 EVIDENCE: The majority of residents and their relatives were generally satisfied with the flexibility the home offered in regard to meeting personal choices where practicable and felt their lifestyle in the home matched their expectations and personal preferences. Some comments received were not so complimentary. There were concerns raised that on occasions staffing pressures led to some residents not having the opportunity to exercise choice around how they were supported in daily living, particularly at meal times. Some individuals felt they needed more help than staff realised. A comment was made that staff are often too rushed to help and they sometimes say so! Comments were made during the course of the inspection and in information received prior to the site visit that some residents had difficulty understanding some members of staff and felt that at times certain individuals did not understand their needs and preferences about daily life. One comment made was “they will only do things their own way, they do not understand what I want or why at times” The home has no plans to vary their policy of recruiting some staff from abroad. The need for the home to maintain good communication with residents was mentioned in previous inspection reports. The homes new manager is aware of the potential difficulties the situation brings and the impact it can have on residents. The manager discussed her plans to improve the situation from the recruitment stage for any new staff and by supporting current staff to increase their abilities with spoken English, where it was felt necessary. The homes future plans in this vital area will need adding to their action plan for improvement. A full activities programme is arranged which includes cultural and religious activities. Information was also seen displayed on notice boards. There were no activities planned for the day of the site visit. Some permanent staff were attending training and agency staff were covering vacant rota hours. Rosters did not establish that dedicated activities staff were currently undertaking other roles in the home as was reported to the CSCI. Family and friends were welcome and knew they could visit the home at any reasonable time. Guest accommodation is available in the home. Efforts are made to ensure meals offered are to residents liking and the subject is included in residents meetings. Not all residents or their family members choose to attend meetings. The Kitchens were inspected. Sound records and procedures were in place. The home has been awarded a clean Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 17 food award. Highly Commended, Silver Level. The Environmental Health Officer had visited and inspected the kitchen provision on the 3RD March 2006. One issue was raised regarding the additional training needs of the Chef and her deputy. The home could evidence training was planned and booked to address. Some comments were received concerning the special dietary needs of a resident that was reported as not being addressed by the home. The situation was investigated and the home was seen to have significantly improved access to dietary requirements, although support with feeding and fluids was still felt by the individual to be an issue on occasions. This was due in part to lack of insight into the individuals level of dependency and staffing pressures, which lead to staff not to be as proactive in offering assistance as they might in other circumstances. Issues for this individual were discussed with the senior nurse and with the manager on feedback. Winchester House DS0000026204.V308911.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16.17.18. Quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit to this service. The home has a clear complaints procedure and both service users and relatives are aware of how to complain. Outcomes from adult protection referrals have been satisfactorily managed and the home continues with robust plans for improvement. Residents’ welfare would be better protected if records detailed accurate and clear reasons for the use of physical means of restraint on all occasions. It should be clear that no other practicable means of securing a residents welfare was possible and record the full circumstances of the decision being made and by whom. EVIDENCE: The home has a comprehensive complaints policy in place and complaints sent to the home were responded to promptly and in accordance with the homes procedures. The home also has a fast track system for complaints. Most residents and relatives spoken with had a good understanding of how to make a complaint. Since the last inspection records show that 6 complaints have been raised directly with the home, two were partly substantiated and the remaining 4 Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 19 were unsubstantiated. Records kept included details of investigations, outcomes and actions taken. The home has been through a difficult period in regard to criticism concerning poor practice and quality of care issues. In some instances criticisms and concerns were investigated and found to be justified. In other cases, alerts raised were found to be unsubstantiated. During this process the home has gained considerable insight into particular areas of weakness and has in place an improvement plan monitored by the Commission. 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. Kent and Medway’s Adult Protection Policy has been adopted by the home. Most staff have received or are in the process of receiving Adult Protection training. The majority spoken with had a good understanding of procedure, they knew when to act and who to report to. Staff said all permanent residents had been offered the opportunity to be registered for a vote. Where residents lack capacity senior staff were said to seek help from their representatives or relatives who would support them regarding their legal rights. The home can access advocacy services. Although brochures of an advocacy service used by the home were seen in ‘evidence’ files that the home maintains, these were not seen on notice boards for residents information. Some residents had bed rails fitted for their protection. The home records these 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. One individual residents care plan however noted that they had declined the use of bedrails, but these were later put on. It was unclear who had made the decision that the individual’s wishes should be disregarded. Records gave clear details of situations that had occurred which indicated a need to protect the resident from further falls and possible harm. Falls were not however charted on separate observation records to give a clear picture of what was happening. The home must always be clear and consistent in records maintained particularly about authorised decisions taken to use physical means of restraint and why. Winchester House DS0000026204.V308911.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20.21.22.23.24.25.26. Quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit to this service. Although the home offers a generally very pleasant environment recent situations have meant that some residents do not have access to sufficient showering and bathing facilities. Residents on the YPD unit do not have bedroom doors with automatic closures linked to the homes fire alarm system. The situation does not pose a risk to their safety as alternative strategies are in place. However, the situation is an inconvenience to some individuals in the home and compromises their feelings of comfort and security. Toilets and other areas where odour is likely to occur should be regularly monitored to ensure the home provides residents with a clean, comfortable and pleasant environment in which to live. Suitable provision should be made for storage in the home to eliminate bathrooms and other service areas being used for the purpose. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 21 EVIDENCE: The new build and refurbished areas of the home are now complete and have been undertaken to a high standard. Décor and fittings are excellent and residents benefit from living in a very pleasant environment. The home now offers services to a quite diverse client group including a Younger Persons Disability Unit of 15 beds. A service, which has been transferred from another Barchester Home in the local area. Winchester House is a very large home and offers 118 beds to service users from the local area and beyond. Some criticisms had been received from residents and relatives prior to the site visit that there were insufficient communal bathing/showering areas provided on the YPD wing. This was investigated. Most bedrooms on this wing have ensuite toilet and sink facilies only and are dependent on timely access to communal facilities. The home had also suffered water leaks prior to the inspection, which put one of the communal bathrooms out of action on YPD. The home was trying to secure the necessary repairs to the bathroom that had been damaged, it was currently unfit for use. Comments were received that the event and the subsequent repair were handled badly. The situation was noted to have had a significant impact on residents who complained of having to wait to access the one available shower room still in use. Another bathroom was seen to have stored items in it. The situation was discussed with the manager. There was no evidence however that the home had not tried to secure the welfare of residents during the difficulties or that they had had not acted appropriately to action repairs as quickly as possible. One resident on the YPD wing also spoke of concerns regarding residents’ bedroom doors that do not have automatic door closures linked directly to the homes fire protection system. The doors have to be kept closed at night to ensure fire safety, which some residents disliked and which made them feel insecure in accessing the attention of staff. This was discussed with the Operations Director a short while after the site visit. It was stated that the provider has a policy of only fitting automatic fire door closures to doors that are sited in fire zones, which include a kitchen facility. The home had discussed this arrangement with the Fire Officer at the planning stage of building work and he had inspected the areas prior to commissioning. The arrangements were found to be safe, satisfactory and met fire regulations. There are currently no plans to alter this arrangement. The home may wish to take this up as a quality of service issue for future consideration. The home has given a high priority to maintenance and servicing of equipment. All equipment monitoring records were seen to be up to date. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 22 The laundry facilities in the home are good, well organised and are designed to control the spread of infection. The Dementia care unit was inspected and found to have a storage room used for wet/foul linen and two residents toilets that were not very clean and smelt strongly of urine. The situation was brought to the attention of the senior nurse. Immediate action was taken to rectify the situation. The home does have suitable systems in place to ensure the home is clean and to avoid odour becoming apparent but staff should regularly monitor important areas where this situation is most likely to occur. Storage appears to a problem at the moment as many items of equipment were seen stored in bathrooms and other utility areas around the home. Staff spoken with explained that the issue of storage had been raised with line managers and a solution was being sought. It is a condition of the homes registration that service users in bedrooms numbered 11-16 are informed in writing of the limited access to daylight within these rooms prior to taking up residence. Windows are approximately four feet from a high grassy bank. The homes compliance with this most recent condition of registration could not be evidenced on the day of the site visit. Barchesters Operations Director has since confirmed that a document is being prepared that will ensure future compliance with requirements. The new garden areas are maturing and now provide a very pleasant environment for all to enjoy. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30. Quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit to this service. Staffing levels must be reviewed to truly reflect residents’ individual care needs versus numbers and competencies of staff on duty. The home is addressing the training and supervision requirements of its staff so they have the skills to meet the needs of residents. The home has insight into particular areas of weakness in this outcome group and has in place an improvement plan monitored by the Commission. EVIDENCE: Staff training was discussed with the new manager and her deputy. The homes training matrix was inspected for compliance with statutory and basic training. Training staff is now starting to take a high priority in the home. This is very positive and encouraging improvement in this area. The manager is aware of the amount of work still to be done, but firm progress is being made. The homes improvement plan was discussed and the following was noted: • Leadership and assertiveness training has now been arranged for trained nurses and heads of departments. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 24 • The deputy manager is to commence tissue viability training at Christ Church College in September 2006 and on completion will become the issue viability link nurse for the home. She will also attend Tissue Viability Link Nurse sessions delivered by Medway PCT. Mentorship training – Two places have been secured for RGN’s at Christchurch College commencing Sept 2006. The provision of trained Mentors will enhance the skills of the trainee RGN’S from abroad, support the development of supervision practices in the home and will further allow RGN’s to support candidates carrying out NVQ’s in Care at various levels. Moving and Handling training for staff has been ongoing and undertaken formally every two weeks in the home. Winchester House now has 3 Certified Manual Handling trainers. Catheter care training has been undertaken. Diabetes awareness training has been undertaken. Care planning training has been going on with all levels of staff. Further Adult Protection Training is booked for November 06 Fire Training is booked for 7th September 06 Wound care training for RGN’s was booked for July 2006. There were two separate sessions. Different clinical areas covered in each. Four more staff commence NVQ at Level 2 and one at Level 3 in September 2006 Two (A1) assessors are to begin training in September 2006. The assessors training once complete will allow the home to assess staff competencies at NVQ levels faster, giving the home more trained staff available on rosters. The manager also spoke of her plans for accessing courses in spoken English for those staff in need of this additional help and support. Formal supervision of staff has now started and supervisors and supervisees are all receiving training. RGN’s will also receive clinical supervision. • • • • • • • • • • • • Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 25 The manager spoke of her plans to continue with recruitment of staff to the level where agency usage is greatly reduced and eventually eliminated. The home follows Barchester’s Recruitment procedures, which are robust and comprehensive. The new manager wants to change the supervision tree. Currently this relies on some people outside the establishment and is fragmented as to clear lines of accountability in the home. This needs to be added to the homes improvement plan. As mentioned elsewhere in the report residents and families raised staffing levels as an area of concern. The inspectors noted that observed resident dependency is high in the home, particularly around the supervision and support needs of some residents. Staffing levels must be reviewed to truly reflect individual care needs versus numbers and competencies of staff on duty. There is currently a high number of agency staff being used to ensure the home operates within guidelines. Many residents dislike the use of agency staff in the home as they have little confidence that they will understand their needs. A system must be introduced that provides agency staff with a simplistic form of induction to ensure their health, safety and support and gives them clear information regarding residents care plan needs and personal preferences when working in the home. This needs to be added to the homes improvement plan. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33.34.35.36.37.38. Quality in this outcome area is adequate. The judgement has been made using available evidence including a site visit to this service. The homes management structure is going through significant change. The new manager and her senior staff have robust plans, which will seek to put the best interests of residents at the heart of their plans for improvement. Clear progress is being made in relation to the homes current improvement plan. EVIDENCE: The homes new General Manager will take up post on September 4th 2006 and will be applying for registration with the CSCI. She has been working in the home on certain days each week since accepting the post, to make herself Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 27 aware of the issues the home has to address and to allow time for the previous manager to hand over. Although not on duty in the home on the day of the visit she quickly travelled to the home and assisted the inspectors throughout the day. The new deputy manager was scheduled to attend training on the day of the site visit. The new manager is known to The CSCI. She is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Throughout the inspection, the manager clearly had residents’ welfare at heart and demonstrated openness and commendable honesty. The new manager discussed her plans to recruit two further Deputy Managers to ensure the management structure of the home is robust enough to cope with the growth in registered provision. It is planned that all three individuals will eventually have responsibilities and accountabilities for each individual service area in the home. Team leaders for each service area will be recruited from within the existing Healthcare Assistant team. The manager believes this structure will ensure accountability for the quality of service delivered and will support and improve communication amongst staff, residents and other stakeholders. The formal supervision of staff has now started and supervisors and supervisees are receiving training. RGN’s will also receive clinical supervision. The manager wants to change the supervision tree, which currently relies on some people outside of the establishment and is fragmented as to clear lines of accountability in the home. A customer satisfaction survey was sent to residents, relatives and advocates in June 2006. Results are currently being collated at Barchester offices in Chelsea. The manager said that there are indications of some negative comments, but also many positives. The results when available will be made available to all stakeholders. The survey exercise will be repeated in January 2007 when a comparison will be made between the two sets of responses. There are administrative staff that support the management role. Residents’ financial interests are safeguarded. The home has comprehensive details recorded. Residents’ financial management details currently known to the home were sent to the Commission prior to the site visit. Informal 6 weekly relatives forums have been held. The manager is to make some adjustments to some aspects of quality assurance in the home. It was agreed that all revisions will be included in the homes updated improvement plan. The manager was aware of the need to develop a continuous selfmonitoring system, based on a systematic cycle of planning, action and review. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 28 The manager is aware of the elements included in the homes current improvement plan and understands the Commission is monitoring this. She intends to revise the current document in light of her own plans for improvements and to address issues raised with her at feedback and in this report. The home has a wealth of Barchester Healthcare policies that are known to the CSCI. The homes local policy for accessing emergency services for residents was discussed. The home was found to act appropriately in such situations. Clear progress is being made since the homes improvement plan was first requested on June 30th 2006. The home now requires a realistic timescale to put their robust plans in to practice and to reach full potential. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 29 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 2 2 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 4 4 2 2 3 3 3 2 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 3 3 2 3 3 2 2 2 Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 30 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 OP2 Regulation 5 (b) (c) Requirement Timescale for action 27/10/06 2 OP4 14 (1) (d) Conditions of registration require the provider to inform residents in writing of the limited access to daylight within rooms 11-16. The statement of terms and conditions or contract provided to service users must include a statement to this effect and the document made available for inspection. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. The Registered Person shall not 27/10/06 provide accommodation to a service user unless it has been confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. DS0000026204.V308911.R01.S.doc Version 5.2 Winchester House Page 31 3 OP4 OP38 18 1 (a) The Registered Person shall, having regard to the size of the care home, the Statement of Purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced people are working at the care home in such numbers as are appropriate for the health and welfare of service users. In that: staff must individually and collectively have the skills and experience to deliver the services and care which the home offers to provide. • Staff training plans must reflect the three service types offered and continue to be pivotal to the improvement plan for the home. An induction system for agency staff must be formulated and records maintained. 27/10/06 • 4 OP7 OP8 14(2)(a) (b) 15 (2) (ad) 17 Schedule 3 Schedule 4 An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. The Registered Person shall maintain records as specified in Schedules 3 and 4. The Registered Person shall keep the service users plan under review. In that: Service users individual plans and records must be comprehensive, consistent and specific in detail of information. Be regularly reviewed and contain additional observation DS0000026204.V308911.R01.S.doc 27/10/06 Winchester House Version 5.2 Page 32 5 OP7 14(2)(a) (b) 15 (2) (ad) 17 Schedule 3 Schedule 4 and monitoring tools as would benefit the health and welfare of the service user. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. The Registered Person shall maintain records as specified in Schedules 3 and 4. In that: daily records must be maintained in such a way as to consistently reflect that staff are following the guidelines in a residents care plan. This is to provide evidence of the care provided and give sufficient detail on which to base the monthly review and to record and evidence staff are following the residents assessment of need. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 27/10/06 6 OP12 OP15 12 1 (a) 2 The Registered Person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users and so far as practicable enable service users to make decisions with respect to the care they are to receive and to their health and welfare. In that: 1. Service users with specific dietary and support requirements must have their needs clearly noted on their plans of care. Staff should be fully aware of them and be ready 27/10/06 Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 33 to offer assistance in the way and at the time service users chose or prefer. 2. Language and cultural barriers between staff and service users should be overcome to ensure that services users choices, needs and preferences in relation to daily living are understood and complied with wherever practicable. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 8 OP22 23 2(l) The Registered Person shall make sure suitable provision is made for storage for the purposes of the care home. In that: • Resident’s bathrooms/toilets are free of the homes stored items of equipment. • Suitable provision is made for storage for the purposes of the home. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 27/10/06 9 OP27 18(1)(a) The Registered Person shall having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that at all times staffing numbers and skill mix of qualified/unqualified staff is DS0000026204.V308911.R01.S.doc 31/10/06 Winchester House Version 5.2 Page 34 appropriate to the assessed needs of the residents. In that: An accurate review of staffing levels must be undertaken to ensure they are appropriate to the needs of service users at the home at all times. The result of this review and its methodology must be received by the CSCI by the given timescale, if not sooner This requirement is outstanding from the last inspection dated 07/02/06 but has been partly met. It is acknowledged that the home undertook one review of staffing levels dated March 2006 prior to the new services at the home being registered and becoming operational. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 10 OP27 18(1)(a) All staff employed in the dementia unit to be trained in dementia care. This requirement is outstanding from the last inspection and has been partly met in the homes current action plan. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 27/10/06 Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 35 11. OP30 18(1)(a) The Registered Person shall, having regard to the size of the care home, the statement of purpose and the needs of the service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. In that: Staff receives accredited training in manual handling. Partly met - included in the homes current action plan. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 27/10/06 12. OP30 18(1)(a) The Registered Person shall, having regard to the size of the care home, the statement of purpose and the needs of the service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the service users. In that: All staff receives accredited training in care planning and risk assessments. Partly met - included in the homes current action plan. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 27/10/06 Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 36 . 13. OP36 18(2) The Registered Person shall ensure that persons working at the care home are appropriately supervised. This requirement is outstanding from the last inspection. The home has made progress with this issue on their current action plan. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale stated. 27/10/06 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 OP1 2. OP1 Refer to Standard Good Practice Recommendations It is recommended that information regarding the light limitations in bedrooms 11-16 is included in both the homes Statement of Purpose and the Service Users Guide. A copy should be provided to The CSCI It is recommended that the manager reviews and revises the homes information documents to reflect her appointment and includes her experience and qualification details. A copy should be provided to The CSCI It is strongly recommended that the situation regarding residents having insufficient access to showering and bathing facilities is fully resolved to service users satisfaction on the YPD Unit. It is strongly recommended that a system be adopted to regularly monitor toilets and other areas in the home where unpleasant odour is likely to occur. It is strongly recommended effective quality assurance and monitoring systems based on a systematic cycle of DS0000026204.V308911.R01.S.doc Version 5.2 Page 37 3 OP21 4 5 OP26 OP33 Winchester House 6 OP33 planning- action – review are introduced. It is strongly recommended that the new manager confirms her intent with The CSCI to recruit two further Deputy Managers to ensure the management structure of the home is robust enough to cope with the growth in registered provision. This item should be added to the homes improvement plan. Winchester House DS0000026204.V308911.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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