Inspection on 07/02/06 for Winchester House

This inspection was carried out on 7th February 2006.

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

The inspector 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 22/08/06

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 Sue McGrath Unannounced Inspection 7th February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 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.V282584.R01.S.doc Version 5.1 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 Barchester Healthcare Homes Limited Mrs Sian Mitchell 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.V282584.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Patients detained under Sections of the Mental Health Act may not be admitted to the home 28th September 2005 Date of last inspection Brief Description of the Service: Winchester House is a care home for older people with nursing needs and includes an EMI unit. Accommodation is provided on two floors with access by shaft lift to the first floor, many of the rooms have en-suite facilities. 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. The home has completed major extension works to the residential and dementia wings and now offers a total of 108 beds. Work has started on the new unit for Physically Disabled Younger Adults. This works is expected to be completed by the end of March 2006 when is will have the facilities to offer 15 beds. The final registration certificate will be issued when all of the outstanding work has been completed. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection under the terms of the Care Standards Act 2000 and took place on the 7th February 2006 between 10.00 and 17.30 hours. Two inspectors, Sue McGrath and Liz Baker, undertook the inspection accompanied by Sue Graham from Kent Social Services. The main focus of the inspection was on the progress of the home in meeting with requirements made at the last inspection, the general environment and the well being of the residents. The Inspectors agreed and explained the inspection process with the Registered Manager. Time was spent reviewing a sample of written policies and procedures, looking at care plans and records kept within the home. Many staff members and residents were spoken with during the course of the inspection. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Some standards were not inspected in full and the last report dated 28/09/05, should be read in conjunction to obtain a full picture. What the service does well: What has improved since the last inspection? Following concerns raised at the last inspection the inspectors focused an the physical care offered to the residents with particular emphasis on personal hygiene. This area of care was much improved and the residents looked well cared for. Some residents confirmed that ‘more drinks were on offer recently’. The administration of medication had improved from the last inspection. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 6 What they could do better: 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.V282584.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-6 Residents benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met; however this information is not always transferred onto care plans. Residents and families also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. Residents cannot be confidant their needs can be fully met at all times. EVIDENCE: Due to the ongoing building works the home’s Statement of Purpose was not viewed on this occasion, it will be viewed at the next inspection when it is expected the new wings will be fully operational and included in the document. Samples of the Service User Guides/ welcome packs were seen in the bedrooms and were found to contain detailed information about the home. Pre-admission assessments were seen in care plans and staff explained how a senior member of staff visited the prospective service user prior to admission. The assessments seen were in good detail and included personal preferences as well as physical needs. These personal preferences need to be transferred Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 9 to the individual care plans. Risks identified during the pre-admission assessment should have detailed risk assessment written when the new care plan is completed to ensure these risks are minimised where possible. Residents and/or family members were encouraged to view the home where possible. The first four weeks were seen as a trial period. Contracts were in place. Specialist equipment had been provided where a need had been identified and staff were mainly seen to interact well with service users. Due to lack of training and understanding in areas identified later (standard 30) in the report the inspectors were unable to confirm that all staff had the skills and experience to deliver the services and care which the home offers to provide. The home does not provide intermediate care. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Residents are put at some risk by inadequacies in the systems for care planning. Residents are treated with respect and their physical care has improved. Residents’ health care needs are mainly met. EVIDENCE: Following comments made at the last inspection regarding the physical appearance of the residents, a lot of time was spent with the residents checking their personal care and appearance. There was a marked improvement in the physical care offered to the residents. Several care plans were viewed and it was noted that the Manager had updated several, however residents (without dementia) spoken to, did not appear to be aware that care plans were held on them. Residents should be involved with the drawing up and reviews of their own personal care plans where possible. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 11 Comprehensive pre admission assessments were seen but critical information had not been transferred onto the care plan and risk assessments had not been accurately or appropriately completed. There appeared to be a lack of understanding on the completion and importance of accurate care planning by some members of staff. This highlighted an urgent need for comprehensive training and ongoing assessment. There needs to be clear protocols in place for the completion and importance of care planning. There also needs to be clear protocols as the level of responsibilities for all levels of staff. Catheter care was also closely inspected and again clear written protocols need to be in place for both care and nursing staff to ensure adequate care and attention is provided to residents with catheters. Another pre admission assessment indicated a prospective resident had several aspects of risk identified. In relation to skin integrity the resident had been assessed as very high risk but the inspector was unable to find any detailed care plan that instructed staff on an appropriate plan of care. Records were not dated or signed, so it was impossible to identify who had completed the paperwork. Staff confirmed that nursing staff normally complete the initial paperwork and this level of poor practise would not be accepted by the Nursing and Midwifery Council who clearly state that client records should be accurately dated, timed and signed, with the signature printed alongside the first entry. There was space on the forms for all of this information to be written. All areas of risk identified in the pre-admission assessment should have a plan of care in place to minimise those risks to both the resident and staff. The inspector does acknowledge that not all care plans were poorly written, but this issued must be addressed urgently, with all staff undergoing training to ensure all work to the same level of competence. During the course of the inspection some staff were observed manoeuvring residents inappropriately. When this was discussed with them it was apparent that the training offered in regard to moving and handling was poor. Staff confirmed that they watched a video and then worked alongside other staff to observe and copy their practise. This form of mentoring is only good if the mentors are providing good examples of techniques. Clearly this is not happening, as staff confirmed residents were often lifted up the bed without the appropriate equipment. This was also observed by the inspectors. The ‘drag lift’ was also observed; this lift has been identified as illegal by the high courts and should not be used. It places both the resident and staff at risk. It will be an urgent requirement that all staff be fully trained by a professionally qualified trainer in the correct methods of moving and handling. Some improvements were noted in the administration of medication. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 12 Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 13 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): 14. The other standards were assessed as met at the last inspection. Residents enjoy a good level of organised activities arranged by dedicated staff. Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Residents are encouraged to exercise choice and control over their lives where possible. Residents benefit from the appetising meals and balanced diet offered by the home and those service users requiring specialist diets are well catered for. EVIDENCE: Residents confirmed that staff treated them well and respected their dignity. Residents and staff also confirmed that, where possible, full choice over daily living skills and activities were actively encouraged. Some good interaction between staff and residents was noticed at times during the day, however several service user stated they sometimes had difficulty understanding some of the staff as their spoken English was not very good. The inspectors also observed this. The home must ensure that staff can communicate effectively with the service users. Good communications skills are vital to ensure safe practises are maintained. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 14 The other standards were assessed as met at the last inspection. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 15 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 and 18 The home had a clear complaints procedure and service user and relatives were aware of how to complain. Residents were protected by the home’s robust Adult Protection Policy. EVIDENCE: The home had a comprehensive complaints procedure in place and complaints were responded to promptly and in accordance with the homes procedures. The home also has a fast track system for complaints. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 16 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, 23, 24 and 26 Residents benefit from living in an extremely pleasant environment. The residents also benefit from having access their own en-suite rooms with sufficient additional toilets and spacious specialised bathrooms. The residents benefit from home’s laundry services, which are well organised and designed to control the spread of infection. The residents benefit from living in a home which is clean, pleasant and hygienic. EVIDENCE: The new wings had been built to a very high standard and the décor and fittings were excellent. Both wings had been commissioned and were in use. Relatives spoken with on the day spoke very highly of the new rooms and stated that they were very happy with the environment. Maintenance was Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 17 given a high priority. Almost all of the residents spoken with were very happy with their new rooms. Some of the rooms (16-11) had very limited view, as they were approximately four feet from a high grassy bank. This also affected the amount of natural sunlight in the room. Some of the residents in these rooms did not mind but other thought it made the rooms dreary. It will be a condition of the new registration that any resident offered one of these rooms are made fully aware of the lack of view and lighting prior to moving into the room. This information must also be reflected in the contracts for those particular rooms. The new garden areas were taking shape and by the spring would offer a very pleasant outside environment for all to enjoy. All of the rooms were en-suite with both toilets and showers; other toilets were also available throughout the home. The bathrooms provided were spacious and well equipped and well decorated. All of the new rooms meet with the specification for size and contents. All areas of the home were spotlessly clean and fresh. The laundry area was very spacious and very well designed and meet with all the requirements for good infection control. The home has several sluicing disinfectors around the home in appropriate places. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents are not receiving a consistency of care because of the home’s instability in staffing levels, particularly with regard to the availability of trained nurses. The care of residents is compromised because of the need for staff to receive further training in dementia care and manual handling and training generally needs to be given a higher priority. EVIDENCE: On the day of the inspection rotas indicated that there were sufficient staff on duty to meet the residents needs. However some residents did comment that staff were always rushed off their feet and could do with more help and at times they did not like to ask for help as staff were so busy The home will be required to reassess all of the service users to reflect their needs in accordance with the Residential Forum to ensure resident needs are fully met. This requirement will be carried over form the last inspection. Staff stated that there was a high turnover of staff still. Staff training was highlighted as an issue. Staff who worked on the dementia wing confirmed they had received no formal training in Dementia care as required from the last inspection. Some of these staff had experience of working with this client group before in previous employment. This is now very urgent. Failure to comply will be dealt with by enforcement action. It would Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 19 appear that often training had been booked and then had to be cancelled for varying reasons. Issues with the standard of Manual Handling training also need to be addressed urgently, as does care planning, risk assessment and catheter care training as highlighted earlier in the report. Without appropriate training it cannot be confirmed that staff are competent to ensure that they fulfil the aims and objectives of the home and the changing needs of the residents. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 37 The residents benefit from having a manager who has a clear development plan and vision for the home, which she effectively communicates to the residents, staff and relatives. The care of residents could be compromised because staff do not receive regular supervision. EVIDENCE: The Manager of the home was a qualified Nurse and also held an English Board Certificate in care for older people. She has many years of experience in the management of care homes and it was clear that she offered a clear sense of direction and leadership for staff. She was, as usual, open and positive about the service provided and had clearly worked extremely hard to ensure the smooth development of the home. The manager was recommended at the last inspection to reassess the management structure within the home to ensure Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 21 she is sufficiently supported by her senior staff. Work has started on looking at the structure and plans were in place to appoint a lead clinical nurse and a head of care. Staff supervision was discussed with some of the staff and with the manager. Different types of supervision were being used, ranging from group supervision to observation of working practises. The home must endeavour to record which staff have formal supervision and for those staff who do not attend group supervision, individual one to one supervision sessions must be given. Some of the supervision notes seen appeared to be team meeting notes, not personal supervision notes. It will remain a requirement that the home can evidence who is supervised and how often this takes place. Supervisors must undertake training in supervision skills to ensure appropriate supervision is given. The home has a wealth of Barchester Healthcare Ltd policies and procedures in place. Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X 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 4 4 X 3 3 X 4 STAFFING Standard No Score 27 2 28 2 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 X X 2 3 X X Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 18(1)(a) Requirement Service user dependency levels to be reassessed in accordance with the guidelines from the residential forum to ensure adequate numbers of staff are employed. Information required by March 31st 2006. This requirement is outstanding from the last inspection. Staff employed in the dementia wings to be fully trained in dementia care. Details required by March 31st 2006. This requirement is outstanding from the last inspection. Care plans to be reviewed to include service user wishes over personal care. Wishes to be acted upon. Action plan required by March 31st 2006. This requirement is outstanding from the last inspection. DS0000026204.V282584.R01.S.doc Timescale for action 31/03/06 2. OP27 18(1)(a) 31/03/06 3. OP7 12(2) 31/03/06 Winchester House Version 5.1 Page 24 4. OP36 18(2) 5 OP30 18(1)(a) 6 OP30 18(1)(a) 7 OP30 18(1)(a) The registered person shall ensure that persons working at the care home are appropriately supervised. Action plan required by March 31st 2006. This requirement is outstanding from the last inspection. 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 receive accredited training in manual handling. 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 receive accredited training in care planning and risk assessments. 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 receive training in DS0000026204.V282584.R01.S.doc 31/03/06 31/03/06 31/03/06 31/03/06 Winchester House Version 5.1 Page 25 catheter care. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 26 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. Extracts may not be used or reproduced without the express permission of CSCI Winchester House DS0000026204.V282584.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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