Inspection on 07/12/06 for Windmill Court

This inspection was carried out on 7th December 2006.

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

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

Other inspections for this house

Windmill Court 10/07/08

Windmill Court 11/07/07

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Windmill Court St Minver Wadebridge Cornwall PL27 6RD Lead Inspector Kerensa Livingstone Key Unannounced Inspection 7th December 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 Windmill Court DS0000067809.V318011.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. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windmill Court Address St Minver Wadebridge Cornwall PL27 6RD 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) 01208 863831 01208 863831 Thomas Henry Mallaband Limited Fiona Jane Khouri Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability over 65 years of age of places (34), Sensory Impairment over 65 years of age (34) Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) named service user under the age of 65 years to be admitted. Date of last inspection Brief Description of the Service: Windmill Court is registered to provide personal care with nursing for up to 34 service users in the category of OP (Old age), PD (Physical disability) and SI (Sensory Impairment). The home is set within its own grounds just outside St Minver (approximately 5 miles from Wadebridge). All rooms are all single occupancy and have en-suite facilities, comprising toilet and wash hand-basin. The premises offer modern accommodation and level access throughout. There are lovely rural views from the rear of the home. The grounds comprise of a variety of garden areas, including an enclosed patio with a seating area in an inner quadrant which is accessible by wheelchair, there is a more formal garden with seating to the side of the property and a large wild/field garden to the rear with paths and seating. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection conducted over one full day by two Inspectors. The Inspectors had the opportunity to meet Service Users, relatives, staff, the Registered Manager and staff working within the home. Service User documentation, Policies and Procedures, record keeping and the environment were inspected. Five service user and seven relatives questionnaires were also gathered prior to the inspection. Since the last inspection a new Registered Manager (April 06) has been appointed and the home has new owners (July 06). The inspectors were concerned about the amount of change that the staff and service users appeared to have had to deal with over a short period of time. All the service users and visitors commented on the quality of the staff and the service that they aim to provide. There were several concerns about the numbers of staff on duty and that staff were under increased pressure to provide the same service with less resources. As part of this unannounced inspection, the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. The current fees for the home are £620 - £650. What the service does well: The Inspector believes that the Service Users are receiving a high standard of individualised care, incorporating their health, personal and social care needs. Service Users stated that their views and wishes are taken in to consideration in all aspects of care. The inspectors were impressed with the professionalism of the staff and Registered Manager and their hard work to ensure that the service users receive the best possible care. The lounges and dining room are comfortably furbished and decorated. Individual accommodation is provided in single rooms and are personalised. The service users enjoy the lifestyle that is offered including the social aspects of life at the home. Visitors are welcomed to the home. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 6 The Registered Manager is very experienced and capable of managing this home. Ms. Khouri has over seventeen years experience with care of the older person and is genuinely committed to supporting this group. A social history is compiled for each service user including family background, significant dates, career info, pets and personal achievements. The meals and snacks provided are of a very high standard. Service users are offered a varied, appealing and wholesome diet suited to individual requirements. The quality and choice of food is excellent. Snacks and homebaking is readily available, service users enjoy the meals and the social aspects of dining. What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User’s Guide are comprehensive documents, however they require updating and some additions. The Commission for Social Care Inspection has received no formal complaints about this home, however relatives have expressed their concerns regarding the staffing and increase in fees by the Registered Providers. The complaints log was inspected, the three complaints received related to concerns relating to a reduction in staffing. Some staff commented that they do not feel listened to by the new company and new systems are being implemented without any consultation. The ethos of the home appears to be changing from an integrated happy environment to a remotely managed business Equipment is sought on an individual basis, however twenty-seven of the beds are divan beds rather that high low beds used for nursing. It is recommended that all rooms be provided with nursing beds as required. Records must be stored in line with data protection legislation and to respect the service user’s confidentiality. Some gaps were noted in the servicing and routine maintenance of the equipment in the home. Environmental risk assessments must be completed. Staff must receive the training that they require e.g. induction, fire and POVA. Service users financial interests are safeguarded. Records must be stored in line with legislation to protect service users confidentiality. Food records must be kept. There has been a marked increase in the use of agency staff, the Registered Manager is attempting to recruit extra staff. Please contact the provider for advice of actions taken in response to this Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Windmill Court DS0000067809.V318011.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 Windmill Court DS0000067809.V318011.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Service Users are provided with comprehensive information to enable them to make their decisions, some additions and updating are required. Contractual information is provided to all service users. Admission to the home is based upon a comprehensive assessment undertaken by suitably qualified staff. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide, which are made available to prospective service users, this includes clear information regarding funding and fees. The Statement of Purpose is available in the reception area of the home. These documents require updating to include more information relating some areas e.g. qualifications and training for care staff, physical environmental standards (listed in NMS 1,1), individual room sizes. The Administrator ensures that the contents are clear to new admissions and their families or representatives. A copy of the service user’s Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 10 guide was observed in Service user’s rooms, this should include a copy of the most recent report. Service users confirmed that they had access to this document. The contract includes terms and conditions as required. All Service Users are provided with the contract and the Inspector observed completed documentation in home’s files. Service user and a relative confirmed that they had read the contract and were aware when changes occurred. Concerns have been expressed regarding the increase in fees from the 1st of January, this is the second increase this year. New Service Users are admitted following a full assessment incorporating the required information by a qualified nurse. The Inspector observed that families or their representatives and other professionals were involved in this thorough process. A plan of care is based upon this needs assessment. Intermediate care is not provided in this home; therefore this standard is not applicable. Windmill Court DS0000067809.V318011.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Inspector believes that the Service Users are receiving a high standard of individualised care, incorporating their health, personal and social care needs. Service Users stated that their views and wishes are taken in to consideration in all aspects of care. Concerns have been expressed that this high standard will be jeopardised if staffing levels are not maintained. EVIDENCE: Following the pre admission assessment, a plan of care is devised. New documentation is currently being implemented and records were in the process of being transferred over to the new system. Each service user has an individualised care plan, this is kept in their room, although this is due to be changed and most records held centrally in the office. Care plans are reviewed as required, but at least on a monthly basis and include assessment tools such as Waterlow Pressure Sore risk assessment, incontinence assessment and Prideaux nutritional assessment. A daily record is kept, this was observed to be mainly health and medical matters. There is evidence that service users and/or Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 12 their relatives are involved in the planning of the care. It is hoped that the existing good practice, of openness and service user led care planning, relating to recordkeeping is not lost with the new system. There is a keyworker system. All service users are registered with one of two General Practitioners and the staff reported good links with the Primary health care team, Physiotherapist, Macmillan nurses and the Community Mental Health team. Specialist advice is sought on an individual basis e.g. Parkinson’s Specialist nurse, Speech and language therapist. Service users are assessed to identify who is at risk of pressure sores and appropriate preventative action is taken when required. Specialist mattresses were evident in the home. Specialist equipment is provided on an individual basis. The assessment process includes the use of risk assessment tools that incorporate risk management strategies, for example the Tullamore Falls Risk Scale. The documentation inspected was regularly reviewed. Continence assessments are undertaken and service users are referred to the specialist nurse when required. Nutritional screening is also undertaken. A dentist will visit as required, the optician visits twice per year and there are regular visits from the chiropodist. Service Users informed the Inspector that their health needs were met, in a manner which they felt in control of and they had choices about who to see and when. Visiting healthcare staff comment favourably on the home. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 13 Qualified nurses under the Nursing and Midwifery Council (NMC) guidelines administer all medication to service users. The Medicine Administration Record (MAR) sheets were signed and dated appropriately. New sheets are to be introduced in January. There is a designated medicines trolley and a suitable facility for the storage of controlled drugs. Suitable storage is provided for the medicines. There is a drugs fridge that is kept locked and fridge temperatures are monitored. The Controlled Drug (CD) cupboard was checked, storage and records were found to be correct. There are policies relating to safe handling of medicines, however these are brief and require greater detail e.g. covert medication, safe disposal of medicines, NMC policy document. Two service users are self administering their medication and are provided with lockable storage. Staff were observed to treat service users with respect, speaking to them in a courteous manner, using preferred names and knocking on doors of bedrooms prior to entering. Service users stated that they are shown respect and they are able to make decisions about all aspects of their care, as if they were living in their own home. Staff were observed to be very attentive and helpful to individuals that they were caring for. Service users were taken to their rooms to be seen by the GP when he visited them. Service users may receive guests in any of the communal areas or in their own rooms. Service users wear their own clothes and the laundry system appeared to support this. All rooms are for single occupancy and may have a telephone installed should a service user wish (there is also a cordless phone available so service users can receive calls in private). The home has a written policy for the Care of the Dying, Last Offices and Terminal Care. The Inspector was advised that staff liaise closely with the family, GP and other professionals such as the Macmillan Nurse to ensure the holistic needs of the service user were met. Service Users and their families or representatives are encouraged to participate in the planning for and dealing with increasing infirmity, illness and dying. This is clearly documented within the care documentation. The home has its own syringe driver. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 14 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. The service users enjoy the lifestyle that is offered including the social aspects of life at the home. Visitors are welcomed to the home. The meals and snacks provided are of a very high standard, and are enjoyed by the Service Users. EVIDENCE: Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 15 Service users were very positive with regard their life style within the home. On the day of the unannounced inspection an outing to a local garden centre was taking place, Christmas shopping and afternoon tea was planned. There is a planned activity programme led by one of the senior carers; with activities varied from ‘group’ to ‘one to one’ sessions depending on individual needs and preferences. Activity afternoons are held in the home. Recent activities were listed as armchair yoga, armchair dancing, mobile library, 1:1 chatting in room, doing nails. Group activities are clearly ‘advertised’ within the home. The home has a good selection of books and games available to the service users. There is a hair salon in the home and the hairdresser visits the home on Wednesdays and Thursday morning. Several service users visited the hairdresser on the day of the inspection. Communion is held fortnightly for those who wish to attend. A record is kept for each service user of any activities they participate in. The inspector was informed that the amount of time that staff had to spend with service users had reduced recently, due to there being less staff being on duty. One relatives commented that ‘the staff are always friendly and happy and there is always something going on. A social history is compiled for each service user including family background, significant dates, career info, pets and personal achievements. The home has an open visiting policy, the Inspector was advised that visitors welcome at any reasonable time. Visitors were observed to be welcomed to the home on the day of the inspection, in a relaxed and friendly manner. Service users are able to maintain links with the community, visit family and friends as they wish. A Visitors Book is located in the reception area of the home. Service users are encouraged to handle their own affairs as they wish to and there is evidence of active family support. The administrator and inspector discussed the importance of service users have access to their money. Service users stated that they could choose how to spend their time, whether to stay in their room or participate in activities, when they wished to get up and go to bed. Service users are offered a varied, appealing and wholesome diet suited to individual requirements. The home offers a choice of three main meals at lunchtime (including a vegetarian option) along with an excellent selection of vegetables; there is also a choice of three puddings (one of which is always a milk pudding). Lunch was observed to be a relaxed and very sociable occasion, taken by many of the service users in the pleasant dining room. Service users were shown the three dishes available and could choose what they wanted, vegetables were individually served to the service users by the care staff; again enabling service users to have exactly what they wanted. On the day of inspection the choices were Sweet and Sour pork with rice, Cheese and Tomato or Celery, Pepper and Cheese Quiche with a selection of vegetables including cheesy leeks, baby carrots, cabbage, creamed and cheesy potatoes. This was followed by Apple Crumble with custard, Fresh Fruit salad Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 16 with cream or Tapioca. Service Users choose where they wish to eat and meals maybe taken in their room, as they prefer. Staff assisted service users in a quiet and discreet fashion. Fresh fruit is made available in communal areas. Biscuits and homemade cakes are provided with hot drinks during the day. A hot or cold alternative is offered at tea -time. Fruit, snacks and drinks are always available. The service users commented on the choice and high standard of food provided by the home. One relative commented that they were concerned the staff are often very busy especially at mealtimes and they understood that staff that have left have not replaced. The Head Cook has obtained her Intermediate Food Hygiene Certificate and the other Cook has the Foundation Food Hygiene certificate. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Relatives and service users are aware of the action to take if they are concerned about anything. There are concerns about staffing and the increasing fees, which have not been an issue at previous inspections. The complaints procedure must be updated to give clear and accurate information. All staff must be provided with training in the Protection of Vulnerable Adults. EVIDENCE: The home has a comprehensive Complaints Procedure that includes timescales and stages for the process. The complaints procedure in the Service user’s guide must be updated to include contact details for the local, not regional office and needs to include the Department for Adult Social Care. The inspector and Registered Manager discussed the statement that if the complainant were not happy with the result of the investigation, it would be referred to the CSCI, as this is misleading. Relatives and service users confirmed that they were aware of whom they could make any concerns known. The Commission for Social Care Inspection has received no formal complaints about this home, however relatives have expressed their concerns regarding the staffing and increase in fees by the Registered Providers. The complaints log was inspected, the three complaints received related to concerns relating to a reduction in staffing. The Protection of Vulnerable Adults policy and procedure has been reviewed since the last inspection, to provide clear instruction as to the steps to be taken in the event of an allegation of abuse. However it states that CSCI will Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 18 be informed by the Department of Adult Social Care, this must be done by the home under Regulation 37 of the Care Homes Regulations. Four staff are booked to attend the Social Services facilitated training. All staff must receive training on the Protection of Vulnerable Adults. The Registered Manager is due to complete the Trainers course facilitated by the Department of Adult Social Care in January. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users live in a safe, well-maintained environment that suit their individual needs. This home is comfortable and hygienic. EVIDENCE: The location and layout of the home is suitable for its stated purpose, providing a homely environment, with wide airy corridors and level access throughout. The home and gardens are maintained to a high standard. The gardens, including a sheltered courtyard are readily available to service users and there is wheelchair access. There is a full time maintenance/gardening person, jobs are listed in the maintenance book and these are promptly dealt with. All rooms are single and with the exception of one have an en-suite facility. One room has an allocated bathroom with a toilet. There are four communal toilets, one shower room and four bathrooms. The communal space comprises Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 20 of a good-sized dining room, lounge and conservatory with extensive gardens. Since the last inspection the lounge and dining room have been swapped over and this is working very well. Furnishings throughout are of a good quality and homely in nature. The lounge and dining room have been recarpeted since the last inspection. The communal areas appeared light and airy. There is a hair salon and designated staff accommodation and storage. The home offers level access throughout for service users; which can be easily negotiated by wheelchair. Handrails are provided throughout the corridors of the home, with grab rails provided in bathrooms and en-suites. Service users with mobility problems had been provided with a wide range of walking aids and frames to maintain independence. Equipment is sought on an individual basis, however twenty-seven of the beds are divan beds rather that high low beds used for nursing. It is recommended that all rooms be provided with nursing beds as required. An emergency call system is provided. Service user’s rooms were pleasantly furnished and rooms were carpeted. Rooms are personalised and homely. On moving into Windmill Court Service users are able to bring their own personal possessions and small items of furniture if it complies with fire and health and safety regulations. All rooms are provided with a lockable space, but only ten out of thirty four have a lockable room. Rooms are individually and naturally ventilated, with the window openings restricted. Radiators are uncovered, but have controlled temperatures, these are regularly checked. The maintenance man informed the Inspector that a separate boiler, which is maintained at 43 degrees C or below, controls the radiator and water temperatures. However two baths were observed to have ‘hot water’ signs where the water was regulated and the sinks in these two bathrooms was noted to have very hot water. Thermostatic valves regulate facilities that offer total immersion areas, such as baths and showers. The inspector was informed that these temperatures are checked. There is adequate natural lighting and the building is well ventilated. As recommended at the last inspection the Registered Persons should undertake a legionella risk assessment and this may involve contacting the Environmental health Officer for advice regarding legionella. There is an automated sluice, which is located away from service users facilities. There were no odours in the home on the day of the unannounced inspection. The home appeared clean and hygienic. The home employs separate cleaning and laundry staff, who were evident during the inspection. The laundry facility appeared well organised and suitable for purpose. There is plenty of ventilation and impermeable flooring. There is one commercial washing machine with sluice facility and one industrial dryer, this is supplemented by a domestic dryer and washing machine for fragile items. Suitable hand washing facilities were available, with liquid soap and paper Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 21 towels. Disposable gloves and aprons are provided for the staff. The home has an Infection control Policy. Windmill Court DS0000067809.V318011.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. Service users’ needs are met by capable and caring staff, who are genuinely committed to working with older people. Recruitment procedures are robust and aim to protect the service user. There are concerns about staffing amongst the service users, their relatives and the staff at the home. Structured skills for care induction standards are not completed within the required timescales. EVIDENCE: A recorded staff rota is kept and copies of recent duty rotas were supplied with the Pre-Inspection Questionnaire. A qualified nurse is on duty throughout the 24- hour period. On the day of the Unannounced Key inspection there was a qualified nurse and six carers in the morning, one qualified nurse and four carers in the afternoon and a nurse and two carers at night. This is for thirtyone service users. This is a reduction in the morning from seven or eight carers at previous inspections. Agency staff have been working at the home recently, fifty four shifts have been covered in an eight-week period, including trained nurses. No one under the age of eighteen is providing personal care to the service users. One relative stated ‘kind and friendly atmosphere, the home is very well run and the quality of care exceptional, but staffing levels could be increased’. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 23 Eighteen out of the twenty-two carers have achieved their National Vocational Qualification level 2, this equates to 81.8 . On the day of the inspection two staff were being presented with their badges for passing their National Vocational Qualification level 3. The Administrator demonstrated to the Inspector that the home operates a thorough recruitment process. Staff files were well maintained. The recruitment records inspected contained the required information including application Forms, contracts, Criminal Records Bureau checks and POVA first checks, training information and two written references. The inspector and administrator discussed that some of the staff had Criminal Records Bureau checks that had not been obtained by the home. These checks cannot be moved from one employer to another, since the inspection the inspector has been informed that these are all due to be redone. New staff are provided with a copy of the General Social Care Code of Practice and contracts of employment. Interview records are kept as recommended at the last inspection. Over twenty-two staff have left the home since the last inspection. Staff are provided with support and supervision on commencing work at the home. There is a designated staff member to support new staff. The induction programme must comply with the Skills for Care induction standards and be completed within the timescales. In house training is provided on a variety of issues recent training included diabetes, motor neurone disease, tissue viability, supporting people with dementia. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 24 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, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Registered Manager is very experienced and capable of managing this home. There has been a significant amount of change introduced to the home since the company bought Windmill Court, this appears to have caused significant uncertainty and depersonalised the way the home is run. The ethos of the home appears to be changing from an integrated happy environment to a remotely managed business. Service users financial interests are safeguarded. Records must be stored in line with legislation to protect service users confidentiality. EVIDENCE: The Registered Manager (Ms Khouri) is a first level registered general nurse and started at the home in April 2006. Ms. Khouri has considerable experience Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 25 having worked with Older People for over seventeen years, haematology and palliative care. She has obtained the English National Board (ENB) 237 in Oncology Nursing and the National Vocational Qualification level 4 Registered Manager’s Award. The Registered Manager has a job description and there are clear lines of accountability in the home. The Manager held a meeting with residents recently and minutes were taken. Regulation 26 visits are conducted monthly by a representative of the company who owns Windmill Court, the reports resulting from these visits are forwarded to the Commission for Social Care Inspection. Some staff commented that they do not feel listened to by the new company and new systems are being implemented without any consultation. The home circulated a quality assurance questionnaire in April to service users and relatives. The results were generally positive and the results were summarised and made available to staff. Policies and Procedures are reviewed annually. Staff sign to say they have read and understood the Policies and Procedures. Prompt action is taken by the home to meet recommendations and requirements. A new annual development plan is to be implemented by the new owners. Copies of any reviews conducted by the home must be supplied to the Commission for Social Care Inspection. Service users and their relatives were able to air their views to the inspectors. The home encourages service users to control their own money where possible, or to entrust this to the next of kin or Power of Attorney. The home holds monies on behalf of a small number of service users and receipts are provided for any expenditure made on their behalf. Several personal accounts were checked and found to be correct. The records were accurate with each account being kept in separate envelopes. There is a monthly invoice system. Valuable can be safely deposited in the safe and a receipt is provided to the Service User. Records are kept up to date. Service users records were observed to be kept in an open office and not in a lockable cabinet. A communication book is in use. Records must be stored in line with data protection legislation and to respect the service user’s confidentiality. A health and safety audit has been conducted recently and the action plan resulting from this is being formulated. Some gaps were noted in the servicing and routine maintenance of the equipment in the home. Two hoists were noted to need servicing at inspection, evidence of servicing has been provided since the inspection. Evidence of hard wiring and portable appliance testing was not available for inspection. Unlocked fire doors are not fitted with an alarm and must be risk assessed. Environmental risk assessments must be completed e.g. freestanding radiators. The loft access in the laundry should be included in the Fire Risk assessment for the home. There is a problem with a boiler in the home and the inspector was informed that a decision was awaited as to when the work can go ahead. The Fire Officer visited in June 2005, the Manager rang Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 26 to request a visit and was informed that a further visit was not planned at this time. The laundry was observed to be unlocked during the inspection and substances hazardous to health accessible. There are designated staff who take on key training roles, within the home there is a Fire Trainer, designated Health and Safety trainer and Moving and Handling trainer. Health and safety training is provided to staff. Staff must receive regular fire training four times a year for night staff and twice a year for day staff, this is not currently being provided. The maintenance person responds promptly to day-to-day requests. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 27 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 3 3 X X N/A 3 3 3 2 3 2 2 3 Standard No 7 8 9 10 11 Score 3 4 3 4 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, Sch. 1 Requirement The registered person provide a statement as to the matters listed in Schedule 1, keep under review and provide a copy to the Commission for Social Care Inspection. The service user’s guide must include a copy of the most recent report and terms and conditions in respect of accommodation to be provided for service users. The registered person shall maintain the records specified in Schedule 4 e.g. food records. The registered person shall make arrangements, by training staff to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered provider shall ensure that the persons employed receive training appropriate to the work they are to perform e.g. induction. The registered persons must ensure that the service user’s records are stored confidentially and in line with legislation. DS0000067809.V318011.R01.S.doc Timescale for action 01/03/07 2. OP1 5 01/03/07 3. 4. OP15 17(2) Sch. 4 13(6) 01/03/07 01/03/07 OP18 5. OP30 18(1c) 01/03/07 6. OP37 Data Protection Act 01/01/07 Windmill Court Version 5.2 Page 29 7. OP38 23(4d) 8. OP38 13(4c) The registered person shall make 07/12/06 arrangements for persons working at the care home to receive suitable training in fire prevention. The registered person shall 01/03/07 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated e.g.unalarmed fire doors. 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. 2. 3. 4. 5. Refer to Standard OP9 OP16 OP22 OP24 OP25 Good Practice Recommendations For the medicines policies and procedures to be developed to cover all aspects of the receipt, recording, storage, handling and administration of medicines. For the complaints procedure to be updated to include the required information. For high low beds to be provided for all service users who receive nursing care. For all service user’s rooms to be fitted with a lock suited to service users’ capabilities and accessible to staff in emergencies. The Registered Provider should contact the Environmental health Officer for advice regarding legionella and any action to be taken. Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Windmill Court DS0000067809.V318011.R01.S.doc Version 5.2 Page 31 - 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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