Inspection on 14/06/06 for Windsor Court

This inspection was carried out on 14th June 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

Windsor Court 12/02/08

Windsor Court 31/10/07

Windsor Court 15/06/07

Windsor Court 09/01/07

Windsor Court 18/11/05

Windsor Court 26/08/05

Windsor Court 21/02/05

Windsor Court 22/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Windsor Court 34 Bodorgan Road Bournemouth Dorset BH2 6NL Lead Inspector Marjorie Richards Key Unannounced Inspection 14th June 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 Windsor Court DS0000032192.V293140.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. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Windsor Court Address 34 Bodorgan Road Bournemouth Dorset BH2 6NL 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) 01202 554637 01202 297554 info@win-court.co.uk www.win-court.co.uk Lyndale Healthcare Ltd Mrs Margaret Glanville Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th November 2005 Brief Description of the Service: Windsor Court is located in a quiet tree-lined road in a residential area some three quarters of a mile from Bournemouth town centre with all the facilities that can be expected in a large town, e.g. banks, post office, shops, library and places of worship. Getting to the town centre requires negotiating a steep hill as does accessing public transport although the nearest bus stop is within 200 yards of the home. Windsor Court was originally a grand gentlemens residence before being converted to a hotel and still retains many of the features and appearance of a building that was used for that purpose, although it is now registered as a care home, providing personal care for up to 42 older people. The home has a wheelchair accessible entrance area with a small lounge bar adjacent to the generous hallway. Further communal areas, comprising the spacious dining room, TV and quiet lounges are all located on the ground floor and furnished much as if the premises was still a hotel. All rooms have high ceilings and big windows. There is a good-sized, secluded and level garden at the rear of the home that is mainly laid to lawn, surrounded by mature trees and a large car parking area at the front for visitors. Windsor Court is owned by Lyndale Ltd, a family business. A five-year refurbishment plan is currently in progress, which is updating facilities and improving the standard of accommodation. Residents accommodation is located on the lower ground, ground, first and second floors of the home with access between floors via a wide staircase, passenger or stair lifts. Aids and equipment are available for residents who may have disabilities. The home is centrally heated throughout. All of the forty-three bedrooms are for single occupancy, with thirty-eight having their own en-suite WC and bathing facilities. The remaining five comprise two pairs of bedrooms, with each pair sharing the en-suite facilities and one room that has an en-suite WC and wash hand basin. Windsor Court provides 24-hour personal care, all meals, laundry and domestic services. Residents are encouraged to participate in a range of activities organised in the home. An inter-denominational religious service takes place in the home every Sunday. The current scale of charges ranges from £431 to £625 per week. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 9.75 hours on the 14th June 2006 and was carried out by two Inspectors. The purpose of this year’s first annual key unannounced inspection was to review all key National Minimum Standards, review progress in meeting the 8 requirements and 6 recommendations that had been made at the previous inspection and to check that the residents living at Windsor Court were safe and properly cared for. A tour of the premises took place and records and related documentation were examined including the care records for five residents. Time was spent observing the interaction between residents and staff, as well as talking with thirty-two residents, the majority in the privacy of their own bedrooms. The daily routine and mealtimes in the home were also observed during the inspection. Discussion also took place with Mrs Margaret Glanville (registered manager,) Mr James Glanville (on behalf of Lyndale Healthcare Ltd.), the two Senior Assistant Managers and some of the staff on duty. The pre-inspection questionnaire, sent to the home before the inspection for completion, was returned with accompanying documentation as requested. The Inspectors were made to feel welcome in the home throughout the visit. As part of the inspection process, comment cards were distributed to the care home for completion by residents, relatives, G.P.s, health and social care professionals etc. The following comment cards were received; 12 from residents, 5 from relatives, 3 from care managers, 1 from a healthcare professional and 2 from General Practitioners. All expressed satisfaction with the care provided. What the service does well: From time spent with residents it is clear that they feel comfortable and relaxed with most staff and appreciate their friendly approach. Staff were observed throughout the inspection to be interacting with residents in a relaxed and caring manner and treating residents with courtesy, patience, kindness and respect. Residents are able to go to their rooms at any time, thereby offering an opportunity to be on their own if they wish, or allowing privacy for any visitors or personal care needs. Residents are able to choose their own lifestyle within the home and their individual preferences and routines are respected. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 6 Residents commented, Everyone is very friendly here. I think the staff do a good job. If I want to be on my own, I can be. The staff respect my wishes. Open visiting arrangements are in place and residents are encouraged to maintain contact with family and friends and the wider community. Residents are generally satisfied with the choice and standard of food, which provides a balanced diet. The majority of residents feel the food provided is of good quality. Residents commented, I think the food is very good indeed. They are very willing to make a special effort and get what you ask for. The food is nice. There is no shortage of anything. A system is in place for dealing with any complaints. Residents are confident complaints would be listened to and dealt with appropriately. Inspection of the premises and contact with residents confirmed the home is routinely kept clean, with no unpleasant odours. Windsor Court has achieved the recommended minimum ratio of 50 trained members of care staff at NVQ level 2, to help ensure residents are in safe hands. The home regularly reviews its performance and actively seeks the views of residents, staff and relatives to ensure Windsor Court is run in the best interests of residents. Systems are in place to ensure that residents have their financial interests safeguarded. What has improved since the last inspection? Care plans are now being regularly reviewed and evidence was seen on some care plans of involvement with residents and/or relatives. Following visits by the Commission for Social Care Inspection Pharmacist Inspector, significant improvements have been made in the arrangements for the recording, handling and administration of medicines in the home. Records indicate that residents are receiving their medicines as prescribed. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 7 What they could do better: More detailed information is required in the homes pre-admission assessments to ensure that only those prospective residents whose needs can be met are offered places at Windsor Court. Windsor Court has a care planning system in place, but this does not always provide staff with the information they require to meet the health and personal care needs of residents. Risk assessments were viewed and found to be poorly completed, not detailing sufficiently the actions to be taken to minimise any such risks. At the two previous inspections, residents commented that they would like to see a wider range of activities available at Windsor Court. No further progress has been made in ensuring residents have the opportunity to participate in a range of organised activities that provide opportunities for stimulation and socialisation. A requirement for Adult Protection training, to ensure a proper response to any suspicion of abuse, was first made following the inspection in August 2005. Discussions with staff and examination of records show this has still not been achieved for all staff. This means arrangements for protecting residents are still not satisfactory, placing them at possible risk of harm or abuse. Windsor Court is an attractive period property, which has been adapted for use as a residential care home. However, the standard of accommodation in many areas is looking rather tired. Much of the paintwork in corridors is badly chipped. There are currently insufficient storage areas available for equipment, such as wheelchairs. (Plans are in hand for a complete refurbishment of Windsor Court, which will include redecoration and recarpeting throughout, the covering of all radiators for resident safety and the provision of new assisted bathrooms, additional communal areas and storage space.) In general, residents and staff feel that the staffing levels are satisfactory, although at busy periods of the day there are sometimes delays, especially after lunch when taking residents back from the dining room. This was evidenced by the Inspectors, who observed one resident left waiting in their wheelchair in the dining room for assistance, whilst some staff were taking their lunch break. Practices in relation to recruitment of staff need improvement as residents are potentially placed at risk through a failure to always carry out appropriate checks before staff commence working in the home. The staff training and development programme has yet to be completed, to ensure staff are suitably trained and competent to carry out their work. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 8 Mrs M. Glanville is not currently carrying out her role as registered manager and is not in full-time day-to-day charge of the care home. A new manager has been appointed and will be seeking registration with the Commission. A formal staff supervision system has been commenced, as a means of ensuring good practice, but this is not always being implemented at the recommended intervals. Environmental issues and some working practices do not always ensure that the health, safety and welfare of residents and staff are promoted and protected, therefore leaving them potentially at risk. For instance, a number of bedrooms do not have a bedside or overbed light, creating difficulties for some residents at night. The threshold strip at the entrance to some bedrooms is missing, creating potential tripping hazards. Staff were observed to sometimes leave potentially harmful cleaning materials unattended and accessible to vulnerable residents. 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. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable at Windsor Court. Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Windsor Court. More detailed information is required in the homes pre-admission assessments to ensure that only those prospective residents whose needs can be met are offered places at Windsor Court. EVIDENCE: Individual care records are kept for each resident and five of these were examined, including those of recently admitted residents. Where the Local Authority makes placements at Windsor Court, assessments are carried out by care management personnel from the funding authority and these are passed on to the home prior to admission. Mrs Glanville confirmed that the home always carries out its own pre-admission assessment for all prospective residents to determine whether the home can meet their care needs. The records demonstrate that prior to moving to Windsor Court, such preadmission assessments have taken place. However, the form used for this Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 11 purpose does not always provide sufficiently detailed information and is not always signed and/or dated. Following the homes pre-admission assessment, a letter of confirmation is written to the prospective resident so that they may feel assured their care needs will be met. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Windsor Court. Windsor Court has a care planning system in place, but this does not always provide staff with the information they require to meet the health and personal care needs of residents. Procedures for administering medicines have been improved to ensure the protection of residents. Residents say they are comfortable with the friendly approach of staff and are satisfied with the way that most staff deliver their care and respect their privacy and dignity. EVIDENCE: Care plans are intended to provide staff with the information they require to meet the health, personal and social care needs of residents. Each resident has his or her own individual plan of care, but following examination of five care plans, it could not be evidenced that sufficient or relevant information was always available to clearly direct the care staff. For example, one care plan Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 13 examined for a resident with high dependency needs states, Clean mouth after every meal. Continue oral hygiene and keep mouth moist and clean. There is no clear instruction to staff as to how this is to be achieved. Fluid charts observed in this residents bedroom had not consistently recorded the amounts of fluids. The daily reports document staff observations and changes in residents needs. However, information is not always recorded to demonstrate that action has been taken to meet these identified needs. Risk assessments are in place, but those seen were poorly completed on a form providing little space for detail. For example, an Assessment of Risk to Resident and Staff listed: Toileting = pads and commode. Transfers = hoist plus 2 carers. This does not assess the risk to the resident or staff and does not detail sufficiently the actions to be taken to minimise any such risks. There is little evidence to demonstrate that residents psychological, social or religious needs have been recognised and appropriate support provided, as necessary. Care plans are now being regularly reviewed. Care plans should be agreed and signed by the resident or their representative wherever possible. Evidence was seen on some care plans of involvement with residents and/or relatives. Residents have access to health care services. There was evidence of visiting healthcare professionals eg GPs, district nurses and chiropodists etc. The newly appointed Senior Assistant Manager demonstrated an awareness of the shortfalls in care planning and is currently undertaking a review of all care plans and making improvements. Following visits by the Commission for Social Care Inspection Pharmacist Inspector, significant improvements have been made in the arrangements for the recording, handling and administration of medicines in the home. Records indicate that residents are receiving their medicines as prescribed. Residents are able to go to their rooms at any time, thereby offering an opportunity to be on their own if they wish, or allowing privacy for any visitors or personal care needs. From time spent with residents it is clear that they feel comfortable and relaxed with most staff and appreciate their friendly approach. Staff were observed throughout the inspection to be interacting with residents in a relaxed and caring manner and treating residents with courtesy, patience, kindness and respect. Residents commented, Everyone is very friendly here. I think the staff do a good job. If I want to be on my own, I can be. The staff respect my wishes. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Windsor Court. The activities currently provided are not sufficient to meet the range of stimulation that residents wish for. Open visiting arrangements are in place and residents are encouraged to maintain contact with family and friends and the wider community. Residents are able to choose their own lifestyle within the home and their individual preferences and routines are respected. Residents are generally satisfied with the choice and standard of food, which provides a balanced diet. EVIDENCE: At the two previous inspections, residents commented that they would like to see a wider range of activities available at Windsor Court. No further progress has been made in ensuring residents have the opportunity to participate in a range of organised activities that provide opportunities for stimulation and socialisation. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 15 Mr Glanville says plans are being made to consult residents about the activities they would like to see and collating this information about each residents background, social history, previous hobbies and interests etc. Such information will help ensure that the activities to be provided at Windsor Court will be meeting the individual needs, preferences and expectations of residents. Residents commented, It gets monotonous sitting in the lounge. The activities are bingo and someone who sings. I would like to see more activities. We have some entertainment, people that come and sing sometimes. There is bingo, but I would have to be desperate to do that. There is not enough going on, nothing much to do. It would be nice to get out sometimes. Mr Glanville says visitors are made welcome at any reasonable time. Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. A few residents are able to go out of the home alone and others with their families or friends. A telephone is available for any residents wishing to make phone calls. A number of residents have their own telephones installed in their bedrooms and Mr Glanville says several also have mobile phones so they are easily able to keep in touch with relatives and the wider community. Residents are encouraged to choose their own lifestyle within the home and make choices wherever possible. These include choosing when to get up or go to bed, what to wear, how to spend their time, what to eat or drink and also freedom to come and go as they please. They are able to bring their own possessions into the home to personalise their bedrooms. Residents confirmed that their individual preferences and routines are respected. One resident commented, I can please myself what I do, when to get up or go to bed, but I prefer to stay in my room most of the time. The home has a policy and procedure in place regarding the residents right to access their records if they wish. Personal records were seen to be kept securely, with due regard for confidentiality. Residents have three meals a day but the main meal is provided at lunchtime. In the spacious dining room, lunch was served in a relaxed, unhurried atmosphere with discreet staff assistance provided wherever necessary. 26 residents chose to eat their lunch in the dining room, but residents may also eat their meals in the TV lounge, bar area or in their bedrooms. The recently appointed chef demonstrated knowledge of individual likes/dislikes and said alternatives could always be provided to suit individual taste and preference. The menu shows that residents enjoy a healthy, well-balanced diet. Special diets can be catered for. Lunch on the day of inspection was as follows: - Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 16 Asparagus soup, followed by roast breast of chicken with barbecue sauce / or omelette; with creamed or new potatoes, peas and mushrooms. Apricot and almond sponge with custard or cream, or tapioca pudding. The majority of residents felt the food provided was of good quality. Residents commented, I think the food is very good indeed. They are very willing to make a special effort and get what you ask for. The food is nice. There is no shortage of anything. There was some suggestion that, on occasion, cooked meals conveyed to bedrooms did not always remain hot by the time they were served. Mr Glanville will check this to ensure meals remain hot when served away from the dining room. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Overall quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Windsor Court. A system is in place for dealing with any complaints. Residents are confident complaints would be listened to and dealt with appropriately. Residents remain at possible risk of harm or abuse, as action is still being taken to ensure that all staff have received training in Adult Protection issues. Such training is needed to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents. A copy of the complaints policy is also available to all visitors in the entrance hall. Mr Glanville confirmed that no complaints have been received by the home since the last inspection. Contact with residents demonstrated they would feel able to voice a complaint and feel their concerns would be taken seriously, and acted upon. Comments included: If I was worried about anything I would tell someone straight away. The staff are very approachable if you have a problem.” The home has an Adult Protection policy in place to protect residents from possible abuse. This makes reference to the Department of Health No Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 18 Secrets guidance, which is also available to staff. The requirement for Adult Protection training, to ensure a proper response to any suspicion of abuse, was first made following the inspection in August 2005. Discussions with staff and examination of records shows this has still not been achieved for all staff. This means arrangements for protecting residents are still not satisfactory, placing them at possible risk of harm or abuse. Bournemouth Borough Council social services directorate is currently investigating two Adult Protection referrals. Mr Glanville says that Adult Protection training is now in progress for all staff and will be completed shortly. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Windsor Court. Windsor Court provides a comfortable environment for residents. Considerable investment is planned for the future improvement and refurbishment of the home. Windsor Court is clean with no unpleasant smells, making daily life more pleasant for all in the home. EVIDENCE: Inspection of the premises confirms that routine maintenance is being carried out. Maintenance records are kept and maintenance staff ensure prompt attention to any defects identified. Records also demonstrate regular servicing of equipment, such as hoists, passenger lift and stairlifts to help ensure a safe environment for residents. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 20 Windsor Court is an attractive period property, which has been adapted for use as a residential care home. However, the standard of accommodation in many areas is looking rather tired. Much of the paintwork in corridors is badly chipped. There are currently insufficient storage areas available, resulting in items such as wheelchairs and a clinical waste bin being left in corridors and a commode and stepladder being stored in the ground floor bathroom. One resident commented, This place used to be rather grand when I first came here, but now it is getting a bit shabby. I put up with it because I like the people here. Another resident said, Everything is excellent. We all have a standard of living and I could not be happier. (Comment card) Plans are in hand for a complete refurbishment of Windsor Court, which will include redecoration and re-carpeting throughout, the covering of all radiators for resident safety and the provision of new assisted bathrooms, additional communal areas and storage space. Mr Glanville says he hopes this work will commence during 2006. The laundry is sited on the lower ground floor and a member of staff is dedicated to managing the personal laundry of residents. The laundry is equipped with washing machines that have sluice programmes and are able to operate at 65ºC for a minimum of ten minutes. Although an infection control policy is in place, the laundry floor surface is not impermeable for ease of cleaning and there are no hand washing facilities available for staff. On the lower ground floor, incontinence pads were found to be stored on open shelving. The hot tap in the staff WC did not turn off properly. Suitable facilities and procedures are in place in respect of the disposal of clinical waste. Hygienic hand gel is available at various points around the home and is used to help minimise the possible spread of infection. Residents spoke highly of the laundry service and standard of cleanliness within the home. They keep the home very clean, which is not easy in an old building like this. The laundry service is very reasonable and prompt too. I have no complaints about it. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 21 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 and 30 Overall quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Windsor Court. Sufficient staff are on duty to provide care to residents, although at busy times, some residents said they sometimes had to wait for assistance. Windsor Court has achieved the minimum ratio of 50 trained members of care staff at NVQ level 2, to help ensure residents are in safe hands. Practices in relation to recruitment of staff need improvement as residents are potentially placed at risk through a failure to always carry out appropriate checks. The staff training and development programme has yet to be completed, to ensure staff are suitably trained and competent to carry out their work. EVIDENCE: Examination of the staff rota, discussion with residents, Mrs M. Glanville, managers and staff, as well as observation throughout the inspection, demonstrated a sufficient number and skill mix of staff to meet the current needs of the 38 residents accommodated. However, the majority of residents have high/medium dependency needs, so staffing levels will need to be kept constantly under review. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 22 On the day of inspection, five senior care assistants and three care assistants were on duty in the morning and three senior care assistants and three care staff during the afternoon and evening. From 7.45 p.m. until 8 a.m. there were three wakeful night care staff on duty, including two senior care assistants. In addition, at least one member of the management team is on duty each day and available on call at all other times. The home also employs chefs and kitchen staff, housekeeping/domestic and maintenance staff. In general, residents and staff feel that the staffing levels are satisfactory, although at busy periods of the day there are sometimes delays. Residents commented, The staff are generally very caring and helpful. Staff are hard pressed and have a tremendous amount to do. There are enough staff. Sometimes there can be a wait if they are busy, but that is okay. If you need help, they usually come quite quickly. Sometimes if they are very busy it can take a while. At times, staff can be rushed. They do their best for you. The staff are excellent. They (staff) are very patient and dedicated, you couldnt find a better set of people. The staff team includes individuals from countries other than the United Kingdom and the home has a written policy about equal opportunities. In addition, all staff are given a copy of the General Social Care Council Code of Practice for Social Care Workers. This states that staff should, work openly and cooperatively with colleagues, treating them with respect and promote equal opportunities for residents and carers, respecting diversity and different cultures and values. Discussions with staff show that they work well together and find colleagues friendly and supportive. We all work well together as a team, we all help each other. Staff feel that, in general, enough staff are on duty but not always after lunch when taking residents back from the dining room. This was evidenced by the Inspectors, who observed one resident left waiting in her wheelchair in the dining room for assistance, whilst some staff were taking their lunch break. At present, Windsor Court employs 23 care staff. Of these, 12 have achieved NVQ level 2 or level 3 training, which means the home exceeds the recommended minimum ratio of 50 trained members of care staff at NVQ level 2, to ensure residents are in safe hands. Documentation demonstrates that the home is still not operating a thorough recruitment procedure to ensure the protection of residents. The three staff files examined showed that the necessary documentation, e.g., full employment history, POVA check, a statement by the person as to his mental and physical health, two written references etc, had not been obtained. Where staff are coming from abroad, the files demonstrate that appropriate information is gathered about the right to work in the UK and any possible Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 23 restrictions on that work. However, one file examined showed that the permit was only valid until 30/11/05. At the last inspection, it was recommended that a training audit be carried out, to demonstrate that all staff have received the training they need to have the knowledge and skills necessary to carry out their work. This should include moving and handling, Adult Protection, first aid, health and safety and infection control. This has not yet been fully achieved, although some training has taken place. There has been no further progress in developing the homes induction and foundation training programme, in line with the Skills for Care Common Induction Standards, as discussed at the last inspection. It is expected that a structured staff training and development programme, including induction training, will be implemented shortly and will be examined at the next inspection. Further information about training can be obtained from: www.picbdp.co.uk This is the Partners in Care web site and provides lots of information about funding streams for training including NVQ, Life skills and Leadership & Management. www.skillsforcare.org.uk This is the Skills for Care web site and there are downloadable knowledge sets and learning logs for: Dementia, Infection Control, Medication, Workers not involved in direct care. These knowledge sets are the first 4 of approximately 30 that are currently planned. They identify learning outcomes and are designed to be used alongside the Common Induction Standards, which are also available from this web site. www.traintogain.gov.uk This is a programme and funding stream supported by the Learning and Skills Council and Business Link, who provide a skills brokerage role. www.lsc.gov.uk/bdp/employer/eggt_intro.htm This is the Employer Guide to Training website, which is aimed at assisting employers to choose the most suitable training provider to meet their workforce needs by the use of a search facility. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Overall quality in this outcome area is poor. This judgement has been made using available evidence including a visit to Windsor Court. Mrs M. Glanville is not currently carrying out her role as registered manager and is not in full-time day-to-day charge of the care home. A new manager is shortly to be appointed. Windsor Court regularly reviews its performance and actively seeks the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Systems are in place to ensure that residents have their financial interests safeguarded. A formal staff supervision system is in place as a means of ensuring good practice etc, but this is not always being implemented at the recommended intervals. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 25 Environmental issues and some working practices do not always ensure that the health, safety and welfare of residents and staff are promoted and protected, therefore leaving them potentially at risk. EVIDENCE: The staffing roster continues to show a reduced presence by the registered manager, although other members of the management team are available in the home. Mrs Glanville has not yet undertaken the NVQ level 4 in management and care. She is seeking retirement from the role of manager, although she will continue to have involvement in the running of the home. At the last inspection, Mr Glanville discussed planned changes in the management structure of the home and it is hoped that these will be completed next month when a new manager takes up her appointment and will be seeking registration with the Commission for Social Care Inspection. Mr Glanville and the management team are working hard to implement a number of planned improvements. The home will benefit from the overall guidance and sense of direction that a new manager will bring. Mr Glanville says the new manager will pay prompt attention to the issues raised in this and previous inspection reports. Staff feel the present management team to be supportive, The assistant managers are not afraid to roll up their sleeves and help staff if necessary. Mr Glanville is very approachable. Members of the management team and staff frequently spend time talking with residents informally to obtain their views. Residents and relatives complete quality Assurance questionnaires annually. Comments or suggestions are discussed and a plan drawn up to action these wherever possible. Mr Glanville says a new quality assurance questionnaire will be sent to residents, relatives and other visitors to the home within the next few weeks. It is hoped to view the results of this questionnaire at the next inspection. Monthly staff meetings provide opportunities for staff to express their views and ideas. The minutes are displayed on the staff notice board. In addition, twice yearly social occasions are held, where staff and management can get together as part of a teambuilding exercise. On the day of inspection, staff were looking forward to just such an event, an evening meal in a local restaurant. The majority of residents either manage their own financial affairs or have relatives and/or representatives to assist them. The home holds some monies for residents. A record is kept showing all deposits and withdrawals and entries are signed by the resident. Receipts are retained, as necessary. One Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 26 record was checked and found to be accurately maintained. All monies and related records are held securely. Care staff should receive formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. Staff supervision is taking place but not always at the recommended intervals, i.e. six times a year. Meetings held to discuss disciplinary issues should not be counted as formal supervision sessions. Staff appraisals are carried out annually to assess any training needs, ensure staff are fulfilling their role satisfactorily and are meeting the needs of residents. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, portable electrical appliances etc are regularly serviced and maintained. Detailed maintenance records are kept and maintenance staff ensure prompt attention to defects etc, whenever necessary. Fire records show appropriate checks being carried out within the home. Suitable arrangements are in place for specialist servicing of the fire warning system, emergency lighting and fire fighting equipment. However, some issues did raise concerns about risks to resident safety, e.g., unguarded radiators and pipework. Mr Glanville says it is intended to fit guards to all radiators as part of the planned refurbishment and completion of this task will be made an early priority. It was also noted that a number of bedrooms do not have a bedside or overbed light, creating difficulties for some residents at night. The threshold strip at the entrance to some bedrooms is missing, creating potential tripping hazards. Staff were observed to sometimes leave potentially harmful cleaning materials unattended and accessible to vulnerable residents. All substances that could be potentially hazardous to health must be handled and stored safely. Although evidence was seen that moving and handling training has now been provided for many care staff, this has not always ensured good practice within the home. During the inspection, staff were observed moving a resident to a chair using a handling belt. No attempt was made to explain to the resident beforehand what was going to happen, or to talk her through the move properly. Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 1 Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement The registered person must ensure that new residents are admitted only on the basis of a full assessment. Pre-admission assessments undertaken by the home must be fully documented and contain the information detailed in this Standard. (Previous timescale of 28/02/06 not met). All aspects of each resident s health, personal and social care needs must be recorded and regularly reviewed, at least monthly. Care plans are to be agreed and signed by the resident or their representative wherever possible. (Previous timescale of 28/02/06 not met). Health care needs must be fully documented in each residents care plan. These should include detailed risk assessments and careful completion of any necessary documentation, e.g., fluid monitoring and dietary intake charts where risks have been identified with eating and drinking. DS0000032192.V293140.R01.S.doc Timescale for action 30/09/06 2 OP7 14 and 15 30/09/06 3 OP8 17(1)(a) 12(1)(a) 30/09/06 Windsor Court Version 5.1 Page 29 4 OP12 16(2)(m) and (n) 5 OP18 13(6) Arrangements must be made to ensure residents have opportunities to participate in a range of activities that provide stimulation and socialisation. It is required that all staff receive suitable training in Adult Protection issues, to ensure a proper response to any suspicion or allegation of abuse. (Previous timescales of 31/12/05 and 28/02/06 not met). It is a requirement that all parts of the home are kept reasonably decorated. It is a requirement that suitable provision is made for storage. This includes incontinence pads, which should not be stored on open shelving. The registered person must not employ staff to work with residents until satisfactory checks have been carried out. (Previous timescale of 28/02/06 not met). A detailed training and development programme must be completed, to ensure staff have the training necessary to carry out their work. This should include induction training, moving and handling, Protection Of Vulnerable Adults, health and safety, basic first aid, food hygiene and infection control. It is a requirement that arrangements are made to ensure the registered manager is in full-time day-to-day charge of the care home. (Previous timescale of 28/02/06 not met). 30/09/06 30/09/06 6 7 OP19 OP26 23(2)(d) 23(2)(l) 31/12/06 30/09/06 8 OP29 19(1) 31/07/06 9 OP30 18(1) 30/09/06 10 OP31 8 and 9 31/07/06 Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 30 11 OP31 9(2)(b)(i) It is a requirement that the registered manager has the qualifications, skills and experience necessary for managing the care home. The registered manager should obtain an NVQ level 4 in management and care, or equivalent. (Previous timescale of 31/12/06 still current). The registered person must ensure that staff are appropriately supervised. Formal supervision should take place at least six times a year. (Previous timescale of 28/02/06 not met). The registered person must ensure that the home is kept free from unnecessary risks to residents safety. Potentially harmful chemicals and cleaning fluids must be kept under lock and key and not left unattended when in use. The registered person must ensure that suitable lighting, including bedside lighting, is provided for residents. The registered person must ensure that a safe system for moving and handling residents is in place. Where training has been provided, the registered person must monitor staff to ensure this is being implemented satisfactorily. 31/12/06 12 OP36 18(2) 30/09/06 13 OP38 13(4)(a) (c) 31/07/06 14 OP38 23(2)(p) 30/09/06 15 OP38 13(5) 30/09/06 Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is recommended that, where possible, further information about each residents background, social history, previous hobbies and interests etc. is recorded, to ensure that the activities on offer at Windsor Court will be meeting the individual needs, preferences and expectations of residents. It is recommended that consideration be given to further measures to improve hygiene and infection control in the laundry. E.g., by ensuring floor surfaces are impermeable and easily cleanable and hand-washing facilities are available for staff. It is recommended that, as refurbishment takes place, the guarding of radiators be made an early priority, to ensure resident safety. 2 OP26 3 OP38 Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Windsor Court DS0000032192.V293140.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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