Inspection on 12/09/06 for Windsor House

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 House 01/05/07

Windsor House 09/05/06

Windsor House 24/11/05

Windsor House 23/06/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Windsor House Windsor House 209 Wigan Road Standish Wigan WN6 0AE Lead Inspector Kath Smethurst Unannounced Inspection 12th September 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Windsor House DS0000062654.V308554.R02.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. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windsor House Address Windsor House 209 Wigan Road Standish Wigan WN6 0AE 01257 421325 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) Mr Ghulam Haider Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16), Physical disability over 65 years of age (2) of places Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 16 service users to include:up to 16 service users in the category of OP (Older People over 65 years of age) up to 2 service users in the category of PD(E) (Physical Disability over 65 years of age) The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. The Registered Person must ensure that a varied range of activities is planned and implemented by 31/1/05 9th May 2006 2. 3. Date of last inspection Brief Description of the Service: Windsor House is a large detached property in Standish. The home is situated on the main road to Wigan and Standish town centres and is approximately five minutes drive from local amenities. The front of the home offers impressive views over fields and the countryside. Car parking is available at the front of the home, and there is a large well-maintained garden at the rear of the premises. There are five double and six single bedrooms. There are no en-suite facilities but toilets and bathrooms are situated close to bedrooms. The home provides personal care and support for sixteen residents over the age of sixtyfive. Fees are £345 per week. Additional charges are made for hairdressing and transport. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the second key inspection. The previous key inspection took place in May 2006. Two inspectors visited on this occasion and the site visit lasted six and a half hours. One of the inspectors looked at the way staff gave residents their medicines. The other inspector looked around parts of the building, checked some paperwork about the running of the home and the care given. The home had not been told that the inspectors would visit. To get more information about the home six residents, the owner, the acting manager and four staff were spoken with. Carers were also watched as they went about their work. Before the inspection, comment cards were sent to relatives and people such as social workers, district nurses and doctors. Five relatives and a district nurse returned comment cards. What the service does well: What has improved since the last inspection? What they could do better: Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 6 There were still some things needing to be put right in the home, which should have been done by June 2006. One of the most important of these is to have a permanent manager in place. Assessments (a detailed record of exactly what help the person will need) need to be improved so staff have all the information they to give the right care to each person. While there is some information about the things residents need help with, the records (care plans) need to have more written information, so that people reading them have a clear picture of what each person needs help as well as what is important to them. Staff also need to make sure that residents and their relatives have seen the care plans. Risk assessments relating to people going out and being left unsupervised need to be completed and reviewed regularly. This needs to be addressed quickly to make sure any risks to residents safety is known. Medication records need to improve to make sure residents are given the right medicines. More social activities inside and outside the home need to be arranged and the type of social activities for residents with special needs (such as dementia) needs to be increased. More written information about what staff need to do if they find a resident isn’t being treated properly is needed. To ensure the home remains comfortable for people living there plans need to be made to replace the lounge/dining room carpet and bedroom furniture. More staff need to be recruited in order that staff don’t work very long hours. This needs to be addressed to make sure the quality of care provided for residents is of a good standard. The number of staff working at night needs to be looked at. Some staff have not received the training they need to do their jobs properly. For example more training is needed in understanding the special needs of people with dementia. As well as how to move residents safely, first aid, writing reports and what to do if a resident isn’t being treated properly. One to one meetings with the manager and staff need to begin, to make sure staff are doing their jobs properly and to check if they have received the training they need. Some health and safety things need to be put right in order to protect the residents. The radiators are very hot and need to be covered. Staff need to make sure the fire alarm is tested every week. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 7 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 House DS0000062654.V308554.R02.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 Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4. Standard 6 does not apply to this home. Quality in this outcome area is poor. This judgement has been made from evidence gathered during and before the visit to the service. Written information available for prospective residents and their families needs to be improved in order to help them decide whether to stay at Windsor House. Proper assessments are not being carried out prior to residents being admitted which results in care needs not being identified and planned for. The specialised and complex needs of some residents are at risk of not being met, as relevant training and guidance had not been provided for care staff. EVIDENCE: Some progress has been made in improving the range of information provided to prospective residents and their relatives. A service user guide has been produced but further development is needed. The service user guide contains details of the homes aims and objectives, admission criteria, services provided and complaints procedure. However, information relating to the staff employed Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 10 and their qualifications still needs to be incorporated. It is important to include this information in order for prospective residents and their representatives to make an informed decision as to the suitability of the home. Consideration also needs to be given to producing the guide in other formats i.e. large font and audiotape to make the information more accessible. It was also unclear as to whether copies of the service user guide had been given to residents and their representatives. A statement of purpose still needs to be developed. In previous visits to the home concerns had been raised in regard to the assessment process undertaken by the home’s acting manager. Some improvement was noted during the last inspection. It was therefore concerning that there had been deterioration in the assessment process as identified during this visit. Examination of residents care records indicated some residents had been admitted without a proper assessment having being completed. The care records of the two most recently admitted residents were examined. A brief assessment had been undertaken covering areas such as mobility, eating, communication, medical history, mental state, hygiene, orientation and socialisation. There was no information in the pre-admission assessment document to demonstrate any background information had been sought and copies of the relevant care management assessments were not held on file. Some sections in the assessment documents were blank. It was also noted that areas relating to mental health had not been explored fully and in one case contradictory. For example in one care record a resident was described as being “mildly confused” in one section but “very confused” in another. This means staff would not know what level of care would be appropriate for this resident and any areas of risk prior to the resident being admitted to the home. Feedback from residents and in returned comment cards from relatives indicated they had no complaints about the care provided. From talking with and observing how staff worked it was evident staff tried to do a good job despite the lack of comprehensive written guidance and specialised training. The home was caring for people with specialised and complex needs and not all care staff had received training (e.g. dementia and mental health needs). The home was not registered by the CSCI to do this. An example of this related to a resident who displayed behaviour, which upset other residents. To overcome this staff took this resident to her room where she spent most of the day. Concerns were raised regarding this practice. This resident was isolated and when spoken with (in her room) was quite upset and anxious. There was no written guidance for staff as to how best to divert and occupy this resident. No account had been taken in respect of the level of risk of this resident being left for long periods unsupervised. This was discussed with the new acting manager who offered assurances this would be looked into. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made from evidence gathered during and before the visit to the service. No progress has been made in ensuring care plans have sufficient information to guide staff providing care and to make sure all care needs are identified and planned for. Residents’ health needs appear to be met but this was not always reflected in documentation, which could result in important information being overlooked. Some progress has been made in improving the management of medication however, the handling of medication and the accuracy of record keeping still needs to be improved to ensure medicines are handled safely, and to avoid any risks to residents. Personal support is offered in such a way as to promote resident’s privacy and dignity. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 12 EVIDENCE: Individual plans of care are available but little progress has been made on the requirement made in previous inspections to ensure all aspects of health, personal and social care needs are identified and planned for. Four care plans were examined to find they were generalised and not tailored to individual needs. The plans had been photocopied from a sample care plan and did not relate to individual care needs. Discussion with the new acting manager indicated that she had formulated a sample care plan for the former manager in order to assist her in developing new care plans. It would appear the former acting manager used the sample for all the residents without taking note of their specific and very individual needs. Significant information had not been recorded. This was evident in all the care plans examined. For example one of the residents displays behaviour which some residents find challenging however there is no mention of this in the care plan or any written guidance for staff to follow. Whilst risk assessments were in place, covering nutrition, tissue viability and moving/handling not all had been reviewed on a regular basis. For example in one of the plans the risk assessment covering nutrition had last been reviewed on the 1/6/06 while in another there was no date when the pressure area assessment had been completed. It was also noted that a risk assessment for one resident who regularly goes out (in a taxi) had not been completed. As previously noted one resident with cognitive difficulties spends a lot of time (unsupervised) in her room, once again no risk assessment is in place. A particular concern relates to entries in residents daily records. In one record there were no entries in the night diary sheets since the 24/8/06 a second since 23/8/06. The lack of entries in day diary sheets is also apparent. For example the last entry in one record was dated 30/8/06. It was also noted that the same member of staff made the entries from the 16/8/06 to the 30/8/06, but when cross referenced with the rota this member of staff had not worked on some of the day’s entries had been made. This was discussed with the member of staff who made the entries. She said that only two of the staff (on days) documented events in the records. The reason being that the other staff were from overseas and were not confident writing reports in English. This system is wholly reliant on staff memory and as such is open to error. This needs to be addressed as a priority to ensure important information is recorded. There was still no evidence that the care plans had been signed and agreed by residents and or their representatives. This needs to be addressed to ensure there is evidence of residents and/or their representatives have been consulted about plans to deliver care. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 13 Separate health care records are in place, however there were no entries in any of the records examined. In two cases the residents had lived at the home for a relatively short time so may not have needed to see a GP or other professionals. During the last inspection, the records looked at contained details of GP visits and attendance at hospital appointments. However given that a number of the staff do not make written entries in records, it is possible some visits had not been recorded. This should be looked into. Prior to the inspection, comment cards were forwarded to local healthcare professionals in order to obtain their views. A district nurse returned one comment card. No concerns were raised. The new acting manager knew that weakness in the handling of medication had been identified at the previous inspection. She was watching the morning medication round to see where improvement was needed. There were improvements in the storage of medication and some improvements in the record keeping. Unwanted medicines had been returned to the pharmacy and the medication storage was orderly and secure. Records of medicines received into the home and of unwanted medicines returned to the pharmacy were made making it possible to track the handling of medicines in the home. Records of controlled drug handling had improved and were generally up-todate. One omission was noted; the record of controlled drug administration for the previous evening was not witnessed. The handling of controlled drugs needs to be witnessed as part of the extra security needed for this type of medicine. Weaknesses in the medication administration records and associated care plans remained to be addressed. The current months medication administration records had only been in use for two days (started 11th September 2006) but there were already some mistakes. For example, records showed that teatime medicines had not been given to two residents the day before then inspection. Looking at the medicines in stock it appeared that the medicines had actually been given. As previously identified, one resident does not use two inhalers. Last months records said: ‘does not need – keep a check’. Records did not show that the prescriber had been consulted and there was no care plan showing what needed to be checked. It was not possible to confirm the current dose of warfarin for two residents and the record of INR testing (a test to determine the dosage) was not up-todate for one resident. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 14 Comparison of the administration records with an antibiotic in stock showed that the tablets had not been given correctly. Most medication administration records were pre-printed but where handwritten entries were made they were not signed, checked and countersigned. As previously discussed, the second check is recommended to reduce the risk of mistakes when copying instructions from the pharmacy label to the medication record. Photographs were used between resident’s medication administration records to help with positive identification, but most of these were missing. Staff said that they had read the medication policies and procedures but a copy could not be found on the inspection day. The homely remedies policy had not been implemented. This meant that non-prescription medicines (medicines that can be brought in a chemists shop) were not available to residents. The signature list for staff authorised to handle medication was not up-to-date and it was not possible to tell whether all staff handling medication had completed assessed training. Those residents who were able to comment indicated that staff respected their privacy and dignity. During the inspection staff were observed to treat residents with respect and consideration, were attentive to individual needs and were discreet. Residents were seen to be dressed in clean, well maintained clothing appropriate to the weather. One relative who returned a comment card wrote, “The residents always look clean and well cared for”. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made from evidence gathered during and before the visit to the service. The range and frequency of activities both inside and outside the home need to be improved to ensure residents social care needs are met. Visiting arrangements in the home are good ensuring links between residents and their relatives and friends are maintained. In the main personal choice is offered in such a way as to enable residents to exercise choice and control over their lives. Meals are good and the needs of residents are well catered for with a balanced and varied selection of food provided. However the way liquidised meals are presented needs to be reviewed to ensure they look more appetising. EVIDENCE: Examination of the duty rosters indicated a part time activity co-ordinator has now been employed from 10am to 2pm. However on the day of the visit this member of staff did not arrive until nearly mid-day and left before 3pm. Given that a co-ordinator has been employed it would have been expected that the Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 16 range and frequency of activities would have increased but this was not the case. The advertised activities on the day of the visit did not take place. Individual activity records are maintained and a sample was examined. One was blank. In a second the last entry was on the 27/7/06. For this particular resident activities recorded included “Out, chat and lying in bed”. A third record read, “Cards, shopping, watching TV”. This resident was spoken with. He said he liked to go shopping but was unable to do so because the member of staff who organised this was on holiday. He found this very frustrating, as the home was not near any shops, which he could walk to. This was discussed with the acting manager who offered assurances she would address this. While one resident goes out there was no evidence of other residents being able to go out on a regular basis. There have been no recent outings or trips out. During the last inspection it was noted the provision of activities for residents with specialist needs (i.e. dementia) was limited. This remains relevant. Activities such as reminiscence and sensory activities (baking) are not arranged. During the inspection two residents with cognitive difficulties spend the day for the most part alone and unoccupied. This needs to be addressed. When their duties allowed care staff were seen chatting with residents. A friendly but respectful banter was seen. A number of overseas staff are employed by the home. The acting manager needs to be mindful there may be social differences and care should be taken to ensure residents preferences are met. Residents with religious beliefs are encouraged and enabled to maintain links. Care plans contain details of resident’s preferred religion. The home has an open visiting policy. There are no restrictions on the time people visit, evidence of which was highlighted in the visitor’s book where entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents. Visitors spoken with during the last inspection indicated staff always made them welcome when they visited. In the main, residents who were able to comment expressed satisfaction with the care provided and organisation of life in the home. One resident spoken with told the inspector how she liked to spend time in her room and was able to do this. This resident also confirmed she was able to rise and retire at her preferred time. Another resident spoken with indicated he liked to go out shopping. However was unable to do so the week of the inspection due to staffing issues. It should be noted a number of residents have memory and communication difficulties so were unable to confirm they were able to exercise choice. Nevertheless observation of care practice indicated residents could make Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 17 choices. For example some residents were seen to choose the privacy of their own rooms or walk in the garden. Resident’s rooms are personalised and residents are able to bring personal items in the home. During the visit staff were seen to offer residents different drink options. The menus were inspected and were found to be well balanced and varied. And while choice is not offered in the menu alternatives are provided. Breakfast is served on a flexible basis, the main meal being served at lunchtime, and a lighter tea being served at around 4 p.m. Drinks and snacks are provided throughout the day. Meals are home cooked and the use of convenience foods is limited. Breakfast comprises a choice of cereals and toast. A cooked breakfast is not on the menu but care staff advised one would be provided on request. The lunchtime meal was observed. The dining area was clean and tables were set with linen tablecloths. The cook served the meal. On the day the meal consisted of beef casserole, cauliflower and mashed potatoes followed by fruit and cream. No one was rushed and second helpings offered. Three care staff supported residents. This appeared sufficient for the numbers of residents. One of the residents required a liquidised meal and also required assistance with eating. This resident was not brought to the table through personal choice. It was noted that the meal had been liquidised together, which is not in line with recommended practice and it looked unappetising. When residents require a liquidised meal the each element should be liquidised separately in order to make the meal look as appetising as possible. Residents spoken with had no complaints about the quality, quantity and choice of food provided. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor. This judgement has been made from evidence gathered during and before the visit to the service. The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. Protection policies, procedures and training need to be improved to ensure people living in the home are protected from harm or abuse. EVIDENCE: A complaints procedure is in place. A system is in place for recording the concerns/complaints brought directly to the homes attention. The complaints book was examined to find there were no documented complaints since the last inspection in May 2006. No formal complaints have been received by the CSCI since the last inspection. Those residents who were able to comment had not made a complaint but all indicated they felt able to approach staff. None of the relatives who returned comment cards had made a complaint and most knew whom to approach if such a situation arose. One relative who returned a comment card indicated he/she was unaware of the complaint procedure. One way of addressing this would be to ensure relatives are given a copy of the service user guide. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 19 Some progress has been made in ensuring residents are protected. However there are still a number of outstanding requirements relating to polices, procedures and staff training. For example no action has been taken in developing an appropriate protection of vulnerable adults policy. The “abuse” policy contains information about the types and recognition of abuse, however it did not contain information of the steps to take in the event of an allegation or suspicion of abuse. This lack of information could potentially jeopardise any adult protection investigations. Following the last inspection the inspector forwarded a copy of the local authority protection of vulnerable adults procedure to the home. This could not be located on the day of the visit. The new acting manager is advised to obtain a copy of the local authority protection of vulnerable adults procedure, so staff can familiarise themselves with the content. In regard to POVA (protection of vulnerable adults) training some improvement was noted, with four staff having undertaken training. The remaining staff have not yet completed any training and there was no definite date when they would. During the last inspection recruitment records examined showed appropriate checks had not been undertaken prior to new staff commencing work. Progress was noted in that CRB (criminal record bureau) checks have now been carried out. The system for protecting resident’s financial interests is inadequate and needs to be improved. This is discussed later in the report. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 & 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered during and before the visit to the service. A recent programme of decoration and refurbishment has resulted in improvements, providing residents with a clean, pleasant and comfortable environment. To ensure all residents continue to benefit, plans need to made to replace some carpets and furniture. The shortfall regarding health and safety needs to be addressed to minimise the risk of harm to residents. EVIDENCE: Windsor House is a large detached property in Standish. The home is situated on the main road to Wigan and Standish town centres and is approximately five minutes drive from local amenities. The front of the home offers impressive views over fields and the countryside. Car parking is available at the front of the home, and there is a large well-maintained garden at the rear of the premises. Fixtures and fittings are domestic in style and the addition of flowers, pictures and ornaments add to the homely atmosphere. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 21 Since the owner purchased the home in December 2004 the standard of the environment has improved significantly. Communal areas and bedrooms have been redecorated and new beds and curtains purchased. Five bedrooms were examined. The bedrooms viewed were personalised with photographs and personal mementoes on display. Doors are fitted with locks that can be opened by staff in an emergency. During previous inspections it was noted wardrobes, lockers and drawers were old and showing signs of wear and tear. This remains relevant. The lounge/diner carpet was seen to be threadbare and as such needs to be replaced. The filing cabinet (office) also needs to be replaced. The drawers are broken and one can’t be opened. Plans need to be made to replace these items so standards don’t fall below an acceptable level. It was also noted that while functional the fixtures and fittings in the bathrooms were somewhat dated. Consideration should be given to replacing toilets, wash hand basins and baths on a gradual basis. During previous visits staff advised that plans had been made to fit a shower in one of the bathrooms. This has yet to be addressed. Odour control in the home was generally satisfactory. However bedrooms 3 and 4 had strong malodours. These rooms were viewed in the late afternoon but a strong smell of stale urine was still apparent. An issue with odour control in bedroom 3 was also identified during the additional visit undertaken in March 2006 and the unannounced inspection in May 2006. During the last inspection the former manager indicated staff regularly cleaned carpets. It is evident that the odour has impregnated the carpet in bedroom 3 and the only way to resolve the issue is to replace the flooring. A requirement to replace this carpet was made during the last inspection but has still to be addressed despite written assurances action would be taken. It is totally unacceptable for a resident to have to live with such a situation and steps need to be taken to rectify this issue. It is also unclear how carpets are cleaned as staff advised the home does not have a carpet-cleaning appliance. It was also noted that the vacuum cleaner was old and staff said it was ineffective. During the previous inspection visit it was noted that radiators were very hot to the touch. A requirement was made to fit either radiator covers or low surface temperature radiators. This still needs to be addressed despite written assurances in the action plan, which stated, “Radiators have been turned down and covers will be placed on them by the dead line given (31/7/06). While it is acceptable to turn the temperature of the heating down during the warm summer months, this would not be appropriate during cold weather. As identified in the previous inspection the lack of radiator covers could prove potentially hazardous for residents. Steps need to be taken to address this issue as a priority. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 22 There were no adverse comments from residents and visitors who returned comment cards regarding the cleanliness of the home. Policies and procedures were in place with regard to infection control. Staff were provided with protective aprons and disposable gloves. Liquid soap and paper towels were provided near to hand washing facilities. Staff were observed to be maintaining good hygienic practices. All laundry is undertaken on site and residents spoken to had no complaints about the standard of laundry service provided. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made from evidence gathered during and before the visit to the service. The staff team are committed to providing good care to the residents but additional staff need to be employed to ensure the standard of care provided for residents is not compromised. Limited progress has been made to ensuring all staff have received appropriate training, this could result in the quality of care provided for people living in the home being compromised. Recruitment information needs to be improved to ensure residents’ safety and protection. EVIDENCE: During the last inspection concerns were raised in regard to the number of hours staff were working. This remains relevant. A number of staff were still regularly working in excess of 56 hours per week. Another area of concern related to the shift patterns. For example in addition to catering duties the cook also works one night a week. On the 11/7/06 this member of staff worked from 8am to 2pm as cook but then came back at 8pm and covered a night shift until 8am in the morning. This meant she only had a six-hour break between shifts. It was also noted that on the 9/7/06 the cook worked till 2pm, then provided sleep in cover until 8am on the 10/7/06 and then worked Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 24 until 2pm covering catering duties. Furthermore on week ending the 2/7/06 one of the night staff worked from 8pm to 8am on three nights and provided sleep in cover on the remaining four nights. The following week (week ending 9/7/06) the same member of staff worked three nights and provided sleep in cover on three nights. In a period of fourteen days this member of staff only had one day off. These were not isolated incidents and duty rosters showed these type of shift patterns were the norm. The effect of working very long hours for an extended period could eventually take a toll on staffs own health and well being which could affect the quality of care provided. This needs to be addressed to ensure an appropriate number of staff are employed. A review of domestic and night staffing arrangements also needed. Currently no domestic cover is provided. Care staff are responsible for cleaning and other domestic duties. At night one member of staff is on waking duty (supporting 16 residents) with an additional member of staff providing sleep in cover. In the past these arrangements have not been an issue as dependency levels were relatively low and the home had vacancies. This is not the case now. A number of recently admitted residents have very complex needs while the needs of some long term residents have also increased. An urgent review of both domestic and night staffing arrangements needs to be undertaken. Despite the concerns raised staff were observed to respond speedily to requests made for assistance made by residents. While residents said staff were looking after them well staff training opportunities provided need to be improved upon. Limited progress has been made in addressing the requirements made during the last inspection. Examination of the training matrix showed that there were still gaps in mandatory training. For example records indicated only four staff have undertaken moving and handling, basic life support (first aid) and POVA (protection of vulnerable adults) training. Two staff have completed medication training and three infection control. A significant number of staff are yet to complete training and there was no indication of when this is to be addressed. As previously discussed some overseas staff are not completing care notes, as they don’t feel confident in their written English. Report writing is an important aspect of their job so steps need to be taken to address this training need. The sample of staff files examined contained an induction checklist but the content does not meet specifications set by the National Training Organisation. Some staff still need to undertake specialised training relating to the care of people with dementia. The training matrix indicated that five staff have completed some training in this area. However it is not clear whether this training was sufficient to equip staff with the knowledge they need. The matrix showed that awareness of dementia and POVA (protection of vulnerable adults) Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 25 training both took place on the same day, which would indicate the content and areas covered were brief. While staff were kind and attentive towards residents the approach taken with two residents with cognitive difficulties showed a lack of awareness. Both spent their day alone (one walking around the home, one in her room). Staff contact related to personal care and meal times. No action was taken to occupy these residents. This would indicate further more in depth training is required. The percentage of staff in receipt of NVQ (National Vocational Qualification) level 2 remains low. Of the current staff compliment only two staff have attained the award. Discussion with staff indicated that staff have still not been registered for training despite written assurances that “three members of staff will start their NVQ 2”. The acting manager offered assurances she would look into this. All the above need to be addressed in a staff development programme. Some progress was noted in the recruitment procedures were noted but further development is still required. The personnel files for four staff were requested. One file could not be located. Of the three files examined all now contained evidence of POVA/CRB ((Protection Of Vulnerable Adults/ Criminal Records Bureau) checks having been completed. Two references were in place and application forms had been completed. It was however noted that information contained in application forms was insufficient. For example in one employment history was incomplete, there was no indication of the duration of previous jobs or the date/month started and finished, gaps in employment had not been explored and the reasons for leaving previous positions had not been given. All this needs to be addressed. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is poor. This judgement has been made from evidence gathered during and before the visit to the service. While temporary management arrangements are satisfactory a permanent manager needs to be appointed as soon as possible to ensure there is clear and stable leadership. While some quality assurance systems are in place, further improvement is needed to ensure the home is regularly monitored and to provide evidence resident’s views are sought and acted upon. Money kept on behalf of residents is not being managed properly, which could result in resident’s financial interests not being protected. A supervision system needs to be developed to ensure staff are well supported. Shortfalls were identified regarding the health, safety and welfare of residents and staff, which needs to be addressed to minimise the risks to all parties. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 27 EVIDENCE: Since the last inspection someone has been appointed as temporary manager until a permanent appointment can be made. She is deputy manager at another of the owners care homes. She has extensive experience in caring for older people, is a qualified nurse and has obtained the NVQ (National Vocational Qualification) level 4 registered managers award. On the day of the visit it was her first day so she had not had the opportunity to address the outstanding requirements. However it was evident by the end of the inspection visit she had a good understanding of the areas, which need to be improved The support of the owner is vital in addressing the areas, which need to be improved upon. The provider also needs to forward an improvement plan with details of how the requirements are to be addressed. Although these interim arrangements are satisfactory it is important that a permanent manager be appointed as soon as possible as the home has been without a registered manager for a year. An application for a new manager to be registered with CSCI will then need to be made. Some quality assurance systems are in place. For example satisfaction surveys have been given to residents and their relatives. A sample of returned surveys were examined to find all who responded were happy with the care and services. The owner continues to visit regularly and completes brief written reports of the findings of these visits. The content of these reports need to be further developed. For example more detailed information in respect of the views of residents, relatives and staff. Feedback from residents and from relatives in retuned comment cards indicated informal consultation takes place. However these discussions are not recorded. Formal resident meetings are not held. Staff spoken with indicted regular staff meetings do not take place. All these areas need to be addressed. Despite written assurances from the former manager that a formalised supervision system had been introduced, there was no written evidence of staff having received supervision or of any appraisals having taken place. This needs to be addressed to ensure staff receive the support they need to do their jobs properly. Formal supervision should be held 6 times a year and must cover care practice, philosophy of the home and development needs. During the last inspection the former manager advised that the home did not hold any monies for residents. This situation has since changed. The new Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 28 acting manager located a large amount of money and envelopes (containing money) in a locked drawer. However there was no evidence of any accounting system being in place. There were no records of monies credited and debited and there was no evidence any receipts had been obtained for financial transactions. This needs to be addressed as a priority. Consideration should also be given to obtaining a safe, as the storage now used is not particularly secure. A sample of service and maintenance certificates including the lift and gas were checked at the site visit. All were up to date. During the last inspection it was identified there was no fire risk assessment and the former manager was unable to produce any records relating to tests to the fire alarm, inspection of means of escape, checks on fire safety equipment or fire drills. This remains relevant. There was no evidence of either a fire risk assessment or fire log being in place. Staff have now undertaken fire safety training. As previously noted some staff still need to complete health and safety training (moving & handling and first aid). The accident records were examined and found to be appropriately maintained. Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X 3 X X 2 X 2 STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 1 X 1 Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement A statement of purpose must be developed. The service user guide must be amended to include details of the relevant qualifications experience of staff. Prospective residents must not be admitted without a full assessment being completed. Timescale for action 31/10/06 2 OP3 14 31/10/06 3 OP7 15 Care plans must reflect full 31/10/06 details of residents assessed needs (see standard 3.3); care plans must be drawn up with and signed by residents or their representatives. Timescale 6/4/06 & 30/6/06 not met. Risk assessments must be completed for any activities, which could pose a risk to resident’s safety. See body of report for details. Risk assessments must be reviewed on a regular basis. The registered person must ensure that accurate records of DS0000062654.V308554.R02.S.doc 4 OP7 15 31/10/06 5 6 OP7 OP9 15 17(3)(a) 31/10/06 09/10/06 Windsor House Version 5.2 Page 31 medication administration are maintained. (Not met from 10/03/06) 7 OP9 18(1)(a) The registered person must ensure that carers handling medication are trained and assessed as competent. (Not met from 12/06/06) The registered person must ensure that medicines are administered as prescribed. A programme of activities must be formulated and implemented which meets the needs of all residents including those with cognitive difficulties. A policy must be drawn up for responding to any suspicion or evidence of abuse or neglect. Timescale 31/01/06 & 30/6/06 not met. To ensure staff are fully conversant in abuse procedures all staff must be provided with training. Timescale 31/01/06 & 30/6/06 not met. The lounge/dining room carpet must be replaced. Radiators must be guarded or have guaranteed low surface temperatures. Timescale 31/7/06 not met. Steps must be taken to rectify the malodour in the identified bedroom. Timescale 06/04/06 & 30/6/06 not met. 09/10/06 8 OP9 13(2) 12/09/06 9 OP12 16 30/11/06 10. OP18 13 31/10/06 11. OP18 13 30/11/06 12. 13. OP19 OP25 23 13 & 23 31/12/06 30/11/06 14. OP26 16 31/10/06 15. OP27 18 Additional staff must be recruited 30/11/06 to ensure staff do not work excessive hours and that DS0000062654.V308554.R02.S.doc Version 5.2 Page 32 Windsor House unexpected contingencies can be covered. Details of how this is to be addressed to be detailed in the improvement plan. 16 OP27 18 A review of the number of domestic and staff working on nights must be undertaken. Details of the review findings to be included in the improvement plan. Action must be taken to ensure 50 of staff attains NVQ level 2. Details of how this is to be addressed to be detailed in the improvement plan. Timescale 31/01/06 not met Application forms must contain a full employment history, together with a written explanation of any gaps in employment. All new staff must complete induction training, which meets TOPPS specifications. Timescale 01/03/06 & 30/06/06 not met. All staff must complete mandatory training including moving and handling and first aid. Timescale 31/01/06 & 30/6/06 not met. Training in report writing must be provided. To ensure the specialist needs of residents living in the home dementia care training must be provided for all staff. Timescale 01/09/06 not met An application for a suitably qualified, competent and experienced manager to be DS0000062654.V308554.R02.S.doc 31/10/06 15. OP28 18 31/10/06 16. OP29 7,9,19 31/10/06 17. OP30 18 31/10/06 18. OP30 18 30/11/06 19. 20. OP30 OP30 18 18 30/11/06 30/11/06 21. OP31 8&9 30/11/06 Windsor House Version 5.2 Page 33 registered with CSCI must be submitted. 22. OP33 26 The person responsible must ensure written reports as to the conduct of the home in keeping with regulation 26 contain more comprehensive information relating to the views of residents relatives and staff. To ensure residents financial interests written records of all financial transactions must be maintained. To ensure staff receive the support they need to do their jobs properly a formal supervision system must be introduced. Timescale 30/6/06 not met. To ensure the safety of both residents and staff tests of fire safety equipment must be recorded. Timescale 30/6/06 not met. A fire risk assessment must be completed. Timescale 30/6/06 not met. 31/10/06 23 OP35 13 31/10/06 24. OP36 18 31/10/06 25. OP38 13,16,23 31/10/06 26. OP38 13,16 31/10/06 Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 34 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 OP1 Good Practice Recommendations In order to ensure the service user guide is more accessible consideration should be given to producing the guide in large font and audio formats. Handwritten MAR entries should be signed, checked and countersigned. The signature and initials list of staff authorised to handle medication should be kept up-to-date. Consideration should be given to the implementation of the homely remedies policy. To make liquidised meals more appetising each element should be liquidised separately. The activity programme should be reviewed to ensure more trips outside the home are provided. Consideration should be given to obtaining a carpet cleaning appliance. As part of the homes planned programme of refurbishment consideration should be given to replacing toilets, sinks and baths. As part of the homes planned programme of refurbishment consideration should be given to purchasing new wardrobes, chest of drawers and lockers. 2 3 4 5 6 7 8 OP9 OP9 OP9 OP12 OP12 OP19 OP21 9 OP24 Windsor House DS0000062654.V308554.R02.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 House DS0000062654.V308554.R02.S.doc Version 5.2 Page 36 - 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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