CARE HOMES FOR OLDER PEOPLE
Windward Retirement Home Totnes Road South Brent Devon TQ10 9JN Lead Inspector
Graham Thomas Unannounced Inspection 5th October 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 Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Windward Retirement Home Address Totnes Road South Brent Devon TQ10 9JN 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) 01364 72386 Thurlestone Court Limited Mrs Geraldine Maria Swift Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age of places (20) Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: Thurlestone Court Ltd. took ownership of the home on 1st November 2005 and registered as Providers. Ms. Brigitte Harvey is the Responsible Individual. The home is now part of a group of loosely affiliated companies and partnerships collectively known as The Court Group. This group has a number of homes in the Torbay and South Hams areas of Devon and promotes a corporate identity and ethos. Windward House is a detached property set in its own grounds in the village of South Brent. The home currently provides care for up to 20 older people some of whom may have a physical disability and mobility problems. Accommodation in the main building is on two floors in mainly single rooms with en-suite facilities. A stair lift operates between the two floors. At the time of this inspection, part of a substantial extension to the home had been completed. Eight service users had moved into new rooms in this extension. This forms part of a planned extension and refurbishment which will upgrade existing accommodation and provide additional places. The home’s fees currently range between £256 and £485 per week. Service users pay additionally for some items such as hairdressing, chiropody and newspapers. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included a visit to the home over one and a half days. The Inspector toured the premises and spoke individually with five service users individually and others in groups. Four staff were interviewed. Discussion also took place with the Registered Manager, Responsible Individual and three visitors. The Inspector joined service users for a midday meal. Care plans and other documents were examined. The home’s systems for the administration of medicines were inspected. What the service does well: What has improved since the last inspection? What they could do better:
Prospective service users should be sent a letter before moving in assuring them that the home can meet their needs. Risk assessments and management plans are needed for areas under refurbishment. The use of the stair lift should be risk assessed. Written guidance is needed for staff concerning “as required” medication. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 6 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. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can feel confident that their needs will be properly assessed before moving into the home. EVIDENCE: The files of the three most recently admitted service users were examined. All contained comprehensive assessments. These had been conducted before the service users had moved into Windward. Care plans had been produced for each service user and signed by the service users and/or their representatives. No letters had been sent to prospective service users confirming that the home could meet their needs. Windward does not provide intermediate care. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be assured that they will receive good personal and health care at Windward. Their nutritional needs will be particularly well served. EVIDENCE: A total of eight care plans was examined. Four were examined in greater detail. Each plan had been signed by service users and/or their representatives. Plans for some of the more recently admitted service users were awaiting the addition of photographs. The plans had been reviewed regularly and service users had signed their reviewed plans. Each plan contained details of particular individual needs. Examples of recording included details of oral care, a falls diary, and weight monitoring. Risk assessments were found in each plan. At the time of inspection a new system of nutritional screening was being implemented and this was reflected in the plans. Systems for promoting and maintaining service users’ health were examined. All service users are registered with the local GP. The files examined showed evidence of both routine and specialist healthcare treatment. Health issues were discussed with service users. All felt that they received good health care and were able to see a doctor when needed. The new system of nutritional screening and monitoring was of particular note. The advice of a consultant
Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 10 nutritionist had been sought. Detailed screening and monitoring systems were being implemented. The home’s new kitchen had been fitted with sophisticated equipment. This enabled food to be prepared in a way which maximises the nutritional value of the food. Discussions with the home’s cook and other staff demonstrated an awareness of the high nutritional standards which the home is implementing. Fresh ingredients were used in the preparation of meals, one of which was sampled. Fresh fruit was being offered with every meal and with morning and afternoon drinks. Detailed information was available in the home concerning food and its relationship to good health. Levels of hydration are monitored and service users were being encouraged to take plenty of fluid. In discussion, the Registered Manager stated that this had made a measurable contribution to the service users’ general health. An effect had also been noted regarding specific issues such as skin condition and reliance on medication. The home’s systems for the administration of medicines was examined. A monitored dosage system was in use. During building work a temporary storage arrangement had been introduced which was sufficiently secure. Records of the administration of medicines were sampled. These were found to be up-to date and in good order. The use of homely remedies was supported by a professionally approved list. No controlled drugs were in use but storage and recording arrangements were in place if required. One service user had been prescribed Diazepam “as required”. It is recommended that written guidance should be produced for staff to identify the circumstances under which this and any other “as required” medication is to be administered. All the service users with whom the Inspector spoke felt that their privacy and dignity was respected. This was further confirmed by the visitors with whom the inspector spoke. Staff were seen to knock on doors before entering. All intimate care took place in the privacy of service users’ rooms. Preferred forms of address were recorded in individual plans and were being used by staff. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 11 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 - 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users at Windward are well supported to pursue their chosen lifestyles EVIDENCE: The Inspector discussed daily life and social activities with staff, service users and visitors. The home provides such activities as group games, slide shows, memory games aromatherapy and massage. These were advertised on the home’s notice board. Efforts have been made to make this information “eyecatching”. Games and activities facilitated by staff take place daily. Some service users choose not to participate and this choice is respected. This was observed by the Inspector and discussed with service users. Occasional trips out of the home take place some of which are funded by the home. Flexibility in the routines of the home were observed in practice and commented upon by visitors. For example, service users may take meals in their rooms if they wish. Visitors commented that the visiting arrangements were flexible and that they receive a warm welcome to the home at all times. Service users and visitors confirmed that they were able to meet in private if they wished. Visiting clergy enable service users of different denominations to practice their religion. Those who are able can visit local places of worship.
Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 12 Social events such as fetes are held which enable service users to maintain contact with the local community. During the inspection friends from neighbouring sheltered accommodation were taking lunch in the home with service users. The Registered Manager stated that this was a regular occurrence. During the inspection service users were exercising choice in their day-to-day routines and activities. Those who wished to do so spent time quietly in their rooms pursuing their own interests such as reading and watching television. Others chose to join in activities. Choices of meal were offered as part of a routine discussed with the cook and seen on menus. Information was available to service users and visitors concerning advocacy services. Individual rooms contained many personal items including furniture which service users had chosen to bring to the home. Neither the Registered Manager nor the home’s owners were acting as appointee for handling service users financial affairs. The high standard of nutritional arrangements in the home is described in the previous section of this report. The Inspector joined service users for a midday meal. This comprised fresh salmon and a salad. A temporary dining room was being used whist building work was in progress. This was arranged with small dining tables around which groups of service users ate and chatted in a congenial atmosphere. A choice of meal was on offer and vegetarian options were available. Scrutiny of menus and discussion with the cook confirmed that this was routine. One service user was receiving assistance to eat from an experienced staff member. In discussion, service users were generally satisfied with their meals. One visitor felt that the standard could be improved. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can feel confident that their concerns will listened to and taken seriously. The Registered Manager and staff are effective in protecting service users from abuse. EVIDENCE: Thurlestone court Ltd. has a complaints policy and procedure. A complaints record is maintained and this was inspected. In discussion service users and visitors felt confident that their concerns would be taken seriously by the staff and Registered Manager. Awareness training is provided for staff concerning the protection of vulnerable adults from abuse. In discussion staff were clear about the action they would take in the event of a disclosure. The Registered Manager has a well-developed understanding of abuse issues. She has previously acted in a commendably robust and determined way to protect the interests of service users. This vigilance has been sustained in monitoring the protection of individuals. Service users’ financial affairs are handled by relatives or professional advocates. Small amounts of money are securely stored for service users in the home. Receipts are kept and any transactions recorded. These records were sampled and found to be in good order. Policy statements preclude staff from gaining financial benefit from service users. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a generally clean, comfortable, homely and well-maintained environment. Some service users are now benefiting from new accommodation appointed to a high standard. EVIDENCE: At the time of inspection Windward was in the middle of a major programme to extend and upgrade the premises. This will eventually provide extra places which the Registered Provider is intending to register. The Registered Provider, Registered Manager and staff of Windward are commended for minimising the potential disruption to service users during this development. Since the last inspection new kitchen and laundry facilities had been completed. A new wing had been built into which service users had moved. This comprised eight bedrooms, all with en-suite facilities and a large lounge. Communal bathing and toilet facilities were equipped for people with disabilities. Confirmation has been received that this extension meets building control and fire regulations. A further eight service users were accommodated
Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 15 at the time of inspection. They occupied the pre-existing two storey main building. The new accommodation had been fitted and furnished to a high standard. All the new individual rooms were comfortably furnished and attractively decorated. The furniture and soft furnishings were of high quality. Service users confirmed that the rooms contained all the furniture they required. Some had chosen to bring their own furniture to the home. Rooms were fitted with locks and each room contained lockable storage. A new cordless call system was in operation. The spacious lounge was light and airy with an open aspect. Ramped access led to the outside of the building. This was, again, comfortably furnished with high quality domestic style furnishings. All areas had access to good natural and artificial lighting. Radiators and hot pipes were all covered and water temperature was regulated. During the tour, the Inspector noted that heating in the new wing was insufficient. Service users also commented that they were cold. This followed a sudden overnight change in the weather. The Registered Manager immediately remedied the situation and the premises remained well-heated for the rest of the inspection visit. In the main building, individual accommodation was receiving the necessary maintenance to maintain comfort and safety. Access to the upper storey was maintained with the existing stair lift. Rooms in this area shared communal bathing and toilet facilities. Dining facilities had temporarily been moved to a lounge area whilst the new dining room was being completed. Though there was an evident control of risks in areas under refurbishment, this should be covered by a written risk assessment. Around the home various aids and adaptations were seen. These included such items as toilet frames, booster seats and hoists. The new laundry was equipped with “state of the art” machinery for washing and drying. The washing machine had a sluicing facility and was capable of hot wash cycles. Floors and walls in the laundry were cleanable. Hand washing facilities were available for staff using the laundry. Cleaning equipment was colour coded for different uses and cleaning staff were clear about the system in operation. Separate disposal arrangements were seen to be in place for infected waste. A high standard of cleanliness was evident around the premises. The staff and Registered Manager are commended for their diligence in controlling offensive odours. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 16 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 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are generally well supported by the home’s staffing arrangements. EVIDENCE: During the inspection there were enough staff on duty to complete necessary tasks and meet the needs of service users. This included time spent with service users individually and supporting group activities. The pattern of staffing in the rotas seen indicated similar staffing levels. Night duty was covered by one sleeping and one waking staff member. One visitor felt that this was insufficient to meet her relative’s overnight needs. This was discussed with the Registered Manager and Responsible Individual who agreed to keep this staffing under review. A training plan was seen during the inspection. Structured induction and foundation training is provided for new staff. Workbooks were seen as well as materials with professional guidance on topics such as a carer’s relationship with service users. Over 50 of staff hold an NVQ qualification in care. Staff confirmed that they were supported to undertake or improve their qualifications. The home has access to the Court Group’s rolling training programme. This includes health and safety topics and subjects which are relevant to the needs of the service user group. Examples of this training include infection control, death and dying and customer care. Staff files were examined including those of the most recently recruited. The files showed evidence of thorough recruitment practice. This included
Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 17 completing an application form and supplying two references. The staff interviewed confirmed that recruitment included a formal interview. Criminal record checks had been conducted and reference numbers are recorded in the files. Certificates regarding these checks are held separately but one was produced on request for inspection. The Registered Manager and Responsible Individual confirmed that the staff occasionally deployed from other homes in the group were employed by the same company. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are led by a very competent manager who is an excellent role model for her staff and diligent in safeguarding service users’ health and welfare. EVIDENCE: The Registered Manager has managed Windward for a number of years under the present and previous ownerships. She holds the Registered Managers Award and NVQ level 4 in care. This training is supplemented by short courses such as an “understanding dementia” course recently undertaken. Staff and service users were clear about lines of accountability in the home. The Registered Manager demonstrated a clear understanding of her role and a commitment to meeting the National Minimum Standards. She has demonstrated diligence in rectifying any shortfalls identified during inspections and other internal processes. She has also shown an ability to deal effectively
Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 19 with complex issues to protect service users and maintain the standards of care in the home. In discussion she presents a calm, open and objective approach to her work and provides a good role model to staff. The ethos of the home under the Registered Manager’s leadership is commendable. The atmosphere is warm and friendly whilst maintaining clear professional boundaries. Staff indicated that they felt well supported. During the inspection a former staff member was visiting the home and clearly pleased to meet with former colleagues and residents again. Strategies are in place to promote and improve the quality of the service. For example, regular staff and residents meetings enable service users and staff to contribute their views about the home. Service users had completed an activities questionnaire. Documents were seen showing work being undertaken towards the “Investors in People” award. The Manager had evaluated feedback from staff training. Service users’ financial affairs are handled by relatives or professional advocates. Small amounts of money were securely stored for service users in the home. Receipts were kept and any transactions recorded. These records were sampled and found to be in good order. Policy statements precluded staff from gaining financial benefit from service users. Health and safety issues were examined. The Registered Manager stated that the home has bi-monthly visits from the Court Group’s Health and Safety Officer who provides advice and guidance. Up to date checks of fire safety systems and procedures were recorded in the home’s fire log book. Staff had received training in fire safety. A fire evacuation pack was seen which contained service users’ details. Records of training reflected staff access to the Court group’s rolling training programme in health and safety issues. This included topics such as infection control, moving and handling and first aid. Documents were produced which demonstrated up-to date maintenance and servicing of systems and equipment. For example, a gas safety certificate dated 25 June 2006 was seen. Testing of personal electrical appliances had taken place in May 2006. The stair lift had been serviced in January 2006. Risk assessments for the building were available for inspection. As previously stated, a risk assessment for areas under reconstruction and refurbishment is recommended. A risk assessment should also conducted in respect of the stair lift. Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 4 3 3 3 3 X 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 X X 3 Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP3 OP9 OP38 OP38 Good Practice Recommendations Prospective service users should be sent a letter before moving in, assuring them that the home can meet their needs. Written guidance for staff should be produced for all “as required” medication The Registered Manager should produce a risk assessment and management plan in respect of areas of the home under reconstruction / refurbishment. A risk assessment for the use of the home’s stair lift should be produced Windward Retirement Home DS0000065813.V306233.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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