Inspection on 18/10/05 for Windy Ridge Nursing Home

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Windy Ridge Nursing Home 13/03/08

Windy Ridge Nursing Home 27/09/07

Windy Ridge Nursing Home 13/03/07

Windy Ridge Nursing Home 14/06/05

Windy Ridge Nursing Home 22/12/04

Windy Ridge Nursing Home 02/08/04

Windy Ridge Nursing Home 10/02/04

Windy Ridge Nursing Home 25/06/03

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

CARE HOMES FOR OLDER PEOPLE Windy Ridge Nursing Home 32 Barton Lane Barton On Sea New Milton Hampshire BH25 7PN Lead Inspector Gina Pickering Unannounced Inspection 18th October 2005 11:00 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 Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 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. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Windy Ridge Nursing Home Address 32 Barton Lane Barton On Sea New Milton Hampshire BH25 7PN 01425 610529 01590 644678 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) MNS Care PLC Mrs Auxillia Negute Madechangu Care Home 21 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (21) of places Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 4 service users may be accommodated at any one time in the DE category. 14th June 2005 Date of last inspection Brief Description of the Service: Windy Ridge Nursing Home is a care home offering nursing care for up to 21 service users that have dementia illnesses. The home is situated in a quiet residential area of Barton on Sea. The registered provider of the home is MNS Care plc who own several care homes throughout the country. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5.5 hours on 18/10/05. The inspector spoke to four care staff, the cook, the administrator, the manager, three relatives, and nine service users as well as touring the communal environment and inspecting a sample of documents. Relatives expressed their satisfaction with the care and service provided by the home. Staff members were observed treating service users with respect and dignity. What the service does well: What has improved since the last inspection? Great improvements have been made to the pre admission assessment process resulting in a comprehensive picture of the persons physical, social, mental and general health needs that enable the home decide whether that persons needs can be effectively managed at the home. Prospective service users and their representatives receive relevant information prior to moving into the home allowing them to make informed decisions about the home. Service users are now able to access all communal areas of the home. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 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 Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6. Prospective residents receive information regarding the service provided by the home prior to admission allowing them to make an informed decision about the suitability of the home. Service users and their representatives are made aware of their rights and obligations of residency at the home with revised statements of terms and conditions of residency. A procedure for the assessment of prospective service users is in use and utilised well to ensure that prospective residents needs are met on moving into the home. Windy Ridge does not provide intermediate care. EVIDENCE: Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 9 The manager has reviewed and revised the statement of purpose to reflect the service provided at the home. This is presented to each prospective service user and their representatives in the form of a home brochure. Service users statement of terms and conditions of residency at the home are in the process of being revised to reflect amended charges. The inspector was informed that these shall then be presented to the service users representatives for signing. A new pre admission assessment process has been implemented. This results in a comprehensive assessment of personal, physical, social, health and mental health needs being obtained. Information gathered from this process enables the home to conclude whether that person’s needs can be met by the home. The home does not provide intermediate care. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 Care planning systems result in detailed information being available of the service user’s health, personal and social needs. Assessments and good practices at the home ensure that the individual’s personal, health and social cares needs are met. EVIDENCE: Individual plans of care that concentrate on the strengths and weaknesses of the individual are in place for each service user. Details within these documents allow the individuals personal, health and mental health needs be met. Monthly reviews ensure that individuals changing needs and the action required to meet these changing needs are documented. Nutritional, tissue viability, continence needs, risk of falling and moving and handling assessments are performed monthly to assist in monitoring the individual’s health care needs as well as documenting the actions required to meet the service users needs for these issues. Service user’s documents Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 11 include details of contacts with health service professionals such as GP services, specialist nurses, chiropody, dentists and opticians. Relatives spoken to told the inspector that relevant health care professionals are contacted promptly if there are any concerns about the health of their relative. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 12 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 Within the restrictions of not having an activity organiser employed at present social activities are well-organised providing stimulation and interest for the people living at the home. Meals are nutritious and balanced and offer a healthy and varied diet for the service users. EVIDENCE: At the time of the inspection the home was without an activity organiser that relatives and the staff confirm has resulted in a reduction in activities planned for service users. The manager informed the inspector that she is planning to interview for the post in the near future. Throughout the inspection it was noted that staff interact well with service users, engaging in conversation, dancing with and taking individual service users for walks around the home’s grounds. Detailed records of service users social needs and the activities taken part in will be the responsibility of the activity organiser when appointed. A three weekly rotating menu plan is displayed in the entrance hall of the home indicating that service users are offered a varied nutritious diet. Records are maintained of the food taken by service users. Relatives stated that their relatives receive a varied diet and service users expressed their satisfaction with the meals provided. Discussion with the chef evidenced that he continues Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 13 to explore means of improving the meals for the service users. He has requested a ‘bain marie’ hot trolley from the organisation so that meals can be served in the dining room allowing service users to have more choice over the quantities of the meals provided rather than having to plate the meals up in the kitchen. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 14 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 Service users and their representatives are confident that they are able to voice concerns and complaints with the assurance that they will be dealt with promptly. EVIDENCE: A complaints procedure is in place and displayed in the entrance of the home as well as being made available to all service users and their representatives. Discussion with relatives and service users evidence that they are aware whom to address any concerns to. Relatives confirmed that they believe any concerns they raise will be dealt with promptly and with sensitivity by the management of the home. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 15 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 & 26 Improvements have been made to the internal doors allowing service users full access to all communal areas of the home. Good hygiene and infection control practices within the home contribute to the health and well being of the service users. EVIDENCE: Retainers that are released in the event of fire alarms being sounded are now in place on the heavy internal doors allowing full access to all areas for the home for the service users. A tour of the home evidenced that the home is kept clean and free from offensive odours. Bathroom areas were clean on the ay of the inspection. Dispensing soap and paper towels in service user’s bedrooms and the bathrooms promote the control of infection. Hand washing gels are available throughout the communal areas of the home. Staff were observed adhering to Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 16 handwashing procedures after attending to service users. Protective equipment such as gloves and aprons are available. The upstairs bathroom has a bath that has water stains in it; this does not present a pleasant environment. Discussion with the manager revealed that plans are being made to refurbish this bathroom. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 17 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): 29 Recruitment practices at the home have yet to fully protect the welfare of those living at the home. EVIDENCE: Recruitment polices and procedures are in place. A sample of staff files were inspected to evidence the recruitment process is adhered to. Many of the staff members at the home are from overseas; documentation in their files indicate that they have the correct permits to work in the UK. Written references were missing from some of the staff files. This was discussed with the manager; the head office of MNS Care plc holds the references. A request was put to the head office during the inspection to send copies of all written references to the home. A discussion was held with the manager regarding the need to ensure that all staff members receive a satisfactory CRB and POVA clearance prior to commencing employment at the home. In all but one of the staff files there were records of CRB and POVA checks. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 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 & 35 & 38 Service users live in a home that is managed by a competent manager who offers leadership, guidance and direction to the staff members. Service users financial interests are protected by good practices employed by the home. The welfare of service users is not fully protected by ancillary staff having not received training about the moving and handling of objects. EVIDENCE: The registered manager, Leah Madechangu, has been in post for one year. Since her appointment improvements have been seen in much of the documentation and a reduced staff turnover. Staff and relatives speak highly of her commitment to the home and her caring nature towards the service users and staff. With the support of the Director of Nursing she has increased the Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 19 trained nurse establishment of the home allowing her to direct her energy towards the management of the home. None of the service users at the home are able to manage their own finances; these are managed by their relatives or appointed solicitors. A safe procedure is in place for service users to keep small amounts of ‘spending money’ on the premises. Service users are able to have a lockable area within their bedrooms to keep money and valuables if they wish to. A requirement for ancillary care staff that handle objects to receive moving and handling training has yet to be actioned. The manager assured the inspector that this was in the process of being arranged. Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 21 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 OP29 Regulation 18(1a) Requirement Timescale for action 30/10/05 2 OP29 18(1a) 3 OP38 12 The registered person must ensure that two satisfactory written references are obtained and kept on site for all employees. The registered person must 30/10/05 ensure that all staff members receive as a minimum a POVA first clearance whilst awaiting full POVA and CRB clearance prior to commencing employment at the home. The registered person must 30/11/05 ensure that all staff at the home receive training with regard to moving and handling. This requirement was not met by the previous timescale of 30/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011456.V257478.R01.S.doc Version 5.0 Page 22 Windy Ridge Nursing Home Standard Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Windy Ridge Nursing Home DS0000011456.V257478.R01.S.doc Version 5.0 Page 24 - 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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