Inspection on 27/09/07 for Windy Ridge Nursing Home

This inspection was carried out on 27th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Windy Ridge Nursing Home 13/03/08

Windy Ridge Nursing Home 13/03/07

Windy Ridge Nursing Home 18/10/05

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 Christine Walsh Unannounced Inspection 27th September 2007 10:20 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.V344900.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. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 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 01425 610929 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 Mrs Anne Mary Sellars 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.V344900.R01.S.doc Version 5.2 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. 13th March 2007 Date of last inspection Brief Description of the Service: Windy Ridge Nursing Home is a care home offering nursing care and personal care for up to 21 service users that have dementia in the older person category. The home is situated in a quiet residential area of Barton on Sea with access to some local amenities and close to the seafront. Accommodation is provided on two floors with a stair lift that allows access to the first floor. MNS Care PLC owns the service. Fees range from single room ground floor £680 a week. Double room £585 a week. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit formed part of the key inspection process and was carried out over one day by Mrs C Walsh, regulatory inspector. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to the visit to the home. In addition “Have Your Say” resident and relatives comment cards were sent of which a small number have been received. At the time of the visit the manager was on leave and the senior member of staff on duty assisted the inspector with the inspection. The information obtained to inform this report was based on viewing the records of the people who use and work at the service, of which two were looked at in depth. The care and support practices of staff were observed in addition a relative, staff and residents were spoken with. A tour of the home took place and documents pertaining to health and safety were viewed. The home has been subject to a management review due to failing to meet required standards. The home has been required to complete an improvement plan to inform the Commission for Social Care Inspection of how they intend to improve standards. This was assessed as part of the inspection process. What the service does well: Windy Ridge does well to ensure the medical and mental health needs of the people who use the service are appropriately met, including their medication: A relative said: “The home always lets me know if my wife is unwell and makes sure she sees the doctor if she needs one”. A range of activities are arranged throughout the course of the year to celebrate changes of the seasons and special events in peoples lives such as Summer Fetes, Harvest Festivals, Halloween Parties, birthdays and anniversaries. The visitors are made welcome and are welcome to spend mealtimes with their relatives. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 6 The home provides wholesome and well-balanced nutritious meals, prepared and cooked by an experienced cook who has a national vocational qualification, a food hygiene certificate and is to undertake an awareness course in nutrition. Windy Ridge does well to provide a comfortable and clean environment for people who use the service to live, where their bedrooms are personalised and reflect their individuality. What has improved since the last inspection? What they could do better: Despite an improvement in many areas of the home identified as not up to standard previously, there are still a number of areas of improvement required, some of which the manager is already aware of. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 7 The home has improved its assessment and care planning process but the managers must ensure these are appropriately completed to provide a holistic overview of the person’s individual needs. The home must ensure that identified risks such as those who are immobile and accommodated on the first floor have risk assessments undertaken on them and documented. These residents are at risk of not have their personal care and social care needs met. Despite staff receiving training in dementia and the importance of respecting people’s choices, decisions and individuality staff do not appear to put this into practice. Staff were observed not interacting and communicating with residents in a valuing and respectful way, to refer to some older than you as a “Good girl” is both devaluing and disrespectful. Staff were also observed not listening to what people were saying which caused undue stress and agitation. Despite an improvement in menu’s and nutritional assessments the failure to monitor and record weights of residents at risk places them at risk. Mealtimes are disorganised and not enjoyable for some. Better attention to individual requirements and support at these times is required. The home provides information to people about how they can raise concerns and complaints, however the home must ensure people are provided with details of other agencies they can refer to if they remain unhappy with the outcome of a complaint. The home must also consider how it can empower residents with dementia to raise concerns if they wish. The continued failure of the home to recruit staff using robust procedures compromises the safety of their health and welfare. The home is suitability clean, decorated and furnished however it does not provide suffient accessible bathing facilities for the residents potentially compromising their personal hygiene and when they wish to bath or shower. The home quality audits the service by seeking the views of the relatives and holding residents meetings, however this needs expanding to include others who have a stake and interest in the service such as GP’s and care managers. Despite the home ensuring staff receive training in fire safety the home fails to provide a safe environment as it cannot demonstrate that is has complied with the requirements issued by the Fire Safety Service. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Windy Ridge provides people who use the service with information about the home, which enables them to make a decision if to accept a placement. However the home could improve on this by developing and accessible version for those people with cognitive and sensory difficulties. The complaints section of the brochure requires completing. Improvements have been made in assessing the needs of people who may wish to use the service, however the assessment documentation must be completed in full to provide a holistic assessment of their needs. The home does not provide a service to people requiring intermediate care. EVIDENCE: Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 11 The annual quality assurance assessment (AQAA) tool informed us that the home has made improvements in the documentation it uses to improve the assessment process and recognises areas of improvement that it must make such as meeting the needs of people with dementia Following the last visit to the home it was reminded that it must pre assess all new service users before they are admitted to the home. This was tested by viewing the statement of purpose, service user guide and the assessment documents of five residents. Each resident has a copy of the Service User Guide in their bedroom; this is a brochure that has been provided in large print and is clearly laid out describing the facilities and the care and support the residents can expect to receive. The Statement of Purpose states that a comprehensive pre admission assessment will be carried out prior to accepting any prospective service users. The home can demonstrate that this process has improved and is undertaking assessments. It obtains detail of personal information such as date of birth, next of kin and GP details. It documents the prospective residents physical and mental health care needs, and their ability to carry out day-to-day life skills such as washing, dressing, eating and drinking. Life histories are obtained and provide good information on the prospective persons family, occupation and important events in their life and their social, cultural and spiritual needs are also recorded. However it was established that not all areas of the assessments have been fully completed or a reason indicating why it has not been completed. These included pre admission details, long-term assessment of needs and life histories for some residents. The senior member of staff stated that for some residents they are currently transferring information to the new systems and they hadn’t all been completed. He stated he would ensure that this is done. The senior member of staff on duty explained the process used to assess prospective residents, which includes if applicable gaining information from the placing authority, meeting with them in their own home with friends and relatives or in other forms of care such as hospital and where possible inviting them to visit the home. A relative said: “I looked at a number of homes before seeing Windy Ridge and I knew this was the right one for my wife” Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has moved some way to improving the standard of information in care plans and describing how people who use the service have their health, wellbeing, and medication needs met. However the home falls short of demonstrating that it is providing a person centred approach to meeting the needs of people with dementia, that it adopts respectful approaches and assesses specific individual risks. EVIDENCE: The AQAA informed us that the care planning process has improved and will give keyworkers and supervisors an opportunity to focus and clearly monitor individual residents immediate and long term needs. However as stated in the AQAA the manager recognises that the home has a long way to go in Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 13 responding to individual requests, residents individuality and in improving the staffs understanding of dementia. Following the last visit to the home it was reminded that it must ensure all residents have a care plan that describes how the staff must meet their assessed needs. To test this five residents care plans were viewed, senior and care staff were spoken with, the views of a visitor were sought, interactions between staff and residents were observed, two of which were closely monitored for a considerable amount of time. The home has introduced a new system for holding and recording information held on the residents. This information is easy accessible and easy to follow for staff. Care staff are nominated as keyworkers and are supervised by senior staff to ensure they are recording, monitoring and reviewing information. A member of staff said: “The care plans provide me with information on how to support the residents” The care plans describe the level of care the resident requires however not all provide full detail on needs related to personal care, daily routines, weight or how they move around. The senior member of staff responsible for care planning said he would review them and was clearer of what detail is required. There was information of how staff must support a resident when they are showing signs of agitation, however through observation it was established that the residents agitation was not alleviated as staff approaches were inconsistent and the resident was not clearly communicated with. The residents have their mobility assessed and moving and handling risk assessment are in place, however the home does not look at the individual risks to residents such as moving around the home unsupported and heightened state of agitation and isolation. It was established that two residents accommodated on the first floor are immobile and require full support with their personal and health care needs. They are unable to be bathed as they cannot access the bathroom and do not socially engage as this means four staff assisting them to move downstairs. This was identified at the previous visit to the home and the home was informed that the residents must be able to gain access to all areas of the home as according to documented wishes and safety. The home is required to risk assess these areas of concern and consider moving the residents to ground floor accommodation. The home has developed and maintained good relationship with the local Primary Care Trust and the residents are supported in accessing care as Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 14 required. All the residents are registered with the local surgery. GP’s visit the home on request. Evidence of GP and other health care professionals’ visits are documented in residents personal files and gives clear detail of the outcome and action required following the consultation. Four “have your say” comment cards were received from GP’s two of which had positive comments to make about the home and staff and two others expressed concerns regarding the level of understanding the staff demonstrate. The senior member of staff on duty was notified of this. The home has a medication policy and procedure in place. All medications are stored securely including those that should be kept in the fridge and controlled drugs. The senior member of staff reported that changes are being made in the way that the home holds and administers medication. The home is keen to adopt a more personal approach to the administration of medication and has fitted each bedroom with a medication cabinet. Through observation of the administration of medication it was noted that residents are referred to as “good girl” when they take their medication and spoken over when recieving their medication. The manager identifies in the AQAA that she is aware that improvements are needed in the awareness and approach to people with dementia this was evident during close observation of interactions between residents and staff over a considerable period of time. The homes Statement of Purpose and Service User Guide informs prospective residents that they will be listened to and their privacy and dignity upheld, staff who were spoken with were clear of their role in supporting residents to maintain their independence, dignity and privacy, choice and respect, however this was not demonstrated through observation. Interactions between staff and residents were a mixture of positive and negative approaches, The staff were observed to dismiss a resident who was searching for answers and was clearly agitated and failed to give her the reassurance she was looking for. They were observed to enter the dining room and leave again without communicating or making none verbal contact with residents. Windy Ridge Nursing Home DS0000011456.V344900.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made some progress in improving the recreational and social facilities for the people who use the service, however further improvements could be made in developing a person centred approach to residents hobbies and interests, likes and dislikes. The people who use the service are supported to maintain links with family and friends, however the home must address the internal isolation of some people who use the service. The people who use the service and who have dementia must be supported by staff that understand the importance of supporting them to maintain and continue to exercise control in their lives. The appointment of a new cook has improved the quality and choice of meals provided in the home, however the home must address the presentation and support provided at mealtimes. EVIDENCE: Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 16 The AQAA informed us that they openly invite visitors to the home, encouraging them to join the residents for mealtimes and that the home is developing its activity programme. The home recognises where improvements need to be made, such as developing and improving menu plans and community participation. This was tested by viewing personal plans for five residents, viewing activities, speaking with the newly appointed cook, observing staff interactions with residents throughout the day and especially over the evening mealtime period. There is evidence that the home is working to improve activity for the residents as they have recently invested in an activity coordinator and access to outdoor entertainment. Photographs posted around the home and in an album demonstrate that the home has regular events, recently holding a harvest festival. Other events include a summer fete, celebrating birthdays and anniversaries and encouraging dog-patting sessions, which are reported as being very successful. On the day of the visit the residents were being entertained by an external activity coordinator who was encouraging the residents to sing and dance, some of the residents appeared to enjoy this and the facilitator interacted in a friendly warm manner. Some residents said they preferred their own company and occupied themselves with reading, playing puzzles or watching television. A small number of residents were observed to be confined to their bedrooms due to lack of mobility, being situated on the first floor of the home. The residents also have limited cognitive ability, these residents are at risk of social isolation as staff undertake a task orientated approach, such as eating, drinking and changing the resident rather than spending quality time with them. The home could not provide evidence that they spend quality time with these residents. Each resident has an activity plan in their personal files, where staff code what activities the residents has been involved in for the day, these showed that either the residents carried out the same activities everyday or haven’t done anything as the records had not been filled in. The home is advised to keep better records. The home welcomes visitors offering them beverages and an opportunity to have a meal with their relative or friend. A relative visiting the home at the time of the inspection said that he is always made very welcome, that the staff are always very pleasant and showed kindness to his wife. The Visitor Said: “I visit at all times of the day and my wife always looks clean, tidy and comfortable”. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 17 Through viewing care plans and speaking with staff it is evident that the home promotes the philosophy of choice and respect. Care plans state that residents must be given choices in areas of personal care, mealtimes and staff must adopt a flexible approach when supporting residents to make a choice of when they wish to get up and go to bed. The residents are offered a verbally choice of menu to residents the day before it is given provides evidence that staff are not fully aware of the inhibited cognitive functions of people with dementia. This was evidenced when a resident became upset at teatime, as she had been given something to eat that she did not like. The staff must also communicate clearly when offering choices so as not to confuse the residents. The home has appointed a new cook who is undertaking a national vocational qualification (NVQ) and will be attending a course in nutrition awareness. The cook appeared happy and confident; she demonstrated that she has an awareness of special diets, presentation and the importance of offering alternative choices. Each resident has a nutritional assessment undertaken on them. But residents with whom the home has concerns about their nutritional intake and level of activity did not have their weight recorded as stipulated in their care plans. Through observation it was established that mealtimes are very stressful for some residents. Some residents showed signs of agitation and the movement of staff and mixed message from staff caused confusion. The dining room went several minutes without a staff member present leaving residents to fall asleep, walk around repeatedly and attempt to take others food and drink. A resident was observed to become very anxious that she had made a lot of mess, the sitting position and utensils of another caused her difficulty to eat her meal in a dignified way and another’s meal went cold because she was left unnoticed by staff for approximately 15 minutes. Windy Ridge Nursing Home DS0000011456.V344900.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides information to people whom use the service on how to raise concerns and complaints, however this needs improving upon to ensure people have all the information they require and it is in an accessible format for those with sensory and cognitive disabilities. The home does well to ensure the people who use the service have their welfare protected by staff who have a good understanding through training of the need to protect vulnerable adults, however the home needs to ensure the dignity and respect of residents age and abilities are not compromised by staff who do not appear to have an appropriate understanding of how to support their needs. Such as using appropriate ways to address people and manage challenges. EVIDENCE: The AQAA informed us that the home has policies and procedures on how to respond to complaints and the manager has direct links with the managing director and director of care for support and advice in respect of allegations of abuse. This was tested by speaking with the senior member of staff. Speaking with a visitor, seeking staffs understanding of abuse and viewing training records. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 19 A copy of the revised Statement of Purpose and Service User Guide was provided at the time of the visit, the Statement of Purpose gives clear details of how a concern or complaint can be raised with the management team and the following process, however it does not give details of how they can contact other agencies. The Service User Guide does not give information on complaints, although there is a place headed complaints in the document. A relative stated that he had no concerns about the care of his wife but said he would have no worries raising his concerns if he had any and was assured the home would listen. A recent survey undertaken by the home provided evidence that overall representatives of the people living in the home were very satisfied or fairly satisfied with the service their relative is receiving. The senior member of staff on duty who is also responsible for training staff provided evidence that all staff have received training in abuse and stated that discussions regarding abuse are regularly had in staff meetings. There is evidence that the home also receives abuse awareness training each year from the Altziemers Association. Staff with who were spoken with confirmed they had received training and were aware of what constitutes abuse and how to report concerns. Windy Ridge Nursing Home DS0000011456.V344900.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use the service are provided with a comfortable, clean and homely environment to live in, however limited bathing facilities compromise peoples wishes to bath when they want. The people who use the service are protected from the risk of infection as the home has good infection control procedures in place. EVIDENCE: The AQAA informed us that the home is very clean throughout, but recognises it could do better to provide additional shower facilities and monitoring the cleanliness of specific areas such as the kitchen. This was tested by undertaking a tour of the home, which included viewing some bedrooms, bathrooms, communal areas, the kitchen and laundry. It also included speaking with the people who use the service and ancillary staff. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 21 The home was clean airy and tastefully decorated and furnished with high quality furnishings throughout. Bedrooms were noted to be clean and tidy and personalised. A large enclosed garden that attracts various wildlife, a specific interest for one resident was reported to be used frequently during the summer months. The home has a first floor bathroom and two shower rooms one of which has been out of action since the beginning of the year. The first floor bathroom is only accessible to people who are mobile. Residents accommodated on the first floor who are immobile are unable to access this bathroom. It was established at the time of this visit as well as previously that the shower room was still out of action. This will be made a requirement. The main communal area of the home is a large conservatory. At the time of the visit the conservatory was at a comfortable temperature and air conditioning units, fans and heaters have been installed. Staff also regularly check and keep a record of the temperature during the day. During the observation period undertaken over teatime the inspector became chilled as a fan had been left on in close proximity to where residents were sitting. The flooring in the hallway is uneven and appears to be breaking up under the floor covering. The home has systems in place to minimise the risk of cross infection, visitors are asked to use antibacterial hand scrubs and staff were observed to be wearing protective clothing such as disposable aprons and gloves. Staff receive training in infection control including ancillary staff. The home has designated cleaners and a laundress, all areas of the home were noted to be very clean and fresh throughout. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has appropriate staffing levels to meet the current needs of the people who use the service. The home has made improvements to the level of training staff receive, however the effectiveness of training should be monitored to ensure staff implement the knowledge they have received. The home has made improvements in collecting recruitment data for staff, however further improvements are required to ensure the home protects the people who use the service from potential risk of harm. EVIDENCE: The AQAA informed us that the home has completed a review of its recruitment procedures and in the last five months there has been a surge in training including obtaining information for staff to undertake a national vocational qualification (NVQ). To test this care and support practices were observed, the duty rota and training and recruitment records were viewed and time was spent with the senior member of staff responsible for training. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 23 Through out the course of the day staff were observed going about their duties in a relaxed and unhurried way, residents were supported to get up when they wished and the appearance of all residents was clean and tidy. The duty rota provided evidence that there is always a trained member of staff on duty and suffient numbers of staff to meet the current needs of the residents Concerns raised during the previous visit in respect of staff care time being eroded by undertaking ancillary work has been rectified with the appointment of a member of staff responsible for preparing and cooking the evening meal. The home demonstrates that it is keen to have a qualified workforce and encourages staff to undertake a NVQ. Staff with whom the inspector met with confirmed that they had undertaken an NVQ and the training coordinator has made links with a local college in order that more staff can undertake the qualification. The home has appointed a new administrator that has spent considerable time auditing staff recruitment files to ensure all documentation is in place and improvements were noted, however of the four newly recruited staff files viewed it could not be demonstrated that the home had undertaken a protection of vulnerable adult check before two staff started working in the home, therefore placing residents at potential risk of harm. This requirement has been issued on two previous occasions. The home nominated a senior member of staff as a training coordinator; certificates demonstrating that the member of staff has qualifications to teach were seen. An audit of staff training has been undertaken and shortfalls have been identified as well as a record of a rolling schedule of training. The training coordinator and certificates seen demonstrated that staff have received mandatory training such as moving and handling, fire training, health and safety, first aid and food hygiene as well as specific training such as dementia care. Practices observed through the course of the visit and recorded throughout the body of this reported demonstrated that staff are not applying theory into practice including the way that staff communicate and understand the needs of people with dementia. A member of staff stated that if a resident wants to leave the home she will tell them that they can’t because they are old and can’t look after themselves any more. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has recruited a manager who is aware of how the home needs to improve to meet the needs of the people who use the service. The financial interests relating to the management of personal allowances of the people who use the service are safeguarded. However the home must ensure all areas of the home which are a potential risk to the health and safety of people who use the service including recruitment and fire safety. EVIDENCE: Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 25 The AQAA informed us that the homes management and administration and principles of high quality of care put into practice, however the home recognises there are areas of improvement to be made in communicating to staff the homes goals and objectives. This was tested by the viewing of various administrative documents and procedures throughout the course of the visit, and observing and speaking with staff. The manager was on holiday at the time of the visit and the senior member of staff on duty assisted with the visit who was able to answer the majority of the questions put to him. When staff were asked their views of the management of the home, they were very positive stating that things had greatly improved over the last several months and that they felt better supported and supervised. A relative spoke kindly of the new manager praising her and her staff for the improvements that have been made. The home has recently undertaken a quality review of the service and overall comments recieved from relatives were positive. Evidence was not found to include residents and health care professionals in this quality review. Evidence of how the manager is going to make improvements to the service based on the comments received was also not found. Staff confirmed that the home holds regular resident and staff meetings, where the views of the residents and staff are listened to and acted upon. The home receives monthly visits from senior managers who undertake a quality audit of the home known as a regulation 26 visit. The home looks after small amounts of residents’ monies. Accurate records for the individual monies are kept, with all money being received and expenditure by the residents recorded. The home can demonstrate that staff receive training in health and safety, including fire training and areas of the home that could be a potential risk to the residents are regularly monitored such as hot water outlets. However the home cannot evidence that it is complying with fire safety regulations and requirements issued following a visit to the home by fire safety officers in 2006. A number of areas of non-compliance were identified such as the lack of adequate emergency lighting, an appropriate fire risk assessment and appropriate fire doors. The senior carer on duty was aware that the service was taking steps to rectify the concerns but did not have the evidence available. Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 26 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 1 Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement To ensure the people who use the service identified assessed needs can be met by the home all areas of the assessment document must be completed. To ensure the people who use the service have their individual health, welfare and social needs met the home must ensure care plans are completed in full and regularly monitored and updated. Attention must be given to those who are immobile. The home must ensure risk assessments to include mobility and social interaction are undertaken on the people who are accommodated on the first floor. Timescale for action 30/11/07 2. OP7 15 30/11/07 3. OP7 13(4)(a) (b)(c) 13(5) 12/11/07 4. OP10 12(4)(b) The home must ensure the 12/11/07 people who use the service are communicated with in a way that they understand and must be DS0000011456.V344900.R01.S.doc Version 5.2 Page 28 Windy Ridge Nursing Home respected at all times. 5. OP30 12(1)(a) 12(2) 12(3) 12(4)(a) (b) 23(2)(f) The home regularly monitor the staff to ensure they are demonstrating that they an understanding of the needs and individuality of the people who use the service. The home must ensure the people who use the service receive their meals in a congenial setting that meets their personal requirements. The home must provide the people who use the service with and accessible complaints procedure and provide details of other agencies who can be contacted to assist with complaints. The people who use the service must have sufficient bathrooms and shower facilities in working order to meet their needs. The home must ensure the people using the service are protected by undertaking thorough recruitment checks on all staff including obtaining CRB and POVA first checks prior to commencing employment at the home. This is a repeated requirement from 30/10/05 and 13/03/07. 10. OP38 23(4)(a) – The home must ensure the home 30/11/07 (c)(i) – provides a safe environment to (v) live and contact the Fire and Rescue service to notify them of the delay in meeting requirements made by them in DS0000011456.V344900.R01.S.doc Version 5.2 Page 29 12/11/07 6. OP15 12/11/07 7. OP16 22(2)(6) 22(7)(a) 30/11/07 8. OP21 23(2)(j) 31/12/07 9. OP29 19(1)(a) (b) 30/11/07 Windy Ridge Nursing Home 2006. 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 Standard Good Practice Recommendations Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Windy Ridge Nursing Home DS0000011456.V344900.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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