Inspection on 11/01/08 for Wingates Residential Home

This inspection was carried out on 11th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wingates Residential Home 07/08/08

Wingates Residential Home 03/05/06

Wingates Residential Home 01/12/05

Wingates Residential Home 09/06/05

Wingates Residential Home 20/10/04

Wingates Residential Home 10/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Wingates Residential Home 95 Chorley Road Westhoughton Bolton Lancashire BL5 3PG Lead Inspector Sarah Tomlinson Unannounced Inspection 07:45 11 January 2008 th 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 Wingates Residential Home DS0000009309.V347411.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. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wingates Residential Home Address 95 Chorley Road Westhoughton Bolton Lancashire BL5 3PG 01942 813840 01942 811506 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Sabir Khan Mrs Shila Khan Mrs Christina Nicola Crowther Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered for a maximum of 25 service-users to include: Up to 25 service-users in the category of OP (Old Age not falling within any other category). The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 3rd May 2006 2. Date of last inspection Brief Description of the Service: Wingates is a privately owned care home. It is registered with us (the commission) to look after up to 25 older people with personal (residential) care needs. The home is on a main road in the Westhoughton area of Bolton. There are pubs and shops nearby, and the home is on bus routes for the town centre. The home is on two floors (with a lift) and includes the original building and a purpose built extension. The home has 23 single bedrooms and 1 double bedroom (although this is currently used as a single). All have wash hand basins, with 2 also having en-suite toilets. There is an assisted shower room on both floors, with a further assisted bathroom on the first floor. There is one main lounge with an adjoining, smaller second lounge and a separate dining room. The entrance is at the rear of the home, where there is a car park and a garden with mature trees, plants and a lawn area. Current fees range from £355.39 to £360.54 (hairdressing, dry cleaning and toiletries are extra). Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The visit, which the home was not told about beforehand, lasted just over 11 hours. We talked to 6 residents, 2 visitors, the manager, the deputy manager, 3 carers, the cook, the administrator and a visiting district nurse. We also spent time watching how staff cared for residents and looked around parts of the building and at some of the home’s paperwork. When we arrived we were told the manager, Mrs Christina Crowther, was leaving very shortly. (Once a new manager is employed, they will have to apply to us to become the registered manager). Before the inspection, the home completed a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they feel they do well and what they need to do better. This helps us decide if the management of the home sees the service they provide the same way we do. It did not mention the relationship difficulties between the management team and the co-owner that we found. Before the inspection, we sent surveys to people who visit and work in the home. Seven relatives and 3 staff returned them. Their views are included. What the service does well: Wingates was homely and pleasant. Residents felt they were well looked after. One resident said the home was “smashing, grand”; another that staff were “lovely”. Relatives praised the home saying “they have gone out of their way to please [my relative]…they seem to be most patient”; “Wingates is first class…nothing was too much trouble…everyone is very cheerful and helpful”. We saw staff caring and speaking to residents in a warm and kind manner. The staff team were experienced and changed very little (with few staff leaving). Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 6 Residents and families said good things about the food - “its grand”; “very good food, makes a lovely vegetarian meal for my mother”; “the chef will make me anything”. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Wingates Residential Home DS0000009309.V347411.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 Wingates Residential Home DS0000009309.V347411.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (Standard 6 is not applicable, as intermediate care is not provided). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about potential residents was received appropriately. Some minor improvements to the information they in turn received about Wingates would help them make a more informed choice. EVIDENCE: We looked at information provided to potential residents and their families about the home. There was a combined Service User’s Guide and Statement of Purpose (brochure). This provided basic information about the home and was only available in a standard format. As the brochure was aimed at older people, a larger type size throughout would be helpful (e.g. a minimum of 14). A clearer explanation that both long and short term (respite) care was provided would also be helpful. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 9 Some minor changes were needed to the brochure - the provider’s address was missing and must be added; as only 2 lounges were usable, the description of the premises will need to be amended if the 3rd lounge continued to be used for storage (e.g. wheelchairs); the description of the dining room as ‘large’ needed removing (to reflect it had been swapped with the lounge). An issue date would be useful to show when the brochure was last updated. With regard to visitors being able to look at our most recent inspection report, a copy was kept in the reception area and the brochure also advised visitors to ask to see it. Records and discussion confirmed that before a potential resident moved in, a detailed assessment of their needs was received. The manager also visited them in their own home or in hospital (to confirm whether Wingates could meet their needs). Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a caring and respectful staff team. Gaps in records possibly placed residents at risk of their needs not being fully understood or met. EVIDENCE: We looked at 3 care files. Care plans and risk assessments were in place and contained personalised information. However, they were not always reviewed every month and kept up to date. For example, whilst accident records for 1 resident had been completed and partly acted upon (with a GP visit requested), the related care plan and risk assessment had not been updated. They also did not show how residents and/or their families had been involved with what was written in them (although relatives felt they were kept well informed). Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 11 To reduce duplication and help keep information up to date, we advised some records could be combined (e.g. as well as individual risk assessments there was also a further general risk assessment; there were 2 monthly checklists to show what records had been reviewed; and monthly weights were also being recorded twice). The standard of writing in daily diary sheets was satisfactory, with personalised entries. However, monthly review entries usually just stated “no change”. Brief information about residents’ backgrounds and life history was written in ‘personal profiles’. These would benefit from being developed, particularly for residents with confusion. Photographs of residents staying for respite were missing from care files and medication records. Residents were receiving a range of health care checks (e.g. from the district nurse, GP, optician, continence advisor, chiropody). However, details of these were recorded in different places. To allow issues to be easily tracked over time, we advised the home try using an existing health record sheet for all of a resident’s heath information. During the inspection, the district nurse team (who visit the home twice a day) raised several concerns with us. At the last inspection, we had asked the quality of pressure area prevention regarding mattress quality be improved. The home had since bought 6 new pressure ulcer prevention/reduction mattress overlays. However, at this inspection, the district nurse team still had concerns about bed quality. The district nurse team had also observed some staff moving residents in wheelchairs without footplates being used and poor infection control techniques from some staff (e.g. not wearing gloves and aprons; soiled bed linen left on the floor in corridors). After the inspection, we spoke with Mr Khan, the co-owner about these matters. We requested a meeting be arranged between himself, the new interim manager and the district nurse team to formally address their concerns. We will monitor the outcome of this meeting. We looked at the medication system. There was generally a clear audit trail of medicines received into the home and being administered to residents (including controlled drugs). There were some gaps on administration record sheets (MARs sheets) where medicines had either not been administered (with no explanation noted) or given but not signed for. The handwritten MARs sheets for respite residents were not being checked and countersigned. We advised written confirmation of respite residents’ medicines should be routinely asked for before admission (e.g. via a facsimile from their GP). We advised when medicines were prescribed with a variable dose (e.g. 5 or 10mls) the MARs sheet should state the usual dose, with any exceptions then noted. One resident staying for respite care was looking after some of their own medicines. Although good practice, we were concerned the home was Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 12 unaware of this and so had not carried out a risk assessment to make sure the resident could safely self-administer their own medicines. Medicines were kept safely, although time limited medication such as eye drops needed to be dated on first opening. The home planned to address the limited storage space for medicines through a forthcoming extension. Until then, as medicines had to be taken to another lockable room to be booked in, enough time must always be allocated to enable staff to safely follow the home’s procedures regarding this. With regard to how staff cared for residents, we saw staff treating residents in a warm, kind and respectful manner. We talked to 4 residents who all felt well looked after (the home was “smashing, grand”) and described care staff as “lovely”. Two visitors were happy with the care their relatives were receiving and 3 survey replies from relatives were also positive, saying “[the home] have gone out of their way to please [my relative]…they seem to be most patient”; “very good communication with my mother & myself…they always contact me when an incident had occurred”; “Wingates is first class… nothing was too much trouble…everyone is very cheerful and helpful”. Residents could use a payphone on the first floor landing, although they were also able to use the office telephone and all rooms had telephone points. We observed a resident receiving their mail unopened. We discussed bedroom door locks. Whilst all had a suitable ‘thumb turn’ lock on the inside, most of the outer locks were unsuitable. Only two rooms had been fitted with locks to enable a resident to secure their room when leaving it (to safeguard their possessions and privacy). We also discussed the protective covers used on many armchair seats in the lounge. We felt this did not promote residents’ dignity as their colour made them very visible, identifying the person sitting there as somebody with continence needs. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing at mealtimes needed reviewing to ensure residents enjoyed the good food provided. To ensure all residents’ social needs were met, social activities needed developing. EVIDENCE: The home did not employ an activities co-ordinator. Senior care staff carried out daily social activities, which usually took place in the afternoon (since the last inspection staffing levels had returned to 3 staff in the afternoon, which helped ensure activities usually took place). However, as the same small group of residents usually took part, a greater variety of activities needed to be developed (so more residents, including those with confusion received meaningful, social stimulation). Good practice was Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 14 noted, as residents family pets were encouraged to visit and a couple of residents were also involved in the domestic routines of the home (folding serviettes). This could be developed, with residents being encouraged and supported to help with a range of ‘jobs’ (e.g. dusting ornaments; folding towels/linen; helping set and clear tables at mealtimes (and as planned, gardening). We also discussed the frequency of activities, as many residents who got up early received little stimulation between breakfast and lunchtime. The television was on for much of the inspection, although most residents were not watching it (and could also not see or hear it). One relative’s survey reply said “activities can be improved…I would like to see activities 4/5 days a week, I am aware certain members of staff do things when time is permitted”. One staff survey reply suggested “more entertainment in the home and more outings”. Visitors felt they were made welcome. Residents and their families were able to personalise bedrooms. We watched breakfast being served. The dining room had a poor standard of furniture – many chairs did not have armrests and none had glide rails. Although new chairs and tables had been ordered and were due to be delivered shortly. Tablecloths and tablemats were used, although the latter were very worn and needed replacing. Eleven residents were in the dining room at 7.45am. We were told many residents liked to rise early (and staff shift patterns had recently been altered to enable residents to do this). Residents were eating a variety of cooked and cold breakfasts. However, we were concerned no staff stayed in the dining room to help residents, with 3 residents’ breakfasts going cold and unpalatable in front of them. The daily menu was usually displayed on the dining room door. There was one lunchtime meal, although records plus residents and families confirmed alternatives were regularly provided - “very good food, makes a lovely vegetarian meal for my mother”; “the chef will make me anything”; “its grand”. To reduce record keeping, we advised one general daily record with details of any alternatives made (and who for) would be fine. We were impressed with the chef who was very enthusiastic, conscientious and committed. No pureed meals were currently provided, although the chef confirmed each item would be kept separate (to maintain taste, texture and appearance). The home confirmed all staff that worked in the kitchen had valid food hygiene certificates. Good practice was noted, as fortified and full fat milk was used (including in the homemade soups). The home had been without a 2nd cook since Christmas, with care staff and one of the co-owners working in the kitchen. The vacancy had now been filled and the new staff member was due to start next month. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 15 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for protecting residents from abuse and for taking concerns seriously were in place. Further training would strengthen this system. EVIDENCE: Residents and visitors felt able to raise any concerns and knew who to talk to. The home’s complaints procedure was detailed in the brochure and displayed in the reception area. As this was behind the administrator’s desk and in small print, it would be easier to read if it was in a larger type size and/or moved. We had received no complaints since the last inspection. Two had been received by the home. One of these had been upheld, regarding a resident sent to A&E without a staff escort. We discussed where information about complaints was kept as we had some difficulty in accessing this. We advised one central record should be kept, to which the manager has access. The home had recently bought a training video about understanding abuse and safeguarding issues. Good practice was noted, as the manager confirmed all Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 16 staff, including domestic/support staff, had now received training in this area (although staff training records did not show this). We discussed the new Mental Capacity Act 2005, its impact on the home and the need to arrange staff training in this area (we showed a copy of the government’s easy read booklet about the act and gave details about ordering free copies). Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 17 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, 20, 22, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Wingates was pleasant and homely. Better control of the air temperature would make the home more comfortable. EVIDENCE: Wingates was bright and welcoming with an acceptable standard of décor, including the use of wallpaper, which helped it appear homely. Since the last inspection the ground floor bathroom had been changed into a new assisted shower room, there were new curtains in the lounge and bedrooms were being redecorated to a good standard as part of a rolling programme. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 18 However, there were some ongoing issues - at our last 2 inspections we had identified the lack of storage space, with the 3rd lounge being used for storage. We found this again at this inspection, with a large number of wheelchairs being kept there. The home was advised it should not reduce its communal space. However, a forthcoming extension will hopefully resolve this problem. Replacement of old bedroom curtains was now about to take place (to be ordered next month). At this inspection we also found – the fire door at the top of stairs, which had no automatic closure, was being propped open/catching on the carpet; a large split in the kitchen floor; and water stains on the ceilings in the main lounge and dining room (which were due to be addressed). There was also a cracked double-glazed unit in the 3rd lounge. It became very warm during our visit, reaching 25C by the afternoon. Although residents may chose to have their own rooms as hot as they wished, for comfort and to avoid drowsiness, communal rooms should remain nearer to 20C (also, excessive sleeping during the day may be contributing to some residents’ early waking). The home was already monitoring the air temperature in communal areas each weekday morning, with records showing 24C/25C were regularly being reached. With regard to specialist equipment, we discussed the height of toilets. All were very low and most did not have raised seats fitted. We advised the home review these arrangements to ensure more raised seats were not needed. We also discussed how residents were weighed. The home did not have seated weighing scales and used ordinary scales. However, these are impractical for residents who have difficultly standing (resulting in inaccurate recording). With regard to smoking, one resident who was staying for respite care smoked. This was done outside, which was what they did at home. We advised the home needed to clearly state in its brochure its policy about smoking policy. Residents can then make an informed choice before they decide to stay. We found the home was clean and tidy and smelt fresh, which residents and visitors agreed was usual. New bedding was to be ordered shortly (we found extra sets were needed; to ensure adequate stocks of clean linen). The sealed flooring in the communal toilet near the lounge was becoming stained and will need replacing. As a result of the forthcoming extension plans (which would involve building on the rear garden), the area at the front of the home was being dug up to create a new garden. We were concerned about this proposal as the home was on a busy, noisy, main road. However, we were told after the inspection new garden space is also to be created at the rear. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs were better met now staffing levels had improved. Recruitment practices generally protected residents, although some gaps in basic staff training did not. EVIDENCE: At the last inspection we had found staffing levels had dropped from 3 to 2 staff during an afternoon and evening. At this inspection these had returned to 3 staff on duty all day (and 2 at night). We looked at rotas from October and November 2007, which showed acceptable staffing levels. Good practice was noted, as senior staff had a paid handover. Also, shift patterns had recently altered to accommodate residents’ requests to get up early (day staff said they used to come on duty but had not been able to respond to the number of requests for help). There was now a 1hour overlap between night and day staff, with night staff finishing at 8am and day staff starting at 7am. However, as noted earlier in the report, the manager needs Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 20 to monitor morning staffing arrangements to ensure residents received any help they needed to eat breakfast. Good practice was noted, as there was a low staff turnover with the staff team remaining stable. There was a current vacancy for a senior day carer. One new carer had just started. We looked at their recruitment file. Appropriate checks had been made, including suitable references. The manager had followed up an issue (with a telephone call), but the date and details had not been recorded. Whilst proof of identity had been seen (in order to request the CRB disclosure), copies had not been kept. A photograph was missing (the need for all staff files to contain a recent photograph had been raised at the last inspection). There was also no evidence of the applicant’s NVQ qualification. Good practice was noted, as the new starter was undertaking a 2-week shadowing period, during which time they were supernumerary. They had completed a basic induction checklist and were about to start the Skills for Care induction pack. With regard to NVQ training, 10 of the 16 care staff (63 ) had the NVQ level 2 award (although this did not take account of agency staff, which need to be included). A further 6 staff were undertaking the award. We looked at training for 3 staff. Annual refresher training in fire safety and training in the safe administration of medicines had been completed. However, staff training files were not up to date, with these training details missing. We were also concerned to find annual refresher training in moving and handling was out of date for 4 staff. With regard to additional training, good practice was noted as basic first aid and falls prevention course had been attended. We discussed developing such training further. The current resident group included people who had diabetes and people with confusion. Informal, in house training sessions could supplement external training and the internal training videos, and ensure all staff had training in relevant areas. These sessions could become a regular part of staff meetings or part of extended handovers (with outside professionals (e.g. district nurses, community psychiatric nurses) also invited to speak). Two pressure area care courses had been booked, although one had been cancelled. Due to the concerns raised by the district nurse team, we advised all staff should complete the course as soon as possible. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 21 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, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Previous improvements in the running of the home were now at risk due to the breakdown in the relationship between the manager and the co-owner. EVIDENCE: During the inspection we found out the manager (Christina Crowther) had recently handed in her notice and would be leaving soon (finishing 23rd January 2008). The co-owner will need to provide details of what the interim management arrangements will be, once Christina has left. (We were informed after the inspection, the deputy manager Donna Norman, would be the acting Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 22 manager until a new permanent manager was appointed). The co-owner should write to residents’ families to explain about these changes. The current registered manager, Mrs Christina Crowther, had been in post for approximately 2 years (attaining her Registered Managers Award (NVQ level 4) since the last inspection). The staff team spoke about her very positively. The district nurse team also felt they had a “good working relationship with Christina…[she] has motivated staff”. During the inspection, we were told about the breakdown in the relationship between the management team and the co-owner, Mr Khan (who visits the home several times a week). Difficulties had existed for over 7 months. An external mediator had been involved to try and resolve the issues. With regard to formal staff supervision, these had not been taking place (although 1 staff member had received an appraisal). The home had several methods of checking out the quality of its service. Residents meetings were held and annual surveys were sent to relatives and visiting professionals. A staff survey had just been developed, but had not yet been used. The monthly quality monitoring meetings held between the owners and the management team had not taken place since July 2007. Small amounts of money were held on some residents’ behalf. We were not able to check these, as the safe keys were not available. Before the inspection, the home provided details that all safety and maintenance checks were up to date. During the inspection we confirmed these for the lift, hoists, electrical wiring installation (re-test due 11/09) and fire alarm and fire equipment. The fire alarm was also tested weekly, with different zones activated each time. We advised different staff should help with this (to encourage familiarity and confidence). The means of escape were also formally checked each week. At the last inspection we had asked the fire risk assessment be updated and regular fire drills take place. The manager confirmed the assessment had been updated and records showed regular fire drills were now carried out. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 23 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 24 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. 1 Standard OP7 OP8 Regulation 15 (1) (2) (b) Requirement To ensure residents are kept safe and receive the care they need, care records must be kept up to date. To ensure residents’ health does not deteriorate due to the beds provided by the home, the concerns of the district nurse team must be fully investigated. All records regarding medication must be completed accurately to show medication can be accounted for and residents are being given medicines as prescribed. Any omissions, variations or errors in the administration of prescribed medication and the reasons for these must be clearly recorded. Risk assessments must be carried out with residents who look after some or all of their own medicines, to make sure they can do so safely. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 25 Timescale for action 07/03/08 2 OP8 OP22 12 (1) (a), 13 (4) (c) 07/03/08 3 OP9 13 (2) 07/03/08 4 OP12 12 (4) (b) To better meet the social needs of all residents, the activities programme must be developed. To ensure residents’ health and wellbeing, staff must provide support to those who need help to eat and drink. To provide a safe place to live and work the fire door at the top of stairs needs adjusting. To help ensure residents are comfortable and alert, air temperatures in communal areas must be monitored, with action taken through out the day, to ensure they remain closer to 20C. 31/05/08 5 OP15 12 (1) (a) 07/03/08 6 OP19 OP38 23 (4) (c) (i) 23 (2) (p) 22/02/08 7 OP25 22/02/08 8 OP29 19 schedule 2 To protect residents, staff 31/05/08 recruitment records must contain a recent photograph, proof of identity and proof of relevant prior training and qualifications. To ensure residents’ (and staff) safety, all staff must undertake annual moving and handling training. 31/05/08 9 OP30 18 (1) (c) (i) 10 OP31 Section 11 of Care Standards Act 2000 To meet the home’s conditions of 31/05/08 registration, once the existing manager has left, a new manager must be recruited. They must then submit their application to us for registration. To promote the effective running of the home, the monthly owners/managers meetings must re-start. Copies of the minutes must be provided to us each month. 07/03/08 11 OP33 26 (3) (5) (a), 12 (5) (a) Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 26 12 OP36 18 (2) To support staff, they must receive regular supervision (with records kept). 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations To ensure information about the home is correct, the combined Service User’s Guide and Statement of Purpose should be updated (with regard to the points identified in the main body of this report). It should then be kept under review and revised where appropriate. CSCI and residents should be notified of any revision within 28 days of any change. 2 3 OP7 OP8 OP8 To reduce duplication and improve ease of use, the number of forms in care files should be reviewed. As agreed, the home should meet with the district nurse team to address their concerns about communication and moving and handling and infection control practices. To ensure residents’ receive the correct medication, all hand written entries on the MARS sheets should be checked and countersigned. To promote their effectiveness, time limited medicines should be dated on opening (e.g. eye drops). 5 OP16 To show complaints are properly dealt with, one central complaints record should be kept to which the manager has access. To enable staff to correctly work under the new mental Capacity Act 2005 guidance, staff training should be arranged. To ensure residents have enough indoor communal space, DS0000009309.V347411.R01.S.doc Version 5.2 Page 27 4 OP9 6 7 OP18 OP7 OP14 OP17 OP20 Wingates Residential Home OP22 the home should continue to provide at least 4.1sq metres of communal space for each resident (if they did not provide that amount of space at 16 August 2002, they should continue to provide at least the same communal space for each resident as they did at 31 March 2002). Storage space should be created to allow the 3rd lounge to be become a usable room. Wingates Residential Home DS0000009309.V347411.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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