Inspection on 07/08/08 for Wingates Residential Home

This inspection was carried out on 7th August 2008.

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

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

Wingates Residential Home 11/01/08

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 14/11/2008.

CARE HOMES FOR OLDER PEOPLE Wingates Residential Home 95 Chorley Road Westhoughton Bolton Lancashire BL5 3PG Lead Inspector Sarah Tomlinson Unannounced Inspection 7th August 2008 07:00 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 Wingates Residential Home DS0000009309.V368961.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.V368961.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 Miss Carrie Ashton Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Wingates Residential Home DS0000009309.V368961.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. 11th January 2008 2. Date of last inspection Brief Description of the Service: Wingates is a private care home, registered with us (the commission) to provide care for up to 25 older people. The home is on a main road in the Westhoughton area of Bolton. It is on two floors (with a lift), with a purpose built extension. The home has 23 single bedrooms and 1 double bedroom (which is used as a single). All bedrooms have wash hand basins, with 2 also having en-suite toilets. There is an assisted shower room on both floors and an assisted bathroom on the first floor. There is a main lounge with an adjoining conservatory lounge, a third smaller 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 with a lawn and small patio area. There are pubs and shops nearby, and the home is on bus routes for the town centre. Current fees range from £364.27 to £369.42 (hairdressing, dry cleaning and toiletries are extra). Wingates Residential Home DS0000009309.V368961.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 inspection visit, which the home was not told about beforehand, lasted approximately 11 hours and was carried out by two inspectors (one of whom was a pharmacy inspector). During the visit we talked to several residents, visitors and staff (including the manager, one of the owners and care and catering staff). We also spent time watching how staff looked after residents and how medicines were given. We looked around parts of the building and at some records (including those for care and medication, staff recruitment and training, and health and safety). Before the inspection, we received feedback from the district nurse team, who visit the home on a twice-daily basis. Their views are included in this report. The home’s previous manager (Mrs Christina Crowther) left at the beginning of the year. Ms Donna Norman, the deputy manager, then acted up until a new manager, Miss Carrie Ashton, was appointed on 12th May 2008. What the service does well: What has improved since the last inspection? The new manager was enthusiastic and motivated. She was making a range of changes, which were benefiting residents’ health, safety and wellbeing. The brochure had been updated, so people thinking about moving into Wingates had clearer, more helpful information. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 6 A meeting with the district nurse team had resolved a query about residents’ beds, confirming they were of an acceptable quality and size (with the special mattresses provided by the district nurse able to fit with some practical adjustments). A new medication and treatment room provided much needed storage and working space. More social activities were being provided, helping to keep residents stimulated. There was new dining room furntiure, which was easier for staff to use and better-suited residents’ needs. Staff were being recruited properly and getting the right basic training, keeping residents safe. 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.V368961.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.V368961.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. Quality in this outcome area is good. (Standard 6 is not applicable, as intermediate care is not provided). This judgement has been made using available evidence including a visit to this service. Prospective residents and their families received clear, helpful information about the home. Information about their needs was appropriately received by the home, ensuring they could be met before admission was agreed. EVIDENCE: Prospective residents and their families received a brochure (which was a combined Service User’s Guide and Statement of Purpose). The brochure was easy to understand, with clear information about the home and the service it provided. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 9 At the last inspection, we had advised some minor changes were necessary and had also suggested some minor improvements. These had been acted upon. The owner’s address had been added and the description of the premises updated to be more accurate, including that smoking was not permitted. The format had improved, with the brochure now provided in a larger type size (more helpful to its target reader group of older people). An issue date had been added to show when it was last updated. There was a clearer explanation about both long and short term (respite) care being provided (including a statement that this is now only for residential (personal) care). Records and discussion with the manager confirmed before a potential resident moved in, a detailed assessment of their needs was received. Wingates Residential Home DS0000009309.V368961.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. Residents’ health and wellbeing were benefiting from improvements to care practices. This was put at risk by gaps in care records and poor medication management. EVIDENCE: We looked at four care files. At the last inspection, whilst care records had generally been in order they had not always been reviewed regularly and kept up to date. At this inspection we found a mixed picture. Some care plans and risk assessments were up to date, others were not (e.g. one resident’s risk assessment that identified them at ‘high risk’ of falls had not been reviewed since April 2008; another resident’s recent poor health, including increasing falls, was not reflected in their care plan or risk assessments). Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 11 We also advised, in addition to the existing risk assessment, a care plan was needed for any resident who was identified at high risk of developing or who had developed a pressure sore. Staff needed guidance about bathing, position changes, any specialist equipment being used and any pain relief required. Significant weight loss had recently been noted in two residents’ files. Action had been taken with regard to one resident, with the involvement of the dietician. Staff had not made the new manager aware of the other resident’s weight loss. The weight loss had not been linked back into either resident’s care plan or risk assessments. The home did not have any seated weighing scales. Residents were weighed on domestic scales. The new manager queried their accuracy (and planned to recheck both residents’ weight). The need to ensure all residents’ weights can be accurately monitored was discussed. Action was usually taken when a resident’s health deteriorated, e.g. GP and district nursing visits arranged; ‘falls clinic’ and dietician referrals made; and specialist outpatient appointments organised. Routine sight tests and foot care appointments were also arranged. However, details about these health issues and checks was still not always recorded in a central place (for each resident). Having accurate, up to date information about a resident’s health history helps to make sure any health issues they have are monitored over time, ensuring any treatment or follow up visits they need take place. At the last inspection we had discussed reducing the number of forms in care files to avoid duplication and improve ease of use. The new manager had started to make some changes - regarding the order of forms, the introduction of a body map (to record and monitor any bruises, skin breaks or pressure sores), plus new care plans. Introducing a new care plan format would take some time. We advised it was acceptable to have two different systems running during this transition period (allowing new forms to be trialled before introduced for the whole resident group). However, to accurately reflect residents’ care needs, the ‘old style’ forms must continue to be regularly reviewed and kept up to date whilst still in use. Good practice was noted in one new care plan, with everyday language used to explain medical diagnoses. At the last inspection, the district nurse team (which visited the home twice a day) had raised several concerns with us. This included an ongoing issue regarding bed size. We had requested the home meet with the district nurse team to address their concerns. This had taken place and it was confirmed beds were of standard single size and the specialist pressure relieving mattresses provided by the district nurse team would fit with a minor adjustment to the headboards. The district nurse team felt the new manager had started to make very positive changes to care practices – residents’ mobility was increasing as staff were supporting people to walk rather than use wheelchairs; residents were Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 12 being taken to the toilet more regularly (improving continence care and treating residents with greater dignity). Communication had improved, with a new system to request support from the district nurse team. The new manager and district nurse planned to meet on a monthly basis to monitor these changes. Accident records were completed appropriately, although as noted information was not always being linked back to care plans and risk assessments. We suggested a monthly accident audit was tried (with information noted about ‘who’, ‘where’ and ‘when’) to help identify any patterns (and to prompt the updating of care records). As part of our inspection the pharmacist inspector looked at how medicines were handled. The new manager explained she was aware of weaknesses in the handling of medication, had already spoken to staff and was planning to carry out audits (checks) to try and ensure improvements were made. We similarly saw examples of poor medication handling during our visit (although medication refresher training had been provided). We compared a sample of medicines records and stock and found some inaccuracies in record keeping that could place people at risk of medication errors. We saw records sometimes wrongly showed medicines had been given, when they had not. For example, two records showed more doses of an antibiotic had been given than actually received into the home. It was of serious concern that we saw one example where records showed someone had been given their medicines incorrectly for eight days. It was not possible to track the handling of these medicines to see what was actually administered. A handwritten note (unsigned) recorded: ‘Please ensure that X has teatime medicines and sign please’. The manager had not been made aware of this error and it was not clear what action had been taken. There was a lack of information about the correct use of medicines prescribed ‘when required’. To help ensure consistency, there should be individual guidance about when these medicines should be given. Most medication administration records were pre-printed by the pharmacy but we saw handwritten records were poorly completed. We saw examples where records did not include the person’s name or the ‘month and year’ of administration. Mistakes in medicines record keeping put people at risk of mistakes when medicines are administered, and of these going unnoticed. Records for the receipt of the main monthly medicines delivery were made, but it was evident when medicines were received at other times, a receipt record was not always made. It was not possible to account for all unwanted medicines, as refused medicines were not included in the record of medicines for safe disposal. Residents were able to look after and take their own medicines if they wished to, and were able, and this helped them to remain independent. Staff Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 13 explained two people looked after their own creams, but it was unclear what support they needed to apply them properly. The level of support provided to help ensure safe self-administration should be recorded and reviewed at regular intervals. Medicines including controlled drugs were mostly safely stored but one controlled drug was not stored and recorded correctly because staff did not know it was a controlled drug. We advised a list of commonly prescribed controlled drugs was kept in the home for reference (to help ensure they were identified and so handled correctly). With regard to how residents were cared for, we saw staff treating residents in a warm, kind and respectful manner. We talked to two residents who had lived at the home some time and to one new resident. They were positive about the home and felt well looked after. Two visitors were happy with the care provided. They felt they were kept well informed and involved. They both were positive about care staff. One described them as “lovely” and had been very pleased with the effort care staff and the chef had gone to regarding a recent birthday celebration for their mother. Staff spoken to had a good understanding of residents’ individual needs and care preferences. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Residents were benefiting from improvements in social activities. Residents enjoyed the good food provided. EVIDENCE: The home did not employ an activities co-ordinator. Care staff carried out daily social activities, which usually took place in the afternoon. At the last inspection, whilst activities were provided only a small number of residents took part. We had advised a greater variety of activities were needed, so more residents, including those with confusion, received meaningful, social stimulation. At this inspection, bingo, sing-alongs, quizzes, word games and manicures were the regular activities provided. We were pleased to note some improvements had taken place. An external activities co-ordinator also now visited every fortnight to provide reminiscence and armchair exercise sessions. Five residents had recently enjoyed a sandwich making session organised by the new manager and chef. There were also plans to introduce cake-making Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 15 sessions. A relative had suggested a BBQ, which was currently being organised. We advised these improvements needed to continue, so a varied and stimulating range of one to one and group activities were provided for a resident group of varying abilities. Brief life histories were recorded, providing information about a resident’s job history, interests and important people in their life. The new care plan format also included a section on ‘hobbies’. Information from these should be used to help develop the activities programme. In addition to formal, organised activities, informal ones (which particularly benefit residents who are unable to join in planned activities) could be developed further. Residents could be more involved with the domestic routines of the home, e.g. dusting ornaments, folding towels/napkins, helping set and clear tables at mealtimes and making their own bed. We also discussed how existing links with local schools could be built upon. There were two systems to record residents’ involvement in an activity - a communal activity file and a column in individual daily care notes. The communal file showed what had been provided and who took part. However, many residents were not named. Introducing separate, individual activity sheets for each resident would more clearly identify who had not taken part. With regard to individual daily care notes, their format of a very narrow column for recording social activities (allowing only one word entries) was unhelpful. No meaningful information was being recorded and columns were usually being left blank. At the last inspection, the television in the main lounge had been on for much of our visit, although most residents were not watching it (and could also not see or hear it). The television was off during this visit. The problem of not all residents being able to see or hear the television had been raised at a recent relatives’ meeting. Relatives had been advised the planned extension would help remedy this, with more lounge space to be created. In the meantime, the smaller, third lounge was available (where one resident had recently enjoyed watching the tennis). A summer newsletter, in helpful large print, had been produced and was out on display. This included information about the appointment of the new manager, planned building work, staff training and social activities. Visitors felt they were made very welcome, with one visitor currently staying for lunch each day. Residents and their families were able to personalise bedrooms (e.g. with photographs and ornaments). With regard to residents having control over their lives, when we arrived at 7.00am, one resident was up. Call bell buzzers were sounding and a further Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 16 six residents were up by 7.30am. Night (and day) staff confirmed they were under no pressure to get people up, with residents able to wake naturally and choose when to rise. Residents were usually taken straight into the dining room where the chef or the cook provided them with a hot drink and a cooked or cold breakfast. At the last inspection, we had been concerned care staff did not remain in the dining room to help residents. Whilst the new manager confirmed she usually monitored breakfast; ensuring residents received the help they needed to eat, we observed she was temporarily unable to carry out this role. Low staffing levels meant on the morning of the inspection and for the previous couple of week she had not been supernumerary but had been carrying out care duties. We were pleased to note, new dining tables and specialised chairs (with arm and glide rails) had been provided. The new manager had also changed seating arrangements (to make better use of the space). More mobile residents now sat further away from the entrance. Two residents preferred to eat elsewhere, one in the conservatory lounge and one in their bedroom. Good practice was noted, as to promote a healthy diet, the new manager had introduced the serving of fresh, cut, soft fruit usually 5 days a week (with mid morning or afternoon drinks). Residents also now had a choice of fruit juices at lunchtime. To build upon this, after the inspection, we gave the manager details of ‘Water for Healthy Ageing’, a best practice toolkit for care homes regarding the provision of adequate fluids and the prevention of dehydration. With regard to menu choice, only one main meal was served at lunchtime. Although the chef and staff knew residents’ likes and dislikes extremely well, with daily records showing alternatives were provided. Residents spoke positively about the food; one said it was “very good”. A cook had now been recruited, covering the chef’s days off. The chef remained very enthusiastic, motivated and committed to his work. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. Arrangements for protecting residents from abuse or harm and for taking concerns seriously were in place. EVIDENCE: The home’s complaints procedure was detailed in its brochure. Minor improvements suggested at the last inspection regarding the copy displayed in the reception area had been acted upon. It was now in a larger print size and had been moved, making it easier to read. Advocacy leaflets were also out on display. The home had received one informal complaint since the last inspection. This had been investigated and partially upheld. The new manager had taken appropriate action to prevent a reoccurrence. Although a record had been made of the complaint, this was not in the complaints record book. We advised all complaints (informal as well formal) should be recorded (to demonstrate concerns were listened to, taken seriously and acted upon). We had received one complaint, which was investigated during our visit. Of the three allegations made, one was not upheld. The second, regarding Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 18 staffing levels was upheld (see ‘staffing’ section of this report). The third allegation regarding a specific concern about medication practices was not upheld. Although as noted, other serious concerns were found (see ‘health and personal care’ section of this report). No safeguarding alerts had been received. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Wingates provided residents with a clean, comfortable, safe and homely place to live. EVIDENCE: Wingates was bright, attractive and welcoming, with an acceptable standard of décor and furnishings (that were domestic in style). Wallpaper was widely used, helping the building appear homely and comfortable. There were also vases of fresh flowers around the home. Since the last inspection, new bedroom curtains had been provided and extra sets of bed linen bought (to ensure an adequate amount). The water stains to Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 20 the lounge and dining room ceilings had been painted over. A medication and treatment room had been provided (with space for residents to be seen). In preparation for the forthcoming extension, a new car park area had been created and a small new patio area at the front (although seating had not yet been provided). (As discussed at the last inspection, a garden area was going to remain at the rear, away from the busy main road). Storage space remained very limited. An ongoing issue of the third lounge being used to store wheelchairs had been resolved. This room was now a clear and pleasant space, although the conservatory lounge had become rather cluttered. An upstairs toilet was also being used as a storage room. As noted at the last inspection, additional storage space will hopefully be created with the forthcoming extension. At the last inspection, despite daily monitoring by the home, we had found it was getting too hot in communal areas. At this inspection, temperatures were still being monitored and usually showed lower readings. As autumn approached and the heating began to be used on daily basis, monitoring would be needed throughout the day (with prompt action taken to maintain a comfortable temperature). (Excessive temperatures can make residents drowsy, at times contributing to inadequate fluid and food intake and early morning waking). At the last inspection, we had discussed the protective covers used on many armchair seats in the lounges. They were very visible, identifying the person sitting there as somebody with continence needs. At this inspection, although new covers had recently been bought, they were still very noticeable (as the matching armchair colour was unavailable). We felt covers were not routinely necessary for all residents. The armchairs were waterproof and any recurring continence problems should be identified and acted upon by care staff. Several minor maintenance issues were identified at this inspection. The carpet in the main lounge was becoming very worn in places and will need replacing. The shower curtain in the ground floor assisted bathroom was dirty. The lock was missing from the first floor bathroom. The sealed double glazing unit in one bedroom had deteriorated, with condensation obscuring the view for the resident. We looked at the aids and equipment provided to meet residents’ needs and maximise their independence. At the last inspection, we had discussed bedroom door locks. Residents could choose to lock their doors from the inside (with suitable ‘thumb turn’ locks). Two rooms had outer locks to allow those residents to lock them when empty (to safeguard their possessions and privacy). We observed one of these residents using this lock, which was a small padlock and rather difficult to use. Fitting outer locks that were better suited to residents’ capabilities as standard would be helpful and also encourage and promote privacy and dignity. Such locks could be trialled in the Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 21 forthcoming extension, as could the fitting of handrails on both sides of corridors (they are currently provided along one side only). We also discussed personalising bedroom doors (as also recently suggested by a relative), which would also help residents find their way around. Bedroom doors currently displayed numbers only. We discussed also using people’s names, pictures or (old) family photographs (particularly for residents with confusion) (ensuring these are in line of vision for the resident concerned). Although not currently provided, we also discussed the use of ‘trigger/pressure mats’, which can be helpful in alerting night staff when residents who are at risk of falling, get out of bed. The home was planning to buy a new hoist. We found the home was clean and smelt fresh, which residents and visitors agreed was usual. Wingates Residential Home DS0000009309.V368961.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 good. This judgement has been made using available evidence including a visit to this service. Residents benefited from improvements in recruitment practices and basic staff training. This had been put at risk by inadequate staffing levels. EVIDENCE: Rotas showed staffing levels were generally being maintained (with 3 care staff during the day and 2 at night). However, on the morning of the inspection staffing levels were inadequate. The new manager was not supernumerary and was providing care. The skill mix and number of other staff was also unsatisfactory. These arrangements had been in place for the previous few weeks. We advised whilst it was acceptable and expected to have a staff team with a varied skill mix, staffing levels must show enough staff are on duty to meet the needs of residents. The manager’s hours also need to be supernumerary (particularly as the deputy post was vacant). The support worker role also needed to be clarified. Before the end of the inspection, the new manager arranged for an agency carer to work the next day, increasing staffing levels to an acceptable level. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 23 The new manager explained the above situation was about to be remedied with the appointment of two new staff and had arisen in part due to the home’s commendable policy of not appointing new staff until full police clearance (via their CRB disclosure certificate) had been received. We advised in light of the above inadequate staffing arrangements, the home could consider using the POVAFirst facility (enabling new staff to start work under close supervision, with partial clearance). In the mornings, the home continued to use a one-hour overlap between night and day staff (to meet residents’ requests to get up early). The paid afternoon handover for senior care staff had temporarily stopped whilst the new manager reviewed working arrangements. With regard to NVQ training, just over 50 of care staff have an NVQ level 2 award in care (with 2 staff holding an NVQ level 3 award). A further 7 staff were undertaking the level 2 award and a senior carer the level 3 award. We looked at the recruitment files of four recently employed staff. Good practice was noted, as a panel of usually two asked standardised interview questions, with responses noted. New application forms had been introduced, with a clearer layout. Appropriate checks had been made, including obtaining suitable references. At the last inspection, a recent photograph, proof of identity and proof of relevant prior training and qualifications were missing from some files. The new manager had reorganised files for existing staff, with photographs now fixed to the front of each. The manager was about to provide photographs for the new starters, plus copies of relevant training certificates that had been seen at interview. Copies were now being kept as proof of identity. New starters initially worked in a supernumerary role (e.g. four shifts for one new carer). Good practice was noted, as new staff attended a 7-day induction training programme (provided free from Bolton Social Services). We advised the additional basic induction checklist done with the home should be developed to support this external training. This would ensure new staff received an induction specific to Wingates and its residents group (particularly as places on the external induction course were not always readily available). This could also include formal observation of their care practices and skills (from which their competence and any training needs could be assessed). We were looked at training for existing staff. At the last inspection, staff training files had not been up to date. Annual moving and handling refresher training had also been out of date for some staff. At this inspection, training files were now up to date and the new manager was also developing a training matrix. Fire safety, infection control and dementia awareness training had also taken place. Not all staff had received pressure area care training; although this was still due to be provided by the tissue viability nurse specialist. Wingates Residential Home DS0000009309.V368961.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, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The relationship between the new manager and co-owner was working well, with residents benefiting from a better-run service. Gaps in fire safety practices put this at risk. EVIDENCE: The home had a new manager, Miss Carrie Ashton. The previous manager, Mrs Christina Crowther had left the home on 23rd January 2008. Ms Donna Norman, the deputy manager, had acted up after her departure. Miss Ashton Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 25 was appointed on 12th May 2008, being in post for just three months when we visited. Miss Ashton had recently attended her interview with us as part of her application to become the home’s Registered Manager. This application was successfully completed shortly after this inspection, with Miss Ashton becoming the Registered Manager from 18th August 2008. Miss Ashton was motivated, enthusiastic and committed to improving the running of the home. Miss Ashton had worked in elderly care for over fifteen years. She had NVQ level 2 and level 3 awards in care and had recently completed the Registered Manager’s Award (NVQ level 4). She was aware of many of the concerns we raised during the inspection and had already started to introduce changes that were benefiting residents’ health, safety and wellbeing. At the last inspection, the relationship between the previous manager and the co-owner, Mr Khan had deteriorated. The new manager felt supported by Mr Khan and that they had a positive working relationship. As noted, we were concerned Miss Ashton’s hours had recently not been supernumerary (particularly as the deputy post was vacant). We were told this was a temporary situation, which would be resolved as soon as the newly recruited care staff started work. With regard to how the home monitored the quality of its service, the monthly quality monitoring meetings between Mr Khan and the manager (which had lapsed with the previous manager) had restarted. Satisfaction surveys had been sent out, in advance of a meeting with relatives. Issues and ideas raised in the surveys were then discussed at this meeting (e.g. ideas for new social activities were made; there was a request for a notice board with staff photographs, names and designations so visitors can identify the people they see working in the home; and as noted, suggestions were also made for a summer BBQ and the personalising of bedroom doors). We advised the results and any action taken from survey and the meeting now needed to be published and made available to residents and their families (e.g. displayed in the hallway and detailed in the home’s newsletter). Small amounts of money and valuables were held on some residents’ behalf. These were stored safely and securely, with appropriate records kept. Four cash balances were checked at random and found to be correct (there were two minor discrepancies as toiletries purchased not yet been accounted for). At the last inspection, formal staff supervision had not been taking place. The new manager was aware all care staff needed receive formal supervision at least six times a year and had been waiting to get to know staff. She had now started to carry out supervision sessions. With regard to safe working practices, we looked at maintenance records for the lift, hoists, gas and electrical appliances and at fire safety records. These Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 26 were all satisfactory, apart from the fire drill record. We were concerned, as no drills had been held since 2007. A fire safety risk assessment was also needed. We advised the new manager contacted the fire safety officer for guidance and advice as soon as possible. The Environmental Health department had carried out Health and Safety, and Food Hygiene inspections since our last visit. Both were satisfactory, with no recommendations made. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 27 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 2 X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 28 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 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. [Previous timescale of 07/03/08 not met]. 2. OP9 13 (2) 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. [Previous timescale of 07/03/08 not met]. Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 29 Timescale for action 07/10/08 26/08/08 3 OP27 18 (1) (a) The numbers and skill mix of staff must ensure residents’ needs are met. To ensure the safety of residents, staff and visitors, regular fire drills must be carried out (in accordance with the home’s fire safety policy and fire safety risk assessment). After the next fire drill is held, a copy of the fire drill record must be forwarded to us. When produced, a copy of the home’s fire safety risk assessment must be forwarded to us. 26/08/08 4 OP38 23 (4) (c) (e), (5) 07/10/08 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 OP7 OP8 Good Practice Recommendations Staff need to be clear of their responsibilities in reporting and recording information (i.e. weight loss) to ensure residents’ health and wellbeing is not put at risk. To ensure residents’ health is properly monitored and not put at risk, the accuracy and suitability of the home’s scales should be monitored. To maintain the home and better meet residents’ needs, the minor repairs, maintenance and adaptations identified in the main body of the report should be addressed. 2 OP8 3 OP22 Wingates Residential Home DS0000009309.V368961.R01.S.doc Version 5.2 Page 30 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. Extracts may not be used or reproduced without the express permission of CSCI Wingates Residential Home DS0000009309.V368961.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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