Inspection on 14/08/06 for Winston House

This inspection was carried out on 14th August 2006.

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

Winston House 04/11/08

Winston House 27/11/07

Winston House 23/05/07

Winston House 14/03/06

Winston House 21/11/05

Winston House 31/03/05

Winston House 01/06/04

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Winston House 68 - 69 The Promenade Southport Merseyside PR9 0JB Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 10:00 14 & 15 August 2006 th th X10029.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 Winston House DS0000017265.V308166.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 and Care Homes for Adults 18 – 65*. 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. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winston House Address 68 - 69 The Promenade Southport Merseyside PR9 0JB 01704 532188 01704 530112 winston.house@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes (No. 2) Limited 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) Mrs Valerie Kay Care Home 64 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (34) of places Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Variation agreed for 1 named resident under pensionable age Service users to include up to 30 OP and up to 34 PD The service should employ a suitably qualified and experienced manager who is registered with the CSCI 14th March 2006 Date of last inspection Brief Description of the Service: Winston House is a large detached building, which was originally built in the late 1800’s and was converted into a nursing home in the 1940’s. The home is situated across from the marine lake on the promenade area of Southport, which is within easy access of the amenities of this seaside town. The care home offers nursing care for 34 younger adults with physical disability and 30 older persons with general nursing needs. The home is divided into 3 units over four floors with the older persons unit on the top floor and the two younger adult facilities on the basement, ground and first floors. There is ramp access to the front of the home and the two lifts access all four floors. A nurse call system is in place and suitably adapted bathrooms are situated throughout the home. Park Care Homes Ltd own Winston House and it is managed by Mrs Valerie Kay Weekly fees range from £310.29 to £1377.62. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days and lasted 15.5 hours. This was the key unannounced inspection to be carried out as part of the regulatory requirements. Two inspectors visited the home for the process of inspection. As part of the inspection process all areas of the home were viewed including residents bedrooms. Care records and other nursing home records were inspected also. Discussion took place with the registered manager, deputy manager, administrator, registered nurses, housekeeping, kitchen and care staff. One to one interviews took place with 3 staff. Several residents were also spoken with. Residents were interviewed in private and their views obtained on how the home was run and the care and support provided. Relatives were spoken with also. Other health professionals who come into contact with the residents on a regular basis were canvassed for their views also and their views are included in this report. The Commissions pharmacist carried out an inspection also and his comments are reported separately. What the service does well: Residents feel that Winston House is their home. They enjoy the friendly and homely atmosphere. Comments from residents include, “I’ve lived here for ten years, I’m very happy and well looked after”. One relative commented, “The best thing I ever did was to let Winston House do their job”, “this shows Winston House is not an institution, but a home. I cannot believe the progress our ‘relative’ has made”. The home runs a comprehensive training programme for all staff employed, and sufficient staff is on duty to provide residents with an effective team to care for and support their needs. Staff interviewed commented, “staff are supportive, the residents and staff are good fun, it’s friendly, I have no concerns about the residents care, I like working here”. Additional comments from staff include, “it’s a good home, a very relaxed atmosphere with no strict rules and families are encouraged to visit” and “the home is great, friendly, it’s a nice mix, staff are supportive”. The home has a varied clientele and staff are enthusiastic about their involvement in caring for the residents and trying to meet their individual needs. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 6 Many of the residents have varying and sometimes complex needs therefore it can be challenging to maintain their health and welfare whilst promoting their individual choices. Residents are however able to choose how they wish to live their lives. Some of the residents are due to visit the Southport flower show and others take up the various activities arranged including a favourite of shopping locally. One resident had a shopping visit to the Trafford centre. A few of the residents are going on small group holidays with one resident going to Spain. What has improved since the last inspection? What they could do better: The home needs to improve their contact with other health care professionals to ensure the optimum care and support is provided for the residents. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 7 The home needs to access educational and training opportunities that are suitable for the younger adults individual needs. Additional time needs to be spent in promoting social rehabilitation for the younger adults. Some of the residents were observed during the inspection to be in need of some further support with their individual grooming. This needs addressing to ensure that their dignity is maintained. The home needs to promote residents rights by ensuring a complaints record is in place and residents finances and records are accessed easily. A new system is to be implemented by Craegmoor but has yet to be formally introduced. Residents who are at risk of physically assaulting other residents or staff need to be reviewed and transferred if necessary to another more suitable service to ensure their needs are met safely. Some areas of the home are in need of repair, which would enhance the environment for the residents although residents interviewed are happy with the home. The home need to ensure that all new staff employed in the home has all the necessary checks in place prior to appointment to ensure that residents in their care are protected. The home have tried to interest the residents in attending meetings where they would be able to discuss any issues that concern them and gain feedback on their views. This has been unsuccessful therefore the home need to try and find another way of encouraging the residents to participate in sharing their views on how the home is run so that residents know they are being listened to and their views are used to change the way the home is run where practical. 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. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA5, OP3. OP6 is not applicable The quality outcome in this area is adequate. This judgement has been made using available evidence including a site visit to the home. The home is at present trying to upgrade facilities for the younger adults, which will help to promote their independence. EVIDENCE: There have been no recent admissions since the last inspection in March of this year. Therefore we cannot assess the standards fully to see if there are any improvements in the assessment process. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 10 The home has been experiencing difficulty having all residents care reviewed by social services but this remains a priority. One resident has been reviewed since the last inspection and is due to be transferred to another service. Another resident who was unsettled in the home is now being cared for at home. Since the inspection visit some of the younger residents have been actively involved in setting up a separate kitchen/dining and sitting area that they would be able to use and access independently. Under the supervision of a senior member of staff and with some care staff to assist the residents have decorated both rooms. This facility will go some way to giving some of the younger adults the independence they wish. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): YA6,9,16,18,19 OP7,8,10 The quality outcome in this area is adequate. This judgement has been made using available evidence including a site visit to the home. The home needs to improve their contact with other health care professionals to ensure the optimum care and support is provided for the residents. EVIDENCE: Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 12 The Commission’s pharmacist inspected YA 20 and OP9. Six of the residents were case tracked (all care files are examined) during this inspection. All of the residents’ case tracked had care plans/service user plans in place. The older persons care needs are identified and entered on their individual care plan with monthly reviews of care evidenced in the documentation. Other documentation including medical history, risk assessments, nutritional assessments, Waterlow (tool to measure risk of developing pressure sores), assessments and manual handling documentation is in place. One resident who is receiving residential care has wound care documentation evidencing regular entries by visiting District Nurses. This documentation is kept separately in the residents’ room. Regular discussion with the District Nurses needs to take place so that senior staff keeps up to date with regard to wound care/treatment. Evidence of attendance at hospital clinics is documented and entries on the daily evaluation of care with regard to some wound care is recorded. Key worker entries are evidenced with any social activities residents attend recorded. Accident records are documented. Relatives’ communication records are in place in some files with contact details of NOK but not all. There is no resident agreement to the plan of care/service user plan. Agreement needs to be obtained from residents who are having any invasive procedures i.e. rectal examination and administration of suppositories. Chiropody treatment needs to be identified in care files. There is evidence of results of eye tests in some care files but it is not clear if residents wear spectacles. Some residents interviewed stated “I have not been to the dentist for years and my lower denture is loose”. All residents should have access to dental care on a regular basis. Some residents have not had their religious needs identified or catered for. One residents weight fluctuates quite dramatically from month to month and as they would be vulnerable to being nutritionally compromised the weight measurements should be increased to weekly to enable nursing staff to monitor this resident more closely. This resident would also benefit from a referral to the Diabetic Specialist Nurse for further advice/intervention. Younger adults being cared for have in some cases varied and complex needs. The home access specialist input where they can to provide support and expertise advice in how they care for and support them. Service user plans evidence how challenging behaviour is managed with regard to some of the residents who live in the home. For some of the more challenging residents one to one care is provided and this is documented in the service user plan and was observed during the inspection visit. Entries are made on occasion (in daily record) with regard to residents refusing to accept any support or care by staff to ensure their needs are met. This information should be recorded in detail as refusal to accept nursing intervention may compromise their health and welfare. The home have accessed further specialist advice from senior medical staff with regard to residents who refuse personal care and their comments have been documented. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 13 It may be that some residents are inappropriately placed in the home therefore it is important that if the home feel they cannot meet their needs they need to seek alternative placement with support from the residents social worker and relatives where applicable. Residents interviewed are happy to live in the home and have done so for many years. Comments from residents interviewed include “I’ve lived here ten years and am very happy and well looked after”. Staff were observed to interact with residents in a friendly and respectful manner. Health professionals in the PCT (Primary Care Trust) and community were canvassed on their views on how the home was run and confirmed that residents are visited in the privacy of their own rooms. The feedback from the health care professionals was generally of the same opinion. The home has difficulties in some areas including poor communication, lack of senior staff to link with, lack of understanding with regards to residents needs, specialist advice is sometimes not acted upon, inappropriate decisions are made with regard to management of residents and misunderstanding instructions. These views are from various health professionals. Some of the residents interviewed confirmed that they have access to equipment necessary for them to be as independent as possible and includes electric wheelchairs and hoists. Speech therapy and other healthcare professionals are accessed where needed as evidenced in care files. Residents interviewed stated, “staff are helpful with personal care, I have a shower” and a relative interviewed stated, “You can see they (spouse) is kept spotlessly clean”. Some of the residents interviewed use the homes hairdresser regularly others go out to their own hairdresser. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 12,13,15,17 OP 12,13,14,15 The quality outcome in this area is adequate. This judgement has been made using available evidence including a site visit to the home. The home need to access further training/educational facilities to ensure the younger residents needs with regard to further personal development are addressed. EVIDENCE: Many of the younger adults have complex needs and are unable to participate in training or educational activities. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 15 The home is having difficulty in accessing local educational and training facilities for the younger adults who have expressed a wish to take part. At present only one resident has been able to access an external exercise and painting class. The home employs two part time assistant therapists five days a week who communicate with the residents on a regular basis. One therapist interviewed stated, “I meet with the residents regularly and find out what type of activity they wish to be involved in and organise it for them. Residents who don’t wish to participate are then given time by me on a one to one basis. The time is spent chatting, giving the resident a pedicure or other beauty treatments”. All activities and outings are advertised on each floor. Residents enjoy regular trips out on the homes bus. It is a popular activity. Residents interviewed stated, “I like going out in the bus, it was Wales last week”. Residents are able to access local transport facilities including taxis. Residents are encouraged to continue their friendships and relationships with their families and friends. Relatives interviewed stated, “I visit regularly each week and I’m able to make my own cup of tea”. Generally residents are able to choose how to spend live their lives. Residents interviewed stated, “I go to bed when I want and get up when I want” and “I do what I like, I go out every day and I visit friends and have tea with them on Fridays”. All residents in the home are encouraged to participate in local activities including bowling, cinema, shopping and local pubs, restaurants and cafes. Local churches visit to provide Holy Communion but not all residents interviewed took up this opportunity. One resident interviewed stated, “I would like to have Communion”. Residents interviewed gave mixed comments about the meals. Comments included, “the food is excellent” and “the food isn’t any better at all, I sometimes get burnt food”. Residents are encouraged to eat their meals in the ground floor dining room but residents who wish to take their meals in their rooms are accommodated. Menus are set up weekly and published on each floor of the home. Food served is also logged in the kitchen diary. Nutritional assessments are in place for residents and are regularly reviewed. Residents who are nutritionally compromised have their nutritional intake planned and set up via PEG (Percutaneous Endoscopic Gastrostomy) feeds. The Speech Therapist is available where necessary to monitor the swallowing reflex of residents where needed. At present there are no facilities for the younger residents to prepare or cook food but a designated area in the basement has been identified and is to be refurbished with new equipment where needed. A separate sitting/dining area will be available also next to the kitchen area. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 16 This project has been long in the planning. Since the inspection the basement area has been decorated with the involvement of the younger residents and equipment is to be purchased shortly. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 22,23 OP 16,18 The quality outcome in this area is poor. This judgement has been made using available evidence including a site visit to the home. The home does not have all the required policies and procedures in place to ensure the protection of residents. EVIDENCE: A complaints procedure is in place. One or two concerns raised by relatives have been documented in care files. There is no complaints book in place in the home, which means many concerns/complaints raised are not documented. No record of investigation and outcomes are logged. All concerns however minor must be logged and followed up with the investigation and outcomes documented. There have been isolated incidences where residents have attacked other residents or staff therefore policies and procedures need to be reviewed in the light of this. The home has informed the Commission of these incidents though the correct procedure. POVA (Protection of Vulnerable Adults) checks are carried out and evidenced in staff files. Craegmoor Health has recently commenced new financial procedures with regard to residents’ monies. One resident interviewed stated, “we handle our own finances”. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 18 The inspector was unable to case track any residents’ monies. The Manager and Administrator advised that records were now being held centrally at head office and are awaiting new financial records yet to be implemented. Residents’ monies and financial transactions must be available so that they are open to inspection. One resident has recently paid £10 towards an item bought on their behalf by the home but there is no financial record of this and the resident has no receipt for the £10. The Administrator confirmed this. All residents must have access to their own bank account and be able to draw on their money when wished. Where needed residents may need the support of relatives or an advocate to ensure they are managing their finances well. All residents have a lockable facility in their rooms. An anonymous complaint was received through social services via the contracts department. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 24,30 OP 19,26 The quality outcome in this area is good. This judgement has been made using available evidence including a site visit to the home. Some areas of the home are in need of repair, which when acted on will enhance the environment for the residents. EVIDENCE: In the last year Winston House has undergone a major upgrade throughout the home including new furnishings and beds. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 20 The public areas of the home have been decorated in a domestic style and new furnishings ensure a comfortable environment for the residents. All floors in the home are accessed by lift access and automatic access through the front entrance also. Therefore wheelchair users are independent in their movement throughout the home. One large window in the lounge/dining room area is easily opened out to its full extent as the safety catch is damaged therefore this needs repair to ensure resident are not placed at risk. The new furnishings are of good quality but it some areas of the home carpets are damaged through cigarette burns and in some rooms the carpets are patchy with carpets not quite fitting the room and different parts of carpeting put in place to cover the floor. Bedroom 67 has handles missing of drawers, the shower room is being used as a temporary store therefore preventing resident access, room 71 and 64 has mixed carpets, there are cigarette burns and torn carpet under the sink, bedroom 42 is odorous, room 32 the carpet is badly fitted and stained, room 44 the ceiling tile in the en-suite is loose and the pelmet in the bedroom missing, the sluices on the ground and first floor are badly stained, one shower room has no handles on the sink taps and one of the basement flats needs decorating as the kitchen units and lower walls and skirting boards are scraped from wheelchair use. Residents’ bedrooms and the public areas are generally in a clean condition. Residents interviewed stated, “they cannot grumble as the room is well cleaned and they (staff) bring in the laundry each day”. Relatives interviewed confirmed they were happy with the cleanliness of the home, commenting, “the home was spotless when I visited”. The laundry was viewed during the inspection and was seen to be clean and well organised. It is situated separately from the kitchen. The machines have a foul laundry facility. The home has an approved contractor dealing with clinical waste. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 32,34,35 OP 27,28,29,30 The quality outcome in this area is good. This judgement has been made using available evidence including a site visit to the home. The home runs a comprehensive training programme for all staff employed, and sufficient staff are on duty to provide residents with an effective team to care for and support their needs. EVIDENCE: The staffing rota evidences all staff employed at the home days and nights including domestic staff. Staffing rotas show sufficient staff on duty. All night staff on duty are waking night staff. At times of sickness the home are able to use bank staff and draw on the other homes in the group if necessary. A staff member interviewed stated, “we are rarely short of staff, extra staff come from the other homes if needed”. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 22 Residents’ views with regard to staff in the home are generally positive. Residents interviewed stated, “the day staff are very good, on nights some staff are not as nice” and “some (staff) are very good, night staff are not very good but Mike (Registered Nurse) is very good”. Other residents interviewed were complimentary about the staff that work in the home. Residents feel ‘at home’ and find the atmosphere friendly and supportive. Relatives interviewed with regard to staff commented, “staff are very nice, I can speak to Val (manager), my husband can get quite upset but the night staff, Maureen (night manager) is very good”. Five staff files and training records were examined. The recruitment process has improved a little, although one staff file has one reference on file and it was undated. A new reference form and letter are to be sent out for new employees. Employment history is evident in application forms and in some files this information is quite detailed. Photographs of staff are evident and copies of birth certificates and passports are in place. PIN (Personal Identification Number) for registered nurses has been verified. CRB (Criminal Record Bureau) checks (at enhanced level) and POVA checks are in place for staff. One carer is qualified to NVQ Level 2, four have gained Level 3 and a further 4 staff are in the process of attaining the Level 2 qualification. Training files evidence induction programmes and training attended with certificates in place. The deputy manager co-ordinates and provides much of the training with external courses accessed where needed. Most of the training is up to date with a few staff due to update their mandatory training in the next few weeks. Training provided for the staff includes manual handling, first aid, fire safety, COSHH (Control of Substances Harmful to Health), BFH (Basic Food Hygiene), health and safety, POVA, abuse, infection control, equal opportunities and management of violence and aggression. Staff interviewed confirmed they had received sufficient training to carry out their role effectively. Comments from staff include, “I have had lots of training and I am able to meet the residents needs”. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): YA 37,39,42 OP 31,33,35,38 The quality outcome in this area is adequate. This judgement has been made using available evidence including a site visit to the home. The home needs to ensure that residents, relatives and staff views on how the home is run are obtained and recorded on a regular basis. This will enable the home to feedback and act on their views and therefore improve the service. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Manager has been employed in this capacity for 3 years. Prior to this the manager has many years experience as a RN and had been employed as the deputy manager for 5 years. The manager has the RMA (Registered Managers Award) and has kept up to date with mandatory training including, POVA and abuse. The manager is also a Palliative Link Nurse for the local hospice and has recently attended a mentorship course at Manchester University to enable the home to provide support and placements for student nurses during their period of training. Staff interviewed stated, “I enjoy working here”, “I can speak to the manager okay, it’s a good home, a very relaxed atmosphere with no strict rules and families are encouraged to visit” and “the home is great, friendly, it’s a nice mix, staff are supportive and I can speak to Sue or Mark and no one seems unhappy, if I had any concerns I would speak to Sue or Val”. The most recent residents questionnaires were carried out last year. The results of which were general satisfactory. The manager has arranged residents meetings but residents do not turn up therefore the activities/occupational therapy assistant visits the residents around the home on a regular basis and speaks with them. Their views are obtained but not documented formally. The home has not sought the views of other health professionals on how the home is run. Residents relatives’ views have not been sought recently either on a formal basis. The general staff meeting was held last week and minutes were viewed. A RN meeting was held during the inspection visit. Residents care plans are quality reviewed regularly. A quality assurance audit is completed by the home and sent to head office. The financial records of residents were not available to view and the manager has advised that they are now held at head office. Staff receive mandatory training and records are in place in staff training files to confirm this. A training needs assessment is carried out on an annual basis to ascertain individual staff training. The certificates for servicing of hoists, electrics, gas appliances and boilers are in date. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 25 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 X 2 X 3 X 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 2 36 X 37 X 38 3 Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 26 YES Are there any outstanding requirements from the last inspection? 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 Regulation 15 Requirement The Registered Person must ensure that all residents agree and sign their care/service user plan. That the plan must include the resident/relative/advocate where agreed. Some of the care plans must be written in more detail. The service user plan for the younger residents must be reviewed at their request or a minimum of 6 monthly to reflect their changing needs. This must be in a suitable format and a copy held by the service user unless there are clear and recorded reasons for not doing so. For the younger resident who may be capable of aggression, cause harm or selfharm individual procedures are to be in place in their service user plan. The Registered Person must ensure the home have documented evidence to show they have gained the permission of the residents to carry out any invasive procedures such as catheterisation/rectal DS0000017265.V308166.R01.S.doc Timescale for action 11/12/06 YA6 2. OP8 12 (2) (3) 11/12/06 YA19 Winston House Version 5.2 Page 27 examinations/treatment. 3. OP8 13 (1) b The Registered Person must ensure all residents are enrolled with registered practitioners to ensure regular check ups of dental health, opticians and chiropodists with documented evidence in place. Where residents refuse this must be documented. The Registered Person must ensure that nutritionally compromised residents have their weight monitored weekly and advice is sought from the Diabetes Nurse with regard to the residents whose weight is erratic as discussed. The Registered Person must ensure that a senior member of staff liaise with visiting health care professionals on a regular basis to ensure continuity of care for all residents who require their services. Documentation relating to residents additional health care and support must be included on care files. The Registered Person must ensure that residents who wish to are able to attend church services/communion. The Registered Person must ensure that staff assists residents in finding out about education or training suited to their needs. The Registered Person must ensure that there is a complaints record kept of all issues raised or complaints made by residents with details of any investigation, action taken and outcome. This record must be checked at least 3 monthly. The Registered Person must ensure that all residents’ DS0000017265.V308166.R01.S.doc 11/12/06 YA19 4. OP8 12 (1) b 16/10/06 YA19 5. OP8 13 (1) b 11/12/06 YA19 6. OP12 YA11 YA12 12 (4) b 11/12/06 7. 12 (1) b 22/01/07 8. OP16 22 (3) (4) 16/10/06 YA22 9. OP18 17 (2) Sch 4 (8) 11/12/06 Winston House Version 5.2 Page 28 YA23 and (9) 10. OP19 YA24 23 (2) b 11. OP29 19 (1) (c) financial records are kept available and open to inspection. Residents must also be able to access their individual bank account with the help of a relative or advocate where agreed. The Registered Person must 11/12/06 ensure that the residents’ bedrooms and public areas are checked for wear and tear and repairs; replacements are carried out to an agreed timescale with records kept. Areas of concern are highlighted in this report. The Registered Person must 16/10/06 ensure all reference checks are authentic and in place. Two references are required for each new member of staff. One of which must be from the previous employer. This is an outstanding requirement. The Registered Person must ensure that quality-monitoring procedures are in place to ensure the views of the residents, relatives and staff are obtained. 11/12/06 12. OP33 24 (1) (3) 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 OP4 YA3 Good Practice Recommendations The inspector strongly recommends that all residents should have their needs reviewed with social worker/relative involvement where required. In particular the younger residents in the home whose needs are changing. It may be that specialist guidance/intervention DS0000017265.V308166.R01.S.doc Version 5.2 Page 29 Winston House 2. YA7 3. OP8 4. OP8 5. YA13 6. 7. YA14 OP15 is needed to ensure their individual needs are being met. The inspector strongly recommends that all residents should manage their own finances; where support and tuition are needed, the reasons for, and manner, of support are documented and reviewed. The inspector recommends that all information with regard to residents additional healthcare needs should be recorded on care files. Such as if a resident wears spectacles/dentures. The inspector recommends that where residents refuse care and support that this should be evidenced in detail in care files. Where additional advice/support has been sought from relatives/other healthcare professionals this is to be documented also. Any unnecessary risks to residents to be identified and so far as possible eliminated with records of risk assessment documented. The inspector recommends that residents should be made aware of the information and advice available about local activities, support and resources offered by specialist organisations. Staff time with the residents should include weekends and evenings outside the home. The inspector recommends that residents’ interests should be recorded and any activity attended to be logged in care files. The inspector recommends that the cleaning schedule be adhered to when the Chef is on days off. Winston House DS0000017265.V308166.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Winston House DS0000017265.V308166.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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