Inspection on 27/11/07 for Winston House

This inspection was carried out on 27th November 2007.

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

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

Other inspections for this house

Winston House 04/11/08

Winston House 23/05/07

Winston House 14/08/06

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 Key Unannounced Inspection 27th November 2007 08:30 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.V350270.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.V350270.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 Ltd 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) vacant post 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.V350270.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Variation agreed for 1 named resident under pension able 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 6th September 2007 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. Weekly fees range from £351.50 to £1342.29, with additional charges for hairdressing, chiropody, newspapers and magazines. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit took place as part of the unannounced key inspection. This was the second key inspection this year. It was conducted over one day and lasted 9 hours. For the purpose of inspection two inspectors were present. Forty-one residents were accommodated at this time. As part of the inspection process most areas of the service were viewed including residents bedrooms. Care records and other nursing home and young adult records were viewed. Discussion took place with many residents, staff and visiting relatives. The inspection was conducted with the proposed manager Mrs Margaret Sadi. Discussion also took place with the cook, housekeeper, care staff, registered nurses and domestic staff. An Expert by Experience also assisted in the inspection process. An Expert by Experience is a person who, because of their shared experience of using services and/or ways of communicating visits a service with an inspector to help get a picture of what it is like to live in or use the service. During the inspection four residents were case tracked. (their care files were examined and their views of the service were obtained). All of the key standards were inspected and also previous requirements and recommendations from the last inspection in September 2007 were discussed. Satisfaction forms “Have your say about…..” were delivered to the service to be distributed to residents, residents relatives, staff and health professionals prior to the inspection. A number of comments included in this report are taken from surveys and from interviews. An AQAA (Annual Quality Assurance Assessment) was completed by the manager prior to the site visit. The AQAA comprises of two self-assessment questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. What the service does well: There are continued good support systems in place for the manager. The manager has regular access to the area manager who visits the service monthly. Documented evidence of the monthly visits was viewed. Additional visits also take place and these are also documented. Detailed reports including resident contact are documented. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 6 Accident/incident records continue to be well recorded. The manager ensures correct procedures are followed and all agencies including the Commission are informed when necessary. The residents meetings ‘your voice’ continue to be held to ensure residents representatives are involved in the changes and improvements for the service. What has improved since the last inspection? Following consultation with residents’ representatives a new information pack has been produced, which will give prospective residents an insight into how Winston House is run. The format has been improved to include an ‘easy read’ version, which includes picture information also. The assessment process has improved and ensures detailed information is collated prior to admission to the service. This then provides sufficient information to help set up residents person centred care plans. The ongoing monthly evaluation of care ensures staff are monitoring individual residents changing needs. Care plans/person centred plans have improved and are more detailed to reflect residents’ needs and preferences. These are reviewed monthly or sooner to reflect changing need. Residents and their families are involved in the reviews of care where possible. The management of medications has improved with all staff signing the medication records following administration of prescribed medicines. Accurate records are kept. Regular monitoring of medication is carried out with records kept. Registered nurses are assessed for their competency with regards to medication and documented evidence shows this. Risk assessments are in place and these are regularly reviewed with records evidencing this. The complaints procedure has improved to ensure residents understand the process. Work on the fire doors is well under way therefore ensuring safer environment for residents. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 7 The service is cleaner and tidier and a new sluice facility has been provided. Most staff have had additional training including equal opportunities to enable them to understand the needs of residents with a disability. Residents and relatives were generally complimentary about the staff that work at Winston House. Relatives interviewed stated, “My daughter has lived here for ….. years and most of the time it is fine, they look after her very well, I take my hat off to them”. Residents interviewed stated, ““I’m very demanding you know but staff are very nice” and “all staff are nice to me”. The manager has attended staff supervision training and has booked dates with individual staff. Quality assurance systems are in place, which provides feedback from residents on how the service is run. What they could do better: Wound care documentation has improved but the manager needs to ensure these are audited more closely to ensure all wound records are up to date and reflect the changing needs of the wound and treatments. Residents under the services care need to be closely monitored with detailed information recorded of all residents’ wounds including residents provided with residential care. The menus are at present not offering any choice at lunchtime. Residents interviewed confirmed that they could have something else if they did not like the food on offer but the choice was limited to cold meats. Residents interviewed stated, “sometimes it’s ok, I’m not happy with the food, but the chef is very thoughtful, yesterday he made me a special plate of vegetables to go with my fish”. Residents’ representatives have requested that the chef is invited to residents meetings and this has been approved. The service needs to promote stimulating activities for residents so that residents’ individual needs and outcomes are met. The proposed employment of an activities person would benefit residents. The service has taken steps to make sure that all residents have access to the communal facilities and are not confined to their rooms. Discussion with the manager confirmed that progress is being made in this area. However major improvements to the doorways are required. The complaints process does not ensure that residents’ complaints are acted upon. One resident has complained about their shower facility some months ago and this has still not been resolved. This needs to be addressed. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 8 Residents’ comfort is compromised by a lack of attention to environmental shortfalls. Some areas of the service need to be redecorated/upgraded. New crockery would benefit residents, as much of it is miss matched. Dining tables are quite high for some of the residents especially the older persons therefore this needs addressing to ensure residents can eat their meals in comfort. Some of the residents interviewed had concerns when trying to communicate with some of the staff. “Residents interviewed stated, “some of the staff don’t speak English and it is difficult to communicate”. There is a significant number of overseas staff working in the service therefore the manager needs to ensure that residents are not at risk of isolation due to communication difficulties. Strategies are in place to try and monitor residents’ views of the service. When residents do speak up, their concerns need to be addressed so that residents know that they are being listened to. The service needs to ensure that the manager is registered with the Commission. 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. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 9 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.V350270.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3 (18-65) and Standard 3 (Older Person) were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process ensures detailed information is used to set up residents person centred care plans. The ongoing monthly evaluation of care ensures staff are monitoring individual residents changing needs. EVIDENCE: A new information pack is being produced for prospective residents. Residents’ representatives are being consulted in regard to the format being produced. A shortened version of the service user guide has been produced and approved by residents representatives and includes ‘easy read’ information and photographs for prospective residents. The philosophy of care Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 11 has also been updated. These were viewed. The statement of purpose has been updated and a copy has been provided to the Commission. The assessment process has improved although the document itself is titled assessment older persons. The manager is aware of this and has taken this up with senior management to ensure younger adults assessment documentation is so titled. The actual information that is included in the assessment covers a wide area and all needs have been assessed and detailed information is present. The assessment evidences a pre admission assessment with all personal and medical information recorded. The reason for admission is recorded and the person carrying out he assessment has signed and dated the documentation. Other health professional input to be provided during their stay is identified. With regard to residents whose needs change during their stay ongoing evaluation of their care is evidenced in care documentation and advice has been sought and treatment /intervention carried out where needed. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,9,16,18,19,20 (18-65) and Standards 7,8,9,10 (Older Person) were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Wound care documentation has improved but not enough to provide staff with an accurate up to date record of wound care needs and treatments for the individual resident. This places the residents at risk. EVIDENCE: Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 13 The care plans gave a clear account of the residents’ needs and clear guidance on how the staff is to meet those needs taking into account positive outcomes for the resident. Care plans are reviewed and evaluated monthly to reflect changing needs. The plan is drawn up with the resident were possible or their family. Reviews record if the resident has been involved. Residents are also supported by a key worker system. Care plans are not provided in a picture format/simple English and this could be improved by the service. Two older person care plans were also viewed. These evidence that all assessed needs have been identified and addressed in the individual care plans. Nursing/personal care and support is reviewed monthly or sooner with family input support recorded also. Specialist intervention has been sought and advice with regard to improving the care of residents has been put into place with documentation confirming this. The care plans now give full and detailed information on how to assist residents so that staff can follow an individualised care plan reflecting the specific needs of the resident. Residents also have access to other healthcare professionals as evidence through resident interviews and care files. Residents interviewed stated, “care is good”. One carer confirmed that planned care is carried out and stated, “I help …. with all her personal care and support her to do exercise routines”. Risk assessments are in place for residents were needed and are regularly reviewed. Action is taken to minimise risk and hazards. Pressure relieving equipment is in place where needed and residents have Braden scores (tool to assess risk of developing pressure sores) reviewed monthly. One resident interviewed stated, “the air mattress was leaking so staff have now been trained to use the new bed”. Residents who have catheters in place have basic information recorded but the individual catheter care is not recorded. Wound care charts are now in place and are improved although one resident’s record of wound care was not up to date. Immediate action was taken to up date the residents wound care records. Discussion with the Registered Nurse on duty confirmed that the residents wound had improved since admission to the service. Another residents wound care evidenced satisfactory recording keeping. One resident who receives wound care stated, “I’m happy with the way my foot is being dressed”. One resident is receiving input from other health professionals regarding their wound care but the documentation in place did not identify fully the progress of the wound or treatments. The manager was advised to liaise with the professionals to ensure the service were fully aware of the wound care, treatment and progress. From the review of records concerning the wound care of one resident it was evidenced that communication between the service and district nurses was not sufficient for staff to monitor and inform external professionals of changes in the residents condition. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 14 Medication storage and records were viewed. New medication trolleys are secured to walls when not in use. A different pharmacy now supplies medication and so far the manager has been pleased with the service. Most medication is now blister packed. Medication sheets evidence all medication with date of commencement of medication, amount carried forward and dose prescribed. Medication records viewed evidenced the registered nurse signatures at each administration time. Medication trolleys were well organised and evidenced good stock control. Residents interviewed confirmed that they received their medication on time stating, “my medication is given on time and everything is ok” and “the nurse is always on time with my medication and my blood sugars are done”. Residents spoken with confirmed that the carers always treat them with dignity and respect and their wishes for privacy is upheld. Preferred names are recorded on care documentation. Residents also confirmed that they were able to have the same gender to assist with personal care. During the inspection one resident was observed to be seated in an undignified manner. Staff were advised immediately and took appropriate action. The manager was advised to ensure appropriate clothing was provided for this resident so they could protect their modesty. This will ensure the resident’s dignity is maintained. Residents are able to consult with health care professionals in the privacy of their own bedrooms or through out patient appointments at hospitals and surgeries. Two resident’s bedrooms were noted to be odorous. The manager was advised to take action regarding this, as it does not promote the dignity of the resident. It was noted that one of the residents sitting in the dining room was not eating lunch and during this time staff did not talk to them. When questioned staff stated, “sometimes ……….doesn’t eat”. The lack of response from the staff does not preserve the equality and diversity needs of the individual. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,17 (18-65) and Standards 12,13,14,15 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to promote stimulating activities for residents so that residents individual needs and outcomes are met. EVIDENCE: Care plans viewed demonstrated that the residents right to make decisions, were possible, has been taken into account and addressed in the plan of care. Residents are also supported to make decisions with family and solicitors who act on their best interests. Care plans showed that residents are supported in Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 16 their daily living to make decisions (were possible) such as – what to eat and what to wear and how they wish to be handled. The plans record how best the residents communicate and how they demonstrate their well being e.g. in their expressions, mood etc. Care plans also highlight areas for staff to avoid which may trigger the residents into becoming agitated. Some of the residents interviewed confirmed that they knew about their care plans and had made choices regarding how they wished to live their lives. Residents stated, “I discussed my care plan, I choose to go to bed early and I go out with my support worker 2 days a week to the little pub and sit outside” and “I usually say when I want to go to bed and get up, if there is anything going on in the lounge I do join in-I still go out with my family shopping, I have a shower and a regular daily bed bath, always the ladies to help-I prefer that”. One resident is isolated in their bedroom because they are immobile and have no wheelchair facility at present. A wheel chair assessment has taken place, however further advice has to be sought to ensure physical access is freely available to all resident areas of the service. The manager confirmed that this is being looked into and will entail further improvements to the doorways to enable access to the communal areas. Residents were interviewed about how they enjoy living in Winston House and their comments included, “I’m happy with the care, I like it here, I like my room, the views and the camaraderie, I do like it here, and I don’t want to move” and “I’m cheesed off at the moment it’s not the same anymore all the staff that looked after me have all left and I’m thinking of doing the same, I don’t feel that it is my home anymore”. Most of the younger adults are unable to obtain suitable employment due to the complexity of their needs. One younger adult does attend an art class weekly. Another young adult plays regularly in a local band. During the inspection visit there were no activities arranged for the day. The residents interviewed stated, “we have occasional outside entertainment once or twice a year, Christmas is nice here they decorate the home nicely, we have Christmas dinner and presents”. The activities programme was viewed and was limited in the provision. Communal areas are used to watch TV, DVD’s and mix with other residents. There are large communal areas on the ground floor and smaller communal areas on the other floors. Activities include – pub lunches, hairdresser, and trips out in the bus but are restricted to a number of residents who regularly take part. A trip to the pantomime is arranged in the near future. The service needs to organise activities to provide the residents with stimulation and access to interests of their choice. Care plans identify residents’ interests but these are not promoted in their daily lives. Staff interviewed stated, “we need more activities” and “there is no full time activities person at present. Some individual carers do things with the Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 17 residents, they went to Blackpool on Sunday for the Christmas light display and some residents have been on two holidays this year, they went to Beatrix Potter in the Lake District and have visited various football stadiums. The residents go bowling, to the cinema, pub lunches, one young adult goes to an art class, quizzes with other homes during the quiz tournament season and inter homes carpet bowls”. Some of the residents go to church. One of the local churches visits regularly. Menus are being updated and the manager and chef were advised that a choice of meals must be made available for all residents at lunchtime and displayed on the menu. The daily menu was not on display for residents benefit. Residents interviewed confirmed that they could have something else if they did not like the food on offer but the choice was limited to cold meats. Residents interviewed stated, “sometimes it’s ok and sometimes I go out to buy my own, I go shopping and cook it in the microwave”, “ I’m not happy with the food, but the chef is very thoughtful, yesterday he made me a special plate of vegetables to go with my fish”, “the food is alright-you get a choice at teatime” and “I get toast and a hot drink for supper”. Older persons and younger adults share the same dining room, which can be noisy at times. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22,23 (18-65) and 16,18 (Older Person) were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints process does not ensure that residents’ complaints are acted upon. EVIDENCE: A copy of the safe guarding adults procedure is in place –all staff are aware of the new procedures. Staff training records confirm that most staff has attended abuse training. Safe guarding adults and prevention of abuse policies have been updated. The AQAA stated that 5 safe guarding adult referrals have been made. There have been 4 investigations. The manager has informed the appropriate agencies promptly. A copy of the complaints procedure is situated on each floor. A new easier read format has been issued and residents’ representatives were consulted to ensure the format was appropriate. Residents were canvassed for their views on the complaints handling in the service. Residents stated, “my daughter makes any complaints, “I don’t like to make a complaint-sometimes I don’t feel I can talk to them about things”. Most of the residents and their relatives canvassed where aware of the complaints procedure. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 19 Relatives interviewed said they would have no problem discussing any concerns with the staff or the manager. The complaints file was viewed and one complaint evidenced a resident had complained about their shower thermostat being broken. Discussion took place with this resident and they confirmed that this had been a problem for some months, stating, “they have sent out 4 different people to look at it and nothing has been done, it has been going on for months”. The manager confirmed this. The manager was advised to follow it up so that the shower could be repaired and the resident could use his or her own facility. One resident raised concerns with the expert by experience today and this was followed up by one of the registered nurses on duty that recorded their concerns on the complaints and concerns documentation. Residents are encouraged were possible to handle their own financial affairs. One resident has a solicitor who handles all affairs. Residents interviewed stated, “my finances are managed by my daughter” and “I look after my own money-my mum helps me manage it”. Financial records are discussed later in the report. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,26,29,30 (18-65) and 19,26 (Older Person) were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ comfort is compromised by a lack of attention to environmental shortfalls. EVIDENCE: The handy person carries out the daily checks and records them. A tour of communal areas and a number of resident rooms was made. New improvements included new carpets on upper floors. Private rooms were Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 21 found to be clean with some in need of re decorating/refurbishment. A number of showers in rooms were found to be not working or leaking. One bath was without taps and wallpaper from a sky light above a bath was about to fall off. These were brought to the attention of the manager at the visit. Residents living in the service were generally happy with their accommodation. Residents interviewed stated, “I like my bedroom flat”, and “I have been given a lovely room with a scenic view there is also a lounge with television and videos”. One resident is awaiting a new wheelchair, however the wheelchair will be too wide to fit through the bedroom door and other doorways in the service. This will restrict their access therefore further advice is being sought with regard to improvements required in the building to enable the resident to access communal areas. One resident could benefit from additional sensory input in their bedroom, as this would make a more pleasing environment for the resident to live. Locks are provided for resident on their bedroom doors. Some of the residents’ doors are unable to be locked in view of their safety and complex care needs. The kitchen is in the basement of the service with all stainless steel surfaces kept in a clean condition. There are plenty of storage rooms for equipment and food. Walls and floors are tiled for easier cleaning. Hot foods, fridge and freezer temperatures are recorded daily. Food in fridges is covered and dated. Hand washing facilities are in place. A diary is kept of all meals given to residents. Cooked breakfasts are available for residents three mornings a week and fresh fruit and vegetables were observed in storage rooms. Fruit was readily available for residents on the various departments. Residents’ crockery is still mixed with lots not matching. It would be of benefit to the residents to have new crockery suitable for their individual needs. The dining tables in use were noted to be quite high. This benefited residents who were using wheelchairs but not the older resident therefore the service need to provide additional suitable tables to ensure the older residents can eat more comfortably. The laundry facility is fully equipped with 2 driers and 2 washing machines with a sluice facility. Walls and floors are tiled and clean and tidy. A first aid box is in place. Control of Substances Hazardous to Health (COSHH) data and solutions are stored in a locked facility. Relatives interviewed with regard to the laundry service stated, “the washing here is excellent, …..is always clean”. The service has now purchased new sluice facilities for each department, which is cleaner and more efficient that the old sluice facility. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34,35 (18-65) and 27,28,29,30 (Older People) were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being cared for by trained staff that are recruited using the correct procedures. EVIDENCE: Staff rotas were viewed and evidenced sufficient staff on duty including an additional carer to ensure one to one care was provided for a resident. Residents were interviewed with regard to staff and stated, “I’m very demanding you know but staff are very nice”, “the night staff are quite good”, “I think the staff are very good they get training but some of the carers aren’t qualified but excellent at doing the job”, “all staff are nice to me”, and “staff are not able to spend much time with you”. Relatives canvassed for their views commented “the staff are very professional very caring and compassionate, nothing is too much trouble for them”. One Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 23 family interviewed stated, “My daughter has lived here for ….. years and most of the time it is fine, they look after her very well, I take my hat off to them”. Staff interviewed stated, “we need more staff in the afternoon” and “staffing levels are not too bad”. Four care staff have qualified to Level 2 NVQ and 6 to Level 3. The training matrix evidences a full training programme is ongoing with induction and NVQ included. A few of the staff are out of date with manual handling but this has been arranged for December 2007. Staff interviewed confirmed they had attended training and stated, “yes all training is up to date-all mandatory manual handling, infection control, tissue viability, also ‘aggression training’. The staff member confirmed they had supervision and the manager carried out a medication competency check”. Some of the residents interviewed had concerns when trying to communicate with some of the staff. “Residents interviewed stated, “some of the staff don’t speak English and it is difficult to communicate”, “there can be a bit of a problem understanding a couple of them” and “it is difficult to understand staff”. There is a significant number of overseas staff working in the service therefore the manager needs to ensure that residents are not at risk of isolation due to communication difficulties. Staff were observed to interact with residents in a friendly manner throughout the day. Staff interviewed stated, “I have worked here for years, I get on well with everyone, I think the people here are well cared for” and “I like working here”. We chose a selection of staff files to look at. Most of the staff files evidenced pre employment checks were in place with start dates, two written references, previous training attended and certificates, educational history, medical questionnaires, passport copies, supervision and police checks. One staff file contained information except their application form and police check. The manager advised that all details are with the head office and once completely processed will be sent on to the service as the others have been. A ‘Whistle Blowing’ procedure is in place and displayed in the front hall. Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39,42 (18-65) and 31, 33, 35 and 38 (Older Person) were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Strategies are in place to try and monitor residents’ views of the service. Building work continues in the service to help ensure a safer environment for residents. EVIDENCE: Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 25 The service employs a manager who is yet to be registered with the Commission. The manager Mrs Margaret Sadi has a professional certificate in management; a health and social care degree and has management experience at her previous post. The manager attends regular area manager meetings, which provides support for the manager. Staff interviewed stated, “I find the manager very approachable, the manager comes round the home once a day to meet with residents and chat to staff, she is supportive”. Staff interviewed confirmed that residents meetings were now being held and stated, “your voice meet every two months, and our service user representative goes to alternate services to meet–and representatives come from other services (younger adults) to meet here. Questionnaires have been sent out to all residents, relatives and staff in October with responses going to head office. Some of the returned residents questionnaires were viewed. The ongoing area of concern for one resident was their faulty shower thermostat. An analysis of the results is carried out and was viewed. Areas of concern are followed up where residents have identified themselves. The minutes from residents meetings were viewed and ‘Your Voice’ area conferences were viewed also. This shows that residents are now being consulted with regard to changes in the service. The minutes have been printed in large and normal print with pictures included. Heads of department meetings are also held and minutes recorded. Policies and procedures have been updated for this year. Audits are carried out throughout the year and include the building audit, which was carried out in January. An action plan to improve the quality of the service is in place and dates of areas completed have been recorded. Other areas audited include healthcare and residents health and safety. This is carried out monthly by the managers and sent to the regional office. The area manager Melanie Ramsey conducts monthly visits and completes a detailed report including information on care plans, resident’s reviews, discussion with residents, environmental concerns and discussions with property representatives. Financial audits of residents’ monies were carried out in September 2007 by head office. A copy of residents’ financial statement is provided for residents each month. Financial records were viewed and financial transactions/receipts and interest gained are documented. The up to date (Sept 07) training matrix was viewed. Mandatory and other training has been provided for the staff to include manual handling, fire, health Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 26 and safety, cosh, basic food hygiene, first aid, adult abuse/pova, infection control, equal opportunities awareness, challenging behaviour and induction. Specialist contracts are held for disposal of clinical waste and needles. Accident records have been completed. Incident records have been completed and copies sent to the Commission Fire evacuation assessments are in place for residents who are bed/wheelchair bound. Fire alarm tests and fire equipment are fully serviced. Lighting, fire risk assessments, checks on auto doors and all other health and safety checks are in place including water temperatures. Building work with regard to the fire doors is still ongoing. Winston House DS0000017265.V350270.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 3 2 X 3 3 4 3 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 2 21 X 22 2 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 12 (1) (a b) Requirement The registered person must ensure that wound care is fully documented with prescribed treatment and progress recorded also. Previous timescale of 1/10/07 not met. The registered person must ensure that residents are able to participate in activities/cultural events of their choice with regard to their individual ability/capacity. The registered person must ensure that when a complaint is made the complainant must be informed of the action that is to be taken and ensure that the complaint is addressed promptly. Specifically the residents shower complaint. The registered person must ensure that the equipment is kept in good repair and that decoration/refurbishment of the service is carried out. The registered person must ensure that residents are able to access all public areas of the service including access through their bedroom doors. DS0000017265.V350270.R01.S.doc Timescale for action 22/12/07 2 OP12YA14 12 (4) (b) 16 (2) (n) 01/03/08 3 OP16 YA22 22 (4) 22 (3) 31/01/08 4 OP19 23 (2) (c d) 01/03/08 5 OP22YA24 23 (n) 23 (2)(a) 31/03/08 Winston House Version 5.2 Page 29 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 2 2 3 Refer to Standard OP3 YA6 OP7 OP10 Good Practice Recommendations It is recommended that the new assessment documentation should identify on the heading that it is a young adult assessment or an older person. It is recommended that care plans for younger adults should be improved to provide a picture format/simple English document. It is recommended that detailed catheter care should be recorded on care plans. It is recommended that residents’ dignity should be maintained always and in particular to provide suitable clothing for the residents who need to protect their modesty. It is recommended that new crockery and appropriate height dining tables should be provided for residents. It is recommended that residents who have cognitive impairments live in an environment that promotes their well being. There is a significant number of overseas staff working in the service therefore the manager should ensure that residents are not at risk of isolation due to communication difficulties. It is recommended that the manager be registered with the Commission. It is strongly recommended that the service provides a choice of meals at lunch time and that the menu is displayed for resdients benefit. 4 5 6 OP15 OP22 OP30 7. 8. OP31 OP15 Winston House DS0000017265.V350270.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Winston House DS0000017265.V350270.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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