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Inspection on 19/10/05 for Winstonian House

Also see our care home review for Winstonian House for more information

This inspection was carried out on 19th October 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Winstonian House provides a reasonably homely environment for the residents living there, in terms of facilities and furnishing. The staff group is stable, and is long serving in the main. Staff are well trained, with practically all having at least attained an NVQ level 2 qualification in care. Residents are able to come to Winstonian House following an assessment of their needs, which is carried out by the home in advance, so as to ensure that they can meet the prospective resident`s needs once there.All residents and visitors spoken to during this visit said that the home was very welcoming, and that staff were very attentive, and would do anything they could to address any queries and concerns should they arise. All indicated a good degree of satisfaction regarding their care, the manner in which it is delivered, their relationships with staff, and the quality and quantity of food provided for them.

What has improved since the last inspection?

Following this latest inspection it is clear that there have been only a small number of improvements, with many that were required not addressed. A newly drafted recruitment policy should ensure that any future recruitment could be carried out in a way that will ensure adequate safeguards and protection for vulnerable residents. A small number of maintenance repairs have been attended to satisfactorily, and fly screens have been fitted in the kitchen, and storage of chemicals has been made more secure.

What the care home could do better:

Although residents indicate quite clearly their satisfaction with their care, the standard of care planning and record keeping at Winstonian House is not satisfactory. Gaps and omissions in care records and in medication administration charts could place residents at risk. Attention to the standards of maintenance, cleanliness and hygiene has been seriously inadequate at Winstonian House. Some repairs and requirements for improvement have gone unheeded, and many areas of the home are unclean and unhygienic. Despite CTCH Ltd having provided systems for monitoring the quality of the services provided at Winstonian House, the home has not implemented the use of them. As part of the enforcement process to achieve the home`s compliance a warning letter is to be issued to the home on the basis of these shortfalls. Residents indicate that they enjoy a good standard of food, however the home must ensure that records pertaining to food are sufficiently detailed to demonstrate what is actually served at each meal time.It has taken the home a long time to successfully address the breakdown of the lower ground floor stair lift, but it looks likely that this is about to be resolved satisfactorily. The home has not kept the CSCI informed, as is required, regarding any adverse incident affecting a resident, such as an accident or injury. Although staff receive formal supervision, the home should increase the amount actually given to each person. Servicing records for certain fixtures and equipment were not available for inspection, and must now be provided to the CSCI for this purpose. Training records regarding staff moving and handling training must also be provided, as the standard and frequency of this training was unclear. An improvement to the fire safety training records has also been recommended, in order that the content of the training is clear.

CARE HOMES FOR OLDER PEOPLE Winstonian House 42 All Saints Road Cheltenham Gloucestershire GL52 2EZ Lead Inspector Ruth Wilcox Unannounced 19 October 2005, 09.30 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Winstonian House Address 42 All Saints Road Cheltenham Gloucestershire GL52 2EZ 01242 577927 01242 577927 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CTCH Ltd Mrs Sally Bonner Care Home 18 Category(ies) of OP Old Age (18) registration, with number of places Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11/7/05 Brief Description of the Service: Winstonian House consists of three terraced houses, which includes an end of terrace; all have been modified to create one property. The home is in the All Saints residential area of Cheltenham, close to local shops and the parish church, and is part of the C.T.C.H. Ltd group of homes. The centre of Cheltenham and Pittville Park are close by. It is registered to provide personal care to eighteen service users over the age of 65 years, and can provide respite care if this is wanted. Any elements of nursing care that may be needed are sourced from the local community nursing service. Accommodation is on three floors all served by stairlifts, though the stairlift from the lower ground floor rooms, despite being replaced since the last inspection, continues to be out of action. Fourteen bedrooms have en-suite facilities. The lower ground floor has two bedrooms, a bathroom and a small lounge/diner; people who smoke use this room. The remaining bedrooms are located on the ground and first floors. The communal accommodation consists of two open plan lounges leading to two dining areas. Patio doors from the lounge provide access to the small garden. There is a pond, flowerbeds and a paved area where service users can sit. The front of the house has a ramp for easy access and a few parking spaces. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection on one day in October, over a period of 5.5 hours. The manager was not present, but the CTCH Ltd Group Care Manager attended, offering assistance where required. Most other staff were helpful when approached, and were observed going about their duties whilst interacting with residents. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. Nine residents and two visitors were spoken to directly in order to gauge their views and experiences of the services and care provided at Winstonian House. The arrangements for visitors were looked at, and the systems for addressing complaints and monitoring the quality of the service were also considered. The quality and choice of meals was inspected. The arrangements for the recruitment, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: Winstonian House provides a reasonably homely environment for the residents living there, in terms of facilities and furnishing. The staff group is stable, and is long serving in the main. Staff are well trained, with practically all having at least attained an NVQ level 2 qualification in care. Residents are able to come to Winstonian House following an assessment of their needs, which is carried out by the home in advance, so as to ensure that they can meet the prospective resident’s needs once there. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 6 All residents and visitors spoken to during this visit said that the home was very welcoming, and that staff were very attentive, and would do anything they could to address any queries and concerns should they arise. All indicated a good degree of satisfaction regarding their care, the manner in which it is delivered, their relationships with staff, and the quality and quantity of food provided for them. What has improved since the last inspection? What they could do better: Although residents indicate quite clearly their satisfaction with their care, the standard of care planning and record keeping at Winstonian House is not satisfactory. Gaps and omissions in care records and in medication administration charts could place residents at risk. Attention to the standards of maintenance, cleanliness and hygiene has been seriously inadequate at Winstonian House. Some repairs and requirements for improvement have gone unheeded, and many areas of the home are unclean and unhygienic. Despite CTCH Ltd having provided systems for monitoring the quality of the services provided at Winstonian House, the home has not implemented the use of them. As part of the enforcement process to achieve the home’s compliance a warning letter is to be issued to the home on the basis of these shortfalls. Residents indicate that they enjoy a good standard of food, however the home must ensure that records pertaining to food are sufficiently detailed to demonstrate what is actually served at each meal time. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 7 It has taken the home a long time to successfully address the breakdown of the lower ground floor stair lift, but it looks likely that this is about to be resolved satisfactorily. The home has not kept the CSCI informed, as is required, regarding any adverse incident affecting a resident, such as an accident or injury. Although staff receive formal supervision, the home should increase the amount actually given to each person. Servicing records for certain fixtures and equipment were not available for inspection, and must now be provided to the CSCI for this purpose. Training records regarding staff moving and handling training must also be provided, as the standard and frequency of this training was unclear. An improvement to the fire safety training records has also been recommended, in order that the content of the training is clear. 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. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All residents are admitted to the home on the basis of a full assessment of their needs, ensuring that they can receive the care that they require. EVIDENCE: Assessments for prospective residents are performed by the home, prior to admission. The pre-admission assessments for two particular residents were inspected, and both were adequately recorded. Winstonian House does not provide intermediate care. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10. There is no clear and consistent care planning system in place to adequately provide staff with the information they need to ensure they are meeting residents’ needs satisfactorily. The home has made limited progress with regard to the administration of medications, which potentially places residents at risk. Care and support is offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: Each resident has an individual plan of care, which directly links to an assessment of all their needs, including risk assessments in some cases. Four were selected as part of the case tracking exercise; each had been regularly reviewed. There were a number of shortfalls and gaps in the care records, which concerned the following areas: • One record showed the resident was at risk of falling; there was no specific assessment or care plan to address this problem D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 11 Winstonian House • • • • • • • • • • • The same record showed the resident should be weighed each month; there were no records to confirm that this had been carried out The second record showed that the person was at risk of panic attacks, which affected their breathing; there was no care plan to address this problem The same resident was under the care of the community nurse for leg wounds; there was no record of the nature of the wound, and no care plan to demonstrate how it was to be addressed by the home’s staff on a day to day basis; the resident was also prescribed an antibiotic, apparently for an infection in the wound, though this was only referred to in the daily record The third record showed that the resident had an illness which affected communication and memory; there was no care plan to address this problem The same resident was very clearly at risk of falling; there was no risk assessment documented to address this The same resident had not been weighed, despite the care plan indicating that it should be done each month The same resident was assessed as having some continence problem occasionally; there was no care plan to address this The fourth resident had not been identified as being at risk of developing pressure sores, but the reviews showed that in fact they were developing problems with their heels, which was requiring care and treatment; there was no care plan to address this, and the assessment was not reflective of the actual circumstances The same resident was at great risk of falling. A risk assessment had been carried out, but the moving and handling care plan was not reflective of the risks The same resident had had a recent fall, and sustained a serious injury to their arm, requiring hospital treatment; there was no recording around this incident, apart from an accident record that transpired not to be reflective of the circumstances The same resident had swallowing problems, and weight records showed a gradual weight loss; there were no records addressing this at all. Other aspects of care plans were much more positive, and were personalised very well, and were evidently mindful of residents’ wishes and preferences. Case tracking confirmed many health needs being met, with the support of community health services. Although standard 9 was not inspected in full on this occasion, medication charts were inspected to assess whether the home had complied with previously issued requirements. Compliance had not been achieved in one of the areas, and on this occasion further shortfalls in recording were identified; these were as follows: Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 12 • • • • • Two medications that had been prescribed to be taken twice each day for two separate residents, had only been administered once each day An analgesic that was prescribed to be given three times each day had not been given at all An antibiotic, which case tracking confirmed had been administered had not been signed for when given A discontinued medication had been crossed through, with no direction as to why or by whom Two prescriptions had been obliterated, either by a white sticker, or by complete masking with ink. Residents’ and visitor comments about the staff and the care they receive were positive. All of those spoken to said that staff were kind, caring, helpful and supportive. Each resident spoken to said that they were very happy with their care, with some saying that staff were respectful to them. Some residents were choosing to remain in their room, and the staff respected this. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 15. The visiting arrangements at the home ensure that residents can keep close contact with their families and friends in accordance with their wishes. Dietary needs of residents are adequately catered for, with a selection of food available that meets their tastes and choices. EVIDENCE: The home provides a relaxed and informal environment for visitors, and does not place any restrictions on them. Two visitors said that they felt welcome in the home at any time of theirs or their relative’s choosing. Both found the staff very amenable, very approachable, kind and caring. Both were very satisfied with the care their relative was receiving. One visitor said of Winstonian House, ‘it’s not posh, but it’s home, and it suits Mum very well indeed’. Residents spoke positively about the quality and quantity of food provided for them. There are very close relationships between the staff and the residents, with residents’ dietary preferences well known. Lunch appeared to be one main meal, with no other options available. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 14 However, it was reported that if anyone wanted something different that this would certainly be accommodated. The supper records demonstrated this fact, as they were varied according to individual choice. One visitor said that staff were very sensitive to her relative’s dietary preferences and abilities. The Cook was reminded that all items served at a mealtime must be recorded, including any alternative options. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. The home has a satisfactory complaints system, with evidence that residents and visitors feel that any concerns they may have are listened to and acted upon. EVIDENCE: The written Complaints procedure was clearly displayed on the notice board, and is also provided to residents in their copy of the Service User Guide. Residents and visitors confirmed that staff were very attentive to them, with some saying that staff will do what they can to help them. Visitors confirmed their satisfaction with the manner in which staff responded to them, saying that they would immediately address any concerns and queries, and were always receptive. One visitor said that the manager was ‘lovely’, always listened to their concerns, took them seriously and addressed them. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26. The failure to address maintenance issues in full, and the poor standards of hygiene and cleanliness in the home do not create a pleasing and pleasant environment for residents to live in. EVIDENCE: Over recent months there have been a large number of environmental maintenance and hygiene issues requiring attention. Only limited progress has been made in this regard, and there remain some areas for attention, in particular regarding very poor standards of hygiene and cleanliness. Areas are as follows: • • • A large number of light bulbs are not working A potentially dangerous (if used) and broken hoist remains in situ in a communal bathroom, despite a previous requirement to remove it Despite confirmation that blending valves are fitted to hot water outlets and are regularly checked, a number of random ‘hand-checks’ confirmed D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 17 Winstonian House • • • • that the hot water temperature is still running above that which is considered safe A number of bedrooms, en-suites, and a communal bathroom were very dirty, with some areas odorous, despite a previous requirement to ensure that improved standards of hygiene and cleanliness were achieved Despite the provision of fly screens following the last inspection, there were flies in the kitchen, and the ‘Insectocutor’ was switched off (this was switched on when pointed out) The fire door between the lower ground floor lounge and kitchen has still not been made safe, despite two attempts; the door would not provide an adequate safety measure in the event of a fire in this high risk area Despite a previous requirement the extractor fan in a ground floor toilet has not been repaired Other areas still outstanding include the lower ground floor stair lift, which has been out of action for many months. A new one is due to be fitted in the very near future; this will be followed up at the revised due date of 31 October 2005. Corrective actions have been taken to the wash hand basin in the laundry, so that staff can wash their hands there, and the extractor fan has been repaired in the lower ground floor bathroom. The kitchen, which is situated in the basement, is very claustrophobic, and has a very ‘jaded and tired’ appearance, and it has been recommended that this be prioritised for redecoration. The corners of the floor, areas around the sink, and the fixtures and fittings are not cleaned to a satisfactory standard. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29. Staffing provision is adequate to meet the care needs of the residents currently living in the home. Improvements to recruitment procedures will provide assurances that suitable staff are employed for the protection of residents. An excellent level of support for staff to pursue their professional development ensures that they can establish a good understanding of their roles. EVIDENCE: There remains a very stable staff group at Winstonian House. Good and inclusive relationships have been formed between them and residents, with staff very aware about residents’ needs. It is possibly of some relevance that there is no designated cleaner for the home, with care staff taking responsibility for cleaning it. Given the poor standards of cleanliness, it must be a consideration that this system is not working. Staff working patterns do not vary, and one copy of a set rota is available. Time sheets go a stage further, and demonstrate exactly which member of staff worked each shift, indicating any changes or absences. There has been no recruitment to the home since the last time records were seen. CTCH Ltd has introduced a new clearly laid out recruitment procedure to Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 19 be followed in the event of any necessary recruitment; it has been agreed with CTCH Ltd that they will notify the CSCI when this occurs. The home has made excellent progress with the NVQ training programme, with all staff, bar two, having achieved at least a level 2 qualification. A number are already progressing to level 3 or 4. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36, 37 & 38. Management systems must be employed more rigorously in certain areas if they are to consistently ensure that the welfare, health and safety of the residents is safeguarded. EVIDENCE: The current manager has had a very long serving career at Winstonian House. She has previously been registered with the CSCI, but has not undertaken any management qualification, apart from a management course many years ago, which was specific to care homes at that time. She intends to retire next year. CTCH Ltd has devised a number of quality monitoring tools, which are based on seeking the views of residents and visitors. Despite a requirement to reintroduce these systems, this has not been addressed at this time, with the home failing to implement any of them. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 21 Conversely, there is much evidence that the manager and staff are very receptive to resident and visitor comments, but on a more informal basis. People confirmed that points do get addressed if they raise any. Random samples of staff supervision records were inspected. Each of these demonstrated that the staff concerned had received three formal sessions during the past 10 months, meaning that they were unlikely to get the six sessions recommended under this standard. Annual appraisals have not been carried out as part of this programme. During the case tracking exercise, it came to light that the home had failed to inform the CSCI about a recent accident and subsequent serious injury, which had occurred to a resident. The accident record for this was seen, but was not accurate in its content. There was some evidence that health and safety issues are addressed satisfactorily in many areas, with written policies, procedures and risk assessments, provision of necessary equipment and staff training. However records to confirm manual handling training were not there, though it was reported that the manager is a manual handling trainer herself. Apart from a fire safety questionnaire given to staff earlier this year, fire training records were slightly ambiguous and the content of the training was not always clear. The fire alarm system and emergency lighting is checked weekly and monthly respectively. There was no direct evidence provided to confirm that the electrical installation had been checked for safety (reported to have been done in December 2004), and this was the same with the stair lifts, the water and heating boilers and the portable electrical appliances. A community loan hoist had been serviced recently. Chemicals and detergents are locked away, and COSHH data sheets are provided. Staff have received one day’s ‘Appointed Person’s’ First Aid training. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 1 x x x x x x 1 STAFFING Standard No Score 27 2 28 4 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x 2 x x 2 2 2 Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 23 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 7 Regulation 13(4.c) Requirement Care plans must contain a risk assessment, with particular reference to falls, and include details of actions taken to reduce or eliminate the degree of risk identified, which must be subject to regular review. (previous timescale of 31/5/05 not met in full) Staff must prepare written care plans for all areas identified in the body of this report, which will clearly demonstrate how residents full range of needs are to be met. Staff must ensure that an accurate record is kept of any accident affecting a resident, including any subsequent treatment. Staff must monitor and record residents weights in accordance with their care plan, particularly in cases where a nutritional risk is identified. Staff must ensure that they sign medication charts consistently, for every drug administered. (previous timescale of 31/5/05 not met in full) Discontinued drugs must be Timescale for action 30/11/05 2. 7 15(1) 30/11/05 3. 7 & 37 17(1.a) Schedule 3 12(1.a) 30/11/05 4. 8 30/11/05 5. 9 17(1.a. Schedule 3. 13(2) 30/11/05 6. 9 30/11/05 Page 24 Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 7. 9 13(2) 8. 9 13(2) 9. 9 13(2), 17(1.a) 17(2) Schedule 4 23(2.c.p) 10. 11. 15 19 12. 19 13(5) 13. 19 13(4.a) 14. 19 23(4.c.i) clearly identified as such on the medication charts, with the date and name of the person responsible recorded. (previous timescale of 31/5/05 not met) Staff must ensure that medications are given in accordance with Doctors instructions, as prescribed. Staff must ensure analgesic medication, which may not always be required by a resident, is reviewed by the Doctor, so that alternative instructions can be established for the benefit of the resident. Staff must not completely obliterate medication record entries with the use of ink or white stickers. Staff must ensure that a detailed record of all food items served to residents is maintained. The Registered Person must undertake an audit of all lighting throughout the home, making the necessary repairs to dim or faulty lighting fixtures. The ground floor bath hoist must be removed from use until serviced by a qualified engineer, and deemed fit and safe for use. (previous timescale of 30/4/05 not met) The blending valves to the hot water supply must be checked to ensure that safe temperatures are achieved in all areas accessible to residents. (previous timescale of 31/5/05 not met) The fire door between the kitchen and the lower ground floor lounge/diner must be repaired and maintained to such a standard as will reduce the risks of spread in the event of a 30/11/05 30/11/05 30/11/05 30/11/05 31/12/05 30/11/05 30/11/05 30/11/05 Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 25 15. 19 23(2.c) 16. 26 23(2.d) 17. 18. 26 27 16(2.j) 18(1.a) 19. 33 24(1) 20. 37 37 21. 38 13(5) 22. 38 23(2.b) fire. (previous timescale of 31/7/05 not met) The extractor fan in the toilet opposite room 4 must be repaired to working order. (previous timescale of 31/5/05 not met) All areas of the home must be kept clean and hygienic. (previous timescale of 31/7/05 not met) All areas of the kitchen must undergo a thorough deep clean. The Registered Person must undertake a review of the staffing arrangements regarding cleaning duties. The Registered Person must maintain the quality assurance system for reviewing and improving the care and services at the home. (previous timescale of 31/7/05 not met) The Registered Person must ensure that notice is given to the CSCI regarding any of the events under this regulation. The Registered Person must provide evidence to the CSCI that staff receive regular moving and handling training. The Registered Person must provide evidence to the CSCI of the following servicing and safety checks: Electrical installation; Stair lifts; Water and heating boilers; Portable electrical appliances. 30/11/05 30/11/05 30/11/05 31/01/06 31/01/06 30/11/05 31/12/05 31/12/05 Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 26 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. 3. Refer to Standard 8 19 36 Good Practice Recommendations Staff should weigh and record residents weights each month. Priority should be given to a redecoration programme in the kitchen. Staff should receive formal supervision at least six times each year. Staff should receive an annual appraisal as part of this programme. 4. 38 The home should maintain clear training records, which will demonstrate the type of training given in terms of fire safety. Winstonian House D51_D03_16653_Winstonian House_v247003_191005_UI_Stage4.doc Version 1.40 Page 27 Commission for Social Care Inspection Unit 1210 Lansdowne Court Gloucester Business Park Brockwoth Gloucester GL3 4AB 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. 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