Inspection on 20/05/08 for Winstonian House

This inspection was carried out on 20th May 2008.

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

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

Other inspections for this house

Winstonian House 11/05/09

Winstonian House 29/05/07

Winstonian House 24/07/06

Winstonian House 19/10/05

Winstonian House 12/04/05

Winstonian House 22/11/04

Winstonian House 01/06/04

Winstonian House 04/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Winstonian House 42 All Saints Road Cheltenham Glos GL52 2EZ Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 20th May 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winstonian House Address 42 All Saints Road Cheltenham Glos GL52 2EZ 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) 01242 577927 01242 577927 CTCH Ltd Mrs Sally Anne Hobson Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 18. 8/11/07 Date of last inspection 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 CTCH Ltd group of homes. The centre of Cheltenham and Pittville Park are close by. It is registered to provide personal care to eighteen older people, 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 stair lifts. The lower ground floor has two bedrooms, a bathroom and a small lounge/diner. The remaining bedrooms are located on the ground and first floors, with communal bathrooms on each. The communal accommodation consists of two open plan lounges leading to the dining room. Patio doors from the lounge provide access to the small garden. There is a pond, flowerbeds and a paved area where residents can sit. The front of the house has a ramp for easy access and a few parking spaces. Information about the home is available to prospective residents and interested parties in the printed Service User Guide, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for Winstonian House range from £368.60 (lower Local Authority rate), to £518 per week. Hairdressing, Chiropody, Toiletries, Magazines and Newspapers are extra charges. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. One inspector carried out this inspection over one day in May 2008. 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 three residents being closely looked at in particular. The management of residents’ medications was inspected. Survey forms were issued to a number of residents, visitors and staff to complete and return to CSCI if they wished. None chose to respond. Some residents were spoken to directly in order to hear their views and experiences of the services and care provided at Winstonian House, and some of the staff were also interviewed during the course of this inspection. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for safeguarding the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision 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. We required an Annual Quality Assurance Assessment (AQAA) from the home, which was provided, the contents of which informed part of this inspection. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 7 There were some recording omissions in residents’ care plans, and the home is now required to address these, and ensure thorough and detailed recording that addresses each aspect of residents’ needs. Despite the tighter medication controls that had been introduced, there was an unmet requirement in this area that needed more robust attention to ensure it was fully rectified. There was a need for the home to pay more attention to the needs and choices for those residents requiring a special diet, such as in diabetes. They also should improve the quality and detail of their catering records. We identified some issues of concern in relation to a financial arrangement for one particular resident that required greater transparency, and have also required some training for staff in the safeguarding of vulnerable adults. Improvements to financial records for the management of residents’ monies were required. There were some maintenance and hygiene issues requiring attention. The laundry facilities were inadequate in terms of infection control protocols, and despite this had been utilised during a recent infectious outbreak at the home. Winstonian House does not currently have a manager in post. Staffing levels had been temporarily reduced due to a reduced resident occupancy, and a number had left. This was producing a degree of instability for the residents, however the home did recognise this as an area for them to stabilise as soon as possible. We found that the normally good focus on staff training was lacking on this occasion, and also that the general monitoring of standards here was not being adequately effective at this time. Some risk assessment work was required in order to ensure an improved level of safety for two particular residents in certain areas. 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. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 10 EVIDENCE: We considered the pre-admission process for two of the most recently admitted residents to the home. In each of these cases the resident had been admitted under emergency measures through a referral from the local authority. A representative from the home had not had the time to visit the prospective resident in person to perform their own assessment prior to them being admitted here. Staff from the home had discussed each case on the telephone with the Social Worker concerned, and with a family representative where applicable, and had received a copy of the local authority assessment by facsimile. An example was seen to demonstrate the pre-admission assessments that were performed under more controlled circumstances, which showed that peoples’ needs were assessed and understood before they came into the home. Winstonian House does not provide intermediate care. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home generally have their health and care needs met, although gaps in recorded care planning are posing risks in this regard. EVIDENCE: Each resident had their own personal plan of care that had been drafted on the basis of a detailed assessment of their needs. Three were selected as part of the case tracking exercise to be inspected in closer detail. In the first case there was a continence care plan, and although the continence nurse advisor had assessed the resident concerned, they had refused to wear the incontinence pads to support their need that the advisor had suggested. There was no recorded toileting programme in place to support this person in this regard, and they were tending to be repeatedly incontinent of urine, with staff actions tending to be reactive rather than proactive in terms of preventative action or support. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 12 We advised the home to implement a recorded plan for staff to follow, in respect to offering reminders and prompts for the toilet, so as to actively promote the resident’s continence and to ensure better hygiene and dignity for them. A risk assessment showed that this person was at risk of developing pressure sores. There was no support equipment in place, and although a care plan directed staff to monitor the pressure areas, staff were not recording what they had done or seen. There were numerous gaps in recording in the daily records for this and other areas, and there was no rationale recorded to support the home’s decision not to introduce support equipment. A recent blood glucose check by a member of staff had been slightly raised. The diabetic nurse reportedly reviewed the resident annually, but since the raised blood glucose had been identified, no referral for an earlier review had been made to the nurse or the doctor. We advised that the home liaise with one of them about this. The second person had been recently admitted to the home, and the assessment carried out on their admission was not fully completed. The assessment showed that the resident had urinary incontinence, with subsequent daily records confirming this. There was no written care plan to address this need. There was a written care plan for their mobility risks, but despite intervention from the physiotherapist, with specific exercises required, the care plan contained no reference to this. As in the first case, daily records were only sparsely written. Risk assessments in relation to pressure sore vulnerability, nutrition and manual handling had not yet been recorded; the deputy manager concurred that this should have been completed by this stage, and agreed to address it straight away. The resident concerned had fallen prior to coming into the home and was at risk in this regard; a falls risk assessment was in place. In the third case a risk assessment showed the person was at risk of falling, albeit low risk, but this was not reflected in their mobility care plan, which also did not include the increased risk associated with their partial sightedness. A pressure sore risk assessment showed a slight risk in this area, but this was not accurate, as they had been admitted here with a pressure ulcer that they had sustained whilst in hospital. The risk factor should have been identified as much higher, and there was no recorded care plan to address the risk. Despite this, pressure area support equipment was in place and the community nurse had been dressing the pressure ulcer. However, there was no written care plan to address this particular need and there was no record of the nursing interventions that had taken place. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 13 The nutritional risk assessment had not been completed in full, and the resident concerned had not been weighed since admission. The resident was using an oxygen concentrator in their room to assist their breathing difficulties. An ‘oxygen in use’ sign was not displayed. We advised that the home displayed such a sign under these circumstances. One of the residents was seen walking alone to her room near to a steep flight of steps that went down to the kitchen; this was reportedly the normal practice for her. Her records showed that she had fallen recently whilst trying to open the patio doors. As such there was degree of risk of her falling down the steps near to her room accidentally, and the home needed to consider and plan to address such risks in this case. Residents spoken to directly said that the staff were very caring, with some saying that staff offered increased levels of support as their needs changed. One resident said that ‘nothing was too much trouble’ for the staff. Another said that ‘everything was 100 ’. One resident said that he had ‘felt better since coming here’, and ‘felt safer with the carers on duty night and day’. A visiting health care professional said that they been coming to this home a long time and had no concerns. They said they found the staff ‘quiet but helpful’. The home was managing all the residents’ medications, and there was no-one who was currently self-medicating. Since the last inspection when concerns were identified with medication management, the home had introduced tighter controls generally, with regular auditing carried out. There were no controlled drugs, and all other medications were securely stored. Further to recent amendments to statutory regulations for controlled drug storage in care homes offering personal care, the home is now required to provide compliant storage facilities for such medications. The deputy manager confirmed that this was being addressed, with a cupboard now on order. Medication administration charts were clearly printed, and in the main were fully recorded by the staff. There were examples of analgesia being prescribed to be used ‘when needed’, with a variable dose directed. There were written protocols to support the use of the medication on this basis, however in some cases the amount of variable dose was note not identified when given. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 14 In one case the prescribed analgesia had not been needed, although was prescribed four times each day. There was no record to demonstrate the medication had been refused, with a reason for omission not identified. The deputy manager decided that she would request this medication be reviewed by the doctor so that it could be prescribed on an ‘as needed’ basis rather than regularly four times each day. Some of the handwritten entries had been signed by two staff, as had been required here on a previous occasion, however there were isolated gaps with this practice. The home’s AQAA identified that the medication policies had not been reviewed since 2002. Staff were seen as being polite and considerate with the residents, and appeared mindful of residents’ dignity. One resident said that staff ‘always knocked on her door before entering’, and were ‘always respectful of her privacy’. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the main, people living in this home have the opportunity to remain socially active and exercise choice. A nutritious diet offers choice and variety, although current shortfalls in catering practice and awareness could pose a risk to them in this area. EVIDENCE: Residents had been consulted regarding their ideas and interests for social activity, and a programme was in progress to suit a variety of tastes, with something happening each day. Trips and entertainments were planned. One gentleman was pursuing his particular hobby of playing drafts, and audiotapes had been provided for those with sight impairment. One particular resident remained socially involved out in the community as well as in the home. Residents spoke positively about opportunities for social activity, saying that they were able to exercise their choice about whether they participated or not. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 16 The AQAA stated that at present social activities were not always completed as planned due to reduced staffing levels; staff being less able to take one lady out to the local shops at this time verified this. A resident recently admitted said that he may want to see the Roman Catholic priest at some point; this had not yet been addressed by the home, but staff confirmed they would when the resident had decided. One lady regularly attended a local church. Five residents were observed sitting in the lounge during the morning, over a period of nearly one hour. Two staff were witnessed going back and forth through the lounge on at least four occasions during this period, but neither of them spoke or interacted with the residents sitting there. The home imposed no restrictions on visitors to the home, although it was not possible to speak directly to any visitors, and nor were any visitor survey forms returned to CSCI. Residents said however, that staff were mindful of their personal choices and preferences, and that their visitors were welcomed at any time. Residents’ choices were generally being observed and respected, with people largely spending their time how they chose, and with regards to their meals and drinks. They had been supported to personalise their own room with their belongings. Each resident spoken to directly confirmed that they felt they were able to make choices in the home. The menus were seen, and these demonstrated that residents had a choice of food. There were two hot choices on offer for lunch and supper, plus two puddings; a list of residents’ choices had been sent to the cook. One resident said that she had not wanted either choice, and had chosen sandwiches instead; she said that staff always accommodated her ‘awkward tastes’. The dining room was pleasantly laid for lunch. The meal looked well presented, with good portions and an appetising appearance. Residents spoke very positively about the food, saying they had ‘a good choice’, and that food was ‘good and plentiful’. The home did not have a designated cook at the time of this inspection, although one was just being appointed, and care staff were allocated to cook whilst being supernumerary to the care team. Carers involved in this had not received recent food hygiene training. We spoke to the carer responsible for cooking on this day, and asked her about any special diets, diabetic diets in particular. She said that tinned fruit in natural juice was provided for diabetic residents, and other than that they could have fresh fruit. This demonstrated very little choice for diabetic residents in terms of puddings. The carer was also unaware of whether certain pudding items, such as custard, were suitable for diabetics. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 17 Catering records had not been properly maintained, with refrigerator and deep-freezer temperatures only recorded once during May, and with only a few recorded for April. Food temperatures had been recorded. The cleaning schedule had not been recorded. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home can be reassured by the home’s complaints procedures and the policies regarding the prevention of abuse, although there is currently scope for an improved level of understanding from certain staff. EVIDENCE: A copy of the home’s complaints procedure was displayed, and had been issued to residents in their information brochure. The home’s AQAA stated that one complaint had been received, although there was no record of this in the complaints folder. The deputy manager said that this was thought to be in relation to information of concern received by CSCI last year regarding catering, which had prompted a random inspection at the time. Residents, without exception, expressed their confidence in the staff to quickly address any concerns that might arise, but said that actually they had none. The home had policies and procedures for safeguarding the vulnerable residents, which included whistle blowing procedures and local contacts should the need arise. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 19 One particularly vulnerable resident had an advocate in place to support them, although there was no record of this in the care plan. There had been a longstanding arrangement for a member of the care team to purchase cigarettes for him. Records showed that a sum of money was regularly given to the staff member in order to buy them. There was no way of verifying from the records that the full amount of money was being spent in this way, or that any change was being returned. A break-in occurred at the home some months ago, which involved the theft of the home’s safe containing residents’ personal money. Despite a police investigation a perpetrator was not apprehended. The home had reimbursed those residents affected. One of the night carers lives on the premises, and on occasions has had personal visitors. One of these visitors had been witnessed walking freely in home and using the food store. As this visitor had been unknown to the care home, and was not associated with any of the residents, this had posed a degree of risk to the vulnerable residents within the home. The carer concerned had received a letter about this practice having to cease, laying out a series of guidelines for his visitors. Training in safeguarding vulnerable adults was provided for staff over a year ago. A more recently employed carer had done training in this area as part of his induction; another had done it more recently with the company’s trained trainer. We spoke to two carers who were aware of the types and signs of abuse, and of the multi agency involvement in cases that might arise. Two other carers we spoke to were not. One said she had done training but could not remember the content of it; this person was hesitant and not conversant in safeguarding procedures. A new carer said she had little awareness in this area, but knew she had to do the training, which was being planned. We recommended that the home obtained the latest Alerter’s Guide for all staff from the Local Authority. The home has obtained an easy-read version of the Mental Capacity Act. The deputy manager had undergone a day’s training in this, but no-one else had. The home had sourced a lot of learning materials, with training planned to address this. There had been two staff disciplinary actions as a result of unacceptable practices in the home. Residents spoke of having confidence in the home and trusting the staff. One said that she felt she ‘knew the staff well and had real confidence in them’. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living here are provided with a reasonably maintained environment, but some poor hygiene standards are posing a risk to the health and welfare of residents in certain areas. EVIDENCE: Winstonian House is not a purpose built home, with the accommodation provided within an old property, which has had some adaptations for its use. The home has access to maintenance personnel through CTCH Ltd. Cyclical maintenance records were seen. Although some areas currently need more attention in terms of upgrading and refurbishment, there had been some progress in this area. A bedroom had been redecorated, and three bedrooms on the first floor had been turned into two to create more space and allow for en-suite bathrooms. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 21 The basement bathroom had been refurbished, although it had not been possible to provide an assisted facility as was planned. The home has plans to create an assisted shower room on the ground floor, and upgrade the very basic en-suite facilities in some of the rooms. No smoking signs were displayed, although smoking was permitted in the basement lounge. Despite self-closing doors to the lounge smoke was not always totally contained, as odour was evident at times in the basement area. A door to one of the ground floor bedrooms did not close in properly, and was identified to the deputy manager at the time for maintenance attention. The fabric headboard in one of the basement floor bedrooms was filthy and ripped, and required replacement. This same room was very malodorous, with the en-suite bathroom being dirty and the floor heavily stained. There was one other room that also was malodorous. The small laundry room had been fitted with more hygienic flooring, and with washable wall covering and new tumble drier. There was no liquid hand soap for the hand basin. Gloves and aprons were provided for staff use. The washing machine in the laundry room had still not been replaced. The home has acknowledged that this machine is not a compliant one in terms of sluicing and disinfection protocols. This is of particular concern as there had been an outbreak of infection in recent months, during which it was confirmed that infected laundry continued to be washed in the machine. The laundry room was not locked and there were chemicals stored in here. The risks associated with this have been pointed out to this home on a previous occasion. The community nurses had removed any dressings and sharp needle clinical waste. The home had liaised with the local council regarding disposal of incontinence waste, and was continuing to double bag it and put it out for household collection, having not been advised to the contrary by the council. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in this home are currently receiving care from a slightly unstable workforce, some of whom have gaps in their knowledge and understanding due to a reduced focus on their training and development. EVIDENCE: The AQAA information in relation to staffing provision was not accurate in some areas, particularly in the number of care hours provided. The AQAA acknowledged there was a need to recruit more staff and stabilise the team. Due to an unplanned reduction in resident occupancy in recent months, there has been a reduced level of staffing. Following a meeting with the Care Provider prior to this inspection, it was clear that this was a temporary measure until resident occupancy could be built up again. Staff said that the arrangements had been satisfactory, but they were beginning to ‘feel things were a bit tight now, with certain things suffering, such as no time to take one of the residents on her normal outing that she so enjoyed and was used to’. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 23 A number of staff had left, and the home was down to two carers at all times for the personal care of the twelve residents, with one waking and one sleep-in overnight. The cleaner had returned here as her normal place of work, having been temporarily deployed to another home within the group. During this period of her absence care staff had taken responsibility for cleaning, but were continuing to do the cooking until the new cook commenced his employment. Residents spoke well of the staff, saying that they were kind and caring, although one said that ‘some were better than others’. The home’s AQAA information in relation to National Vocational Qualifications (NVQ) held by care staff was not accurate due to the number of staff leaving. It stated that there were eleven staff with the qualification at level 2. However there are now only ten care staff employed here, of whom there are four who have the award at level 2, two who have it at level 3, with the deputy manager qualified at level 4. A more recently recruited carer was due to start the level 2 award with an external training provider. Two staff files of recently recruited carers were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. One of these was not precise in terms of dates as it recorded the year only. This made it difficult to identify if there were any employment gaps. Interview notes were recorded, although in one case they could not be located for inspection. Two written references had been provided in each case, although in one case these had not been professional ones, as the employee had previously not had an employer. Proof of identity and medical statements had been obtained. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person, with appropriate actions taken where any issues had been identified. Records showed that new workers had undergone induction training. One person said that they had undergone training in the Common Induction Standards (CIS), but when questioned had trouble recalling detail. This person confirmed she had worked under supervision during this period, and these arrangements were evident on old rotas. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 24 Another carer said she was supervised at the start, and had felt well supported by the staff. This carer said she had not had a formal induction, only training at the start from the manager. However, on checking her records it appeared she had undergone training in the CIS through an external training provider, and although recorded in the interview notes that this was the case, there was no other record of her achievement, and no obvious recognition from her that she had done it. The training matrix showed the latest training dates as having been in 2006, and was not relevant at this time. The deputy manager was aware this had become the case, and was planning to address it. The AQAA stated that eleven staff had had infection control training; the deputy manager said that this had in fact been four years ago. Certain staff were scheduled to attend medication training with a local college. The home has a ‘trained trainer’ for providing manual handling updates for the staff, but there was no evidence of this having taken place recently, apart from new workers. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manner in which this service is currently being managed does not consistently provide reassurance for the interests of people living in this home. EVIDENCE: Winstonian House does not currently have a manager in place, registered or otherwise. The deputy manager is acting in this capacity until a suitable candidate can be found. The Provider has advised CSCI of his plans to secure greater consistency for the management of this home in the near future. During this period an adequately robust quality monitoring system had not been in operation, and despite residents’ level of satisfaction there were a number of areas of the service requiring improvement at this time. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 26 One resident was very aware of the instability in the recent management of this home, but went on to say that she thought they were ‘doing their best to get it sorted out’, and that ‘the deputy manager was very helpful’. The AQAA stated that regular resident meetings took place. This could not be borne out during inspection, with the last meeting having taken place in May 2007. Survey questionnaires had recently been sent out to residents, their families, and visiting healthcare professionals to complete, as part of a quality monitoring approach. The survey questions had been devised in line with the National Minimum Standards and covered equality and diversity, and had been produced in larger print for the residents. A suggestion box was place in the entrance hall. The AQAA indicated that most policy documents had not been reviewed for some time. The Provider carries out monthly monitoring visits to this home and produces written reports as is required. However, following this inspection they will be required to send a copy of the report produced under Regulation 26 to CSCI every month. A number of residents had chosen to place personal money with the home for safekeeping. Random checks on two such arrangements proved to be accurate. Clear and transparent records were generally being maintained in these cases, however concerns were identified in relation to one particular arrangement, which are also reported under standard 18. A member of staff involved in carrying out transactions on a particular resident’s behalf had not signed to acknowledge receipt of the resident’s money, and there were no receipts for the transactions. Receipts for hairdressing and chiropody were evident in a separate book. The full name of the resident had not been recorded, and this could be confusing given some shared the same Christian name. The Fire Safety Officer had visited last year, and had raised concerns regarding the home’s Fire Safety Risk Assessment. In response to this the home has worked hard towards developing a more robust assessment, with evacuation plans drawn up for resident safety. There had been no staff training in this area yet, but evacuation training was planned. The last fire safety training, using a variety of learning methods, was recorded as one year ago, although this had reportedly not encompassed all staff. At least one member of staff confirmed that they had not received any recent fire safety training. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 27 There was a record of fire drills. Regular checks had been carried out on the fire alarms, smoke detectors, fire extinguishers and emergency lighting. Safety checks had been carried out on the heating, the hot water temperatures and the electrical equipment to ensure safety, and records demonstrated that medical equipment and the stair lifts had also been serviced. Records for the most recent heating boiler service were not available for inspection, but the deputy manager said this had been carried out during the week prior to this inspection. Some of the staff had received basic training in first aid. Records showed that this had been three and four years ago for some, without having been updated. We gave advice to the manager regarding the risk assessment of the suitability of this level of first aid provision for the needs of this home. The resident using the oxygen concentrator preferred to have the door to their room propped open. The home was addressing this by placing a wedge under the door. This arrangement poses a fire risk and the home must consider a safer option if the door is to be left open. Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) (2b) Requirement The Registered Person must ensure that care plans are written so as to clearly show how residents’ needs in respect of all aspects of their health and welfare are to be met; to include the continence, mobility and vulnerable pressure area needs identified on this occasion. Reviews of care plans must be recorded in full, with changes in condition or progress made clear. The Registered Person must ensure that a record is maintained of all nursing treatment and interventions. The Registered Person must ensure that appropriate risk reducing measures are taken in order to ensure the safety of the resident accommodated near to the open kitchen staircase. A second member of staff must witness and sign any hand written entries on medication administration charts. This is to ensure thorough checks on the DS0000016653.V359867.R01.S.doc Timescale for action 31/07/08 2 OP8 17(1a) Schedule 3 (k.m.n) 13(4c) 31/07/08 3 OP8 30/06/08 4 OP9 13(2) 31/07/08 Winstonian House Version 5.2 Page 30 accuracy of information recorded in this area against prescribed instructions. This requirement is repeated from the previous inspection. 5 OP15 12(3) 16(2.i) The Registered Person must ensure that diabetic residents receive a suitable diet that meets their health needs, and which also promotes choice for them. The Registered Person must ensure that the arrangements for making purchases on behalf of vulnerable residents are clear and transparent to avoid any risk of financial abuse. The Registered Person must ensure that all staff receive training in the recognition and prevention of abuse of vulnerable residents. The Registered Person must ensure that: • The identified ground floor bedroom door is repaired so as to safely and completely close • The headboard in the identified basement bedroom is replaced. The Registered Person must ensure that a thorough cleansing and deodorising of the identified bedrooms is carried out, to ensure they are maintained in a hygienic and odour free state. The Registered Person must ensure that the laundry facilities in the home are able to perform sluicing and disinfection programmes for foul laundry. The Registered Person must ensure that the laundry room remains locked, so as to hold the chemicals stored in there DS0000016653.V359867.R01.S.doc 30/06/08 6 OP18 13(6) 30/06/08 7 OP18 13(6) 31/08/08 8 OP19 23(2) (b.c) 31/07/08 9 OP26 16 (2) (j.k) 23 (2.d) 31/07/08 10 OP26 13(3) 31/08/08 11 OP26 13(4.c) 30/06/08 Winstonian House Version 5.2 Page 31 12 OP29 19(1.b) Schedule 2 (6) 13 OP30 18(1) (c.i) 14 OP33 26 (5a) 15 OP35 17(2) Schedule 4(9) 16 OP38 23(4d) 17 OP38 13(4c) 18 OP38 13(4c) 23(4)(ci) securely and reduce risks to vulnerable residents. The Registered Person must ensure that a full employment history is obtained for new workers, which includes the dates of previous employment, in order to identify and explore any gaps within it. The Registered Person must ensure that a training programme is implemented to provide all staff with the skills necessary for their work. The Registered Person must ensure that a copy of the report produced on the basis of the unannounced monthly monitoring visits to the home is supplied to CSCI every month. The Registered Person must ensure that: • Staff taking money from a resident’s money placed in safekeeping to conduct transactions on their behalf sign to acknowledge its receipt on the financial record • Receipts for expenditure made on a resident’s behalf are kept. The Registered Person must ensure that all staff receive fire safety training in order to ensure their ability to protect the residents in the event of a fire. The Registered Person must ensure that appropriately updated first aid training is provided for care staff, and that an assessment of the level of training demonstrates its suitability for the needs of the home. In the case of the resident using oxygen and preferring their door to remain open, the Registered DS0000016653.V359867.R01.S.doc 31/07/08 31/08/08 31/07/08 31/07/08 31/07/08 30/09/08 31/07/08 Winstonian House Version 5.2 Page 32 Person must ensure that an appropriate door closing system is in place to ensure the safety of the resident in the event of a fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Staff should write up daily records in full in residents’ care plans • Staff should record their rationale in the care plan for not introducing support equipment in cases where a pressure sore vulnerability has been identified. Staff should record residents’ weight as soon as possible after their admission to the home, in order to have a baseline reading when monitoring nutritional needs. Catering staff should record refrigerator and deep-freezer temperatures at least once every day, and should also record and maintain a written kitchen cleaning schedule. • 2 3 OP8 OP15 Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Winstonian House DS0000016653.V359867.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!