Inspection on 24/07/06 for Winstonian House

This inspection was carried out on 24th July 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Winstonian House 11/05/09

Winstonian House 20/05/08

Winstonian House 29/05/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Winstonian House 42 All Saints Road Cheltenham Glos GL52 2EZ Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 24th July 2006 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.V301366.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.V301366.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 CTCH Ltd Mrs Sally Bonner Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2006 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 residents 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. 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 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 £349 to £485 per week. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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 on one day in July 2006. 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. Eight 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. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI; it was necessary to collate the results of these surveys after this visit, as completed forms in CSCI stamped addressed envelopes were not returned to CSCI in advance, and remained in the home. 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 protecting 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. What the service does well: Winstonian House provides a relaxed and informal atmosphere for the residents living here. Families and friends are free to visit at any time, and are welcome to join in the life of the home. There is a stable staff group here, and there are many examples of positive relationships existing between residents and staff, with residents confirming satisfaction with their care and the staff. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 6 Care staff work with external health care services in order to meet the health needs of the residents. Residents’ personal choices are respected, and there is evidence that their independence is promoted as far as possible. Staff are helpful in terms of helping residents to cope with specific disabilities. There are high levels of satisfaction with the choice, quality and quantity of food provided, with just two people saying that the quality of certain items could be variable. There is an accessible complaints procedure should any resident or visitor need it, and those spoken to had confidence in the staff to listen and address any concerns; just one person had less confidence in this process. The home provides some good training opportunities for its staff, and actually exceeds the minimum standard for the number of care staff qualified to NVQ level 2. What has improved since the last inspection? What they could do better: There have been inconsistencies in how information about the home is shared with prospective residents, meaning that some have not received a copy of the home’s information brochure. Although people are admitted on the basis of an assessment, the standard of assessment recording carried out by the home has been variable, and must be more consistent. There are generally safe systems for managing residents’ medications, but certain aspects of recording require improvement. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 7 Residents’ experience of social activities is variable, and although there is a monthly programme of activities drawn up, it is evident that activities are not always provided; there was some evidence of residents sitting around with little going on around them. The home has appropriate policies for the protection of vulnerable residents, and staff are aware of them. However, it has been recommended that each resident is provided with their own lockable drawer. Winstonian House is an old property, and although adequately maintained and decorated overall, certain parts of the home do have a slightly fatigued appearance and would derive some benefit from a degree of refurbishment. There are some minor issues that require some maintenance attention. Recruitment procedures are largely appropriate, but there are certain aspects of recording that could have been carried out better. There are gaps in the provision of induction training for new staff, and this must be improved in order that risks are not posed to residents. The home has undertaken some work to monitor the quality of its services for residents, but unless this is thoroughly and consistently applied, it will not allow for residents to influence how their home is run. Certain records pertaining to fire safety management and accidents affecting residents require improvement. The long serving manager is retiring at the time of this inspection visit. CTCH Ltd is required to submit their proposal for the continued management of Winstonian House to CSCI. 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 DS0000016653.V301366.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.V301366.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s omission to provide an information brochure to all prospective residents has resulted in some not having sufficient information on which to base their choice about moving there. Assessments must be carried out consistently if residents are to be assured prior to admission that the home can fully meet their needs. EVIDENCE: The home has produced an information brochure about its services and facilities. A small number of residents spoken to during this visit confirmed that they had never been issued with an information brochure. This was because the manager had none in stock at the time of their admission. The brochure is reported to have been under review, with new copies being distributed to the home from CTCH Ltd head office for future distribution. Prospective residents are assessed by the home before their admission there. Copies of assessment forms for some recent admissions contained variable Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 10 amounts of information and detail, with some assessments evidently conducted more thoroughly than others. There was one instance of a resident who was admitted to the home as an emergency; there had been no time for the home to conduct its own assessment under these circumstances, but the manager had obtained a copy of the placing authority assessment prior to the admission. Winstonian House does not provide intermediate care. Winstonian House DS0000016653.V301366.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 at least once during a 12 month period. 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. A new and improved care planning system can now adequately provide staff with the written information they need to meet residents’ health and personal needs. The systems for the administration of medications are generally good, however isolated failures by staff to observe them consistently could pose a small risk to the safety of residents. Care is offered in such a way as to meet residents’ needs in respect of their privacy and dignity. EVIDENCE: Residents have a documented plan of care, which is based directly on an assessment of their needs. Care plans are written in consultation with the resident concerned, and in the main are regularly reviewed; there were isolated examples of where reviews had been carried out less frequently. Three records were chosen as part of a case tracking exercise. Each contained a very thorough assessment of each person’s health, personal and social needs, the results of which were clearly linked to the documented Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 12 plans of care. Records contained risk assessments to address risks of pressure sores, falls and moving and handling; a risk assessment had yet to be recorded for a resident recently admitted, regarding smoking, although this was being addressed. Weight monitoring and nutritional needs were recorded. There were records of appropriate medical interventions from external health care services, including consultations and reviews with doctors, community nurse, chiropodists, opticians and hospital referrals. A community nurse was present in the home during this visit, providing support and guidance to staff regarding a particular health need of one of the residents; this health care professional was satisfied with the care and staff practices they had witnessed in the home. Residents themselves, relatives and visitors, either by written survey responses or in person, confirmed their satisfaction with the care being delivered, and the manner in which staff addressed them. One resident had a number of concerns about their own care, the facilities and services, and was raising these directly with the home and the Group Care Manager for CTCH Ltd. Staff themselves were very conversant in the care of individual residents during the case tracking exercise, and clearly understood individuals’ care needs and preferences. The home has written policies and procedures for managing residents’ medications, provides safe storage, and has clearly printed medication administration records from the supplying pharmacist. Stock levels are appropriate and are adequately controlled. Individual boxed items are not routinely dated on opening to ensure they do not get used beyond their expiry date, however there was nothing to indicate any item was being used beyond its expiry date on this occasion. The management of a resident’s daily injection was discussed, as elements of it were of some concern, and it is now to be the subject of further discussion with the CSCI Pharmacy Inspector separately to this inspection. The author and a witness sign hand written entries on medication administration charts. There were examples of ambiguous handwritten directions for usage of a medication, such as a figure 1 and 3 written in the style of a fraction, as a code for ‘to be given three times a day’. Staff had not recorded how many tablets had been administered in cases where a variable dosage had been prescribed. There are no residents currently able or choosing to self-medicate, although one resident said that she had always done this previously, but had elected not to do this anymore. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 13 There are clearly written protocols for the use of medications that have been prescribed ‘as necessary’. The home has copies of reference material and information regarding safe management of medications, and ensures that staff involved in this area of practice have received appropriate training. Care plans are written in a sensitive way, and show due regard for the level of independence possible, and the privacy and dignity of the individual. Documentation also reflected personal choices and preferences of the individual. One resident said that staff always respected her privacy and independence, but also provided the right amount of support in a sensitive way when needed. Staff were observed to be kind and polite when interacting with residents, and during interview demonstrated an appreciation and understanding of respect for residents’ privacy and dignity. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. 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. The home makes efforts to ensure that residents can exercise choice in their daily lives, but have not consistently ensured that the opportunity to engage in social activities is offered to all. Visiting arrangements are such that residents can keep close contact with their families and friends. Dietary needs of residents are adequately catered for, with a selection of food available that meets their tastes and choices. EVIDENCE: The home devises a diarised plan of organised social activities each month, a copy of which is distributed to each resident. Recorded assessments do take into account the social needs and preferences of each person. A small number of residents said that, although a programme of activities is advertised, it is not always adhered to, and that sometimes activities do not take place. During this visit, residents were spending their time quietly, in various parts of the home in accordance with their choice, but apart from their personal pursuits of reading, television and radio, there was little else happening; some Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 15 residents were sitting quietly for quite prolonged spells, with very little happening around them. However, residents also confirmed that their personal choices regarding whether they participate socially or not is always respected. Others also confirmed that group activities and entertainment do take place on occasions, and that they enjoy them. One resident spoke of a very active social life outside of the home, attending different clubs and the local church. They said that they were able to carry out certain light household chores in their room, as was their wish. This person had sight difficulty, and was also able to enjoy a ‘talking newspaper and magazine’ service from Articles For The Blind. The resident said that the home staff were very helpful regarding reading or writing any of her correspondence. The home has recently held a celebration with residents, families and staff, of the home’s 20 year anniversary. Residents’ families and friends are free to visit at any time of theirs or their relative’s choosing. Residents and one visitor spoken to said that they feel welcome in the home, and that they are offered refreshment. Written survey responses from visitors indicate that they are appropriately consulted and informed regarding their relative’s care. Staff show respect towards residents being able to pursue personal choices and maintain some control in their lives. This is evident in that residents are able to manage their own affairs if they are able, and in the way they can personalise their rooms, spend their time, and select favourite choices of food. Residents in the main confirmed that they feel respected by the staff. One resident appreciated having her lunch served to her on a tray, as she did not feel up to going to the dining room. The menu for the day’s lunch meal was displayed, and although this only reflected one choice of meal, it was clear from records and from discussion with residents and staff, and from observation of the choice of meals served that residents are free to make alternative choices. The cook demonstrated a very flexible and inclusive approach with residents, consulting with them regarding their likes, dislikes and choices. The cook was also very informed about individual dietary requirements. All residents, with two exceptions who said that the standard could be a bit variable, said that the meals were very good. Snacks are available to residents at other times, and a cake had been baked for afternoon tea. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 16 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 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. The home has a satisfactory complaints system, with evidence that, in most cases, residents feel that any concerns they may have are listened to and acted upon. The home’s policies, and staff’s understanding of them, helps to promote a safe environment for the residents. EVIDENCE: A copy of the home’s Complaints Procedure is displayed on a notice board. Written survey responses from residents and relatives indicated their awareness of the procedure, and that staff listened and acted upon any concerns raised. During conversation with residents and with one visitor during the visit, it was evident that they had confidence in the staff to respond appropriately to any issues they might need to raise. However, one particular resident was less confident, and was in the process of pursuing certain issues with the home and its management, saying that some staff are more helpful than others. The home has written policies and procedures for the protection of vulnerable residents, and staff were able to access these, demonstrate their awareness and understanding of what might constitute abusive practice, and knew the steps to take under the Whistleblowing procedure if they had any concerns. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 17 Protection of Vulnerable Adults information from the Department of Health is available in the home. At least two residents have appropriate arrangements in place with solicitors concerning the management and protection of their affairs. The home has taken appropriate action in response to an allegation by a resident regarding some missing money; this has yet to be concluded at the time of this visit. This person has been offered the use of the home’s safe to store money or valuables, and has declined; there is no personal lockable space provided in this resident’s room. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the appearance in this home could be improved, the standard of the environment is satisfactory, and provides residents with a reasonably comfortable and homely place to live. The standards of cleanliness are improving in order to make the home more pleasant and hygienic for the residents. EVIDENCE: The home has a maintenance person, who works across each of the homes in the CTCH Ltd group. Records of maintenance undertaken are kept. Although just adequately maintained and decorated in most areas, the environment generally appeared fatigued, and would benefit from some attention to redecoration or a degree of refurbishment. This was particularly evident in the kitchen. An Environmental Health Inspection has recently taken place, and a number of issues concerning Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 19 cleanliness and maintenance were identified for improvement; the home has made progress to address these. Two bedrooms were being redecorated whilst currently vacant. There is now a designated housekeeper, and the home was generally cleaner than it has been previously, and was less odorous. There were no plugs in the wash hand basins in the communal bathrooms; there was no explanation as to why this was. A ceiling light fitting in the kitchen store cupboard was faulty, and could only be operated if the cook adjusted the light bulb manually. A wheelchair was stored in one of the hallways, in the path of a fire exit, and was pointed out for correction at the time. This visit was conducted on a very hot day, and large electric fans had been provided for the residents’ comfort. One visitor commented that staff had been attentive in ensuring that residents were supplied with plenty of cold drinks during the hot weather. The laundry and chemicals store is situated in the same small room, which is kept locked. A laundry procedure is displayed, which pays due regard to infection control. The washing machine, although large and capable of managing the laundry, is limited in terms of the different cycles, but can wash foul items at an appropriately high temperature. There are hand washing facilities with liquid soap and paper towels in here, as well as in other locations around the home. Gloves and aprons are provided for staff. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. 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. The stable and committed staff group provide consistency, although management shortfalls in any aspect of recruitment practice will pose risks to the vulnerable residents. Staff receive good ongoing training opportunities in order to equip them for their role, however the failure to ensure adequate training during induction of new staff will compromise the safety of residents. EVIDENCE: A staff rota is maintained, although staff shift patterns tend to be set and rarely alter; staff job roles are not identifiable on the rota, making it difficult for the reader to determine who is care staff and who is catering or housekeeping staff. There is provision for three care staff during the morning and afternoon, with just two in the evenings. The care staff receive ancillary support from a housekeeper during the week, and a cook. The Registered Manager has undertaken cooking duties on alternate Sundays, and the Group Care Manager said that she would be undertaking these duties now that the manager is retiring. There is one waking night carer, and there is an arrangement for one sleep-in carer to be called upon each night as necessary. These particular Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 21 arrangements relating specifically to one of the sleep-in carers are currently being considered more closely separate to this inspection. A strength of Winstonian House is the stable group of staff here. They appear to be a very hard working and committed group, and were able to demonstrate good awareness of individual residents’ needs during the case tracking exercise. Residents generally spoke very positively about the staff, saying that they were ‘wonderful’, ‘kind and caring’, and ‘couldn’t do enough for us’. The home has made very good progress with the staff NVQ training programme. Eight care staff have the NVQ level 2 qualification as a minimum, with three having level 3. Two senior care staff are currently on the NVQ level 4 training programme. A selection of staff files was chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Records of interviews were seen. Full and complete evidence of the required pre-employment checks was seen in each of the files, including the enhanced CRB disclosures. Although recruitment practices met the statutory requirements there were some aspects of recording that could have been better; this pertained to risk assessing the employment of staff under certain circumstances. This particular issue is being addressed separately to this inspection. Records indicated that a recently appointed carer had been allocated to a named supervisor at the commencement of her employment. However, despite this there was no recorded evidence of a formally structured induction training programme for this person. Other training records show a range of mandatory and optional training that staff have undertaken in order to ensure their continued professional development. Staff have received updated manual handling training earlier this year, although there were no actual records of this available for inspection during this visit. A district nurse was present in the home providing support and guidance to the care staff in relation to increasing their skills and competencies in meeting the particular health needs of one of the residents. Staff spoke positively about the training opportunities that are available to them. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. 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. There are some shortfalls in the management practices of this home, which potentially compromise the interests of the residents in certain areas. EVIDENCE: The Registered Manager has had a long service history at Winstonian House, and is due to retire at the time of this visit. CTCH Ltd is currently considering its options to appoint a new manager, and to comply with the requirement to apply for registration of a new manager as soon as possible. Certain suggestions have been discussed with CSCI regarding the future management of this home, but a formal proposal is required from CTCH Ltd. A series of self-assessments have been introduced into the home, in order to assist the manager to assess the home’s performance against selected Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 23 National Minimum Standards, identifying strengths and weaknesses, as part of a quality monitoring exercise. Residents received survey forms from the home earlier this year, so that they could have the opportunity to provide feedback on their experiences of the home. However, the questions posed on surveys were restrictive, resulting in residents having only a limited say in the running of the home. The results of these surveys, although not collated, were published in a folder. There was no development plan for the home, which took into account any of the quality monitoring assessments. The home does not offer residents and relatives the opportunity to have regular meetings at which issues and feedback on services could be raised; the manager said that she has endeavoured to remain accessible to people so that they can feel free to raise any issues informally with her. Some residents have placed personal money with the home for safekeeping. Clear and transparent records for each person, which include transaction details, running totals, and receipts, are kept. Residents or their representative sign to acknowledge some transactions, but where this is not possible in the majority of cases, two staff members sign the record to witness on behalf of the resident. The safety of equipment in the home is reviewed under servicing agreements, and up to date certificates are in place for the chairlifts, utilities and electrical equipment. Hot water at outlets accessible to residents is generally maintained at a safe level. The fire alarm system and emergency lighting is regularly checked, and staff last received fire safety training many months ago, at the start of this year; the record does not identify the course content. A fire risk assessment has been conducted, although this does not take into account the training needs of the staff. Issues identified for improvement regarding environmental health in the kitchen pertained to the lack of observation of a cleaning schedule, monitoring temperatures in high risk food areas, and to general cleanliness. The home has taken steps to address these areas. The cook does not routinely check and record the deep-freezer temperatures. One of the senior care staff is to receive training in aspects of food safety, and will then cascade training to others in order to drive improvements in the kitchen. All care staff have undertaken training in First Aid. Accident records did not contain evidence of one particular resident’s recent fall, which was discovered during case tracking process. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 24 Further to a previous requirement for staff to accompany residents using the stair lift, as there are no safety straps provided, staff demonstrated their full awareness and compliance with this. Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 5(2) Requirement The Registered Person must ensure that an information brochure (Service User Guide) is given to all prospective residents. The Registered Person must ensure that all prospective residents have a thorough preadmission assessment, which is fully recorded in detail. The Registered Person must ensure that: • Handwritten entries on medication administration charts contain clearly printed instruction for the use of medications • The amount of tablets given is recorded in cases where a variable dosage is prescribed. The Registered Person must ensure that a programme of social activities is provided that will meet the needs of all residents. The Registered Person must provide plugs to the communal wash hand basins. DS0000016653.V301366.R01.S.doc Timescale for action 31/08/06 2 OP3 14(1.a) 31/08/06 3 OP9 13(2) 31/08/06 4 OP12 16(2.n) 30/09/06 5 OP19 23(2.c) 31/08/06 Winstonian House Version 5.2 Page 27 6 OP19 23(2.b) 7 OP19 8 OP30 9 OP30 10 OP31 11 OP33 12 OP38 13 OP38 The Registered Person must ensure the safety and the return to full working condition of the ceiling light fitting in the kitchen store cupboard. 23(4.b) The Registered Person must ensure that staff do not place wheelchairs in the way of a fire exit. 18(1)(c.i) The Registered Person must ensure that all newly appointed staff receive structured induction training. 17(2) The Registered Person must Schedule ensure that a record of 4(g) individual’s induction training is kept. 8(1)(2) The Registered Person must provide CSCI with details of their strategy to provide consistent management support to the home, including the appointment of a new manager. 24(5) The Registered Person must maintain a system for evaluating the quality of the service provided at the home, which will provide for consultation with residents. 23(4)(d.e) The Registered Person must ensure that the Fire Risk Assessment takes into account the training needs of the staff, so that they receive suitable training in fire prevention, and have drills and practices at suitable intervals. 17(1.a) The Registered Person must Schedule keep a full and detailed record of 3(3.j) any accident affecting a resident. 31/08/06 31/08/06 31/08/06 31/08/06 31/08/06 31/10/06 30/09/06 31/08/06 Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 28 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 4 5 Refer to Standard OP7 OP9 OP18 OP27 OP33 Good Practice Recommendations Staff should review all care plans monthly. Staff should date boxed and bottled medications on opening, to ensure they are not used beyond their expiry date. The home should provide a lockable drawer in each resident’s room. Individual staff roles should be identified on the staff rota. • Regular meetings for residents and/or their relatives should be available • An action/development plan should be drawn up to address the outcomes of quality monitoring assessments and surveys. • The course content of fire safety training should be recorded • The cook should monitor and record deep-freeze temperatures. 6 OP38 Winstonian House DS0000016653.V301366.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth 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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