Inspection on 29/05/07 for Winstonian House

This inspection was carried out on 29th May 2007.

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

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

Other inspections for this house

Winstonian House 11/05/09

Winstonian House 20/05/08

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 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 29th May 2007 09:30 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.V332967.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.V332967.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 To be appointed Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 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 stair lifts. 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 £357.90 (lower Local Authority rate), to £503 per week. Hairdressing, Chiropody, Toiletries, Magazines and Newspapers are extra charges. Winstonian House DS0000016653.V332967.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 over one day in May 2007. 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. A number of residents were spoken to directly in order to gauge their views and experiences of the services and care provided at Winstonian House. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to CSCI if they wished; none were returned. 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, supervision 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 care and accommodation for its residents in a converted older style house, which has some comfortable and homely features, although some aspects of it do appear to be slightly fatigued. Residents are admitted to the home on the basis of a full pre-admission assessment that identifies the person’s needs before admission takes place, Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 6 although it is recommended that assessors consistently complete all parts of the assessment forms in full detail. Each resident has an individual care record that contains personalised care plans, and has access to medical advice and treatment whenever necessary. Residents spoke very positively about the care they receive in the home, seeming to benefit from the relaxed and informal approach that this home adopts. Care staff seen were very attentive, and being long serving were also a very familiar face to the residents. Staff were very aware of people’s needs and preferences. The home has a welcoming approach towards visitors, and enables families and friends to become involved in the life of the home if they wish. Residents are supported to participate socially in the home, regardless of their limitations, and some good community contacts are in place. They are also supported to make personal choices, and can spend their days as they wish. Residents were very satisfied with the standard and choice of food served here, and staff were aware of individual dietary requirements and support needed. The home has a written procedure for dealing with complaints, which is made accessible to all. Almost all people spoken to were happy to raise concerns if they had any, and had confidence in the staff to address them properly. There are regular training opportunities for the staff, and they are making good progress with the National Vocational training programme. Although recruitment of new staff has rarely been necessary due to the stability of the existing team, appropriate procedures are in place for the required pre-employment checks to be carried out. What has improved since the last inspection? It would appear that the most positive development to have happened at Winstonian House since the last inspection is the appointment of a new manager. She has identified the areas needing priority in terms of making improvements amongst the staff team and in the home, and has given the residents and their families the chance to become involved with this process. Following a serious theft in the home, security arrangements have been improved in relation to the safe storage of residents’ money and valuables that have been placed with the home for safe-keeping. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 7 Advocacy support has been sought for a small number of particularly vulnerable residents living here, and residents generally felt that they could have confidence in the home. There are now three carers on duty during weekend mornings, as in the week, which is an increase of one. In addition to this, it is important that the new manager monitors and reviews the low staffing numbers during the evenings to be sure that they continue to meet the needs of the residents. Dementia care training has been introduced for care staff, and staff are generally receiving a much better level of supervision and instruction under the new manager. A new fire safety panel has been installed, and there has been some internal and external redecoration, with a ramp constructed in the basement to improve resident access. The standard of cleanliness has gradually improved over recent months after having raised significant concerns previously, and on this occasion the home was free of odours. What they could do better: Many aspects of the care plans are recorded well by the staff, however these must now be reviewed and updated more regularly and thoroughly, in order to make the necessary documentary changes, and to reflect the care being delivered to residents. Although specific nutritional risk assessments are not currently recorded, the home plans to introduce these in the near future. The systems for managing residents’ medications are mostly safe and satisfactory, however there remain some areas where improvement is required, one of which has been required on a previous occasion. These refer to some recording shortfalls, and to the failure to date control boxed medications. The home is generally adequately maintained in areas accessible to residents, but really could do with some upgrading in certain parts; some of the bathroom and en-suite facilities are old, and not really fit for their purpose. There is no designated laundry assistant in this home and care staff have to undertake these duties; this is not particularly burdensome at this time however, and does not detract from the care of the residents. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 8 The laundry room is very small, and the washing machine in there is old and unable to disinfect foul laundry. The flooring in this room is also cracked, making it difficult to keep clean and hygienic. The home must now consider an upgrade to the laundry facilities, and must provide information to CSCI in this regard. At least one resident smokes in the basement lounge, and this is currently having a significant impact in the surrounding area due to odour and smoke filled atmosphere. This will have to be addressed and rectified as the new Smoking Regulations come into force on July 1st 2007. 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.V332967.R01.S.doc Version 5.2 Page 9 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.V332967.R01.S.doc Version 5.2 Page 10 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 pre-admission assessment process helps to provide people using this service with an assurance that their needs will be met in the home. EVIDENCE: Residents had been admitted to the home following an assessment process that had identified their care needs. There were examples where the home had supported prospective residents to spend some time in the home as a ‘visitor’ and to have a meal there, before actually being admitted. The content of one particular example assessment form had been recorded in only a brief way, with minimal detail in some areas. Despite this, pre-admission assessments were also supported by information provided by other health and social care professionals previously involved in the care of the individual. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 11 An example was also seen where the assessor had deemed a future placement inappropriate at Winstonian House, on the basis of the information obtained during the pre-admission assessment process. The home now confirms offers of placements for prospective residents in the form of a written letter, as is required. Winstonian House does not provide intermediate care. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 12 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 receive appropriate care to meet their needs that is mindful of their privacy and dignity, although some omissions in recorded care planning and medication management could pose some risks in this regard. EVIDENCE: Residents have their own personal care records, referred to as their care plan. Three were selected for closer scrutiny, as part of the case tracking exercise. The needs of each person had been identified using a variety of assessment tools, including risk assessments. The Activities of Daily Living Assessment identified very specific needs of each individual under a series of headings. On the basis of these thorough assessments specific plans of care had been drafted that provided clear guidance for staff regarding the aspects of care needed to meet their needs. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 13 At least two risk assessments appeared to have been assessed incorrectly. One for pressure sore vulnerability had not taken into account the fact that the resident had a sore area that would have clearly identified a much more significant risk factor for this person. The associated care plan for this was out of date, and did not reflect the actual care being delivered. Another was a moving and handling assessment that had not taken into account the person’s one sided weakness following a stroke, which again would have clearly identified a much more significant risk factor. None the less, appropriate medical interventions, support and equipment were in place to meet the needs of these people. A rudimentary falls risk assessment was recorded in each case, and although there was evidently consideration given in this area, the actual recording could have been better. In one particular case, the falls assessment had identified the need for the person to be accompanied when using the stair lift to reduce the risk of falling, as the chair does not have an integral safety strap; this was recorded in the associated care plan. This resident was seen using the stair lift in the morning, with the accompanying carer following at some distance, and not close enough to reduce any risk that had been identified. Nutritional risk assessments were not recorded as such, although in a case where the resident had been losing weight, medical advice had been sought, and due consideration and support was being given to this person during the meal time; associated care plans supported this. Residents were regularly weighed, and the home now has plans to introduce a nutritional risk assessment tool in the near future. Most aspects of the care records were regularly reviewed, although there were some omissions in this regard. There was some evidence that residents are involved in their care planning with staff, but recording could have reflected this better. Using observation and by talking to residents and staff during the case tracking exercise, there was generally evidence to confirm that care was being delivered appropriately in relation to the needs that had been seen on assessment and in care plans. Appropriate medical support had been sourced whenever necessary. Staff were conversant in the needs of individuals, and residents themselves were very satisfied with the way they were looked after. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 14 Residents are supported to manage their own medications if they wish and are able to, although there is only one person currently doing so, and this is just for one item; this was being done within a risk assessment framework. Medications are safely stored, and there are clearly printed Medication Administration Records from the supplying pharmacist. Instructions for usage of medications were generally very clear, however the directions for some external preparations were too vague, and the directions for some eye drops were not specific. In the absence of clear instructions being printed by the pharmacist, staff must hand write clear instructions for use until arrangements are in place to have instructions printed; any such hand written entry must be signed in full by the author, and countersigned by a witness. It was reassuring to see that there were ‘Protocols for Use’ recorded for medications prescribed to be used ‘when necessary’. Many of the medications were dispensed in a monitored dosage system; some were boxed or bottled. It was not possible to conduct a proper audit on boxed and bottled medications, as none of those in use had been dated on opening. Staff must adopt the practice of dating such items when opened, not only for this purpose, but also to reduce the risk of any medication in use to exceed its expiry date, as had happened with one particular liquid preparation that had to be disposed of. Medication administration is only undertaken by specially trained staff, and there was appropriate reference material available if needed. Certain staff had received specific training in the administration of insulin, and had been repeatedly assessed for competency before being able to undertake this task for one of the residents. Carers were observed being very attentive towards the residents. They were also heard being respectful and sensitive to their needs and wishes. Residents themselves confirmed that staff are always very respectful and kind. Care was delivered in the privacy of individuals’ bedrooms, and there was due regard for residents’ dignity throughout this visit. Winstonian House DS0000016653.V332967.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 good. This judgement has been made using available evidence including a visit to this service. People living in this home are supported to exercise personal choice and maintain their social contacts, and have a satisfactory standard of food. EVIDENCE: The home produces a monthly ‘Diary of Activities’ that is issued to every resident. This details a range of opportunities for them, including group activities and social events. A weekly programme is also produced that designates a particular member of staff to coordinate the planned social activity on each day. Residents were consulted about their ideas and preferences for activity at a meeting; recorded minutes of such meetings show that a number of outings and trips were requested. Their individual care plans also take account of their wishes and abilities, particularly in relation to religious needs, with some participating in religious services in the home. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 16 One particular resident who was blind, said that she was enabled to join in any social activities, despite her disability, because staff were supportive to her and gave her assistance in whatever regard she needed in order to participate. This person also said that she regularly went out to attend social clubs in the community, which she particularly enjoyed. Another resident went out to the local shops, accompanied by a member of staff, during the morning of this visit. One gentleman could not recall being asked about social activities, but staff did say that he is always offered the opportunity to participate. Another said that staff were always willing to spend time talking to her. Larger social events were planned and advertised for all residents within this broader care home group, which helps to promote the sense of a wider community for them. Families and friends were also invited to such events, and to join in the life of the home as much as they wish. Although no visitors were in the home during the time of this visit, there are no restrictions placed upon them, and they can visit whenever they or their relative wish. From talking with residents, it was evident that they can choose how and where they spend their time. A small number preferred to remain in their rooms to listen to their radio or have their meal, rather than join with others, and the staff respected this. A group of residents were observed sitting alone in the lounge during the morning, being largely unattended by staff for some time; the manager said that she did not support this, and that staff should be more readily in attendance. Residents said that staff were always very mindful of their choices and preferences, saying that they were always very helpful and kind. One gentleman said that he could ‘do as he liked really’, and that staff were very supportive towards him. One resident chooses to smoke and is able to do this in the basement lounge. However the implications of this are an issue that the home must research in consideration of the new Smoking Regulations that come into force in July of this year. Residents’ bedrooms appear individual to some degree, as residents are able to introduce their own treasured items in order to make them more personalised and homely. Advocacy support had been sourced in a small number of cases, and information in relation to such services was available in the home. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 17 Evidence of individual choices was seen during the service of the lunchtime meal, with residents making a selection from two options available on the menu. At least one resident had chosen another alternative, as she had not wanted either option. Residents were consulted about the menu in advance, and a list of choices was supplied to the cook for her reference. The breakfast meal rarely changes, due to residents’ personal preferences, however it is important that the home remain mindful of how this may change from time to time for certain people. One particular resident who was diabetic, was eating an ordinary sweetened pudding. Staff were aware of his condition, and despite this, regular assessments by the doctor and diabetic nurse had shown his condition to be very stable. A carer was present in the very small dining room throughout the meal, offering help and supervision where needed; she was particularly aware of the needs of one resident who required encouragement and supervision in order to receive an adequate diet. Residents spoke very well of the food here, saying they could have what they wanted, and that it was either ‘good’ or ‘excellent’. Snacks were available between meals if wanted, and a fresh cake was made for afternoon tea. The cook at the time of this visit was on long term absence from the home, and a carer, working extra to the care team, was allocated to this work during this period. The kitchen was seen after the service of lunch, and was reasonably clean. A cleaning schedule, although reported to have been observed, had not been signed to evidence this for some time. Temperatures had been monitored in the refrigerators and deep-freezers, but there were gaps in the temperature checks on high-risk foods. The fly screens had been dislodged behind a banister, allowing flies to enter the kitchen. Winstonian House DS0000016653.V332967.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. Although measures are adopted to protect the rights and interests of people living here, a recent lapse in these has resulted in some abuse taking place. EVIDENCE: Winstonian House has a clearly written procedure for dealing with any complaints or concerns that are raised, a copy of which is displayed in the entrance hall of the home, and is provided to each resident and their representatives in the home’s information brochure. There is a system for recording any complaints, with specifically designated records, and at the time of this visit there were none to inspect as none have been received recently. On previous occasions when it has been necessary, the Group Care Manager has always adopted a robust approach to addressing any complaints that are raised. The residents themselves all said that, although they had no real concerns to raise, they knew staff would always be helpful and would sort out any issues for them. The home has written policies and procedures for the protection of vulnerable residents, and has provided training in abuse and adult protection for the staff. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 19 Those staff spoken to confirmed they had received specific training, and were quite comfortable regarding the procedures to follow in the event they had any suspicions or concerns in relation to the protection of vulnerable adults. Despite this however, there has been a significant theft of certain residents’ money from a safe since the last inspection, resulting in a police investigation. Due to the circumstances of the theft and the apparent knowledge of the thief, it appeared that it involved a member of staff, but the investigation was inconclusive. After consultation with CSCI the home contacted the relevant authorities, besides the police, in order to promote protection arrangements and the interests of more vulnerable residents. An advocate was sourced for one particular person, and attempts have been made in relation to one other. Reimbursements were made to all residents who had been affected, and residents or their representatives were informed of any risks. Security arrangements have been revised to protect against another such incident, although up until a few weeks ago items of food continued to be stolen from the kitchen. The home management remain vigilant and intent on identifying any guilty party, and continue to monitor this. The home has disciplinary procedures to address any staff conduct issues that present a concern, and has had cause to implement these recently. Residents generally said that they had confidence in the home, and indicated their trust and faith in the staff here. Winstonian House DS0000016653.V332967.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 adequate. This judgement has been made using available evidence including a visit to this service. Despite some areas of concern needing attention, Winstonian House provides an adequately maintained environment for the people living here. EVIDENCE: Winstonian House provides accommodation for residents in an older style building that has been converted for its purpose. It has regular maintenance support and is reasonably maintained, although there are certain aspects of it that would benefit from upgrading and refurbishment. This refers in particular to the basement bathroom, which is in such a condition as to render it unusable at this time. There are plans to address this room in the near future. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 21 Another area considered similarly is the small number of en-suites that have been created by the construction of wooden partitions in certain residents’ bedrooms. These were done a long time ago, and remain in place to the present day, and are not considered to be entirely appropriate for the residents in terms of hygiene and dignity. A toilet and basin has been installed behind the partitions, and a door in the partition provides access. There are no ceilings to these structures, and there is a large gap at the top. As part of any refurbishment it was reported that there are possible plans to provide en-suite facilities to two bedrooms on the first floor, and to create a walk-in shower room from an existing bathroom on the ground floor. Since the last inspection isolated parts of the home have had their décor ‘touched up’, with more planned, and a ramp has been constructed to a small flight of steps in the basement to assist resident access. Redecoration was taking place to the exterior of the building at the time of this visit. The standard of cleanliness has improved in recent months, and the home was free of odours on this occasion. Staff have received training in infection control. Gloves and aprons were available, as were supplies of liquid soap and paper towels. Clinical waste produced in relation to continence waste is currently being disposed of with household waste, with no clinical waste contract in place. Advice from the Health Protection Agency regarding this issue was given to the home by CSCI, which seems to be in conflict with what the agency has given directly to them upon their subsequent enquiry. This is worthy of further investigation following this inspection. The laundry facilities are small and basic. It has not been possible for the home to confirm that the one washing machine is capable of washing cycles that will disinfect foul laundry items, in the interests of infection control. Some time ago, wall coverings were applied over the brickwork in the laundry room in order to make cleaning and hygiene easier. However, the floor has not been covered, and there are cracks in the stone floor, which could harbour dirt and infection. There was no liquid soap dispenser by the sink in this room, though there was a sanitising hand gel. Winstonian House DS0000016653.V332967.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 good. This judgement has been made using available evidence including a visit to this service. Following some concern, there is now an increased emphasis on ensuring that people living in this home receive care from a suitably trained and stable group of care staff. EVIDENCE: There is a very stable group of staff at Winstonian House. There are only a small number of them, but this seems to work well at this point due to the small size of the home and the numbers of residents here. However, the provision of only two carers during the evening should be kept under review, especially as one of these has to undertake some catering tasks in the kitchen for the residents’ supper; it is clear that during this period only one carer would be readily available out in the home for a short time. Since the last inspection the number of carers on duty during weekend mornings has risen to three, which is now the same as each weekday morning. The night duty continues to be covered by one waking carer and one sleep-in carer, and a documented risk assessment for this arrangement was carried out at the request of CSCI. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 23 The manager and deputy manager work in a supernumerary capacity. There is one housekeeper on four days of the week, and a cook for each day. Maintenance support is readily accessible from the company’s peripatetic maintenance person. Care staff have to undertake laundry duties. The routines and certain aspects of work practice that have pre-existed at this home have come under more scrutiny and review more recently. Control measures have been put into place to monitor staff performance and to make the necessary changes to ensure that residents’ needs are met more appropriately. Residents, without exception, spoke very well of the staff, saying that they were always really kind and helpful, and would do anything the residents asked. The care staff are making very good progress with the National Vocational Qualification (NVQ) training. Eight staff are already qualified to at least level 2, and there is one other already working towards the award, with another due to start; this person was very much looking forward to this. Due to the stability of the care team, there has been very little recruitment since the last inspection. The home has appropriate policies and procedures to cover staff recruitment. Just one staff record was inspected, and each of the required pre-employment checks had been carried out. The interview notes however, were very sparse and could have been much more informative, especially in terms of a record of evidence relating to exploring any gaps in employment history. Staff have regular training opportunities here, and a recorded training matrix is maintained. Recent training has included some mandatory topics plus some optional ones, all of which were relevant to their role. Some staff have attended dementia care training, and options are being considered for more of them to attend. New staff receive induction training to the home, and work under the supervision of an experienced carer. The manager should ensure that the identity of the supervisor is always recorded throughout any induction period. One particular carer who started in the home last year said that she had been very well supported by the care team, and had worked under supervision whilst she was learning. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 24 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, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is anticipated that after a period of upheaval, the new management arrangements and the planned improvements now in place here will provide better leadership that will offer greater consistency and continuity for the people living in this home. EVIDENCE: It is of some reassurance that a new manager has taken over the day-to-day management of this home since the last inspection. The new manager has a lot of experience in caring for older people in similar settings, and has significant previous managerial experience. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 25 She has already achieved the NVQ level 4 in Care and the Registered Manager’s Award. The progress to submit an application to register her with CSCI has been slow and a completed application is still awaited at this time, despite clear guidance regarding the required procedure being issued some months ago. The new manager’s early focus has been to address shortfalls within staff practices and stabilise a reliable and committed staff team; this has posed some challenges to her, but she demonstrates a commitment to driving improvements at this home, regardless of any obstacles she might face from within the staff team. She is ably supported by a loyal deputy manager, who is currently working in a supernumerary capacity providing assistance with the day-to-day running of the home. Since starting at the home a few months ago the manager has set about consulting with residents and their families in a number of ways in order to gain their views and experiences of the services and care provided at Winstonian House. This has included issuing quality monitoring questionnaires covering a variety of topics, and structured meetings, in which all residents and their families were invited to participate. The manager collated survey results, and wrote action plans further to this, which addressed any issues raised. Staff were informed of areas where there were strengths, and where they needed to improve. Recorded outcomes of surveys and meetings were seen, and these clearly demonstrated a marked improvement regarding a much more inclusive management ethos for residents and their families in the way Winstonian House is run. They also demonstrated the management’s clear intention to drive improvements in this home. Some residents have placed personal money with the home for safekeeping. As previously reported, security of these arrangements has been tightened to protect the interests of those using this service. Clear and transparent records for each person, which include transaction details, running totals and receipts are kept. Residents or their representative are able to sign to acknowledge their transactions, but where this had not taken place or been possible in the majority of cases, two staff members had signed the record to witness on behalf of the resident. A regular audit has been carried out on these arrangements, confirmation of which is signed on each record. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 26 A more structured approach towards staff supervision has been adopted, with individual supervision sessions taking place within a planned and recorded programme. The new manager has endeavoured to provide very clear instruction and supervision for staff not only in this way, but also through staff meetings and handovers between shifts. There have been some positive changes at Winstonian House as far as staff practices go, with all staff being directed in the way of improvement and development; it would appear that some staff have been more responsive to this than others, and emphasis in this area will need to continue. The home has a written health and safety policy and fire procedures. Staff have received training in fire safety and have had regular drills. The manager has assessed each worker’s competency in relation to fire safety, and intends to update fire safety training on that individual basis, within a new fire safety risk assessment being implemented into the home. Manual handling training has recently been delivered, and care staff are qualified in basic first aid. Safety checks and maintenance of all equipment and utilities has been undertaken. The fire alarm system has been regularly checked, and a new fire alarm panel has been installed. Hot water temperatures are regularly checked for safe levels, and the Proprietor has previously confirmed that hot water is stored at appropriate temperatures for the control of Legionella. Accident records are maintained in relation to incidents that have occurred in the home. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 28 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(2)(b.c) Requirement All people living in the home must have their care plan regularly reviewed and updated in consultation with them, so that plans remain relevant to the care being required and delivered in practice. Directions for the use of external preparations and eye drops must be clearly recorded on the medication administration chart. This will ensure that all people living in the home who have these preparations prescribed will receive their medications correctly. This requirement has been repeated from the previous inspection. When boxed and bottled medications are opened staff must date them so that audit trails can be carried out and so that items are not used beyond their expiry date. The registered person must DS0000016653.V332967.R01.S.doc Timescale for action 31/07/07 2 OP9 13(2) 30/06/07 3 OP9 13(2) 30/06/07 4 OP26 13(3) 10/08/07 Version 5.2 Page 29 Winstonian House provide CSCI with written details of their plans to improve and upgrade the laundry facilities. This is so that people living in this home are not put at risk of cross infection that may arise from the washing machine and flooring. 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 Refer to Standard OP3 OP30 Good Practice Recommendations The person conducting pre-admission assessments for people using this service should record their findings in fuller detail on the assessment tool. The manager should ensure that the identity of the supervisor for a new worker is clearly recorded, with a record of any changes maintained. Winstonian House DS0000016653.V332967.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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.V332967.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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