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Inspection on 16/01/06 for Winterbrook Nursing Home

Also see our care home review for Winterbrook Nursing Home for more information

This inspection was carried out on 16th January 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.

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

What the care home does well

The home provides a homely environment for the residents. Staff are caring and friendly. A good mixture of individual and group activities is provided for residents. Medication is well managed. Good quality home cooked food is provided. The owners provide good support in the management of the home.

What has improved since the last inspection?

Broadband Internet services are available in the office. More administrative help has been provided. A television and video recorder have been provided to improve social opportunities. The maintenance arrangements have improved at the home. The complaints procedure has been improved.

What the care home could do better:

The home`s adult protection policy should be improved to give concise local information to staff. The numbers of staff needed to meet the needs of the residents early in the morning and late at night should be clearer. All staff should have basic training in adult protection. The recruitment procedures need to be improved. Staff induction and further care training needs to be improved. Fire safety training needs to be improved. First aid training needs to be provided for more staff. At the previous inspection it was recommended that the home`s infection control policy needed to be amended, and this needs to be addressed.

CARE HOMES FOR OLDER PEOPLE Winterbrook Nursing Home 18 Winterbrook Wallingford Oxon OX10 9EF Lead Inspector Kate Harrison Announced Inspection 16th January 2006 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 Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 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. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Winterbrook Nursing Home Address 18 Winterbrook Wallingford Oxon OX10 9EF 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) 01189696133 Dr Ramnath Narayan Harbhajan Surdhar vacant Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission service users must be 60 years of age and over. Date of last inspection 20th May 2005 Brief Description of the Service: Winterbrook Nursing Home is a 26 bed care home owned by a partnership of two individuals. The home is situated in a residential road in Cholsey, Wallingford, Oxfordshire, and the house was converted for use as a nursing home in 1990. The town centre is nearby, and the home is easily accessible by public transport. The private accommodation is arranged over two floors with a passenger lift and is a mixture of single and double rooms. Communal rooms include two sitting rooms and a dining room, and residents have access to the gardens. The new manager is in the process of becoming registered with CSCI, and manages the home with support from the owners who are in close touch and visit regularly. There is a nurse on duty over the 24 hours, supported by a team of carers, the activities coordinator, and housekeeping and administrative staff. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day when the inspector saw all areas of the home, spoke to staff, residents and relatives, and saw records and documents relating to the care of the residents. The inspector also met with the home’s proprietors, who are involved with the management of the home. As the inspection was planned in advance with the home, the inspector had received the home’s completed pre-inspection questionnaire, giving details of all aspects of the home’s management. Some relatives and health and social care professionals completed the CSCI questionnaire about the care at the home, and their comments were also taken into account when completing the report. What the service does well: What has improved since the last inspection? Broadband Internet services are available in the office. More administrative help has been provided. A television and video recorder have been provided to improve social opportunities. The maintenance arrangements have improved at the home. The complaints procedure has been improved. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 7 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 Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 8 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): 3. Residents’ needs are fully assessed before moving into the home. EVIDENCE: The manager usually conducts assessments in the individual’s own home or in hospital if necessary, and referral information from care managers is recorded. The inspector saw the assessments conducted for two residents covering all the health and welfare needs of the individuals. Care plans are developed from the assessments and the registered nursing input is appropriately assessed. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 9 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): 9 and 10. Medication is well managed. Residents are treated with respect and can see and talk to others in private. EVIDENCE: The home has a medication policy and procedure, and only nurses manage the medication. Medication is ordered monthly and is supplied in blister packs. The inspector checked the procedures, including the controlled drugs, and was satisfied that medication is well managed. The inspector discussed privacy and respect issues with residents and relatives, and was satisfied that residents are respected and that all personal care is delivered in private. Residents can easily contact friends and relatives on the phone, and can see visitors in private. New members of staff receive training on how to treat residents with respect during induction. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 10 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, 14 and 15. Residents value the lifestyle provided at the home, including the range of activities available. Residents are encouraged to exercise control over their lives. Good quality food is provided to residents. EVIDENCE: Personal choice is seen as important for the resident, and the timing of breakfast, for example, is decided by the resident. Residents can bring personal possessions with them if they wish. Ministers of religion regularly visit and some religious services are conducted in the home. The activities coordinator usually documents the life stories of the residents with help from relatives and friends, and residents’ interests and hobbies are integrated into the activities programme. The dedicated activities coordinator works four days a week, and provides a good mixture of individual and group activities. This service is much valued by the residents. Relatives and care managers usually manage the residents’ financial affairs. The inspector saw the home’s menu, and spoke to the cook, relatives and residents about food. Several residents said that the food has improved and that the presentation is better. The inspector was satisfied that good quality home cooked meals are provided to the residents. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 11 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): 18. The home’s adult protection policy and procedure needs to be improved. EVIDENCE: The home’s policy on protecting vulnerable adults is not sufficiently detailed to help staff address allegations of abuse. The policy should be amended to include contact details of the Oxfordshire adult protection support worker. All staff should have basic training in how to protect vulnerable adults. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 12 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): The key standards were assessed at the last inspection and were not assessed at this inspection. EVIDENCE: Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 13 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 and 30. It is not clear that sufficient staff are available at all times to meet residents’ needs. The numbers of NVQ trained staff will soon be appropriate. The home’s recruitment procedures need to be improved to protect residents. New staff should be provided with better induction and foundation training. EVIDENCE: Several residents told the inspector that staff are caring and kind, and one relative commented that they are ‘more than helpful’. Some relatives expressed unease about the staffing levels at night, when one nurse and one carer look after the needs of the residents from 21.00 hours to 07.30 hours. The inspector noted from checking the staffing statement agreed with the previous regulatory authority in 2000 against the staff rota provided, that the minimum staffing levels were not as agreed. The staffing rota showed one carer on duty between 06.00 hours and 07.30 hours, and also between 21.00 hours and 22.00 hours, when the staffing statement showed that the minimum levels should be 2 carers. The inspector understood from the manager that the residents went to bed early in the evening and rose late in the morning, so that an extra carer was not needed at those times. The proprietors should inform the inspector in writing why the agreed staffing statement is not being met, and should propose an amended staffing statement for discussion with CSCI. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 14 Nine carers are currently undergoing the NVQ Level 2 in Care training, and six have almost completed the training. When all nine have completed the training the home will be meeting the standard of 50 trained care staff, excluding the registered nurses. The inspector checked the recruitment files of staff, and found that not all the necessary information was available about staff. All information required by the regulations, including proof of identity, a photograph and references must be available about all staff working at the home. The inspector saw the induction programme for new care staff, which is in the form of a checklist, and recommends that an appropriate induction programme which meets the Skills for Care standard be made available for the home. There is no foundation training programme at the home, and the proprietors should consider how best to provide for the training of new staff who do not undertake NVQ training. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 15 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, 35 and 38. The manager has started the registration process with CSCI. Residents’ financial interests are safeguarded. EVIDENCE: The registered manager left the home in December 2005, and a new manager has been appointed. The new manager has previously worked at the home as the deputy manager, and has started the process of registering with CSCI. The home takes responsibility only for small amounts of petty cash in exceptional cases, as relatives or care managers usually manage residents’ financial affairs when they cannot manage themselves. The inspector checked the records kept and was satisfied that the records are appropriate and that safe storage is provided. The inspector discussed health and safety issues with the manager, and saw policies and records relating to maintaining a safe environment for residents Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 16 and staff. It is not clear from the records that all members of staff have been provided with appropriate fire training including fire lectures in the last twelve months, or that enough staff with first aid training are available on each shift. The proprietors must investigate and inform the inspector of the situation regarding appropriate fire training for all staff. The proprietors must make sure that first aid training is provided for appropriate numbers of staff. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 17 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 X 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X X X 3 X X 2 Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 18 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 OP29 Regulation 19 Requirement Timescale for action 28/02/06 2 OP38 23 3 OP38 13 All information regarding staff detailed in Schedule 2 of the Care Homes Regulations must be available in the home. The proprietors must investigate 28/02/06 and inform the inspector of the situation regarding appropriate fire training for all staff. The proprietors must make sure 31/03/06 that first aid training is provided for appropriate numbers of staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP18 OP18 OP26 Good Practice Recommendations The policy should be amended to include contact details of the Oxfordshire adult protection support worker. All staff should have basic training in adult protection. The home’s infection control policy and procedures should include details of the Health Protection Agency and the local infection control nursing service. Recommendation from last inspection on 20th May 2005. DS0000047824.V259729.R01.S.doc Version 5.1 Page 19 Winterbrook Nursing Home 4 5 OP30 OP27 The proprietors should consider how best to provide for the training of new staff who do not undertake NVQ training. The proprietors should inform the inspector in writing why the agreed staffing statement is not being met, and should if necessary, propose an amended staffing statement for discussion with CSCI. Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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. Extracts may not be used or reproduced without the express permission of CSCI Winterbrook Nursing Home DS0000047824.V259729.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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