Inspection on 19/07/06 for Winterbrook Nursing Home

This inspection was carried out on 19th 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

Winterbrook Nursing Home 24/09/08

Winterbrook Nursing Home 27/09/07

Winterbrook Nursing Home 16/01/06

Winterbrook Nursing Home 20/05/05

Winterbrook Nursing Home 10/02/05

Winterbrook Nursing Home 19/07/04

Winterbrook Nursing Home 02/02/04

Winterbrook Nursing Home 01/12/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Winterbrook Nursing Home 18 Winterbrook Wallingford Oxon OX10 9EF Lead Inspector Kate Harrison Unannounced Inspection 19th July 2006 08:45 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.V304161.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. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 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.V304161.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On admission service users must be 60 years of age and over. Date of last inspection 16th January 2006 Brief Description of the Service: Winterbrook Nursing Home is a care home owned by a partnership of two individuals, and provides care and accommodation for 26 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 there is a garden. The new manager is in the process of becoming registered with CSCI, and manages the home with support from the owners who visit regularly. There is a nurse on duty over the 24 hours, supported by a team of carers, and the activities coordinator, housekeeping and administrative staff who work part-time. The fees range from £588 to £772 weekly. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 08.45 hours and was in the service for 8 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the home since the last inspection. The inspector saw all areas of the home and looked at records and documents relating to the care of the residents. The temperature on the day of the inspection visit was very high, over 30 degrees Centigrade, and the staff worked very hard throughout the day to make residents comfortable by supplying extra drinks and by the use of fans. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs, but needs to improve access to the garden from the dining room/conservatory so that wheelchair users can freely use that part of the garden. What the service does well: What has improved since the last inspection? The key-worker system used at the home means that residents and relatives know the name of the carer responsible for the resident’s care. The laundry has been relocated and is now inside the building. Both the dining rooms have been redecorated, with new flooring laid, and some other rooms have also been redecorated. Staff training has been improved, and a foundation programme is available for those staff members who are not taking the National Vocational Qualification in care. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 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.V304161.R01.S.doc Version 5.2 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.V304161.R01.S.doc Version 5.2 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does not provide intermediate care. EVIDENCE: Following the first referral to the home, information from other professionals such as social workers and hospital staff involved with the individual is gathered. A senior member of the nursing staff, usually the registered manager, visits the individual and carries out the pre-admission assessment. Following the first referral to the home, information from other professionals such as social workers and hospital staff involved with the individual is gathered. A senior member of the nursing staff, usually the manager, visits the individual and carries out the pre-admission assessment, and confirms that the home can meet the individual’s needs before admission. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care planning process has been reviewed and a new commercial system was recently introduced. Staff members are becoming familiar with the new documentation, and the care plans seen showed that appropriate detail was included so that staff knew how to care for the residents. Survey results from the residents show that in answer to the question ‘Do you receive the medical support you need?’ all those who responded said that they ‘usually’ or ‘always’ received it. The manager appropriately refers those who need advice from other NHS professionals, so that all the health needs are met. A new system of managing the medication has recently been introduced, and this works well in the home. All the medication is appropriately recorded and administered, including the controlled drugs. Responses to the CSCI questionnaire show that residents say that staff members always listen and act on what they say, and that they are usually available when needed. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 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, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s activities organiser works 20 hours each week and provides activities for individuals, such as aromatherapy, and group activities such as crafts. The activities programme needs to reflect all the activities available to residents. It was not clear that outings are arranged for the residents, and residents or their relatives should be consulted about their preferences and outings arranged. It is not clear that the routine of the home is arranged to meet the needs of the residents. Several residents were having breakfast between 10 and 11am, and it was not clear to the inspector if this was through choice or due to the fact that no resident who needs help can get up until staff come to assist, and this may be very late in the morning due to the pressure of work. As there is only one carer and one nurse on duty at night until 7.30am, it is not regularly possible for residents who need the help of two carers to get up earlier if they wish to, as the nurse has other duties to attend to. Visitors are welcome in the home, and several were in the home on the day of the inspection visit. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 11 Residents who replied to the CSCI’s survey said that they ‘always’ or ‘usually’ liked the food. Meals are served in the two dining rooms and residents can also choose to eat in their rooms if they prefer to. Staff members discuss the menu with those who need help to choose, and food is served attractively. Special diets are provided when necessary. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 12 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure, and the procedure is displayed in the home. All the respondents to the CSCI survey said that they knew who to address complaints to, and the manager is available to residents and relatives most weekdays. The Commission received information about a concern regarding a staff member since the last inspection and judges that the manager acted properly in investigating the issue. The home has policies and procedures to help staff protect residents from abuse, and staff members know how to contact the local adult protection support worker if necessary. All new staff members have access to information about adult protection. Training for staff was organised to take place recently but was cancelled by the training provider, and is expected to take place soon. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 13 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 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home shares the services of the maintenance personnel with the other homes in the group, so that the service is in the home usually once a week. This means that the nursing and care staff are delegated to carry out maintenance and upkeep tasks, and that several maintenance issues are not attended to. The maintenance book shows that a request nine days previously regarding the devices required by the fire service to ensure automatic closure of doors in the event of a fire (Dorguards) had not been addressed. The corridor carpet is patched where torn, worn in places and soiled, and should be replaced. The last report from the environmental health officer recommended that the flooring in the kitchen be attended to within three months (by March 2006) but this has not been attended to. The proprietor must attend to this request. The proprietor should consider how best to manage maintenance issues, so that all health and safety issues are addressed as soon as possible. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 14 Although the home stands in good-sized gardens the residents have poor access to it, and it is not regularly used. This is because wheelchair access is through the front door, and although the front area is suitable for the residents it is rarely used, as there are not enough staff members available to provide both for the residents’ needs in the front garden area and in the dining room/conservatory in another area of the home. In these circumstances wheelchair access to the garden needs to be available from the dining room/conservatory, so that staff members helping with residents in the garden remain aware of the needs of residents in the dining room/conservatory. Wheelchair users need more paved areas in the garden, especially near the access points. The provider must arrange for the residents using wheelchairs to have appropriate access to the garden, so that their physical needs do not prevent them from using the garden, and so that the home meets its Statement of Purpose and the needs of all the residents. Some relatives said that the home was ‘always’ fresh and clean, but others did not think so. Relatives commented that the garden was ‘scruffy’, that the décor was ‘tired and worn’, and that the carpet cleaning could be better. One comment regarded the cleanliness of commodes, and the inspector understood that the cleaning staff hours have recently been reduced, and now no cleaning staff members work in the afternoons. This means that any cleaning tasks arising, such as carpet shampooing, need to be addressed by the care staff, and that there is little time for the ‘deep’ cleaning needed at the home. Replies to the home’s own quality assurance survey also included comments about the premises, and the proprietor should consider how best to improve the upkeep of the home’s environment including the garden, so that all regular and periodic tasks are identified and addressed appropriately. The laundry has been relocated from outside premises to inside, making it easier for the care staff members to attend to the laundry. The flooring needs to be repaired or replaced to prevent accidents and the spread of infection. The inspector noted that a bottle of liquid bleach was on the floor, and as the laundry room is on a corridor used by residents, the arrangements need to promote the safety of the residents. The proprietor must take action, such as providing a lock on the door, to protect the residents from hazards in the laundry room. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota shows that the staffing levels are not in accord with the statement agreed with the previous regulatory body, as two carers need to be on duty from 9pm to 10pm, and between 6am and 8am. The inspector understood that shifts begin at 7.30am and 9pm, and that one carer is on duty with the registered nurse from 9pm to 7.30am. This issue was discussed at the previous inspection, and the proprietor then confirmed in writing that he believed that the arrangement met the needs of the residents. It was not clear to the inspector that this is still the case, as discussed under ‘Daily Life and Social Activities’, and ‘Management and Administration’, as several of the residents have complex needs needing two carers to deliver the appropriate care when needed. The proprietor must discuss the current needs of the residents with appropriate representatives and professionals and propose a new staffing statement for consideration by the Commission. Staff members work ‘long’ days, sometimes over 13 hours a day, with three breaks totalling one hour included. Four staff members were working a ‘long’ day on the day of the inspector’s visit, as other staff members were attending a training session. The manager also works shifts on the floor to make up the numbers. There is no provision in the staff rota for morning and night handover time, and it is not clear how this can work to the benefit of the residents. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 16 Several residents need two staff members working together to carry out care tasks, and this is at times difficult to achieve and so residents have to wait for attention, especially in the morning. Care staff members are delegated to carry out maintenance and upkeep tasks, and also have responsibility for managing the laundry service, and it is not clear to the inspector how the staff members can carry out all their duties effectively. Issues arising from the staff minutes show difficulties about handover times, and comments from a recent relatives meeting show that relatives are concerned about staffing levels, and about residents being left alone at times in the afternoon. All of the above issues highlight the need for a review of staffing levels. The home has not yet reached the 50 care staff with National Vocational Qualification (NVQ) Level 2. Three carers have NVQ Level 2 and one has NVQ Level 3, and there are four carers registered to start the course. One carer is progressing with the NVQ assessor’s course, as is the manager. The home’s manager is responsible for staff recruitment, and the staff files seen show that correct recruitment procedures are followed. Recent training includes health and safety topics, fire training and personal care topics. Although the manager has worked hard to improve access to training for staff, difficulties remain with staff not attending training in appropriate numbers. Induction training is appropriate and foundation training is provided for those staff members who do not take up the home’s offer and encouragement to take an NVQ course. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 17 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): 33, 35, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s manager has been in post for over six months and is in the process of applying for registration with the Commission. The manager recently carried out a quality assurance survey and is in the process of analysing the data, and intends to inform the residents and their representatives of the results. Although both the proprietors visit the home regularly the unannounced monitoring reports required by legislation are not regularly completed and supplied to the manager. The reports will help to quickly identify issues arising relating to the key areas of managing the home, and will help meet the home’s Statement of Purpose. Residents’ petty cash is well managed, with records of transactions kept. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 18 The home has a safe working policy and statement and a member of the care staff is responsible for the health and safety issues at the home. The inspector remains concerned about the fire safety arrangements at night when only two members of staff are on the premises. The proprietors have arranged for a fire risk assessment to be carried out, and intend to implement the recommendations. Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 19 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 3 8 3 9 3 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 1 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 20 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 OP19 Regulation 16 Requirement The proprietor must take action to meet the recommendations of the environmental health officer’s last report. The provider must arrange for wheelchair access to be available from the dining room/conservatory, so that the home meets the needs of all the residents. The proprietor must take action to protect the residents from hazards in the laundry room. The proprietor must discuss the current needs of the residents with appropriate representatives and professionals and propose a new staffing statement for consideration by the Commission. The unannounced monitoring visits as defined by Regulation 26 must be conducted on a monthly basis and reports of the visits completed regularly. Timescale for action 31/08/06 2 OP19 23 30/09/06 3 4 OP26 OP27 13 18 31/08/06 30/09/06 5 OP33 26 31/08/06 Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations All staff should have basic training in adult protection. This recommendation remains from the previous report, though training was organised and cancelled by the training provider. The proprietor should arrange consultation with residents or their representatives about regular outings, and should arrange for the outings to take place. The activities programme should reflect all the activities available to residents each day. The proprietor should consider how best to manage maintenance issues, so that all health and safety issues are addressed as soon as possible. The proprietor should consider how best to improve the upkeep of the home’s environment, including the garden, so that all regular and periodic tasks are identified and addressed appropriately. The corridor carpet should be replaced where it is worn, torn and soiled. 2 3 4 OP12 OP12 OP19 5 OP19 6 OP19 Winterbrook Nursing Home DS0000047824.V304161.R01.S.doc Version 5.2 Page 22 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. 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