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Inspection on 27/09/07 for Winterbrook Nursing Home

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

This inspection was carried out on 27th September 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 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

What has improved since the last inspection?

All the windows have been replaced with double glazed units. Access from the dining room/conservatory has been improved for people in wheelchairs to access the gardens more easily. The kitchen floor has been replaced. A programme of redecoration and replacement of worn furniture has been started. A deputy manager has been appointed to support the new manager in her role and to co-ordinate training for care staff.

What the care home could do better:

Residents` care records should be improved to provide more information about residents social and recreational care needs and how these are to be met. The care records should also show whether the planned care has met the residents` care needs. The home should involve individuals in the planning of their care and care plans should be updated and agreed regularly with them. The storage facilities and system of recording the administration for certain types of medicines (`controlled drugs`) must be improved to show that the home handles and disposes of these medicines safely and that the residents have received their medications as prescribed by the doctor. The homes written policies and procedures should be more detailed to give staff more useful guidance about best practice in administration and recording of medicines to safeguard residents from errors. A copy of the homes complaints procedure should be available in every resident`s room. All complaints made and the actions taken in response to them must be fully recorded so that residents and their representatives are confident that their concerns have been taken seriously and properly dealt with. The home should review the number and type of complaints it receives to learn from them and improve its service. The home must report any deaths, serious injuries or any incidents affecting, or likely to affect, residents health and well-being to the Commission, as legally required. The programme of planned redecoration and refurbishment of the home should be completed to further improve the home for residents, and to encourage better use of all the communal space in the home so that residents have a choice of areas in which to spend time. The staffing numbers are not consistently maintained at a level that enables residents to receive the care they need. The staffing numbers and skill mix must be reviewed and adjusted as necessary to make sure there are enoughstaff available, especially at peak times when people need additional help with their meals, personal care and planned activities. The homes owners must undertake unannounced monitoring visits (at least monthly) to the home as required by law, and produce a report of their findings that is made available to the manager. These visits must include talking to a number of residents and staff to get their views about the home and the way it is run; and checking to what extent the home is meeting the standards set out in its Statement of Purpose. The home must set up a formal quality assurance system that seeks the views of residents and their families and representatives. The results of any surveys should be shared with residents and prospective residents. This will show that the home has effective ways of checking that the staff follow safe practices and provide a good standard of service to residents. The fire authority must be consulted about fire safety arrangements in the home and updating the fire risk assessments. The planned review and updating of the homes written policies and procedures should be completed so that staff have up to date best practice guidance is available and followed to protect the health and well being of residents and staff.

CARE HOMES FOR OLDER PEOPLE Winterbrook Nursing Home 18 Winterbrook Wallingford Oxon OX10 9EF Lead Inspector Delia Styles Unannounced Inspection 27th September 2007 09:40 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.V352682.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.V352682.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) 01491 833922 01491 836166 winterbrookhome@tiscali.co.uk Dr Ramnath Narayan Harbhajan Surdhar Post 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.V352682.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 19th July 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 set in about an acre of gardens, off a main road and bus route and about half a mile south of Wallingford, Oxfordshire. 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. 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 and housekeeping staff who work part-time. The fees range from £542 to £772 weekly. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’. The inspectors arrived at the service at 09.45 hours. A pharmacist inspector focussed on the way in which the home manages residents’ medicines, whilst the regulatory inspector looked at other standards considered by the commission to be the most important of the National Minimum Standards for Care Homes for Older People. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the homes owners and the manager, and any information that CSCI has received about the home since the last inspection. We asked the views of the people who use the service, staff and visitors seen during the inspection or who responded to questionnaires (‘comment cards’) that the Commission had sent out. A total of 5 relatives’ responses were received. Other comment cards may have been delayed because of a postal strike; information received after completion of the report will be included in future assessments of the home. We looked at samples of residents’ care and medication records, staff recruitment and training records, staff rotas and other records relating to the management of the home. We would like to thank the residents, staff and manager for their time and assistance during the inspection especially as we visited on the day when there was a planned electricity cut that affected the usual routine of the home. The proprietors arrived at the home later in the morning and the inspector was able to discuss their plans and developments. Time was also spent talking to the home manager and her deputy. Feedback was given to the manager and deputy manager at the end of the inspection. What the service does well: Residents and their relatives like the friendly and homely atmosphere. They feel that the care is good and staff are helpful and patient. Comments included were: ‘ My relative always looks very clean, well dressed and seems happy here’ ‘ The staff provide the support [my relative] needs happily – they don’t make [my relative] feel bad about having to ask for help’ Residents and their relatives spoken with were very complimentary about the food and meals. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Residents’ care records should be improved to provide more information about residents social and recreational care needs and how these are to be met. The care records should also show whether the planned care has met the residents’ care needs. The home should involve individuals in the planning of their care and care plans should be updated and agreed regularly with them. The storage facilities and system of recording the administration for certain types of medicines (‘controlled drugs’) must be improved to show that the home handles and disposes of these medicines safely and that the residents have received their medications as prescribed by the doctor. The homes written policies and procedures should be more detailed to give staff more useful guidance about best practice in administration and recording of medicines to safeguard residents from errors. A copy of the homes complaints procedure should be available in every resident’s room. All complaints made and the actions taken in response to them must be fully recorded so that residents and their representatives are confident that their concerns have been taken seriously and properly dealt with. The home should review the number and type of complaints it receives to learn from them and improve its service. The home must report any deaths, serious injuries or any incidents affecting, or likely to affect, residents health and well-being to the Commission, as legally required. The programme of planned redecoration and refurbishment of the home should be completed to further improve the home for residents, and to encourage better use of all the communal space in the home so that residents have a choice of areas in which to spend time. The staffing numbers are not consistently maintained at a level that enables residents to receive the care they need. The staffing numbers and skill mix must be reviewed and adjusted as necessary to make sure there are enough Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 7 staff available, especially at peak times when people need additional help with their meals, personal care and planned activities. The homes owners must undertake unannounced monitoring visits (at least monthly) to the home as required by law, and produce a report of their findings that is made available to the manager. These visits must include talking to a number of residents and staff to get their views about the home and the way it is run; and checking to what extent the home is meeting the standards set out in its Statement of Purpose. The home must set up a formal quality assurance system that seeks the views of residents and their families and representatives. The results of any surveys should be shared with residents and prospective residents. This will show that the home has effective ways of checking that the staff follow safe practices and provide a good standard of service to residents. The fire authority must be consulted about fire safety arrangements in the home and updating the fire risk assessments. The planned review and updating of the homes written policies and procedures should be completed so that staff have up to date best practice guidance is available and followed to protect the health and well being of residents and staff. 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. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. People who use this service have good information about the home in order to make an informed decision about whether the home is likely to suit them. The personalised needs assessment means that people’s care needs are identified and planned for before they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is relatively new in post having been appointed in July 2007. The Service User Guide has been updated to show the change of manager, but the Statement of Purpose needs updating. From the small number of relatives’ responses to the questionnaires sent out by the Commission, it appears that residents and their families and representatives received good information about the home to help them make informed decisions before coming here to live. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 10 The manager said that she, or an experienced Registered Nurse employed in the home carries out the pre-admission assessment for potential new residents. The inspector looked at the care records for 3 residents including their initial assessment information. The assessments available to staff were summarised in the commercially produced paper records used in the home. The assessment information was brief and largely focussed on the physical needs of residents. However, the plans of care seen for most residents had been drawn up by the nurse who had undertaken the assessment and appeared to be sufficiently detailed for care staff to carry out the care to meet people’s physical care needs. Prospective new residents and their families and representatives are invited to visit the home before admission. The first 4 to 6 weeks of a new resident’s stay is regarded as a trial period. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Overall, the health needs of residents are met with evidence of good multi disciplinary working taking place on a regular basis. The care planning system should be improved to show that care is ‘person-centred’ and accurately reflects the care needs of residents. The systems for the storage and recording of medications must be improved to meet legal requirements and to demonstrate that residents are safeguarded from medication errors. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care records for each resident are held in a commercially produced flip folder. Overall, we found that, though residents’ physical care needs or problems are described, there is little reflection of people’s preferred pattern of their day or their social, spiritual or mental health needs. Many of the current residents have dementia and are unable to communicate easily, so that it is important that there is information about their ‘life stories’ to enable staff to know about their interests and hobbies in order to support residents to maintain and develop their independence and abilities as far as possible. The Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 12 manager said that they are considering developing a different system for the care records to make them clearer to read and update. Many of the care records lacked the signature of the resident and/or their relative or representative to indicate that they had been involved in the process of drawing up the care plan and their agreement with it. We looked at a sample of 3 people’s care records in more detail. There was little written evidence of evaluation of the care given – that is, had it satisfactorily met the resident’s assessed care needs or, if not, what changes in the prescribed care were made? For example, one person had a skin problem but there was no description of the size or appearance of the damaged area, or care plan to describe the ongoing treatment or dressings if any to be used. Another person has mental health problems: there were some care directions to staff to assist this person with personal care but less specific guidance about how they should be supported in being involved in activities in the home (either on a ‘one-to-one’ basis with staff or with other residents if they wished). There was limited evidence of people’s nutritional status and documented action to be taken by staff to monitor and report any deterioration in those people ‘at risk’ of poor nutrition because of their physical or mental frailty. It was noted that the activities organiser took responsibility for monitoring how much certain residents had eaten at lunchtime, as they were in the conservatory/activities room for that meal. The manager appropriately refers those who need advice from other NHS professionals, so that all the health needs are met. The home ensures that equipment such as air mattresses and special seat cushions are provided for people at risk of skin damage from pressure (‘pressure sores/ulcers’). The home keeps clear records of medicines received into the home, and those administered to residents by the nurses. There are some blanks in the records that care staff should sign when they administer skin creams and preparations. These should be regularly recorded when these preparations are prescribed by the doctor, in order to show that they are being applied as the doctor wishes. There are no records showing which medicines are sent for disposal, and the home should record these, to show that medicines are handled correctly in the home. Medicines are stored safely, but arrangements for controlled drugs need to be improved, as the cupboard is not big enough to store all controlled drugs in a way that meets the legal requirements. Some controlled drugs were given to residents but not signed out of the controlled drugs register. Accurate records of controlled drugs need to be kept to show that the home is handling these medicines correctly. There is a medication policy available, but this is very brief. It is recommended Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 13 to expand this to include areas such as non-prescription medicines and how to deal with medicines, which are regularly refused by residents. This would provide more useful help and guidance to staff. Most residents are in single bedrooms (22 out of 26). There are mobile screens to protect residents’ privacy in shared rooms; one ground floor shared room did not have a screen available. Staff should make sure that the screens are kept in the residents’ room ready for use at any time. Residents are addressed by their preferred name or title. From the small number of responses to the questionnaires sent out by the Commission all the relatives who replied were pleased with the standard of care given by staff, and their patient and helpful attitude towards residents. 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. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. Opportunities for residents to take part in social activities in and outside the home is variable and does not offer all residents a full and flexible choice in how they spend their day, or sufficient range of stimulating and motivating activities. The meals in the home are good offering choice and variety and nutritional value to residents. 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 from Monday to Friday. She provides activities for individuals, such as aromatherapy, and group activities such as painting, knitting, Bingo, word games, and gentle exercises. During the day the conservatory/dining room was in use for a number of residents who enjoyed knitting or watching others play cards, and chatting with the activities organiser. There was a nice ‘buzz’ of activity and conversation between residents, visitors and the activities worker who was available from around 10 am to 2 pm. There was a calendar of activities on offer for the week ahead. Visitors are welcome in the home, and several were in the home on the day of the inspection visit. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 15 The home has acted on a recommendation from the last report to improve access from the conservatory/dining room to the gardens for residents using wheelchairs. On the day of the inspection most residents stayed indoors as it was cool and the heat was being conserved inside the building while the electricity was off. One resident enjoys helping out in the garden and helps maintain a flowerbed near his room. In the home’s Annual Quality Assurance Assessment, the provider has acknowledged that there is scope for improving the range of activities and outings away from the home and for a more varied activities programme ‘to stimulate interest’. We noted that several residents were still eating their breakfast around 10.30/11.00 am. The inspectors assumed that timing of breakfast might have been residents’ choice or because of the disruption to the home’s usual mealtimes because of the power cut. But from conversation with staff and observation we concluded that those residents needing assistance to eat have to wait for staff to help them and that this is an indication of too few staff available. A similar observation was made by an inspector at the last inspection, with a requirement that the provider review the number and skill mix of staff to meet the needs of the residents. The main kitchen has a gas cooker so that residents were able to have the planned hot menu choices at lunchtime. Residents spoken with (and visitors) confirmed that the meals are very good. Meals are served in the two dining rooms – the conservatory/dining area and a small dining room adjacent to the kitchen - 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.V352682.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. The home has a satisfactory complaints system with some evidence that residents and their families feel that their views are listened to. However, formal processes need to be further developed so that the homes procedures are available, understood and consistently applied. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is available in the Statement of Purpose and Service User’s Guide, and on display in the front entrance hall. These should be updated to show the current manager’s name and qualifications. Copies of the complaints procedure should be available in each person’s room. Currently, residents and relatives are advised that a copy of the complaints procedure is ‘available on request’; this may deter people from raising concerns if they have to ask staff to provide them with the complaints information, especially if their concerns are about individual staff. Three of the four 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. Both proprietors – Dr Narayan ad Mr Surdhar - visit the home together on one day each week and Mr Surdhar often visits more frequently so that any concerns can be raised in person with them if necessary. The complaints record had fewer entries than the number of reported complaints received by the home as stated in their Annual Quality Assurance Assessment (AQAA) – 12 complaints in 12 months. The outcomes and actions Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 17 taken by the home in response to 2 complaints received in 2007 were not documented. This was brought to the attention of the manager and the home owners during the inspection as it is a requirement under Regulation 17(2) and Schedule 4(11) that a record of all complaints must be held in the home and must include ‘the action taken by the registered person in respect of any such complaint’. The homes owners described the action taken in relation to the complaints and this appeared to have been satisfactory. No complainant has contacted the Commission with information concerning any complaint made to the service since the last inspection. There is a copy of the Oxfordshire Multi-agency Guidelines about safeguarding and the reporting of suspected abuse. Two staff questioned were unclear about adult protection issues and said they would report anything untoward to the nurse in charge. They said that they had not received any formal training about safeguarding, but were expected to read the home’s policies and guidance available in the office. The deputy manager confirmed that new care staff are given information about safeguarding as part of their induction training. Staff training had taken place last year as planned. The home should ensure that all staff have regular updates in safeguarding adults, especially as there has been a considerable turnover of staff in the past 12 months, so that all staff are confident and competent in identifying and reporting any suspected abuse. The manager has been in post since July 2007 and said she was unaware of the requirement (under Regulation 37) to notify the Commission of the death, serious injury or other events that adversely affects the wellbeing or safety of any service user or any allegation of misconduct by any person who works at the care home. It appears that there has been under-reporting of incidents: the manager and providers must notify the Commission of any matters that are required to be reported ‘without delay’, so that they can demonstrate that appropriate actions have been taken to protect residents from avoidable risks and accidents ‘as far as is reasonably practicable’. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. There is evidence that the standard of the environment and décor of the home is being improved through a planned programme of refurbishment. Residents have a homely and comfortable environment, though work is needed to improve the appearance and accessibility of communal area space and the gardens, so that residents can move around inside and out of the home safely and freely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home had a planned electricity cut - a large tree was being felled nearby, so that the road outside the home was only open for access and the manager had been informed that power supplies would be off from 09.30 to 1500 that day. This meant that residents on the first floor were unable to use the lift and come downstairs to the communal rooms. Corridor and room doors normally held open on automatic door closer devices Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 19 were closed, restricting residents’ ability to walk or use their wheelchairs to get about the home as easily. The call bell system was not functioning. There was one additional staff member on duty to make sure that residents were checked regularly and could ask for assistance in person from staff as needed during the power cut. The sitting room at the front of the house was only in use by two residents for part of the afternoon. It was not clear whether this was because of the power cut and the conservatory/dining room is a brighter, warmer room for residents to use. However a relative’s written comment indicates that this is usual: ‘there are a number of lounges/sitting rooms, but residents seem to spend lots of time un the dining room or their room, but very little time in the lounge. I think that people could use the space, but that it is easier for staff to have most of the people in one room or in their individual rooms.’ This may be a reflection on staffing numbers and availability of staff to be assist more dependent people when they are in different communal rooms. Residents should always be given a choice in relation to where they want to sit and to feel able to get staff attention if they need help or company, in any part of the home. All areas of the home looked clean and tidy. Recently fitted radiator covers in one upstairs shared room and the front sitting room of the home needed securing as the panels were loose and could be a hazard if they fell onto residents. The sitting room carpet is badly stained and in need of replacement. The homeowner confirmed that the new carpet has been purchased and re carpeting will be completed by December at the latest. All the windows have been replaced with double glazed units since the last inspection. Work to replace the kitchen floor as required by the environmental health officer by March 2006 and as required at the inspection in July 2006, has been completed. The access to the gardens has been improved from the dining/conservatory room so that people in wheelchairs are able to go out onto a path to the garden at the rear of the home. The garden looked unkempt and flowerbeds needed weeding. The homes owners said that contract gardeners are now employed to do the gardening work. They acknowledged that there is scope to improve the home’s grounds so that residents can make full use of them in the better weather. Individual resident’s rooms seen during the inspection were clean, well decorated and personalised with people’s own pictures and photos. Since the last inspection the home has met the requirement made to repair the laundry room floor and the room is locked when not in use to protect residents from hazards. The sluice machine on the first floor was not in use because of the power cut. Later in the day staff reported to the manager that it was blocked and said she would arrange for urgent repair. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. Only limited progress has been made in addressing staffing shortages and there are significant levels of sickness and turnover of staff. As a result residents cannot be confident about the consistency of care offered within the home. The standard of vetting and recruitment practices has declined since the last inspection and should be amended to demonstrate that the systems in place are sufficiently robust to protect residents. The home has plans to improve the training opportunities for staff that should improve outcomes for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were 26 residents on the day of the inspection. Because of the power cut, an additional care staff member was working to make sure that there were sufficient staff to assist residents and make more frequent checks because residents on the first floor could not use the lift and automatic door ‘hold open’ devices were not working. The laundry machines were not in operation - care staff usually manage laundry work in addition to residents’ personal care. The homes Annual Quality Assurance Assessment (AQAA) states that 8 full time, and one part-time staff members have left in the last 12 months. These include the registered manager for the home. Staff members work ‘long’ days, sometimes over 13 hours a day, with three breaks totalling one hour included. One registered nurse had worked a total of 11 days (117 hours) consecutively in a 14-day period. Several staff worked a Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 21 mixture of night and day duties within the same week. There was no evidence in the staff files seen that they had signed an agreement to work in excess of the European Working Time Directive. Samples of the duty rota for a threeweek period covering 10/09/07 to 30/09/07 showed many alterations due to staff sickness, resignation, and annual leave. The manager said that ‘normal’ staffing levels are one registered nurse (RN) and 5 carers in the mornings, 1 RN and 4 care staff in the afternoons and evening until 9 pm and then 1 RN and one care staff member from 9 pm to 07.30 am. The copies of the duty rotas for September showed that there were several occasions when numbers fell below the required levels during the day – for example, 4 instead of 5 care staff in the mornings and 3 instead of 4 in the afternoons. As observed during the inspection, a large proportion of residents need assistance with their meals; one resident was anxious and tearful and needed constant staff presence to reassure them. 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. Though the homes owners confirmed that the manager is authorised to bring in additional staff (bank staff or staff from other homes owned by the same providers) if this is felt necessary to meet residents’ care needs, this does not appear to happen in practice. Agency staff is not used. Whilst this ensures continuity of care for residents, there is a risk that permanent staff will become overtired through working excessive hours without adequate rest periods between. This increases the risk of accidents and a negative effect on residents’ care and staff members’ health. However, relatives’ comments, both on the day of the inspection and in the small sample of written responses to the questionnaires sent out by the Commission, were very positive about the staff and the standard of care they provide, for example: ‘[staff] provide the support [my relative] needs happily’ ‘My [relative] is always clean, well dressed and seems as happy as anybody in his/her condition can be’. The provider must review staffing numbers and skill mix and confirm to the Commission that there are consistently enough suitably trained staff to meet the assessed needs of residents. Staffing numbers should allow for staff training, annual leave and incorporate time for recreation and activities with residents over and above the time required to carry out direct personal care for residents. A sample of 3 staff files (those staff most recently employed to work in the home) was looked at. The recruitment files did not show a consistent and rigorous approach to recruitment in that there was no evidence of job descriptions, the interview process or job offers (subject to satisfactory Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 22 references and CRBs). The Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (PoVA) checks for 2 of the 3 staff, although recent, had not been obtained by the current employer. The manager was reminded that CRBs are not transferable between employers and new checks must be obtained for these staff. The manager was unaware of the PoVAFirst application process that enables the employer to make an initial check to ensure that prospective employees have not been listed as unsuitable to work with vulnerable people. The deputy manager said that new staff are not permitted to work unsupervised until a satisfactory full CRB has been received. This was not the case in practice as observed during the inspection when one carer was seen assisting residents in a first floor room without supervision. The inspector recommended that the manager obtains the guidance published by CSCI – ‘Safe and Sound?’ – that sets out the best practice for recruitment and screening of staff to ensure that residents are protected as far as possible from unsuitable people being employed to work in homes and agencies. The deputy manager has recently been made responsible for the training of care staff in the home. She is an assessor for National Vocational Qualification (NVQ) training. She confirmed that all new care staff complete induction training that meets the standard for the national training organisation. 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 7 carers working towards NVQ Level 2 qualifications. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 23 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, 37 and 38. Quality in this outcome area is adequate. The new manager has not yet had time to develop ad implement the plans for the home; the appointment of a deputy manager and identification of clear roles and responsibilities for training and development of the staff team should improve the outcomes for residents and staff following a time of disruption and staff changes. The home managers must improve the way in which it reviews the homes performance. The fire authority must be consulted about fire safety arrangements in the home. Fire risk assessments should be reviewed and updated so that staff and residents are aware of, and are able to take appropriate action, to minimise any risks to their health and safety. Required notifications must be made by the home to the Commission to demonstrate that the home has taken the appropriate actions to minimise avoidable accidents and situations that may put the health and wellbeing of residents at risk. This judgement has been made using available evidence including a visit to this service. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 24 EVIDENCE: The current manager has only worked at the home since July 2007. She has experience of working in an acute private hospital setting but is new to management, and the Care Standards Act and National Minimum Standards for Care of Older People. The manager is in the process of applying to the Commission to be the registered manager for the home. She is aware this will involve familiarising herself with the Regulations and Standards that apply to care homes to ensure that the standards of care and protection of residents are of a good standard. The providers said at the inspection that the manager will be given sufficient supernumerary time to increase her understanding and knowledge about the legal responsibilities of the manager’s role and to seek advice from other managers, and from CSCI’s website. A long-standing senior care staff member has been appointed as deputy manager and this provides continuity for residents and staff and support for the manager in the day-to-day running of the home. As identified at the last inspection, although both the proprietors visit the home regularly the unannounced monitoring reports required by legislation (Regulation 26 of the Care Standards Act 2000) 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. The proprietors must complete unannounced visits to the home at least once a month. Their visits should include asking residents’ and their representatives, and staff about their views of the home; inspecting the premises and the records of any events and records of any complaints; and a report should be written, with a copy made available to the manager at the home. The homes AQAA showed that there are not written policies and procedures in place for a number of aspects of management of the home. The manager has started the process of reviewing and updating these. As identified in the Complaints and Protection section of this report, the manager was not aware of the requirement to report the death of any resident, serious accident, or any incident affecting the welfare ands safety of residents – for example, the planned electricity cut that affected the home on the day of the inspection. There was no evidence that the home has a system for regularly asking residents and their families about their views about the home and the facilities. The previous manager carried out a quality assurance survey in 2006, but the Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 25 results were not published as far as CSCI are aware. The home must ensure that there is an established system for reviewing the quality of the care and improving this: the process must include consultation with residents and their representatives and a copy of any report of the outcomes of the quality review should be made available to residents and the Commission. The homes AQAA document indicates that the proprietors and manager have improved communication between staff and the proprietors and the care team; and that rotas and specific allocation of work has improved the way in which residents’ care needs are matched. The AQAA also identifies that annual selfassessments and appraisals are planned to improve standards of care. At the last inspection, the proprietors said they were going to arrange for a fire risk assessment of the home to be carried out and for the findings to be implemented. The fire logbook showed evidence of regular staff fire drills and there were planned fire safety training sessions for staff However, the written fire risk assessments have not been revised since 2004. In view of the low staffing levels overnight and the potential impact on fire safety arrangements at night in particular, the proprietors must consult with the fire authority about the fire safety arrangements in the home and review and update the fire risk assessments as necessary. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? 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 OP9 Regulation 13 (2) Requirement That controlled drugs are stored in a controlled drugs cabinet and accurate records are kept. This is to comply with the misuse of drugs regulations. That records are kept of all preparations administered by staff, and all medicines sent for disposal. This is to show that residents are given their medicines as prescribed by their doctor and that the home handles these medicines correctly. A record of all complaints made by residents or their relatives or representatives, or by persons working in the home about the operation of the home and the action taken by the registered person in respect of any such complaint. The home must review the numbers and skill mix of staff employed to ensure that the assessed care needs of residents are consistently met. That notifications are made to the Commission without delay, DS0000047824.V352682.R01.S.doc Timescale for action 31/12/07 2. OP9 13 (2) 30/11/07 3. OP16 17(2) Schedule 4 (11) 30/11/07 4. OP27 18 (1) 30/11/07 5. OP37 37 30/11/07 Winterbrook Nursing Home Version 5.2 Page 28 6. OP33 26 of occurrences as defined by this Regulation The unannounced monitoring visits as defined by Regulation 26 must be conducted on a monthly basis and reports of the visits completed regularly. Establish and maintain a system for reviewing and improving the quality of care Consult with the fire authority about the fire precautions and review of the fire risk assessments for the home 30/11/07 7. 8. OP33 OP38 24 (1) (2) (3) 23 (4) 31/01/08 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations * Improve the records of residents’ care to reflect a ‘person-centred’ approach that involves the resident (as far as possible) and their representatives. * Care records should be reviewed and regularly evaluated to ensure that the care given meets the individuals assessed care needs. Expand the medication policy and procedures document, in order to provide more useful guidance and help for staff to follow. Residents’ interests should be recorded and particular consideration given to people with dementia, visual and/or hearing impairments. Residents should have the opportunity to access any communal space in the home. Each resident should have a copy of the home’s complaints procedure in a format that they can use and understand, accessible in their room. Planned work to replace the carpet and redecorate the sitting room at the front of the home should be completed at the earliest opportunity. The home should complete the review and updating of DS0000047824.V352682.R01.S.doc Version 5.2 Page 29 2. 3. OP9 OP12 4. 5. 6. OP16 OP19 OP38 Winterbrook Nursing Home policies and procedures relating to health and safety matters and safe working practice topics in the home. Winterbrook Nursing Home DS0000047824.V352682.R01.S.doc Version 5.2 Page 30 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: 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 Winterbrook Nursing Home DS0000047824.V352682.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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