Inspection on 10/09/07 for Winterton House

This inspection was carried out on 10th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Winterton House 22/03/07

Winterton House 16/05/06

Winterton House 17/11/05

Winterton House 21/06/05

Winterton House 29/11/04

Winterton House 22/06/04

Winterton House 26/11/02

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 Winterton House Hale Road Wendover Bucks HP22 6NE Lead Inspector Stephen Webb Unannounced Inspection 10th September 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Winterton House DS0000023035.V343892.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. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winterton House Address Hale Road Wendover Bucks HP22 6NE 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) 01296 622203 manager.winterton@fremantletrust.org admin@fremantletrust.org The Fremantle Trust Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2007 Brief Description of the Service: Winterton House is a care home that is registered to provide care and accommodation to forty-one older people. The home is run and managed by The Fremantle Trust and is situated on the outskirts of Wendover, where it is reasonably convenient for local amenities and is accessible by public transport. The accommodation is over three floors and the home is set in very pleasant grounds, with garden areas and seating at the front and rear of the building which are accessible to service users. The home has some adaptations to meet the needs of residents with disabilities, including ramps and handrails, and adapted bathing facilities, and there are two lifts available serving all floors. Parking is available to the front and side of the building. Fees at the time of this inspection range from £397.79 to £600.00 per week. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 10.00am until 6.30pm on 10th of September 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversations with staff members on duty, and discussions with the assistant manager, in the absence of the manager, who was on annual leave. The inspector spoke to a number of the residents during the inspection, and some time was also spent observing the interactions between residents and staff at various points during the inspection and over lunch with the residents. Written feedback was obtained from five residents and the relatives of two of the residents, who were broadly happy with the service provided. Two GP’s and a district nurse also completed inspection comment cards. The inspector also inspected the communal facilities of the home and proportion of the residents’ bedrooms. What the service does well: Prospective residents are provided with information about the home and other relevant matters to inform their decision-making, and an appropriate preadmission assessment is undertaken prior to the decision being made to offer a place to a resident. Residents’ needs and preferences are reflected within their care plans and the home effectively meets the healthcare needs of residents. The home has a system in place to manage residents’ medication on their behalf. The home respects the dignity and privacy of residents and the staff demonstrated a very good awareness of these aspects of care. Residents are offered a very good range of activities and outings, and the home tries to address their varied cultural and spiritual needs. Residents are encouraged to maintain contact with family and friends and visitors are made welcome. They are supported and enabled to make choices and their preferences with regard to how they are supported are recorded and acted upon, within the context of risk assessments where necessary. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 6 Residents are provided with an appropriately varied and nutritious diet, with choices available, and individual cultural needs are addressed. The home has an appropriate complaints procedure in place, which is made readily available to residents and visitors. Most of the residents asked, were aware of the procedure and felt their concerns would be addressed. The home has systems in place to safeguard the residents from abuse. Alt the time of inspection, over half of the care staff and the domestic staff had yet to receive training on safeguarding vulnerable adults, further such training was planned in the near future to address this shortfall. The home provides a homely and comfortable environment for residents, which is suitable adapted to meet their needs. The staff demonstrated warmth in their interactions with residents and offered support positively to individuals. Around half of the staff had attained at least NVQ level 2 and a significant number of others were working towards this. The home’s thorough recruitment and selection system supports and protects residents, and excellent records of the process are kept. The home is well run by the current management team, who have created a positive and motivated staff team. The views of residents and other stakeholders are sought via a quality assurance system, as well as through other forums. The home has appropriate systems in place to manage residents’ personal allowances where this is necessary, in order to safeguard their interests. The health, safety and welfare of residents are promoted by the home. What has improved since the last inspection? The new manager has consolidated the management team and staff morale is positive. More staff have attended equal opportunities training. The home has established an in house bank of staff to reduce the level of use of agency staff. The skills of the staff team have been developed in the area of pressure area awareness and diabetes. The activities programme has been further developed in consultation with residents. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 7 Significant improvements have been made to the physical environment. 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. The summary of this inspection report can be made available in other formats on request. Winterton House DS0000023035.V343892.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 Winterton House DS0000023035.V343892.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): Standards 1, 3 and 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with detailed information about the home and other relevant matters to inform their decision-making. An appropriate preadmission assessment is undertaken prior to the decision being made to offer a place to a resident, to ensure that the home can meet their needs. In the case of an emergency admission this may be undertaken immediately upon admission. Standard 6 is not applicable, as the home does not offer an intermediate care service. EVIDENCE: The detailed service user guide was available on a table in the entrance hall of the home. It included appropriate information regarding the home, staffing and current fees, as well as detailing the comments and complaints procedure. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 10 Leaflets about an independent advocacy service for older people were also displayed, as well as other relevant information. However, the previous inspection report was not on display, though the deputy manager said that this had previously been the case. A copy of the latest inspection report should be made available again, for residents and prospective residents and their relatives to read. Prospective residents or their next of kin are invited to visit the home prior to admission, though not all are able to do so. The prospective resident is visited at home or in hospital in order for a preadmission assessment to be completed. Two of the three case records sampled, had a completed preadmission assessment present together with a copy of the social services assessment on the prospective resident and local authority care plan. The other resident had been admitted as a private emergency placement and a detailed care plan assessment had been carried out immediately upon admission by the home. Winterton House DS0000023035.V343892.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): Standards 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. The identified needs and preferences of residents are reflected within their day and night care plans and associated records and the home effectively meets the healthcare needs of residents. The home has an appropriate system in place to manage the medication on behalf of residents, though a small number of recording errors were noted, which need to be addressed with staff. The dignity and privacy of residents are respected by the staff, who demonstrated a very good awareness of these aspects of care. EVIDENCE: Improvements have been made to the care plan formats since the last inspection, and the home’s development plan indicates that the home is working towards person-centred care planning. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 12 The care plans now include action plans leading on from the identification of the individual’s needs, which take account of any expressed preferences, likes and dislikes with regard to how individuals wish to be supported. The individual preferences and preferred daily routine of the resident are sought and recorded within the care planning format to inform the action plan. Any specific dietary or cultural/spiritual needs are also recorded. Nutritional, moving and handling, and pressure area risk assessments are undertaken, and two out of three files also contained an individual fire evacuation risk assessment, in line with the unit’s development plan. In one case this was not yet in place. It is recommended that individual fire risk assessments be completed for any remaining residents who do not have one. Separate night care plans were also present in each file, which also included evidence that residents’ individual preferences had been sought regarding such things as whether they wished the night staff to check on them regularly through the night, preferred nightwear, times of rising and retiring etc. There were copies of either in-house or local authority reviews on file, indicating periodic review of the care plans. Individual bathing and nail care records were present within care plans. It is suggested that consideration be given to the expansion of these records to a more comprehensive individual personal care monitoring sheet to include other relevant aspects of care delivery, such as dental care, hearing aid battery checks, shaving, bedding change etc. as these records provide both staff accountability (if initials are used to record care input), and a positive record of the care provided. Daily notes are also maintained on each resident though the level of detail therein was variable. Residents are registered with a local GP practice with which the home has a good relationship. A GP from this practice visited the unit during the inspection and discussed the various options regarding the care of one resident about whom the staff were concerned, with the resident and the deputy manager. District nurses also attend the home several times a week. Healthcare records are collectively held within a specific format within the care records, and included evidence of contact with GP, district nurse and others. Staff demonstrated good awareness of healthcare issues during the inspection and effectively communicated any concerns to management. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 13 Feedback from residents and relatives verbally and via inspection feedback questionnaires, regarding the quality of care and healthcare was very positive, except for in one instance where concerns regarding some aspects of care under the previous manager were noted. One resident confirmed that the GP visits the home regularly, and several said that the care staff were very good and “look after us well”. The inspector observed the care staff interactions with residents at numerous points throughout the inspection and these were almost always very positive, appropriate, caring and validating of the individual concerned. Staff were seen to make time for individuals even when they were already busy and there various examples of warmth and concern and proactive input were observed. One respite resident was assisted by a staff member to pack up her belongings at the end of her stay, in preparation for being picked up to return home later that day. The home has an appropriate system to manage the medication on behalf of residents, and none of the current residents are felt able to manage their medication for themselves, aside from the application of some creams. Examination of the medication management and records indicated that these were in order with the exception of a couple of gaps in medication administration record (MAR) sheets. The deputy manager checked and confirmed that the medication had been given but not recorded, and agreed to discuss the recording omission with the staff concerned. The staff must be reminded of the importance of proper recording of all medication. All of the senior staff and the newer carers who administer medication have received pharmacist training on medication, but a number of more long-standing carers have only received in-house training, though they have been identified and are due to receive training from the pharmacist. This is good practice, rather than relying on in-house medication training. The system provides an effective medication audit trail, with the quantities received being recorded on the MAR sheets as well as a separate record of any returns. The medication files include photographs of residents and additional information regarding certain drugs. Controlled drugs storage was appropriate and the home uses an appropriate controlled drugs log to record administration. Two transcription errors were noted in the controlled drugs log book, (where an incorrect number for the remaining tablets was transferred from a completed page to the new page for a particular individual), one of which had Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 14 previously been noted and corrected, and one which was addressed during the inspection. There have also been two previous administration errors relating to controlled drugs, which have resulted in changes to administration protocols to prevent a reoccurrence. One of the above medication errors had been reported to CSCI, as required, but it appeared the more recent instance had not. The deputy manager undertook to complete a Regulation 37 notification relating to this. Any future medication errors should be reported to CSCI under Regulation 37. The home supports residents’ privacy and dignity in various ways including the provision of appropriate locks on bathrooms and toilets and also by having locks on bedroom door to which residents can have the key. Staff indicated that they provide a towel for residents when washing them to support their dignity and always work behind closed doors, and one confirmed that the information regarding the preferences of individuals are recorded within day and night care plans. Staff also leave the bedroom/lavatory, and wait outside, when a resident is using the commode/toilet where this is assessed as appropriate, though residents are not left unsupervised in the bath. Some residents have their own telephone in their bedroom and telephone points were said to be available in all bedrooms to facilitate this. Residents are taken their post to open themselves, though they may be offered help where this is felt necessary; and can receive visitors in private in their bedroom, or within any of the various communal areas. Residents confirmed that the staff worked to respect their dignity and privacy, around such things as knocking on doors, providing care behind closed doors and enabling them to see visitors in private. One confirmed that you could choose not to have regular checks during the night. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered a very good range of activities and outings, and the home tries to address their varied cultural and spiritual needs. Residents are encouraged to maintain contact with family and friends and visitors are made welcome. They are supported and enabled to make choices and their preferences with regard to how they are supported are recorded and acted upon, within the context of risk assessments where necessary. Residents are provided with an appropriately varied and nutritious diet, with choices available, and individual cultural needs are addressed. EVIDENCE: The home has a designated activities coordinator who works from 9.30am to 2.30pm three days per week, who leads on activities planning. The actual activities may be led by the coordinator or by the care staff, to whom she has provided some training. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 16 There is a written activities plan which identifies planned activities through the week (Monday to Friday), with up to three alternatives being available most weekday mornings and afternoons, plus some short exercise sessions. The activities plan is displayed in the home on a notice board, and the various activities take place across all three main lounges so everyone has the opportunity to access them easily, wherever they may spend their time. In addition there are periodic outings and external visits by entertainers and others as well as birthday celebrations. On the day of inspection the home had organised a piper to visit and play bagpipes as part of the birthday tea for a Scottish resident. The enjoyment of this was evident on the faces of the resident and a number of others who shared her celebration with her at a birthday tea provided by the chef. The resulting dancing was also videoed and photographed to provide a permanent reminder of the day. The regular activities include reminiscence and other quizzes, musical bingo, nail-care sessions, scrabble, crosswords, current affairs/newspaper discussion, board games, art and craft sessions, knitting, music and movies. During the summer the home had a “Holiday at Home” month, during which a range of events and visits took place including trips to garden centres, Cotswold Wildlife Park, Water Perry Gardens, Woburn Safari Park, Knebworth, and a home for retired horses; and a barbeque, ice cream, chocolate and cheese tasting events, a Hawaiian day, a strawberry cream tea, a visit by a mobile farm and visits from several external entertainers. Photographs of some of the events were displayed in the home. The home has a minibus available to take residents on outings but has also hired vehicles on occasion to facilitate larger groups. The identified cultural and spiritual needs of residents are addressed by the home, including dietary needs. In the past the home obtained Halal ready meals from a caterer to address one individual’s needs and a Jewish resident (who does not require a diet which fully conforms to Kosher rules). is always provided with a suitable alternative when pork is on the menu. Appropriate arrangements are made to address the spiritual needs of residents on request. At present communion is provided in the home every six weeks, and friends or relatives take two residents to church. The spiritual needs of residents are recorded on admission within assessment and care plan documentation. From the available evidence, the home would be likely to be able to meet the majority of spiritual needs and is able to seek support within the community to support the wider cultural needs of residents. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 17 The manager indicated in the pre-inspection questionnaire, that staff receive training on equal opportunities and will also receive training on cultural awareness. The home was said to welcome visitors and staff were seen to be welcoming to various visitors during the inspection. Most of the current residents have some family contact, and some have regular visits. Visits from friends are also encouraged. Visitors can see residents in the bedroom or in any of the communal areas. As already noted, the identified preferences, likes and dislikes of residents are recorded within their care plan documentation. One staff member confirmed that the day and night care plans contained this information, and that residents are supported to make choices. Such options include their preferred times of rising and retiring, whether they wish the staff to undertake regular checks on them during the night and whether to have their door open at night, (facilitated by means of a door restraint which allows the door to close automatically in the event of the fire alarm sounding). Residents also have day-to-day choice in such matters as their clothing, (though this might be supported where necessary), whether to take part in the various activities on offer, whether to spend time in the communal areas or in their bedroom, what personal items to bring in to personalise their room, and which meal option to choose. The staff were observed offering various choices and options to residents during the inspection, and in one case an item, not on the menu was provided to a resident on her request. Residents confirmed that their preferences were generally adhered to, at least where the staff were familiar with them. The menus indicate an appropriately varied and nutritious diet, and there are choices available at every meal. Specific cultural dietary needs are addressed by the home, either by the chef or through the purchase of appropriate meals from outside contractors. Residents are asked to choose their main meal option the day before to enable the chef to prepare appropriate numbers of meals. The day’s menu is made available on the dining tables. The observed mealtimes were unhurried and appropriate support and encouragement was offered to residents. The dining areas are pleasant and homely and provide for residents to eat in smaller groups. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Feedback from service users indicates that most are confident that any concerns raised would be addressed appropriately by the home and most residents and relatives are aware of how to complain. The procedure is included in the service user guide. The home has systems in place to safeguard the residents from abuse. Although at the time of inspection, over half of the care staff and the domestic staff had yet to receive training on safeguarding vulnerable adults, further such training was planned in the near future to address this shortfall. EVIDENCE: The service has an appropriate complaints and comments procedure and has received a lot of positive feedback from relatives about the care provided. The procedure is detailed in the home’s service user guide, which is available in the entrance hall. Eleven complaints had been received in the last twelve months and all had been addressed appropriately. The complaints log was kept in a systematic fashion together with copies of related correspondence. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 19 No complaints about the home have been received by the Commission in the last twelve months for referral to the service for investigation. Two residents confirmed in conversation, that they were aware of how to complain if required, and this was also confirmed by nine of the ten residents who completed inspection questionnaires and in four of the five completed surveys from relatives. At present the staff were reported not to receive any training input on complaints. It is recommended that this be included as part of the staff induction and foundation training. A relative raised an issue with the deputy manager during the inspection, which was immediately looked into and addressed to their satisfaction. The four senior staff have all received training on protecting residents from abuse and just under half of the care staff have also had this training. A further course on safeguarding vulnerable adults is planned for October or November, for the remaining team members. It is planned to include the domestic staff in this training, which is good practice. One staff member confirmed that they had recently received training on protecting residents from abuse. There have been no instances relating to safeguarding vulnerable adults reported since the last inspection. The home has an appropriate system for the recording, safekeeping and management of residents’ personal allowance monies on their behalf. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, well-maintained environment for the most part, though some further work would be beneficial to address homeliness in some of the bathrooms, and to standardise the quality of environment across the bedroom accommodation. Standards of hygiene were generally good, though there were residual odours in two of the bedrooms which need to be addressed. The home has an appropriately equipped laundry to meet the needs of residents. EVIDENCE: The new manager was said to have secured significant improvements to the physical environment, and indeed the communal areas, which had been completed, were redecorated to a good standard and were carpeted and furnished in a homely fashion. Redecoration was still under way in one lounge. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 21 There are four lounges, together with a number of small seating areas about the home where residents can choose to spend time, and residents dine either in the large dinging room or in the dining area in two of the lounges. Most of the furniture was of a satisfactory standard, though some items were worn. The deputy manager indicated that some replacements were due to be obtained from the closure of another home, where these were of better standard than existing items. The home has thirty-seven single bedrooms and two potential double bedrooms provided over three floors, (lower ground, ground and first). There are two lifts, each serving all floors, one in each of the core buildings, as there is no link between these buildings above the ground floor. Examination of a sample of bedrooms indicated two standards of décor, which on investigation, related to whether residents were privately or local authority funded. Whilst both standards were satisfactory, there was a clear distinction, which would conflict with maintaining a resident’s right to confidentiality regarding their funding arrangements. The higher standard with matching bedding and curtains etc. should ideally be adopted across the board to avoid this obvious distinction, since a two-tier system is not appropriate. Though the vast majority of the building was free of unpleasant odours, some residual odour was evident within two of the bedrooms. It was reported that various attempts had been made to address this in one case, but further work needs to be undertaken to address this problem. Residents are encouraged to bring in some of their own belongings to personalise their bedroom, and some were very homely and individual. The home has a number of bathrooms, one of which is decorated to a very good standard with homely touches such as pictures and plants to enhance the bathing experience. This is also the only bathroom with a modern electric hoist seat integral to the bath, and therefore tends to be favoured by both residents and staff. Two other bathrooms have baths with manual external hoists, but are not yet decorated to the same standard. One bathroom is not used as it only has a standard bath, which none of the residents are able to use. There were also areas of blown plaster in this bathroom which need to be addressed, which may be the result of dampness penetration from outside. Consideration should be given to how best this disused facility could be brought back into use to meet the needs of residents. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 22 Further evidence of water damage was also evident to the decor in the vicinity of the home’s side entrance, and it is understood that some efforts have already been made to discover the cause. The home has a number of separate toilets, some of which have raised seats. Bathrooms and toilets were equipped with appropriate locks, which could be opened from outside in an emergency. Ramps have been provided at various locations in the building to enable residents to mobilise independently where they are able. The kitchen was in good order and equipped with stainless steel equipment and had separate dry-store facilities. There are attractive grounds with lawns and mature trees, and there are various outdoor seating areas with tables, chairs and parasols provided, which were seen in use during the inspection. The home has an appropriately equipped laundry with machines capable of addressing the home’s needs with regard to infection control. Standards of hygiene around the building were observed to be good. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of residents are broadly met at current occupancy levels, though the staffing can be stretched at times of staff sickness and would be more flexible if the full quota of seven staff throughout the day were maintained despite the reduced occupancy, given the layout of the building. The staff demonstrated warmth in their interactions with residents and offered support positively to individuals. Around half of the staff had attained at least NVQ level 2 and a significant number of others were working towards this. The home’s thorough recruitment and selection system supports and protects residents, and records thereof are detailed and systematic. Staff receive a good core training package though aspects of required training remain outstanding for a number of them, and these shortfalls need to be addressed. EVIDENCE: The full daily staff complement for the home is seven care staff including a senior on both the morning and afternoon/evening shifts, but at the time of inspection, the afternoon/evening shifts had been reduced by one carer, to six staff including a senior, owing to the reduced occupancy. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 24 At nights there are three waking night staff on duty each night, who carry out regular checks on residents’ wellbeing throughout the night unless this is not wanted by individuals. A sample of the rotas was examined and confirmed these levels as the baseline, though they are exceeded at times. Given the current occupancy levels the staffing appeared to meet the current needs of residents. Staff were observed to be busy but found time to engage regularly with individuals during the day, and to lead some activities with residents. It was commented that staffing levels could be reduced at times, owing to sickness, and that the provision of seven staff throughout the day would be more appropriate, given the layout of the building, even allowing for the current reduced occupancy levels. The home’s policy is to try to avoid the use of agency staff, to maximise continuity and consistency, and wherever possible, shortfalls are covered by existing staff or relief staff from other homes operated by the provider. The quality of care observed during the inspection was good, with lots of proactive interaction, encouragement and support offered, in ways respectful of the residents’ individuality and rights. There was good evidence of appropriate humour and evident warmth in the interactions observed. Staff gave the impression of enjoying their work and being enthusiastic about their role. Residents appeared at ease when interacting with staff and were not talked down to. As noted earlier, the feedback about staff from residents was generally very positive. Communication and teamwork appeared to be good and it was commented that there had been regular staff meetings since the new manager’s appointment, and staff felt better consulted about the way the home was operated. Around half of the current care staff have attained NVQ level 2 or above and the majority of others have started working towards this. Examination of a sample of two recent staff recruitment records indicated that these are kept securely and systematically, with a recruitment checklist as a front-sheet. All of the required recruitment and selection checks and processes were appropriately evidenced, though in one case the CRB/POVA confirmation Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 25 format was more informative than in the other, where only a brief e-mail confirmation was present. The deputy indicated that the more detailed format may yet be coming from human resources, as this recruitment process had only recently been concluded. The more detailed format is definitely more comprehensive and is commended as a model example of such a record. The deputy reported that the provider operates a dated and signed induction record for new staff, though none was examined on this occasion owing to time constraints. The provider offers a good induction and core training package for the most part, and it was evident that the names of staff without specific core training had been identified in some cases, in preparation for this to be addressed. The deputy manager was aware of some upcoming training to address shortfalls, for example in the case of training on safeguarding vulnerable adults. However, it was noted that none of the care staff appeared to have received appropriate health and safety training, and only the senior carers were currently trained in first aid. As already mentioned under Standard 16 above, staff also do not receive training on responding to complaints, though this may be planned to be included in the customer care training referred to in the home’s development plan. Reference is made within the home’s development plan to providing health and safety training to all staff, and this needs to be actioned. This document also refers to the provision of dementia training to care staff, which has begun to be provided. All care staff also need to be provided with a basic first aid training, and those who have not received training in medication, infection control and safeguarding vulnerable adults, should attend these. The provider/manager should review the core training across the team and address all identified shortfalls. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 26 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): Standards 31, 33, 35 and 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run by the current management team, who have created a positive and motivated staff team. The home is run in the interests of residents and the views of residents and other stakeholders are sought via a quality assurance system, as well as through other forums. The home has appropriate systems in place to manage residents’ personal allowances where this is necessary, in order to safeguard their interests. The health, safety and welfare of residents are promoted by the home. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 27 EVIDENCE: Observation during the inspection and feedback from staff and residents, indicate that the home is well managed by the new manager and his senior staff team. The manager was on leave at the time of this inspection, so the home’s assistant manager supported the inspection process. The manager has attained the Advanced Management For Care diploma and is an in house NVQ assessor. He has attended a range of courses to maintain knowledge of current good practice. Communication between staff appears to be effective, for the most part and a positive team spirit was observed. Regular team meetings are now said to be taking place. Although the assistant manager was not fully aware of the system, the provider reportedly undertakes annual quality assurance surveys of staff, residents, relatives, external healthcare professionals and care managers. This was confirmed within the pre-inspection questionnaire provided by the manager, who also indicated that he attends the monthly residents meetings that are held in the home. The manager also indicated that consultation meetings also take place periodically, where residents and relatives can ask questions of the operations manager. A summary report had reportedly been produced, but a copy could not be located during the inspection. A copy of the summary report should be provided to the Commission. A copy of the latest internal quality audit as part of the management monitoring system was seen, and was dated August 2006. The annual development plan for the service, dated 2006/7, and produced in November 2006, was provided and identifies clear goals and targets across various aspects of the home’s operation and development. This document was on display in the entrance hall. In the long term the home is reported to be due for redevelopment in 2009, though the exact details of this have yet to be clarified. The provider undertakes monthly Regulation 26 monitoring visits to the home and the resulting reports for these visits were all on file in the home for the period since the last inspection. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 28 The home has an appropriate system in place to manage the personal allowance of residents where this is not undertaken by the resident, their family or others. Only the administrator and manager have direct access to residents’ funds, and there is an individual record maintained of any expenditure, together with receipts. The allowance is requested from family or solicitors, who retain appointee-ship, and banked in a collective service user account with separate numbered accounts within. A balance is held securely on site for each resident and accessed by one of the two people identified above. Additional funds are requested when an individual’s balance runs low. The home protects the health and safety of residents effectively in practice, with necessary servicing and safety-checks being carried out as required. The fire alarm was last serviced in January and the lift service took place on the day of inspection. The home’s completed pre-inspection questionnaire confirms that other key servicing has also been carried out. As already noted, there is a need to provide health and safety training to all staff, appropriate to their level of responsibility. Individual fire evacuation risk assessments are being undertaken for residents though not all are yet completed, but the unit’s overall fire risk assessment could not be located. A copy should be forwarded to the Commission. The home has an appropriate accident and incident recording system, and copies of completed forms are held collectively for monitoring. Specific records are maintained of resident falls and these are held collectively for monitoring and also detailed within individual care records. Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 29 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 4 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 30 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 OP9 Regulation 13(2) Requirement The medication administration record must be completed at the time of administering the medication. This is to ensure that residents receive the correct dosage of medication at all times The controlled drugs register must be completed at the time of administering the medication, and the correct number of tablets must be recorded, checked and signed for by both signatories whenever controlled drugs are given. This is to ensure that the correct procedure for the safe handling of controlled drugs is always followed to protect residents. The manager/provider must ensure that identified areas of dampness on the walls are addressed and made good. The manager must ensure that the residual odour evident in two of the bedrooms is addressed effectively. The manager must review the core training for all staff and take steps to address identified DS0000023035.V343892.R01.S.doc Timescale for action 10/10/07 2. OP9 13(2) 10/10/07 3. OP19 23(2)(b) 10/12/07 4. OP26 16(2)(k) 10/11/07 5. OP30 18 10/11/07 Winterton House Version 5.2 Page 31 6. OP38 23(4) shortfalls, where plans are not already in place to do so. The manager/provider must forward a copy of the home’s fire risk assessment to the Commission. 10/10/07 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. 2. 3. 4. Refer to Standard OP16 OP18 OP19 Good Practice Recommendations Consideration should be given to the inclusion of training on complaints, within the induction/foundation training for all staff. The manager should inform the commission when the “safeguarding” training for the remaining staff has been completed. The manager/provider should ensure that bedrooms are all decorated and furnished to a comparable standard, irrespective of a resident’s source of funding. The manager/provider should consider bringing the remaining bathing facilities up to the high standard of the identified facility, and should consider how best to bring the disused bathroom back into service, in order to meet the needs of residents. The manager should supply a copy of the summary report from the most recent quality assurance survey to the commission. OP19 5. OP33 Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 32 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 Winterton House DS0000023035.V343892.R01.S.doc Version 5.2 Page 33 - 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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