Inspection on 16/05/06 for Winterton House

This inspection was carried out on 16th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Winterton House 10/09/07

Winterton House 22/03/07

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 Mike Murphy Unannounced Inspection 16th May 2006 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.V290006.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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 admin@fremantletrust.org The Fremantle Trust Karen Kelly Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2005 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. Winterton house is situated on the outskirts of Wendover town and 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 is accessible to service users. There is parking to the front and side of the building. Fees at the time of this inspection were £370.79 to £550.00 per week. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over two days by two inspectors. On the first day from 9.15 am to 6.30 pm and on the second from 9.15 am to 2.00 pm. The inspection methodology consisted of discussions with residents, managers and staff, examination of records, a walk around the home, consideration of information submitted in advance of the inspection by the registered manager, consideration of completed comment cards submitted by relatives and residents, and examination of the home’s arrangements for the control, storage and administration of medicines. A significant element of this inspection, and to a large extent the reason it extended over two days, was a need for CSCI to be satisfied that a serious failure in the supply of hot water to many parts of the home was being effectively addressed by the Fremantle Trust. Exploration of the cause of the problem and efforts to resolve it ran in parallel with the inspection. By the end of the inspection the Fremantle Trust and contractors felt that they had identified the cause of the problem and the hot water supply had been restored to key areas in the home. Over the following week the registered manager kept CSCI informed of progress. Hot water was restored to all areas of the home and the Trust and contractors were looking at ways of preventing a recurrence of the problem. This inspection has also highlighted a need to review the home’s registration status. 15 residents were recorded as having ‘dementia’ which is out of line with its current registration category. A review of registration, together with a review of the home’s assessment, care planning, care and activity programmes and staff training should ensure that the needs of such residents are appropriately met. Overall, the outcomes of this inspection are uneven. Residents and relatives report a high level of satisfaction with the service and standards of care are generally good. The quality of the food is appreciated. Staff are attentive to the needs of residents and were observed to provide care with sensitivity and with regard to the privacy and dignity of residents. At the same time, however, some aspects of staff practice combined with poor housekeeping and maintenance undermine the standards to which the home aspires. The solution lies in part with the home and in part with higher managers in the Trust. The home can amend aspects of its practice with regard to monitoring standards of care delivery and care plan recording, modify staff practices which compromise the control of infection, address the matters on medicines administration mentioned in this report, and improve standards of housekeeping. It needs the support of senior managers in addressing staff training and particularly in ensuring that the building is maintained to a good standard. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Continue to address weaknesses in care plan recording through audit, supervision and staff training and support. Address those aspects of staff practice which compromise the control of infection within the home. Establish more rigorous monitoring of standards of housekeeping and maintenance of the environment. Adjust assessment, care planning and care delivery activities to ensure that the needs of residents with dementia are being effectively addressed. Priorities for staff training should be adjusted accordingly. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 7 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. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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.V290006.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home is required to use the Fremantle Trust standard contract which does not include all of the information required in the minimum standard and which fails to specify the detail of the service to be provided to the resident. Processes for assessing prospective resident’s needs are thorough and should form a sound basis for a plan of care to meet needs as well as ensuring the home does not admit a person whose needs it cannot meet. A significant number of residents are recorded as suffering from dementia and the home will need to ensure that its assessment and care planning processes are appropriate to the needs of such residents. EVIDENCE: Residents are supplied with a copy of the standard Fremantle Trust ‘Resident’s Contract. The wording of this document, which is outside the control of the home, does not include all of the information required under standard 2.2. Prospective residents are assessed by experienced staff prior to admission. The assessment includes consideration of information provided by the referring Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 10 care manager in the case of referrals from social services. Three resident files were examined and an assessment had been completed in each case. In one case an assessment summary was undated. On admission a comprehensive assessment is carried out as part of the care planning process. On the evidence seen on this inspection the home is ensuring that it is able to meet the needs of most prospective residents before admission. The exception to this is people with dementia. The home’s own information (section C2 of the pre-inspection questionnaire) states that it has 15 people with dementia. While this inspection did not find residents whose needs were not met, the presence of so many residents with dementia in a home which is not registered to provide such care means that such potential can exist and now needs to be addressed by managers. This has implications for (among others) staff training, care planning, care delivery, systems for obtaining consent to care and treatment, and activity programmes. The home does not offer intermediate care. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has comprehensive processes for assessing residents’ needs. However, weaknesses in application can lead to some needs identified at assessment not being included in the care plan and not being referred to in daily reports. This may mean that some needs are not met and that progress is not effectively monitored or recorded. The home’s arrangements for the storage, control and administration of medicines are generally sound. However, weaknesses in recording the administration of controlled drugs may expose residents to risk and need to be addressed by the registered manager. EVIDENCE: A care plan is in place for each resident. Care plans are based on assessment of needs using pre-admission assessment information and the Fremantle assessment format. The quality of care plans examined varied. Care plans contain assessments of daily living activities, moving and handling, tissue viability, nutrition, and falls risk assessment. Plans were reviewed monthly – Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 12 the process being overseen by senior care staff. Some care plans had explanatory notes of a condition (e.g. Dementia) or part of the anatomy (e.g. the thyroid gland), which, while informative, seemed inappropriate in that section of the document. It is suggested that such notes be filed elsewhere in the care plan. The quality of daily entries varied and did not always relate to the care plan. These often brief entries focussed on eating, drinking and personal care provided. There were few entries relating to residents’ involvement in social activities or moods. It was noted in some cases that action plans were not implemented. For example, it was noted in one care plan: ‘GP to monitor blood pressure regularly. Senior staff to take blood pressure daily and record and inform Dr of any significant changes.’ However, the daily record did not have any references to monitoring the resident’s blood pressure. Otherwise the arrangements for dealing with residents’ health care appeared satisfactory. All residents were registered with a GP. A GP visited the home at least once a week. Staff facilitated access to other health care professionals including district nurses, chiropodist, dentist and optician as required. It was noted that one particular resident was on Warfarin treatment. The care plan did not include the action to be taken should the resident sustain injury or reference to food and drink that might interact adversely with Warfarin. It is acknowledged that only senior staff administer Warfarin and that the home has imposed an additional control by storing the medicine in the office cupboard. It would be advisable for all care staff however, to be aware of the potential for adverse interaction between some foods and Warfarin. Advice and information may be obtained from the pharmacy which supplies medication to the home. The medication administration record (MAR) sheets on the four units were examined. One gap was noted on a particular resident’s MAR sheet. Scribbled out entries were noted on some sheets. This is not good practice. It was noted that liquid bottles were sticky. It is recommended that such bottles be wiped after use with a damp cloth. Two bottles of eye drops in use were not dated. It was noted that the night medication trolley is located on the ground floor near to a door that leads into the garden and which is used by staff on occasions when having a break. It is recommended that the location of this trolley be reviewed. It was noted that staff were signing only the controlled drugs register when administering controlled medication and not also the MAR (Medicines Administration Record) sheet. There are two matters here – the controlled drugs register which accounts for the stock of a controlled drug (or a medicine which is treated as a controlled drug) and the MAR which accounts for the record of administration to a resident. This matter was discussed at the end of the first day and a difference of view emerged between the managers and the inspectors. The managers felt that the practice was safe and did not consider that a change in practice was required. Advice was subsequently sought from a CSCI pharmacy inspector who advised that in the interest of safety staff Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 13 should sign the MAR sheet as well as the controlled drugs register. If they don’t there is a risk that another member of staff may assume the dose has not been given and someone may end up with a double dose. It was noted that a single bottle of Olive oil (used to instil oil in some residents’ ears to soften wax) was being secondary dispensed (i.e. from a single large container to a number of smaller containers). The manager stated that the general practitioner had written a prescription for just one bottle to be dispensed and shared amongst all the residents who needed to have such drops. Pipettes were not provided to instil the drops. This was discussed at the end of the inspection and again agreement was not reached between the inspectors and the managers. Again advice was sought from the Commission pharmacist who advised that a proper dropper bottle, clearly named for the individual resident and dated, should be used. It should be discarded after one month. It was noted that the medication stock cupboard had been rearranged and a system to minimise over stocking of medication was in place Residents spoken to indicated that staff treated them with respect. Residents’ preferred term of address was recorded in their care plans. Staff were observed to interact appropriately with residents. All residents were appropriately dressed with attention to detail. A member of staff was observed complimenting a resident on her hairstyle - the resident had been to the hairdresser. Resident’s privacy and dignity is upheld. Medical examinations and treatments are carried out in residents’ bedrooms. The home provides a telephone for residents to make and receive calls. Residents can have their own personal telephone installed in their bedrooms if they wished. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Within the resources available the range and level of activities within the home is good. The appointment of an activities co-ordinator should ensure that the programme is kept under review and is adjusted to meet varying needs and improve the well-being of residents. Systems are in place for managing residents’ finances when required and to facilitate access to independent advocacy. This supports the expression of individual preference and the general well-being of residents. EVIDENCE: The home employs an activity co-ordinator for 15 hours a week. Activities include exercise sessions, bingo, quizzes, music, reminiscence, entertainers, and arts and crafts. Residents spoken to confirmed that they are able to choose whether or not they wish to participate in activities. Some residents spoken to enjoyed sitting in the garden and walking around the grounds. Others like to sit by the foyer observing people coming and going and chatting with each other. Some residents were looking forward to going to the local theatre. The manager stated that there are occasions when residents join those of another Fremantle home for tea and in return Winterton House invites the residents of that home to tea at a future date. Staff confirmed that Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 15 residents go on outings and that residents’ birthdays are celebrated. The home endeavours to meet a diverse range of needs. There are no restrictions on visiting. Residents confirmed that their visitors are made to feel welcome by staff and are offered tea and coffee. A minister from one of the local churches visits the home monthly and offers Holy Communion to those residents who wish to have it. An advocacy service is promoted in the home. Residents spoken to confirmed that they have regular meetings with an advocate from Age Concern who visits the home. The advocate collected residents comment cards in connection with this inspection. Residents are made aware that they can bring in personal possessions with them, the extent of which is agreed prior to admission. Personal items such as armchairs were seen in residents’ bedrooms. Residents spoken to said that staff enabled them to maintain their independence. Lunch was observed and appeared a pleasant and relaxed activity. Portion sizes were adequate and vegetables were served from separate dishes. The choices on offer were sausage plait, a choice of salads, boiled potatoes, carrots and beans. Dessert was lemon meringue pie or ice cream. Fresh fruit was available in all units. Those residents who needed assistance with feeding and prompting were offered staff assistance in a sensitive and discreet manner. Residents reported that lunch was always tasty and portion sizes good. Snacks and teas and coffees are available throughout the day. However, a little more attention to detail when serving coffee, tea and snacks is required. Residents were offered cups of tea or coffee without saucers. Staff were observed serving cakes to residents without using food tongs and biscuits were served direct from a tin. These practices could compromise standards of food hygiene. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home’s arrangements for managing complaints and compliments and for the protection of vulnerable adults are thorough. These ensure that complaints are properly investigated and that residents are protected through clear management procedures and staff training on the subject of abuse. EVIDENCE: The home conforms to Fremantle Trust policy and practice in respect of complaints. The registered manager said that Bucks Social Services are now requiring a ratio of three compliments to each complaint. Records of complaints and compliments are maintained and were made available for the inspection. The home actively promotes the Age Concern advocacy service and the advocate collected the residents comment cards for this inspection. All residents are registered to vote although the registered manager said that the list might need updating. Many residents use a postal vote but a lift can be arranged to the nearest polling station (near the library in Wendover centre) if required. The protection of vulnerable adults (POVA) is covered in induction, both at Fremantle office and in the home. The home conforms to Fremantle policy and liaises appropriately with other agencies, the deputy manager has done a ‘train the trainer’ course and will be running sessions for staff during the course of the year. A whistleblowing policy in place and discussed with staff on Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 17 induction. The telephone number of the confidential reporting system ‘Careline’ (0800 137915) is on the office notice board. Good systems are in place for managing residents monies. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is located in very pleasant grounds a short distance from Wendover village centre. This provides both a tranquil environment with interesting garden wildlife and the amenities of a large and busy village a relatively short distance away. The home is an older building and its physical environment continues to present challenges to managers. Weaknesses in maintaining an adequate supply of hot water to all areas of the building and numerous deficits in the environment compromise the safety and welfare of residents. EVIDENCE: Winterton House is set in very pleasant grounds within walking distance (by footpath) of Wendover village centre. There is limited space for car parking to the front and rear of the building. The home is about three quarters of a mile from Wendover rail station and about half a mile from the nearest bus stop. There is lift access to all levels. The original house was a large country house Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 19 which was extended in the 1960’s to provide 41 places in total. The environment in both the original and the newer wings of the home is now posing increasing challenges for managers. The outstanding problem at the time of this inspection was a variable supply of hot water to all areas of the home. The extent of the problem varied from no hot water in some outlets, a variable and unpredictable supply in many others, to a normal supply in a few areas. This situation had existed for about a week and the maintenance manager of the Fremantle Trust (who was in the home over both days) had engaged contractors to establish the cause of the problem and find a solution. The situation on the first day of the inspection was unacceptable and not only inconvenient for residents and staff but also compromised standards of hygiene and the health and welfare of all involved. The cause of the problem was thought to lie in old water pipes which distribute water around the home. Exploration of the problem ran in parallel with the inspection and by the end of the two days there was a significant improvement in the situation. Work continued over the following two weeks and the registered manager kept CSCI informed of progress. While the problems with the water supply formed a large part of the this section of the inspection other matters were also noted and the following maintenance and housekeeping issues were considered to require attention: • • Cupboards and drawers in Heron Firs and Squirrels kitchenettes require cleaning. Curtains in Firs and Heron units require re-hanging. The work surface in squirrel unit appears worn and should be considered for replacement. Lighting in many areas of the building requires cleaning to remove dead insects and cobwebs. The lampshades in ceiling lights need to be replaced. A broken window in the staff toilet needs to be fixed. Covers on waste paper bins in a number of areas need replacing. Where possible bins should be replaced with the foot pedal type in staff areas. It is accepted that some residents may lose balance when operating pedal controlled bins and that swing top bins are acceptable in those areas. Water staining on the ceiling in bathroom 103 need exploring and remedying Flaking paint on walls in areas of the building need rubbing down and repainting. Damp in areas of the building need remedying Chipped paintwork on bedroom doors and skirting boards need repainting A hole in bedroom door 199 needs filling in to maintain the privacy of the occupant The cleaning schedule in one bedroom on the first floor needs to be reviewed. If odour persists the carpet should be replaced. The laundry room was untidy. Dust was noted on the walls, floor and washing machines. It was noted that cleaning solutions were left in a DS0000023035.V290006.R01.S.doc Version 5.1 Page 20 • • • • • • • • Winterton House • bucket in the laundry room. Such solutions must be kept in a locked cupboard when not in use. Practices which compromise the control of infection were noted. Staff were observed carrying soiled and wet linen in their hands to the laundry room and were not always changing their gloves after contact with residents. Some staff were observed wearing gloves when walking with residents. The stock of white plastic aprons had run out on the first morning and blue aprons were being worn by staff pending the arrival of white aprons in the afternoon. Standards were not uniformly poor and many areas of the home were tidy, clean and hygienic. However, the challenges of this old building notwithstanding, the list above indicates that there is a need to pay more attention to the detail of staff practice with regard to the control of infection, general housekeeping, and maintenance to ensure that the environment is suitable for residents. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has an experienced senior staff team who benefit from the recruitment processes and training and development opportunities offered by the Trust. These ensure that there are appropriate safeguards in appointing new staff and that staff have the qualities and skills required to meet residents’ needs. EVIDENCE: At the time of this inspection the registered manager calculated, on the basis of the numbers and dependency levels of residents, that the home needs 588 hours of care worker time and that it provided 698 hours. This is supplemented by the input of one senior member of staff morning and evening who acts as the duty worker. These numbers are sufficient to maintain six care staff plus one duty worker in the morning and evening and three care staff at night. Care staff are supplemented by catering, domestic and laundry staff. The staff group is multi-cultural. Eight staff held NVQ qualifications (19 ) and eleven were pursuing NVQ’s at the time of this inspection. Staff recruitment is supported by the personnel department of the Fremantle Trust in Aylesbury. The files of five staff were examined. All had completed an application form, had two written references, an enhanced CRB certificate had been obtained for four staff and the fifth had been appointed under a POVA Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 22 first check and was working under supervision until the CRB certificate was received. Three files had good recent photos but two had photocopies of variable quality. All staff are given a copy of the GSCC codes of practice. The home does not employ volunteers directly. The induction and training of staff is organised by the Trust’s personnel and training department. The Trust runs a five day induction programme which covers the introduction of new staff to the Trust and basic training. This is supplemented by further training in the home. All staff have access to the Trust’s ongoing staff training programme which runs events throughout the year and includes NVQ training. It also includes mandatory training plus training on dementia, equal opportunities and challenging behaviour. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The registered manager and the senior staff team are qualified and experienced and are supported by the management systems of the Fremantle Trust in providing a service which meets the needs of residents. However, a failure to maintain an adequate supply of hot water, some staff practice with regard to the control of infection, and weaknesses in housekeeping and maintenance, potentially compromised the safety and welfare of residents. EVIDENCE: The registered manager is well qualified and experienced in the care of older people and is pursuing further training, including the NVQ4 in care, to maintain knowledge and skills. Over the last year this has included managing challenging behaviour, nutritional screening and medication. She is not responsible for any other registered service. The manager’s job description is appropriate to her present position and was reviewed at the most recent Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 24 appraisal in February 2006. Lines of accountability, both within and outside of the home are clear. The main planned quality assurance activity is the annual Fremantle Trust quality audit which is scheduled for the autumn of 2006. The home has a development plan which is developed in line with the Trust’s business planning processes and which was last completed in November 2005. A copy was made available for the inspection. The plan is comprehensive but was considered to lack detail in terms of the resources required to achieve the plans and objective measures of progress. Self-monitoring is considered a continuous process with the manager and deputy manager monitoring the quality of the service as they walk around the home. It is also a feature of key sessions (supervision). The manager feels that lifelong learning for older people is an individual matter. If residents express a wish to pursue something then the home will provide assistance where it can. The manager believes that NAPA (National Association for the Providers of Activities to Older People) can be a useful resource in this respect. Feedback from residents and visitors is obtained informally or through complaints and compliments (of which the home is required through its contract with Buckinghamshire Social Services to have a ratio of 3:1 compliments to complaints). Policies and procedures are reviewed by the Fremantle Trust head office. 29 ‘comment cards’ were returned by residents and their relatives in connection with this inspection. Of 21 resident respondents, 21 of 21 felt ‘well cared for’ and felt that their privacy was respected, 20 of 21 were satisfied with the food, 16 of 21 knew who to complain to, and, 13 of 21 felt that suitable activities were provided. Additional comments included “noisy – too much TV”, “more activities for people with a visual disability”, “meat too tough”, “would like a bath more often”, “more carers” and a wish for “an exercise bike”. Of 8 relative respondents, 8 of 8 were satisfied overall with the care provided (including 1 ‘very’ and 1 ‘mostly’), 2 of 8 had made a complaint, 7 of 8 were kept informed of matters by the home, and 7 of 8 thought that there were enough staff on duty. Additional comments included “favourably impressed with standards of cleanliness”, “it is very noticeable that [name given] has in recent weeks clearly regained a self esteem that [gender] has not had for many years. This is thanks to the caring staff at Winterton House, Wendover and the well managed social atmosphere of the home”, and one critical comment on the level of support offered to one resident regarding the management of a particular issue. With the respondent’s permission this was discussed with the registered manager. Overall there is a very good level of satisfaction with the care provided in Winterton House. There are good arrangements in place for the management of residents’ monies. These are required to conform to the financial procedures of the Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 25 Fremantle Trust and are managed by the registered manager and the home’s administrator. Written and computerised records of transactions are maintained. A system of staff supervision is in place – ‘key sessions’. Six staff files were examined. The picture appeared uneven but it seems clear that the home is endeavouring to resume regular supervision for all care staff. Management processes for the management of health & safety are comprehensive. Unfortunately on this inspection the problems with the hot water supply, a critical factor in a care home, particularly one for older people, dominated other health & safety matters because so many aspects of the service were potentially compromised. It could not be ignored. Three other weaknesses were the absence of a gas safety certificate, apparently because of a difference of opinion between contractors over a matter (the inspection took place in October 2005), the absence of a certificate of electrical safety (the inspection took place in April 2006 and the certificate was awaited), and the need to ensure that clinical waste bins are locked. All other health and safety matters – fire safety, first aid, lift, moving and handling, food hygiene, environmental health, COSHH, disposal of sharps, staff training, and checks on hoists – appeared satisfactory according to the home’s arrangements and records. One of the senior care staff has a lead role on health & safety matters. Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 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 X 2 2 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 2 Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? N0 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 Requirement The registered manager must ensure that medication with a shelf life once opened is dated when opened and first used. The registered manager must ensure that the administration of controlled drugs (or drugs treated as controlled drugs) is recorded in both the controlled drugs register and the resident’s MAR chart. The registered manager must ensure that all needs identified in the care plan are addressed and that records provide evidence of this. The registered manager must ensure that staff practice regarding the disposal of linen and other materials conforms to good practice in the control of infection The registered manager must ensure that the cleaning schedules for the home maintains good standards of cleanliness in all areas. The registered manager must DS0000023035.V290006.R01.S.doc Timescale for action 16/05/06 2 OP9 13 17/06/06 3 OP7 13 17/06/06 4 OP19 13 17/06/06 5 OP19 23 30/06/06 6 OP38 23 17/05/06 Page 28 Winterton House Version 5.1 7 OP38 13 ensure that a satisfactory supply of hot water is maintained in all areas of the home The registered manager must provide CSCI with copies of current certificates of safety for the home’s gas and electrical systems. 30/06/06 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 It is recommended that the registered manager establish systems which will ensure that care plans provide specific details on how needs are met and monitored. Care plans must be dated, signed, show evidence of service user involvement and evidence of review as needs change. It is recommended that the registered manager obtain appropriate individual bottles of ear drops for residents requiring such treatment. It is recommended that the registered ensure that the clinical waste bin has a secure lock It is recommended that waste bins without lids are replaced. The replacements should be of the pedal operated type wherever possible. It is recommended that the home’s development plan include the resources, timescales and measures of progress or achievement of objectives It is recommended that the home seek the advice of a pharmacist with regard to potentially adverse interactions between food and Warfarin and that such advice is incorporated in to the care plans for residents on the medicine. 2 3 4 5 6 OP9 OP38 OP38 OP38 OP9 Winterton House DS0000023035.V290006.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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