Inspection on 17/11/05 for Winterton House

This inspection was carried out on 17th November 2005.

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 10/09/07

Winterton House 22/03/07

Winterton House 16/05/06

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 Announced Inspection 17th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 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.V271618.R01.S.doc Version 5.0 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 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.V271618.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 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. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted by one inspector over two mid week days in November 2005. The inspection methodology consisted of a review with the registered manager of the progress the home was making in relation to the requirements and recommendations of the unannounced inspection conducted on 21 June 2005. The methodology also included discussions with residents and staff, examination of records, indirect observation of practice, consideration of comment cards returned in advance of the inspection, and a walk around the home and grounds. During the course of the second day of the inspection an environmental health officer made an unannounced visit to the home and the (CSCI) inspector briefly discussed the outcome of her inspection at the end. The home has recently updated its statement of purpose and service users guide. These are informative and well written documents. Pre-admission assessment processes are good. The home has comprehensive assessment methods on admission but these are less effective than they might be because of weaknesses in others elements of the care planning and recording system. These are being addressed by the registered manager and senior staff. The home has a key role in developing falls risk assessment and management processes and it is hoped that these will lead to changes in practice which will result in better management of this matter in this and other Fremantle homes. The home offers a varied activity programme but has not recently had an activities co-ordinator in post. This post has now been filled and the appointment of a new co-ordinator offers the home an opportunity to carry out a review of its activities programme once the Christmas festivities are behind it. Because of the age of the home the building is always likely to present a challenge to managers. The grounds are very pleasant and are much appreciated by residents. Much effort has gone into improving the interior of the home over the past couple of years and this work will need to be sustained in order to ensure that it remains a pleasant and safe home for residents. Staffing levels seem adequate and staff benefit from the Fremantle Trust’s training and development programme. Staff supervision complements other training and development activities and all care staff should be supervised six times a year at a minimum. An effective programme of supervision would support other initiatives that are addressing weaknesses in care planning. The registered manager, assistant manager and senior staff are all experienced. Feedback on the quality of the service from residents, relatives and professionals has been positive. Providing the matters identified on this Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 6 inspection are effectively addressed one can only conclude that this is a wellmanaged care home which is providing a valuable service to residents. The inspector would like to express thanks to residents, staff and managers for their time and hospitality during the course of this inspection, and to all of those who completed and returned comment cards. What the service does well: What has improved since the last inspection? What they could do better: Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 7 Continue to address weaknesses in care planning through audit, supervision and staff training and support. Ensure that all care staff receive supervision six times a year. 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.V271618.R01.S.doc Version 5.0 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.V271618.R01.S.doc Version 5.0 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): 1,2,3,4,5 Prospective residents and referrers are provided with sufficient information to help them decide if the home is likely to meet their needs. Some further amendments to current documentation are suggested in order to ensure full compliance with the standards. Processes for assessing prospective resident’s needs are thorough and should form a sound basis for the development of a plan of care to meet needs as well as ensuring the home does not admit a person whose needs it cannot meet. ‘Trial’ visits enable the resident and the home to more fully assess whether the home can meet the person’s needs in the longer term. EVIDENCE: A copy of the current version of the statement of purpose was provided. This is a well written, informative and well presented 15 page document. The document is written in a personal style by the manager. It includes the information required under Schedule 1 of Regulation 4(1)(c). It is due for review in April 2006 and the registered manager should then amend references to ‘National Care Standard’ in page 4 to the Commission for Social Care Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 10 Inspection (as on page 12) and consider inserting a heading at the end of the section on ‘Objectives’. A copy of the current version of the service user guide was provided. This is similarly clearly written and is a useful and practical reference for residents. As a separate document from the statement of purpose it does not fully meet the requirement of standard 1.2 and Regulation 5 (1) (a)-(f). The reference to advocacy on page 11 advises the resident to ask their key worker, manager or ‘…any social worker’. It would be helpful if contact details for advocacy were included in the booklet or the reader referred to where that information might be acquired (such as on a notice board) without having to ask a member of staff. The reference to ‘spiritual services’ on page 18 includes an illustration which might be viewed as a symbol of one particular religion. In a multi-faith society it might be better if this was omitted or a neutral symbol substituted. Reference to places of worship is limited to the telephone numbers of the local Church of England and Roman Catholic Churches. When next reviewing the document the registered manager may wish to include contact details (including location where not in Wendover) of other places of worship. The list of local contacts includes the number of one local public house. It isn’t clear why this particular establishment has been selected. The home’s ‘Resident’s Contract’ is a standard Fremantle Contract and the home is not authorised to make changes. The document supplied for this inspection has two pages and was reviewed in January 2003. It does not include details of the resident’s room, does not say what service is covered by the fees and does not say for what services an additional fee is required. It does include a statement that the Fremantle Trust will operate in accordance with the Care Standards Act 2000 and associated Regulations. The pathways to admission are either direct contact with the home for someone who is self-funding or through social services care management arrangements via a ‘central resource team’. Either pathway will lead to an assessment of the prospective resident’s needs by an experienced member of staff. The home is not registered to accept individuals who have been diagnosed as suffering from dementia. The assessment is structured by a five page form which covers ‘Daily Living Assessment’, ‘Health Assessment’, ‘Mobility’, ‘Relationships/Personal Values’ and ‘Lifestyle/Future Plans’. The outcome of the assessment can lead to acceptance to a place in the home, refusal or deferral pending further consideration. Where a referral is accepted the prospective resident is invited to view the home and to have tea, coffee or lunch. A date of admission may be agreed at that point. A further assessment is carried out on admission and a plan of care drawn up by a key worker. Registered nursing input is provided through NHS community services (usually via the GP practice). Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 11 The assessment process is designed to ensure that the home does not admit someone whose needs it cannot meet. The final decision is that of the registered manager. Staff skills to meet residents needs are acquired through training and experience. ‘Trial visits’ are a routine aspect of all admissions and progress is reviewed after four weeks. The home has provision for emergency admissions which include a review within 72 hours with all parties involved (ref. Service User Guide, page 10). The home does not provide intermediate care. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 12 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): 7,8,9,10 & 11 The home has comprehensive processes for assessing residents’ needs. However, weaknesses in the application of care planning can lead to some needs identified at assessment not being included in the care plan and not being referred to in daily reports. This can mean that some resident’s needs are not met and that progress is not monitored or recorded. The home is developing its systems for falls risk assessment and management. This should lead to better care for older people who are susceptible to falls and a reduction in injury through better management which carried out in partnership with health professionals. The home is changing its provider of medicines, which, with changes in systems, provides it with an opportunity to review practice, correct weaknesses and ensure that it is providing the best service it can offer to residents. EVIDENCE: Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 13 A plan of care is in place for each resident. Care plans include assessments, a summary care plan, a night care plan (a good innovation), a moving and handling plan, healthcare interventions, and daily reports. There are assessments of daily living activities (e.g. communication, dressing, continence, memory, mobility), moving & handling, tissue viability, nutrition, and in some care plans, falls assessment. The overall system is comprehensive. The home is leading work within the Trust on falls risk assessment and management. This work offers opportunities to improve practice across the Fremantle Trust. It does however involve additional monitoring and reporting of falls and it is important that the potential benefits of this are recognised. Four care plans were examined. All had the sections outlined above but the quality of entries varied. The assessment sections were generally well completed but the results were not always carried through to the summary care plan. Some moving and handling assessments in particular were well completed. There were few references to the care plan in the daily record. Some daily entries were very brief. It is felt that one reason for this is that staff tend to write up their notes at the end of their shift when they are under pressure of time. In some care plans, problems noted at assessment were not carried forward to the care plan. This included, according to the assessment, a person who had been diagnosed as suffering from cancer but who was refusing treatment. There was no item on the plan of care in relation to this. On another subject, an inaccuracy on Section 117 of the Mental Health Act 1983 was noted. While this is not a nursing home the nature of the misunderstanding (that s117 ‘enables compulsory placement for aftercare involving social services…’ (it does not; it places a duty on health and social services to arrange aftercare)) could have implications for the resident and it is important that this is corrected. In the case of another resident the summary care plan had ticked ‘action required’ against mental health problems but the health section stated ‘no reports of “mental problems”. Care plans are reviewed monthly. The overall standard of care planning on this inspection was variable. This was discussed with the registered manager. The subject is being addressed by senior staff but is taking time to change and improve. It is acknowledged that this is a complex subject which will need to be addressed through supervision, training and audit. Arrangements for dealing with residents healthcare appear satisfactory. All residents are registered with a general practitioner. The GP visits the home weekly to deal with routine matters. District nurses attend as required. Access to dentists, opticians and chiropodists is arranged either through professionals who are in regular contact with the home or by private arrangement. Other NHS services are usually accessed through the GP. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 14 Assessment for tissue viability, continence and falls form part of the care planning assessment process. According to information supplied by the home in advance of the inspection two residents had pressure sores. The arrangements for the supply of medicines were changing at the time of the inspection. The Trust had established a contract with Boots chemists and some minor changes in systems were likely once all the arrangements were in place a day or two after the inspection. The home is required to conform to Fremantle Trust policy and procedure for the administration of medicines. Staff are required to complete an ‘Induction Check List’ prior to administering medication. This includes acquiring information, familiarisation with systems, supervised practice and a test of competence which is signed off by a senior care worker. This in-house training is supplemented by a distance learning course, training at the Trust’s head office in Aylesbury, and now training by Boots. Copies of signatures of approved staff are maintained. Medicines are prescribed by the GP and are delivered by Boots (who also collect any surplus medicines to be returned). Medicines in one of the ‘lounges’ were checked. Arrangements for the storage of medicines are satisfactory – in a cupboard, trolley and drugs fridge (where required). Verbal instructions are recorded in a book as well as the MARS (‘Medicines Administration Records’) sheet and countersigned by the GP on his or her next visit. Arrangements for the storage and control of Temazepam are satisfactory and stock and administration records were in order. Some housekeeping issues were noted – the date of opening a tube of cream was not recorded, gloves had been left in the medicines trolley, an out of date tube of cream was stored in the fridge and the home was holding a stock of a product which it no longer required. Personal care is carried out in resident’s bedrooms or bathrooms. Consultation and examinations are carried out in resident’s bedrooms. Staff knock on bedroom doors before entering. The home has a policy governing the care of residents who are dying. Resident’s wishes are ascertained on admission – with the exception of those who are temporary residents. The person’s family and friends can visit and stay for as long as desired. Palliative care is accessed through the person’s GP and specialist nurses. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The current range and level of activities within the home is variable. The imminent appointment of an activities co-ordinator should enable staff to review the programme with residents and provide a wider range to meet varying needs and improve the well-being of residents. Systems are in place for helping residents to manage their finances, to access independent advocacy and to allow them to bring personal possessions in to the home. This supports independence, the expression of individual preference and the emotional well-being of residents. EVIDENCE: The home had recently appointed a new activities co-ordinator to work 15 hours a week. The person appointed had not yet taken up post. This is a key post for the home and it is expected to support the development of a coordinated and varied programme of activities in the new year. Activities taking place around the period of this inspection included bingo, dominoes, crafts, exercise sessions (conducted by the registered manager), outings to places of interest and some entertainment taking place in the home. Some individual expressed a wish for a wider range of activity. Mixed views were expressed about daytime television: some residents finding the background noise irritating while others wanted to see programmes. A view was also put forward Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 16 that having the televisions on throughout the day limited informal interaction between staff and residents. Resident’s may see visitors in private if they wish. A number visitors were observed dropping in to the home over the two days of this inspection. The home’s policy on visitors is set out in page 12 of the service user guide (April 2006 version). The ‘Service Users Charter’ states that residents have ‘The right to handle your own affairs or to choose who does this on your behalf if you can’ (should this be ‘can’t’?). According to information supplied by the home in its preinspection questionnaire no residents did manage their own financial affairs at the time of this inspection. The service users guide has a helpful section on financial matters (pages 22 – 28). Residents may bring personal possessions into the home by agreement with the registered manager. Residents in the rooms seen had brought furniture, photographs and other items to personalise their room. The service users guide includes reference to advocacy (page 11). It advises the reader to ‘Please ask your key worker, the manager or any social worker’. It would be helpful if, in addition, it stated where contact details of the advocacy service can be found without having to ask a member of staff. The telephone number is not included in the ‘Useful Local Contacts’ on page 21 of the guide. Residents may have access to their records although this is not stated in the ‘Service Users Charter’ or elsewhere in the service users guide. Meals are provided in accordance with a four week rolling menu. The chef manager said that meals are freshly prepared using food supplied by a local butcher and greengrocer. Breakfast is served from 08.00 hours, lunch from 12.45 hours and evening tea from 17.30 hours. Coffee is served mid-morning and tea mid-afternoon. Snacks and drinks are available at other times as desired. Residents expressed satisfaction with meals provided. Beer, sherry or wine is available on request. The lunch taken with residents on this inspection was a pleasant and relaxed event. Portion sizes were good and vegetables were served from separate dishes on the table. Residents were pleased with the meal. Assistance is provided by staff as required. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 17 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): The home’s arrangements for managing complaints and compliments and for the protection of vulnerable adults are thorough. These ensure that dissatisfaction expressed by a resident is properly investigated by the registered manager, and that residents are protected through clear management procedures and staff training on the subject of abuse. EVIDENCE: The home is required to conform to the policy and procedure of the Fremantle Trust. The policy was last reviewed in 2002. The policy is publicised to residents through ‘Fremantle Feedback’ which invites residents and other to communicate to managers their satisfaction or dissatisfaction with the service. The home has a comments book on display in the foyer. One complimentary entry by an external professional included the name of a resident who was the subject of a case review. This potentially compromises the confidentiality of the resident. In order to maintain confidentiality it is recommended that the registered manager ask such professionals to omit the residents name when entering comments. The registered manager said that most residents are registered to vote. Some out of area residents are not yet registered. The most convenient voting station is the memorial hall in Wendover. The home conforms to the Fremantle Trust policy and practice with regard to the protection of vulnerable adults and abuse (POVA). The Trust provides training on POVA at a basic and update level. The policy is available to staff Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 18 and residents in the ‘Care Manual’. The home does not appoint care staff before it receives a copy of the person’s enhanced CRB check. The Trust has a policy on challenging behaviour and training is available for staff if required. The arrangements for dealing with residents’ monies appear satisfactory. Policy and procedures are in place and monies are mainly managed by the administrator or registered manager. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 19 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, 20, 21, 22, 23, 24. 25 & 26 The home is located in very pleasant grounds a short distance from Wendover village centre. This has the potential to improve the quality of life of residents by providing both a tranquil environment with interesting garden wildlife combined with the amenities of a large and busy village a relatively short distance away. The home is an older building and its physical environment will continue to present challenges to managers. It requires an ongoing and active programme of maintenance and refurbishment if it is to provide a pleasant, comfortable and safe environment for residents. EVIDENCE: The home is located in very pleasant grounds a short distance from the centre of Wendover. There is limited space for car parking to the front and rear of the house. It is about three quarters of a mile from Wendover rail station and about half a mile from the nearest bus stop. Because of the sloping nature of the site the grounds are tiered and the home is located on three levels. There Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 20 is lift access to all levels. The original house was a large country house which was extended in the 1960’s to provide 41 places in total. The environment is a bit frayed in places but the home has maintained an ongoing programme of redecoration in recent years. On this inspection most areas of the home were tidy, clean, bright and quite well decorated. The ground floor corridor which is a bit dark in comparison areas is due for redecoration in 2006. The edges of the kitchen units in Firs and Heron are frayed and could do with replacing. Heron lounge is due to be redecorated before the end of March 2006. There is pressure on storage space. The home complies with local environmental health (an unannounced inspection of which coincided with this inspection) and fire authority requirements. In one area (near the laundry room) it appeared that the supply of power to an exterior facility was through a three pin domestic socket on an interior wall. It would be advisable to obtain the opinion of a qualified electrician on the safety aspects of this arrangement. The home is organised around four groups of 12, 15, 7 and 7 places respectively. Each group has its own lounge and dining area. The two larger groups have their own kitchenettes while the two smaller groups share a kitchenette. The wall in Heron lounge had a damp patch which was due to be treated. There is seating for around eight people in the foyer and this area seems a popular place for people to sit and watch life go by. There is plenty of outdoor space with seating. One of the bedrooms has en-suite facilities. The number of bathrooms and wc’s has not changed since earlier inspections i.e. five bathrooms and fourteen wc’s throughout the building. The home has a range of aids to assist resident’s in bathrooms and wc’s including a Parker bath, manual hoists, overhead hoists, and support rails. Fir’s wc has been modified during the autumn of 2005 and is now said to be wheelchair accessible. Bedrooms vary in size and outlook. The décor in those inspected was in good order and the rooms had been pleasantly personalised by the residents. Natural lighting varies throughout the building. The temperature of the hot water is regulated and tested. At the time of this inspection some variation in water temperature was being experienced in some areas and contractors were to be asked to investigate and rectify this. All areas of the home were tidy, clean and free of offensive odours. The laundry has three washing machines and two tumble driers. The room was tidy, clean and well organised. The laundry is carried out by care staff. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 21 Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 22 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 & 30 The home has an experienced senior staff team who benefit from the recruitment processes and training and development opportunities offered by the Trust. These aim to ensure that there are appropriate safeguards around the appointment of new staff to protect residents, and that staff have the qualities and skills required to meet residents needs. EVIDENCE: A copy of the duty rota was supplied for the inspection. The present staff establishment funds six care staff and one duty senior in the morning, six care staff and one duty senior in the afternoon and evening and two care staff and one senior at night. These numbers do not include the registered manager. In addition to care staff the home also employs a part-time activities coordinator, administrative, catering and domestic staff. A number of part-time care worker posts were vacant at the time of this inspection. The home has used a number of agencies for the supply of care staff in recent years. Agencies provide variable information on the training received by staff. All provide confirmation of CRB check, the level and the CRB reference number. The home is “working towards” attaining the standard of 50 of care staff being qualified to NVQ2 and hopes to have achieved this by the end of the current financial year in March 2006. The Fremantle Trust provides ongoing support to staff undertaking NVQ qualifications. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 23 The files of four recently appointed staff were examined. All had a completed application form, an enhanced CRB certificate obtained before taking up post, two references, interview notes, a photograph of the person, and a medical report. The reference request form does not have space for the date the reference was either supplied or received. However, rectifying this omission is not entirely within the control of the home although a ‘received on [date]’ stamp would be helpful for recording the date on which the reference was received in the home. New staff are provided with a copy of the GSCC codes of practice. Staff are provided with statement of terms and conditions of service. Staff benefit from a good internal training programme provided by the Fremantle Trust. New care staff follow the TOPSS (now ‘Skills for Care’) induction programme. This is supplemented by the home’s own ‘Induction Experience Checklist’ which covers a range of practical care activities. Moving & Handling and basic food hygiene training is provided by the home. POVA training is provided by the Trust. Training records are in place and the home would appear to meet standard 30.4 for care staff to receive three paid days training per year. Staff communicated a favourable impression of the home. It was described as a caring place where residents are well cared for. Staff are friendly and the manager supportive. It was suggested that the level and range of activities could be improved. Staff had knowledge of the homes abuse procedures but not of the ‘Careline’ reporting system. The opportunities for training and development which the Trust provides was acknowledged. The recent appointment of an assistant manager and the imminent appointment of an activities co-ordinator should present opportunities to improve areas of practice where these have been identified. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 24 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): 31,32,33,34,35,36,37,38 The registered manager and the senior staff team are qualified and experienced and are supported by the management systems of the Fremantle Trust. This aims to ensure that residents receive care in a safe and well managed environment. EVIDENCE: The registered manager is well qualified and experienced for the position. She has recently acquired Registered Managers Award (NVQ4), is an NVQ assessor and a ROSPA (Royal Society for the Prevention of Accidents) accredited trainer in moving and handling. She is not responsible for any other registered service. The registered manager undertakes periodic training to maintain her skills. Over the past eighteen months this training has included falls risk assessment, infection control, stoma care and medication. The deputy manager and team leaders currently in post are all very experienced in care Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 25 services. Job descriptions are reviewed at annual appraisal. Lines of accountability, both within the home and within the larger organisation are well defined. The registered manager, in discussing the ethos of the home, said that in some senses it aims to be an extension of the resident’s family by providing good quality care and support. Residents whom the inspector met spoke warmly of the care they received. The registered manager said that staff training, meetings and supervision provide opportunities for managers and staff to discuss the ethos and direction of the home. The Fremantle Trust has a policy on equal opportunities. All staff are given a copy of the GSCC codes of practice and the registered manager believes that she and the Trust conform to the codes. A major quality assurance activity in the home is the annual Fremantle Trust quality assurance audit which is carried out by a manager and a senior manager from another area. This had been carried out in March 2005 and the manager said that a copy of the report had been sent to the Aylesbury office of CSCI. The exercise includes audit of documents and of obtaining the views of residents and other stakeholders. The home development plan is integrated with the organisation’s business planning cycle. A draft plan for 2006/07 should be available towards the end of 2005. The manager meets the service manager monthly. Policies and procedures are reviewed by Fremantle Trust. The manager said that she has endeavoured to meet CSCI requirements and recommendations within the stated timescale. 26 comment cards were returned by residents, relatives and professionals – a very good response. Some of those returned by residents had been completed on their behalf because they were unable to do so themselves. This does not invalidate the content but is an important point to note in such surveys. Two cards had been submitted on behalf of one resident. Resident respondents liked living in the home and felt well cared for. They expressed satisfaction with the food. They knew who to complain to and felt safe living there. Additional comments included: ‘Nice building. Good outlook’’ ‘[Name] feels he couldn’t have been looked after better (his own words)’ ‘I’m quite happy’. ‘I can’t speak highly enough of the helpers – all of them’. ‘Noise at night can be unsettling for other residents’. On the subject of noise, during the course of the inspection one resident said that the noise from the TV in a nearby lounge was irritating and made it difficult to hear people talking. Relative respondents again expressed satisfaction with the home. All found it welcoming, were able to see the resident in private, are kept informed of important matters and were satisfied with the overall care provided (in one case the words ‘very much’ were added). The majority were aware of the home’s complaints procedure. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 26 Professional respondents were also satisfied with the home. Communications were reported to be good, there was always a senior member of staff on duty, care plans are followed and reviewed, and none had received complaints about the home. Additional comments included: ‘The care provided at Winterton is excellent. The staff are bright and very caring. Each person/resident is treated with the utmost care and respect’. ‘Excellent care of clients – permanent and temporary. Well aware of routine and emergency medical problems and deal with them appropriately’. ‘I find the staff are very supportive and tuned in to clients needs. They are also very flexible and helpful. The manager is great in multidisciplinary working’. Overall, therefore, from the comments received, the home is performing well and there is a high level of satisfaction among a range of stakeholders with the quality of the service provided. The manager is a budget holder and is responsible for complying with the Trust’s financial policies and procedures. A valid insurance certificate was on display. The home has a computer link to the Fremantle Trust finance department. Two administrators demonstrated the system for managing residents monies. Procedures include recording transactions on computer and on paper. The home is online to the finance department at Trust head office. The home has facilities for the secure storage of cash and records. Procedures include safe storage, limited access, checks on cash balances, computer and paper transactions and summary returns to the finance department. A sample residents cash balance was checked and found satisfactory. Supervision is established in the Fremantle Trust. The manager is endeavouring to ensure that supervision (‘key sessions’) is carried out monthly. This is currently being achieved for senior staff but attaining that standard - or ensuring the minimum standard of six times a year - for all staff is not being regularly achieved at present. Summary notes are taken. Supervision records are retained in staff folders which also include the job description, person specification, induction notes, the objectives of the home, a development review, and records of training. The home has a system for tracking supervision. Provision for the security of records appears sufficient and records examined during the inspection were in good order and up to date. Arrangements for the security of financial information retained on computer appears adequate. Health and safety practice is governed by the Fremantle Trust health and safety policy. One of the group care co-ordinators has a lead role for health & safety. Hoists and Parker baths are available for residents requiring assistance. Training in the home is supplemented by training provided by the Trust at its head office in Aylesbury. Training is subject based (e.g. COSHH, moving & handling etc.). The registered manager is an approved moving & handling trainer. The chef is an approved trainer for food hygiene. An environmental Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 27 health officer carried out an unannounced inspection during the course of this inspection. A report will be provided to the registered manager but overall the officer appeared satisfied with the home’s standards of practice. The home’s induction programme addresses initial training in moving & handling, basic food hygiene, fire safety and infection control. The Trust maintains an ongoing programme for updating knowledge and skills in mandatory subjects. The manager and home lead for health & safety do a visual check of portable electrical appliances. A contractor carries out an electrical safety check (PAT) of such appliances annually. A report is provided but was not available at the time of the inspection. A check of the home’s electrical wiring is next due in January 2006. The temperature of hot water outlets and of the surface temperature of radiators is checked monthly and records maintained. The home does not have any showers. Window restrictors are in place on floors above ground level. Staff ensure that windows on the ground floor are checked and secured at night and the registered manager said that the subject has been discussed with the crime prevention officer. The Trust has a contract for the disposal of clinical waste. Hoists and Parker baths are checked twice a year by contractors. The lift is checked monthly by the contractor. A certificate of lift safety dated 30 June 2005 was on file. Generic risk assessments are carried out annually. It was not clear from the documentation viewed how action identified on such exercises is recorded. The home maintains an accident book and reporting forms. The home maintains good practice in reporting to CSCI under Regulation 37. The home was last inspected by the fire service in October 2005 and everything was found to be in order. Fire training was carried out in August 2005 and is repeated two yearly. The home is divided into seven zones for fire purposes. A fire alarm point is checked weekly. Emergency lights are checked weekly. The fire alarm system and fire extinguishers were last checked by contractors in July 2005. Fire risk assessments were carried out by the manager and health & safety leaf in July 2005. Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 3 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 3 3 3 3 3 2 3 3 Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 29 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered manager must ensure that service user needs identified at assessment are incorporated into the service users plan. The registered manager must 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. 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 all medication cupboards are kept tidy and organised and a system put in place to dispose of out of date medicines on a regular basis. The registered manager, in consultation with residents, staff and others as appropriate, must undertake a thorough review of the home’s activity programme to ensure that it meets the DS0000023035.V271618.R01.S.doc Timescale for action 31/01/06 2 OP7 15 31/01/06 3 OP9 13 31/12/05 4 OP9 13 31/12/05 5 OP12 16(m)(n) 28/02/06 Winterton House Version 5.0 Page 30 6 OP25 13 (4) needs of residents. The registered manager must obtain the opinion of a qualified electrician on the safety of the power supply (near the laundry) apparently to an external facility 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP29 OP1 OP36 Good Practice Recommendations The reference request form should be updated to include the date of the reference or stamp dated on receipt of a reference. The registered manager should ensure that the service user’s guide complies with standard 1.2 G The registered manager should ensure that all care staff receive supervision six times a year Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Winterton House DS0000023035.V271618.R01.S.doc Version 5.0 Page 32 - 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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