Inspection on 24/01/06 for Winterton House

This inspection was carried out on 24th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Winterton House 28/10/08

Winterton House 08/01/08

Winterton House 18/09/06

Winterton House 09/08/05

Winterton House 17/02/05

Winterton House 17/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Winterton House 5 Epping New Road Buckhurst Hill Essex IG9 5JB Lead Inspector Ms Gwen Lording Unannounced Inspection 24th January 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 DS0000025935.V280084.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 DS0000025935.V280084.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Winterton House Address 5 Epping New Road Buckhurst Hill Essex IG9 5JB 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) 020 8504 1183 020 8559 0818 Ms Jaya Ramjibhai Hira Ms Jaya Ramjibhai Hira Care Home 9 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (9) of places Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Both categories to be used flexibly between the 9 beds. Date of last inspection 9th August 2005 Brief Description of the Service: Winterton House is a care home registered to provide personal care and accommodation for nine older people, some of who may have dementia type illnesses. All bedrooms are single without en suite, but there are sufficient separate toilets and bathrooms. Three bedrooms are situated on the ground floor and the remainder on the first floor. As the home does not have a passenger lift any residents who are accommodated in an upstairs bedroom must be mobile and able to climb the stairs. The large detached house is situated in its own grounds with a large secluded garden. The home has its own transport (mini bus) and designated driver to take residents out. The proprietor is also the registered manager. She holds registered nursing qualifications in both general and mental health nursing. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 10am. It took place over five hours during the late morning and afternoon. Discussion took place with the proprietor, who is also the registered manager; and several members of care staff. The Inspector spoke to several residents in the lounge and one resident who was in his room. In addition a visiting health care professional from the District Nursing Service was also spoken to and asked her views and comments about the care in the home. The home was registered to accommodate people with dementia last September (2005). There is currently only one resident accommodated within this category. A tour of the home was made and a number of care and staff records were looked at. An Immediate Requirement Notice was issued for action to be taken concerning the availability of records relating to fire tests and fire training for staff. The proprietor /registered manager has had a recent bereavement which has impacted upon some aspects of administration within the home, but which do not affect the residents. This was the second statutory inspection visit in the inspection programme for 2005/2006. Over the course of the two visits, all key standards have been assessed. The Inspector would like to thank the manager, residents and staff for their input during the inspection. What the service does well: Those residents who were able to express a view, were very happy with the care they were receiving in the home. During the inspection staff were seen to be providing good personal care and all residents appeared well groomed. There is a very relaxed atmosphere in the home and residents appear unhurried and are given sufficient time and support in their everyday activities. The meals in the home are well-presented and individual preferences and specialist dietary needs are catered for. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Appropriate pre-admission assessments are carried out for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and four files were examined. All records inspected have assessment information recorded and the information had been used to continue assessment following admission to the home and develop written care plans. The records showed that residents, where capable and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing/ funding authority was also on file. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, and 10 Residents’ health, personal care and social care needs are set out in individual care plans but not all care plans accurately reflected the current needs and did not provide staff with sufficient information to ensure that care needs were being met on a daily basis. There are clear medication policies and procedures for staff to follow. However, there are some inconsistencies in the recording of medication, which may result in unsafe practices. Residents are treated with respect and the arrangements for their personal care ensure that their right to privacy is upheld. EVIDENCE: Individual care plans were available for each resident and the records of four residents, including one resident recently admitted, were examined. However, there were some inconsistencies in the practice and standard of care plans and the following was discussed with the manager: Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 10 • Although there was evidence that care plans were reviewed monthly, there was limited evidence on some care plans that reviews were meaningful as they did not always reflect changes to the care required or detail the progress of the individual. For example, one resident’s care plan indicated that he self medicated and emptied his own catheter drainage bag. However, through discussion with the manager and entries in daily records it was evident that the resident’s dependency level had increased and he was no longer able to manage these tasks by himself. The care plan had not been reviewed and updated accordingly to reflect these changes. On examination of the care plan of a resident recently admitted to the home it was noted that the care plan had only been partly completed. • All the care plans examined indicated that residents are seen by other health care professionals such as chiropodists, opticians, specialist nurses and doctors. The Inspector was able to meet briefly with a visiting phlebotomist from the District Nursing Service who was visiting the home. She commented that she: “Visits the home regularly and that staff are kind and respectful to residents and very helpful to her. Residents are looked after well” An audit was undertaken of the management of medications within the home. The following issues were noted and discussed with the manager: • Handwritten entries on Medication Administration Record (MAR) charts must be signed and dated by the person making the entry. The entry must also include the source of the information i.e. GP, relative. An omission was noted for the recording of insulin, as prescribed on the MAR chart. • Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to respect an individual’s dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. Residents spoken to said that all staff were respectful and thoughtful when attending to their personal care. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 11 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): Standards 12, 13, 14 and 15 There is a varied but limited programme of activities available and the lifestyle within the home matches the expectations and preferences of individual residents. More consideration needs to be given to planning individual and small group activities which are suitable for those residents with specialist needs such as dementia to ensure that all residents have a sufficiently stimulating and varied choice of activities. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. The meals in the home are well presented and offer both choice and variety for residents living in the home. EVIDENCE: The home does not have an activity organiser and care staff have responsibility for undertaking activities inside and outside the home. There is a general programme of activities for the home but this is not structured. However, some residents were seen to be pursuing their own interests for example, reading, doing crosswords and puzzles, knitting, Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 12 listening to music. One resident regularly enjoys visits to the local shops to do personal shopping home and another resident regularly visits home. More consideration needs to be given to the specialist needs of people living with dementia. For example, individual activities focusing on the individual’s needs and level of functioning, and adapting activities to have some relevance to the individual’s likes, interests and preferences, past and present. There is a no designated cook and care staff have responsibility for the preparation and cooking of meals. The manager prepares culturally appropriate meals for a resident of the Muslim faith. Meals are served in the dining room, which has been re-decorated and fitted with new dining furniture since the last inspection. Residents may also choose to eat in their rooms. Those residents spoken to who were able to express a view said that they enjoyed the food and that there was always a good choice. The lunchtime meal was being served during the inspection and was seen to be well presented and a choice was offered. Visiting times are flexible and residents are able to receive visitors in the lounge or in their own rooms. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 13 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): Standard 16 and 18 The home’s complaint policy/ procedure provides residents and their relatives with the appropriate information to ensure that their complaints are dealt with promptly, effectively and to their satisfaction. However, not all of the residents would be able to use a formal, written process. Staff working in the home have received training in Adult Protection/ Abuse Awareness to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure and records the nature of the complaint, details of investigation and any action taken. However, some of the residents would not have the capacity to use a formal, written process. At the last inspection a requirement was made for the complaints policy to be produced in an alternative format so that it is more appropriate and easily accessible and understood by people living with dementia. This requirement is outstanding and must be complied with by the new timescale. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. All staff currently in post have undertaken training in Adult Protection/ Abuse Awareness and this forms part of the induction programme for all newly recruited staff. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 14 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): Standards 19 and 26 Generally the standard of the environment within the home provides residents with an attractive, safe and comfortable place in which to live. The environment has improved considerably since the last inspection in meeting the needs of people living with dementia. EVIDENCE: The standard of the décor, furnishings and fittings are generally being maintained to a good standard. Since the last inspection all communal areas of the home have been re-decorated and the kitchen has been completely refurbished. The dining room has also been re-decorated and new dining furniture purchased. New carpet has been fitted to the hall and stairs. The ongoing programme of refurbishment and re-decoration of the home continues. The rear garden has been tidied, debris removed and concreted to one side. All areas of the home visited were clean, tidy and free from odour throughout. A routine visit was made to the home on 19/01/06 by the Public Protection Department. They undertook an environmental health inspection of the kitchen Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 15 premises and the report stated: “New kitchen installed November 05. Very clean and good standards”. Following consultation with the fire safety officer additional fire exits have been alarmed and the rear garden has been secured by the use of a fence on one side and a gate at the other side. (See also comments in Management and Administration) Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 16 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): Standards 27, 29 and 30 Daytime staffing levels are satisfactory and there is sufficient staff on duty to meet the individual assessed needs of the residents. However, the nighttime staffing levels must be reviewed to ensure that they are appropriate to meet the needs of all residents. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: The home has a small but relatively stable workforce and in discussion with staff it was evident that they fully support the main aims and values of the home. There is currently only one resident accommodated within the category of dementia. However, the proprietor/ registered manager must be able to demonstrate that night time staffing levels have been reviewed and are appropriate to meet the needs of all residents, in compliance with the requirement made at the previous inspection. At the previous inspection a requirement was made for all staff working in the home to receive comprehensive and certificated training in caring for people living with dementia. The proprietor/ registered manager has undertaken a training course in “Training and Development Skills for Dementia”. Though care staff have all received a half-day dementia awareness the comprehensive Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 17 training has not yet been undertaken. This is an unmet requirement from the previous inspection and must be complied with by the new timescale. No new staff have been employed since a previous inspection in February 2005. However, at that time all the necessary recruitment checks were being undertaken to ensure the protection of residents. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 18 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): Standards 31, 33, 35 and 38. The manager of the home is a well-qualified and experienced person. However, the manager must ensure that resident’s best interests are safeguarded by the home’s record keeping. EVIDENCE: The proprietor is also the registered manager. She is a registered nurse with qualifications in both general and mental health nursing. She has the relevant clinical and management qualifications and a good understanding of the care needs of people living with dementia. A wide range of records were looked at, including fire safety, recording of water temperatures, portable appliance testing and accidents and incidents. A number of these records were not available for inspection or not up to date. The following issues of concern were discussed with the proprietor/ registered manager: Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 19 • • Records as required by regulation to show that regular testing of fire alarms was taking place, were not available for inspection. Records as required by regulation to show that staff had received fire training at regular intervals, were not available for inspection. An Immediate Requirement Notice was issued for action to be taken concerning the availability of records relating to fire tests and fire training for staff. • • The Portable Appliance Testing (PAT) certificate was out of date and must be reviewed. All hot water outlets must be tested regularly and adjusted accordingly to ensure safe water temperatures are maintained. The general management of records required by regulation and for the efficient and effective running of the home were not being maintained in good order. The proprietor/ registered manager has had a recent bereavement which has impacted upon some aspects of administration within the home, but which do not affect the residents. The proprietor/ registered manager does not have responsibility for any resident’s financial affairs or management of their personal allowances. Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 3 X 1 1 Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP7OP8 Regulation 15 Requirement More comprehensive care planning is required to ensure that staff identify and meet the specialist care needs of residents with dementia. (Timescale of 30/11/05 not met) The home must provide a more varied programme of activities for those residents with a specialist need such as dementia. (Timescale of 30/1105 not met) The complaints policy and procedure needs to be produced in an alternative format so that it is more appropriate, and easily accessible and understood by people living with dementia. (Timescale of 30/11/05 not met) Night staffing levels must be reviewed. (Timescale of 30/11/05 not met) All staff working in the home must receive comprehensive and certificated training in caring for people living with dementia. (Timescale of 30/11/05 not met) All staff must adhere to the home’s policy and procedure for DS0000025935.V280084.R01.S.doc Timescale for action 31/03/06 2. OP12 16 31/03/06 3. OP16 22 31/03/06 4. 5. OP27 OP30 18 18 28/02/06 30/04/06 6. OP9 13 24/01/06 Winterton House Version 5.1 Page 22 the administration of medication. All handwritten entries on Medication Administration Records (MAR) charts must be signed and dated by the person making the entry and include the source of the information. The registered person must ensure that all records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. The manager must arrange for Portable Appliance Testing (PAT) to be undertaken at the required intervals. 7. OP31OP37 9 & 17 28/02/06 8. OP38 23 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Winterton House DS0000025935.V280084.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 DS0000025935.V280084.R01.S.doc Version 5.1 Page 24 - 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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