Inspection on 28/10/08 for Winterton House

This inspection was carried out on 28th October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Winterton House 08/01/08

Winterton House 18/09/06

Winterton House 24/01/06

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Winterton House 5 Epping New Road Buckhurst Hill Essex IG9 5JB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gwen Lording     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Winterton House 5 Epping New Road Buckhurst Hill Essex IG9 5JB 02085041183 02085590818 wintertonhouse@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Jaya Ramjibhai Hira Type of registration: Number of places registered: Ms Jaya Ramjibhai Hira care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 9 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Winterton House is a care home registered to provide personal care and accommodation for nine older people, some of who may have dementia. 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 Care Homes for Older People Page 4 of 27 Over 65 0 9 9 0 Brief description of the care home 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. On the day of the inspection the range of fees for the home was between five hundred and twelve pounds and five hundred and sixty pounds per week. A copy of the Statement of Purpose and Service User Guide is made available to both the resident and the family. A copy of the most recent inspection report is available on request. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection, which took place over five hours. The inspection was undertaken by the lead inspector, Gwen Lording. The registered manager/ proprietor was available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2008/2009. Discussions took place with the registered manager/ proprietor, and members of care staff. We spoke to residents where possible and asked them to give their views on the service and their experience of living in the home. Care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including all communal areas, kitchen and laundry was Care Homes for Older People Page 6 of 27 undertaken. The files of several residents were case tracked, together with examination of other staff and home records. This included medication administration, staff training and recruitment procedures and files, maintenance records and management of complaints. Information was also taken from an Annual Quality Assurance Assessment (AQAA); which was completed and returned to us prior to the inspection. This is a self assessment process, which all providers are required to complete once a year. Additional information was also obtained from Regulation 37, notification of events. Surveys were sent out prior to the inspection for completion by staff, residents where possible and their relatives. We have been told previously by the manager that the majority of people living in the home prefer to be called residents. This is reflected accordingly in this report. We would like to thank the residents and staff for their input during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 27 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive pre-admission assessments are undertaken for all residents. This means that staff have the detailed information to enable them to determine whether or not the home can meet a prospective residents needs. The home does not offer intermediate care. Evidence: From the evidence seen we are satisfied that the home undertakes a comprehensive pre-admission assessment from which a care plan is developed with input from the resident where possible, family members where appropriate, and relevant health and social care professionals. Prospective residents and their families have the opportunity to visit the home prior to admission, talk to staff and assess the homes facilities. We spoke to one residents who told us: I came to visit the home before I made a decision to move in. Staff were very welcoming and helpful. Care Homes for Older People Page 11 of 27 Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, social support and personal care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents needs. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to their medication. Evidence: There was a noted improvement in the standard, detail and construction of care plans since the last inspection. Care plans were more comprehensive and covered health, social and personal care needs. It was evident from the care plans seen and through discussions with residents and staff that residents health care needs were being understood and met on a daily basis. Care plans were being reviewed on a monthly basis or more frequently. However, the manager must ensure that reviews are undertaken in a meaningful way and do not Care Homes for Older People Page 13 of 27 Evidence: become a mechanical exercise with no change being automatically recorded. Staff need to ensure that daily recordings are more in line with the outcomes identified in the care plans, and also that the implications of the Mental Capacity Act 2005 are taken into account in both the care planning and the daily recordings. This was discussed with the manager during the inspection and we also left a copy of the Commissions recent guidance on the Mental Capacity Act 2005. From observations, and discussions with staff and residents, it was evident that the privacy and dignity of residents was being respected. We spoke to several residents and asked about the care in the home. One resident told us: The girls (carers) look after me very well. Another told us: Nothing is too much trouble - I only have to ask. Comments made in surveys also supported this view: As a family we are very grateful for the wonderful care the staff give to Mum. One resident had recently returned to the home following a period of hospitalisation. Staff had visited her every day to encourage her with feeding and other activities. A letter written by her relative said: Sincere thanks for looking after Mum while she was in hospital. Very grateful that she is back home with people she knows and (in her own way) loves. Good care was evidenced when observing staff talking with residents and carrying out their duties. All staff were observed to treat residents with kindness and respect, and there was a positive level of interaction between residents and staff. Staff were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout. Discussions with the manager and the review of medication records show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. Where a resident had an allergic reaction to either medication or food this was recorded on the Medication Administration Record (MAR) chart and in the care plan. However, it is strongly recommended that where such an allergy has been identified; it is recorded more prominently and highlighted on the front sheet of the residents file and on the MAR chart. The home is able to meet the needs of people requiring end of life care. The manager has been trained in the use of end of life care tools such as Preferred Place of Care. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle within the home matches the expectations and preferences of residents. The attitude and practice of the staff working in the home, promote opportunities for people living in the home to remain independent, exercise choice and express their wishes and needs. Evidence: The home does not employ an activity co-ordinator. There is a general programme of activities available but this is not structured. Care staff are responsible for facilitating and arranging any activities. At the last inspection there was very little opportunity for residents to access activities outside the home. From discussions with the manager and viewing the minutes of residents meetings it was evident that staff had consulted with residents about their interests. Outings had taken place with individuals or small groups with similar interests to places such as a local flower show and boat show, and other local trips. The local church group visits once a month and had helped residents pot plants for the garden. The routines of daily living are flexible to suit the differing needs and preferences of all people living in the home. Throughout the visit we observed staff allowing time for Care Homes for Older People Page 15 of 27 Evidence: residents to express their wishes and supporting individuals to make choices in their everyday lives. One resident told us I choose to stay in my room during the morning to make phone calls and deal with my correspondence. I come down to the lounge later in the morning for lunch. Individual residents are also involved in the day to day activities of the home dependant on their capabilities and interests. For example, during the morning of the visit two residents had helped prepare vegetables for the evening meal. Other residents help sew on buttons and do minor clothes repairs, help with drying dishes and fold the washing ready for ironing. Clearly those residents spoken to gain satisfaction from continuing to be involved in activities that they previously undertook at home. residents are enabled to participate in religious services held at the home and other religious activities as desired. Residents birthdays are celebrated within the home, as are other festivals and special occasions. If they wish residents can have a cake and family/ friends are invited for afternoon tea to celebrate the birthday. Residents are also encouraged to choose a favourite meal to be prepared on the day. Visiting times are flexible and family/ friends are encouraged to visit so that residents are able to maintain contact. There is no designated cook and staff prepare and cook all meals. There is a daily menu and a record is maintained of what each individual chooses to eat. A good choice of meal options are available at each meal. The use of full cream milk, butter and cream is used wherever possible to supplement the diets of those residents with reduced food intake or diminished diets. The lunchtime meal was presented in an attractive and appealing manner and there was a nice relaxed atmosphere throughout the meal. Staff were on hand to offer assistance and encouragement where necessary. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and staff team make every effort to sort out any problems or concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to, taken seriously and acted upon. All staff working in the home have received training in safeguarding vulnerable adults to ensure that there is a proper response to any suspicion or allegation of abuse. Evidence: The home has a written policy and procedure for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaints or concerns made to them. Those residents spoken to were aware of how to complain if they needed to. One resident told us: I have all I need - no complaints. I would speak to the manager and I am confident that she would sort matters out quickly. Residents also have access to external agencies and professionals through advocacy and details are displayed in the public areas of the home. All staff have undertaken training in safeguarding vulnerable adults and this is included in induction training for all newly recruited staff. There is a policy on whistleblowing and challenging bad practice at work. Those staff spoken to were able to demonstrate a good understanding of the homes policy and procedures in this area and knew what to do if they had concerns about the safety and welfare of residents. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The overall atmosphere in the home is welcoming and provides a physical environment that is appropriate to the specific needs and lifestyle of the people who live there. Evidence: The standard of the decor, furnishings and fittings are genarally being maintained to a good standard. The home is clean and the odour control is good. Improvements noted to environment since last inspection including decoration of some bedrooms, new bathroom flooring and the purchase of new bedroom and lounge furniture. Bedrooms are generally well maintained and residents and their families are encouraged to personalise rooms so that they are reflective of the occupants culture, religious and personal interests. There are aids and equipment available around the home which are acapable of meeting the needs of all residents. There is one large lounge and a small comfortable dining room with additional lounge chairs. The home has an infection control policy and staff work to this in order to reduce any risk of infection. Care Homes for Older People Page 19 of 27 Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Residents benefit from a committed staff team who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. Evidence: The staffing levels and skill mix of the staff team are in line with meeting the diverse and changing needs of the residents. Staff were being effectively deployed so as to ensure that residents choosing, or needing to remain in their bedrooms were cared for appropriately. There is a small but stable staff team, with very little staff turnover, and no use of bank or agency staff. This does mean that residents at Winterton House do get consistent care from staff they know well. Staff interact and communicate well with all residents and there was a positive level of interaction. Residents we spoke to were very positive about the care being provided to them. We were told: Staff are kind and caring. Another resident told us: The staff help me to be as independent as I can for as long as I can. All staff receive training that is relevant to meeting the individual assessed needs of Care Homes for Older People Page 21 of 27 Evidence: residents in a person centred way. Some training is accessed from external providers such as the London Borough of Redbridge and other training is delivered in house. All staff receive training in essential areas during their induction with a period of shadowing more experienced are staff. The manager and two senior care staff have undertaken training in the Mental Capacity Act 2005. It is a requirement that all staff receive training in this important area, and its implications on the delivery of care to vulnerable people. The registered person is able to demonstrate that they operate a proactive recruitment and selection process in accordance with the requirements of legislation, equal opportunities and anti-discriminatory practice. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. Evidence: The registered manager is also the sole proprietor. She is a registered nurse with qualifications in both general and mental health nursing. Staff commented positively about how well supported they felt by the manager. One member of staff told us: Our manager is very supportive to us. Ms Hira is very resident focused and works in partnership with the families of residents and professionals involved in their care. There have been significant improvements in the management and storage of records since the last inspection. There is now a designated staff office and all records were easily accessed. She has a clear understanding of what further improvements are needed and the key areas, which need development. The Annual Quality Assurance Assessment (AQAA) clearly identifies Care Homes for Older People Page 23 of 27 Evidence: the plans for improvement over the next year. The home has a range of policies and procedures. There are clear written records of all safety checks and accidents/ incidents. Such records were found to be maintained in good order. The manager does not act as an appointed agent for any residents, nor does she have responsibility for any residents financial affairs or the management of their personal allowances. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 30 18 The registered persons must 31/01/2009 ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. ll staff working in the home must receive training in the Mental capacity Act 2005, and its implications on the delivery of care to vulnerable people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Staff need to ensure that daily recordings are more in line with outcomes identified in the care plans, and also that the implications of the Mental Capacity Act 2005 are routinely taken into account in both care planning and daily recordings. It is strongly recommended that where a resident has an allergy to either food or medication; it is recorded more prominently on the front sheet of the residents file and on the Medication Administration Record (MAR) chart. 2 9 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!