Inspection on 08/01/08 for Winterton House

This inspection was carried out on 8th January 2008.

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

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

Other inspections for this house

Winterton House 28/10/08

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 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 09:00 8 January 2008 th 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.V355047.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 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 wintertonhouse@hotmail.co.uk 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.V355047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Both categories to be used flexibly between the 9 beds. Date of last inspection 18th September 2006 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. 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. On the day of the inspection the range of fees for the home was between £500.00 and £540.00 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. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which started at 9am and 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 2007/2008. Discussion took place with the manager and members of care staff. The inspector spoke to residents where possible and visiting relatives. Residents were asked 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 undertaken. The files of several residents were case tracked, together with the examination of other home and staff records. This included medication administration; training records; maintenance records; complaints; accidents/ incidents and staff recruitment files. Information was also taken from an Annual Quality Assurance Assessment (AQAA), which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from Regulation 37, notification of events. Surveys for staff, residents and relatives were sent out prior to the inspection. Residents’ and relatives responses indicated that they were very satisfied with the quality of care being provided in the home. Comments include: “My sister is happy and contented with the care she receives”. “The care home makes people feel as comfortable as possible and treats them as individuals”. “Staff always appear kind and considerate towards my mother”. Staff responses indicated that they felt well supported by the manager and identified their strengths as being able to take into account and meet individual resident needs. As part of the inspection process the views of authorities responsible for placing people in the home and reviewing their care were sought, and are commented on in this report. Several people living in the home were asked how they wished to be referred to. They expressed a wish for the term ‘resident’ to be used, as it is their home. This is reflected accordingly in the report. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans were being reviewed at least monthly but were not being updated to reflect changing needs. Care plans must clearly record individuals personal and healthcare needs and how these are to be delivered. Whilst staff are able to think in a person centred way and give a good verbal account of individual residents care needs, the recording of up to date and easily accessible information is essential to the delivery of quality care. There is a limited programme of activities outside the home and more consideration needs to be given to planning community activities, which are suitable to the needs and preferences of individual residents. The manager must ensure that the home operates a robust recruitment procedure in line with regulation and the home’s recruitment policy, to provide safeguards for people living in the home. 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. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 7 The current office arrangements for the manager do not enable her to undertake her responsibilities in an effective manner. This has a direct impact upon the storage; recording and maintenance of day-to-day records by care staff. The manager must improve and develop systems to monitor practice and compliance with care plans, and the policies and procedures of the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 & 4 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service A pre-admission assessment is undertaken by the manager for all prospective residents and care plans are drawn up from the information in this assessment to identify how residents needs are to be met. However, the specialist needs of people living with dementia must also be identified so that staff understand and are able to meet such needs. The home does not offer intermediate care. EVIDENCE: Individual records are being kept for all residents and their files were examined. It was evident from viewing these files, that a full assessment of needs had been undertaken by the manager, with the involvement of the resident, their family and relevant professionals. Where appropriate, Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 10 information provided by the placing authority was also included. Records examined had full assessment information recorded around the health and personal care needs of the residents. However, at the initial pre-admission assessment the specialist needs of those people living with dementia were being identified to a limited degree, and this area does need expanding so that staff understand and are able to meet such needs. The inspector was satisfied that the manager would not admit a new resident unless she was sure that the assessed needs of the individual could be met. The manager was provided with a copy of the Commission’s ‘Policy and Guidance on Fees Information by Care Homes’. This sets out what information care home providers need to include in the Service User Guide regarding fees ad terms and conditions, and is in a format that is easy to understand. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 & 11 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents health and personal care needs are set out in individual care plans. However, the care plans are not well organised and there are gaps in relevant information. Whilst staff are able to think in a person centred way and give a good verbal account of individual residents care needs, the recording of up to date and easily accessible information is essential to the delivery of quality care. There are clear medication policies and procedures to follow. However, there are some inconsistencies in the management of medication, which may result in unsafe practices. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 12 EVIDENCE: Individual care plans were available for each resident and the care plans and related documentation for four residents were inspected. It was very difficult to undertake case tracking as the care plans are very disorganised; not well constructed; and some relevant information was missing or later found recorded in several different places. Whilst there was evidence that care plans were being reviewed at least monthly they were not being updated to reflect changing needs. There was limited information on meeting the specialist care needs of people living with dementia. The quality of care, which is experienced by someone with dementia, can be improved by the way staff use and understand care plans. A comprehensive care plan can only enhance the care experience of a resident living with dementia. Care planning must include the management and understanding of the behavioural features presented by people living with dementia. Details should also include for example, the use of visual prompts and how the individual’s independence is to be promoted and maintained. Although there was a lack of detailed information in the care plans, in discussions with staff they were able to give good verbal accounts and were generally able to demonstrate a knowledge and understanding of the individual health needs of residents. However, the manager must ensure that care plans clearly record individual’s personal and healthcare needs and detail how they are to be delivered. The recording of up to date and easily accessible information is essential to the delivery of quality care. Good care was evidenced when observing staff talking to residents and carrying out their duties. All staff were observed to treat residents with kindness and respect, and there was also positive interaction between residents and staff. They understood the need to promote dignity through practices such as the way they addressed residents and were seen knocking on bedroom and toilet doors before entering. All residents appeared clean and well groomed. At the last inspection a requirement was made for the registered person to ensure that appropriate weighing equipment is provided for the use of all residents regardless of their mobility. This requirement has been met. All residents are weighed on admission and monthly thereafter. However, weights were not being recorded in one source and this makes it difficult for staff to effectively monitor any weight loss or gain. The manager must ensure that weights are recorded in one consistent record. Records seen indicated that residents are seen by other health care professionals such as district nurse, community psychiatric nurse, chiropody, dental and optical services. Regular blood sugar monitoring was being undertaken for one resident, as directed by the district nurse. The GP visits the home routinely once a month to review all residents. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 13 The inspector spoke to a number of residents and asked about the care in the home. Comments included: “Very homely atmosphere. I am satisfied with everything”. “I came here from another care home. This has been a good move for me. I am able to keep some of my independence and get help when I need it”. The inspector also spoke to the visiting relatives of a resident who has been living in the home for approximately four months. They expressed no concerns and were “very happy with the care”. The home was able to provide culturally appropriate food and meet the individual’s religious and cultural needs, which was very important to them as a family. There had been some progress since the last inspection on the development of ‘End of Life’ care plans and the importance of developing these further was discussed with the manager. Two staff have undertaken training in Palliative/ End of Life Care from West Essex Primary Care Trust. An audit was undertaken for the handling and recording of medicines within the home and Medication Administration Record (MAR) charts were examined. The following issue was discussed with the manager: • Hand written entries on MAR charts must be signed and dated by the person making the entry and include the source of the information. e.g. GP, district nurse. One resident is able to take responsibility for the administration of some prescribed items of medication. A risk assessment had been undertaken and suitable lockable facilities are provided in her room in which to store the items. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. There is a varied programme of activities available within the home, which suits individual needs, preferences and capacities. However, there is a very limited programme of activities outside the home and more consideration needs to be given to planning community activities, which are suitable to the needs and preferences of individual residents. This will ensure that all residents have a sufficiently stimulating and varied choice of activities available to them outside the home. 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. 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. During the visit residents were engaged in activities including, reading, knitting, listening to music and completing a word search puzzle. Individual residents are also Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 15 involved in the day-to-day activities of the home dependant on their capabilities, preferences and interests. For example, peeling vegetables, dusting furniture, and folding washing ready for ironing. Clearly those residents spoken to gain satisfaction from continuing to be involved in activities that they previously undertook at home. There is a very limited programme of activities outside the home. From viewing minutes of the residents meetings it was also evident that they had raised this and expressed their disappointment that no outings had been arranged during the summer. The manager must seek the views of residents around planning activities outside the home, which take into account individual’s interests, preferences and capabilities. At such times staff must also be employed in sufficient numbers so that people using the service are given the opportunity to take part in planned activities in the community. The AQAA completed by the manager also identified this issue as something the home could do better. A new minibus with tail lift has been purchased. From observation and talking to several residents it was evident that the routines of daily living are flexible to suit the differing needs and preferences of all people living in the home. Throughout the visit the inspector observed staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives. Visiting times are flexible and relatives/ friends are encouraged to visit. Relatives commented that they felt very welcomed by staff and were always offered a drink of tea/ coffee. 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. Menus were inspected and found to be balanced and a choice is offered each day. A good choice of meal options are available at each meal. Drinks and snacks are available throughout the day and staff were seen to be offering drinks to residents during the visit. Staff were on hand to offer assistance when needed and this was done discreetly and individually. The manager is aware of promoting issues of equality and diversity and the respect of individual’s beliefs and culture. The manager is able to communicate with one resident whose first language is not English and staff are aware of some key translations in respect of this individuals daily needs. Diets specific to individual’s culture and religion are provided for accordingly. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager and staff make every effort to sort out any problems and concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to and acted upon. All staff working in the home have received training in safeguarding adults 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 for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaints and concerns made to them. At the last inspection a requirement was made for all complaints to be logged whether verbal or written. This was also to include details of investigation, any action taken, and the outcome for the complainant. The complaints log was inspected and the inspector was able to evidence that this requirement had been met. The complaints log indicated complaints received and included less formal concerns/ issues of dissatisfaction. Those residents spoken to were aware of how to complain and to whom. One relative commented in a returned Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 17 survey:”Miss Hira has always, without fail, addressed any concerns that have been brought to her attention”. Staff working in the home have received training in safeguarding adults and this is included in induction training for new staff. Staff spoken to were conversant with the action to be taken if they had any concerns about the safety and welfare of residents or if they witnessed any suspected abuse. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 23 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The overall atmosphere in the home is welcoming and generally the physical environment meets the needs of people living in the home. Some improvements have been made since the last inspection. However, in some areas of the home the decoration and some furnishings are being to look ‘tired and worn’, and are in need of redecoration and refurbishment. EVIDENCE: The building was toured by the inspector, accompanied by the manager, at the start of the visit, and all areas were visited again later during the day. There were no offensive odours and all parts of the home were clean. The inspector was informed that the domestic left in late December and the manager has advertised the position. In the interim a member of care staff is rostered on duty three times a week between 8am and 4 pm to undertake domestic duties. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 19 All of the bedrooms seen were personalised and were reflective of the occupant’s interests, religion and culture. Since the last inspection gates have been erected to the entrance of the front drive; the majority of the windows have been fitted with double-glazing; several bedrooms have been re-decorated; and radiator shelves fitted in the bedrooms. It is acknowledged that there have been improvements made to the environment since the last inspection. However, in some areas of the home the decoration and furnishings are being to look ‘tired and worn’ and are in need of re-decoration and re-furbishment, and in particular the communal lounge. The ongoing programme of refurbishment and redecoration for the home must continue to be progressed, as it will improve the environment for all current residents and any prospective residents. There is only one small lounge and small dining room and residents. Therefore residents do not have any alternative communal areas in which to sit quietly, meet with family/ friends or be actively engaged with other people living in the home. The manager has received information and is fully aware of the recent legislation regarding smoking in care homes, which came into effect on the 1st July 2007. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The written procedures for the recruitment of staff are robust and provide safeguards for people living in the home. However, the manager must ensure that all such procedures are consistently followed in practice. EVIDENCE: The staff rota was inspected and staffing levels were sufficient to meet the assessed care needs of residents. The manager/ proprietor must ensure that her hours of duty in the home are clearly recorded on the duty rota. The home has a small but relatively stable staff team and does not use agency or bank staff. A record is maintained of staff training and records showed that staff have undertaken training in essential areas such as manual handling, food hygiene, administration of medication, and health and safety. Three key members of staff have undertaken Community Mental Health Training to National Vocational Qualification (NVQ) level 3. The AQAA completed by the manager stated that 63 of care staff are qualified to NVQ level 2 or above and the remaining staff are working towards an NVQ level 2. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 21 A discussion took place with the manager around the recently introduced Mental Capacity Act 2005, and the impact it will have upon the delivery of care to vulnerable people. It is essential that all staff working in the home receive adequate and appropriate training in this important area. The files of the two most recently employed staff were inspected. Both files had necessary checks such as Criminal Records Bureau (CRB) disclosures and application forms duly completed. However, there were no references on file for one member of staff. The manager stated that two references had been requested and received before the member of staff commenced employment. She considered that they may have been misfiled, but was unable to locate them during the inspection. At the last inspection the home met all the standards around recruitment of staff. The manager must ensure that the home operates a robust recruitment procedure in line with regulation, and the homes written recruitment policy/ procedure. All such procedures must be consistently followed in practice to ensure that safeguards are provided for people living in the home. The manager is required to request duplicate references for this member of staff. From viewing staff records and talking to staff, it was evident that staff receive regular supervision. Staff meetings are held monthly and the minutes of these meetings were available for inspection. The registered manager is also the sole proprietor. She employs a workforce from diverse cultures and backgrounds. On the day of the inspection it was apparent that the ethnicity of staff was different to that of the majority of people living in the home. In discussion with the manager and staff, and through observation of staff interactions, they were able to demonstrate an awareness of the importance of understanding and meeting the needs of all residents, wherever possible around equality and diversity issues. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 37 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager is a well-qualified and experienced person. However, the manager must ensure that residents’ best interests are safeguarded by the home’s record keeping and robust operational systems. The current office arrangements for the manager do not enable her to discharge her responsibilities in an effective manner. EVIDENCE: The registered manager is also the sole proprietor. She is a registered nurse with qualifications in both general and mental health nursing. She has the Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 23 relevant clinical and management qualifications and a good understanding of the care needs of people living in the home. A deterioration was noted in the management of records since the last inspection. 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. Some information was not available for inspection as it could not be located on the day for example, staff references. It was also very difficult to undertake case tracking as the care plans are very disorganised; not well constructed; and some relevant information was missing or later found recorded in several different places, and entries were not always clear. Requirements around these concerns have been made in this report. There is no designated staff office and the room used by the manager as an office is very small and appears cluttered. There is very little available desk space, only room for one chair and sundry items of furniture and equipment are being stored in this room. This does not provide the manager with suitable arrangements to undertake meetings with staff, relatives, inspectors and other visitors, or receive/ make telephone calls in private and with regard to the confidential nature of any discussions. These current arrangements also cause difficulty and have a direct impact upon the storage; recording and maintenance of day-to-day records by care staff. The manager must ensure that residents’ best interests are safeguarded by the home’s record keeping and robust operational systems. The manager must address these concerns as a priority and improve and develop systems to monitor practice and compliance with care plans, policies and procedures of the home. Currently the manager does not act as an appointed agent for any resident, nor does she have responsibility for any residents financial affairs or the management of their personal allowances. Residents financial affairs are managed by their relatives/ representatives. Other records were looked at including, fire safety, recording of water safety temperatures, Portable Appliance Testing (PAT), and accident/ incident records. These were found to be in good order. The London Fire & Emergency Planning Authority (LFEPA) last undertook an inspection in March 2007. The report states that the premises were satisfactory. The London Borough of Redbridge undertook a food hygiene inspection of the premises on 13/09/07. The report states that the food premises were satisfactory. Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 24 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 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 3 2 3 Winterton House DS0000025935.V355047.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 28/02/08 2 OP7 OP8 12, 15 & 17 3 OP9 13 4 OP12 OP13 16 (2) (m) (n) The registered person must ensure that during the initial preadmission assessment the specialist needs of people living with dementia are clearly identified, so that staff understand and are able to meet such needs. The registered person must 28/02/08 ensure that each resident has a care plans which clearly details how their care needs are to be met and is updated accordingly to reflect changing needs. The care plan must be in a format that provides staff with an up to date basis for the care to be delivered. The registered person must 08/01/08 ensure that all hand written entries on MAR charts are signed and dated by the person making the entry, and include the source of the information. The registered person must 31/03/08 consult with residents and provide a more varied programme of activities outside the home, which take into DS0000025935.V355047.R01.S.doc Version 5.2 Winterton House Page 26 5 OP19 23 6 OP29 19 Schedule 2 7 OP31 OP32 OP37 10 17((1) (a)(b) (2) (3)(a)(b) 23(2)(l) 8 OP37 account individual’s interests, preferences and capabilities. The registered person must ensure that the ongoing programme of refurbishment and redecoration of the premises is progressed. This will improve the environment for all current residents and any prospective residents. The registered person must ensure that the home operates a robust recruitment procedure in line with regulation and the home’s recruitment policy, to provide safeguards for people living in the home. The registered person must ensure that records required by regulation and for the efficient and effective running of the home are being maintained in good order. The registered person must provide suitable storage facilities for all records required by regulation. 31/07/08 08/01/08 28/02/08 28/02/08 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.V355047.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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