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Inspection on 27/08/08 for Winthorpe Hall Care Home

Also see our care home review for Winthorpe Hall Care Home for more information

This inspection was carried out on 27th August 2008.

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

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are provided with information about the home, which helps them determine the suitability of the home in meeting their needs. People said their health care needs are met, that they are afforded appropriate levels of privacy and dignity and receive their medication as prescribed. People said they are happy with the standard of cleanliness at the home. People are protected by the homes recruitment policy and practices.

What has improved since the last inspection?

The statement of purpose now complies with the Care Homes Regulations, and a copy is supplied to people at the home or their representatives on request. People said their private and communal areas of the home are kept warm and comfortable. People said that they are provided with the opportunity to express their opinions, wishes and preferences. People are now provided with written confirmation, which states their needs can be met at the home. A system has been established to ensure that care plans of people who are at risk of falls have risk assessments in place to prevent further falls.

What the care home could do better:

People expressed concerns that limited recreational activities are provided within the home and limited opportunities are available for people to interact within the broader community. People expressed concerns in relation to quality of food provided and the long duration between their teatime meal and breakfast. Further developments are required to ensure that the current management structure is effective in supporting staff in promoting the health and wellbeing of people.

CARE HOMES FOR OLDER PEOPLE Winthorpe Hall Care Home Gainsborough Road Winthorpe Newark Nottinghamshire NG24 2NR Lead Inspector Steve Keeling. Unannounced Inspection 27th August 2008 09:00 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 Winthorpe Hall Care Home DS0000024670.V370528.R02.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. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winthorpe Hall Care Home Address Gainsborough Road Winthorpe Newark Nottinghamshire NG24 2NR 01636 701826 01636 701234 padron@ntlworld.com winthorpeHall.co.uk Mr R C Pountney 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) Francesca Zerbinati Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons 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 category: Old Age, not falling into any other category - Code OP The maximum number of service users who can be accommodated is 28. 12th November 2007 2. Date of last inspection Brief Description of the Service: Winthorpe Hall is a privately-owned care home registered to provide accommodation and personal care for up to twenty-eight people over the age of 65 years. It is a spacious, converted manor house, providing accommodation on three floors, with a two-floor extension in keeping with the architecture of the original building. It is situated in the village of Winthorpe, north of the market town of Newark, close to major road networks. A local bus service goes to both Newark and Gainsborough. Amenities available within the village itself include a post and general shop, parish church, village hall and public house. The village of Collingham, three miles away, has a larger number of amenities, including shops, a doctor’s surgery, dentist, optician, pharmacy and public library as well as restaurants and pubs. The accommodation contains 26 spacious single bedrooms, 16 of which are ensuite, and one double bedroom. There is a passenger lift to the upper floors. The main lounge areas and dining room are on the middle floor with further sitting areas on the ground floor. The property is surrounded by extensive, gardens, which provide people with a tranquil, safe area to walk and sit in. There is a large car parking area for staff and visitors. The fees range from £350:00 to £420:00 each week, which does not include hairdressing and chiropody services or newspapers and magazines. The provider also makes a charge of £7:00 per hour for escorting people to hospital. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 5 Information about the home can be obtained from the manager and via the internet. A service user’s guide is also available in the foyer of the home which contains the last report from the Commission for Social Care Inspection. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. Two inspectors conducted the unannounced visit. The main method of inspection used was called ‘case tracking’ which involved selecting people who use the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager, three members of staff and visitors to the home were spoken with as part of this visit. Medication management was also inspected to form an opinion about the health and safety of people at the home. A partial tour of the building was undertaken which included a sample of people’s bedrooms, to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. Additional information was used to determine the outcome of this visit, which included information provided by the registered provider within an Annual Quality Assurance Assessment plus ten pre inspection “Have Your Say” surveys which were returned to the Commission by people at the home. What the service does well: People are provided with information about the home, which helps them determine the suitability of the home in meeting their needs. People said their health care needs are met, that they are afforded appropriate levels of privacy and dignity and receive their medication as prescribed. People said they are happy with the standard of cleanliness at the home. People are protected by the homes recruitment policy and practices. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Winthorpe Hall Care Home DS0000024670.V370528.R02.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 Winthorpe Hall Care Home DS0000024670.V370528.R02.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): 1,3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are provided with information about the home, which helps them to make an informed decision about the suitability of the home in meeting their needs and assessments are performed prior to moving into the home, to make sure their needs can be met. EVIDENCE: The pre inspection questionnaires asked “did you receive information about the home before you moved in so you could decide if it was the right place for you”, all ten people said “yes”. The information provided by the registered manager in the Annual Quality Assurance Assessment stated, “We ensure that servirce users are aware of our web page winthorpeHall.co.uk and can view our Statement of Purpose and Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 10 our Service Users Guide. We provide short term care and all new residents have a settling in period of a month, each resident has a written contract”. We examined the service user guide which is available to all people in the foyer of the home, it contained the last key inspection report from the Commission for Social Care Inspection, a statement of purpose, a copy of the complaints procedure, a residents charter, an overview of home, aims and objectives, terms and conditions of residency, information about what is or is not included in the fees and a Whistle Blowing policy. Information provided by the manager in the Annual Quality Assurance Assessment stated “We have in place pre-admission assessments using recognised assessment tools to aid this process”. We examined the pre admission assessment documentation which showed it would provide the opportunity to identify peoples needs, to promote their health and well being and provides the opportunity to identify peoples needs in relation to equality and diversity. The assessment process also uses information provided by other agencies, such as Adult Social Care and Health, where available. Winthorpe Hall Care Home DS0000024670.V370528.R02.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): 7,8,9 and 10 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The healthcare needs of people who use the service are recorded and met. Medication is managed appropriately and people who use the service are afforded appropriate levels of privacy and dignity. EVIDENCE: The pre inspection questionnaire asked, “Do you receive the care and support you need?” Eight people said” Always” and two people said “Usually”. Comments made within the pre Inspection questionnaire included “ Dependent on staffing, although there has been some improvement” and “ Most of the carers are kind and efficient others are sometimes quite ruthless”. We asked people who use the service if they feel their needs are being fully met. Comments included “Very good” and “I think so”. We spoke to two people who were sitting in the lounge area, both said they are “very happy”, although Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 12 one expressed concerns that snacks are not always available, and also said “breakfast is boring. It’s always cereal and toast”. (See standard 15) We asked a visitor to the home about the quality of care provided and if her husbands needs being met; the response was “yes, he prefers to remain in his pyjamas and likes to be in his room, the staff respect his wishes” The Annual Quality Assurance Assessment states that “we have a computerised care planning tool and each service users care plan is updated monthly and printed out for residents and family to view. In addition, we get the family to review and sign the care plan”, records were available to support this. The care plans of the two people we case tracked showed that they contained sufficient information for staff to carry out the tasks required to meet peoples needs and the staff said that they have access to the care plans at all times. The care plans include risk assessments to ensure risks are identified and addressed. This includes risk assessments completed for people who are at risk of falls. The electronic care planning and risk assessment procedure prompts staff to review the documentation on a monthly basis to ensure that changing needs are identified and met. The Annual Quality Assurance Assessment states, “All service users have access to doctors, district nurses, opticians, and community health services.” The pre inspection survey asked, “Do you receive the medical support that you need?” Eight people said “always” and two people said “usually”. Comments included “has improved”. Records showed and people said that they do have access to General Practitioner’s, District Nurses, Chiropodists and Optical Services. We saw a District Nurse visiting a person on the day of the inspection. On the day of the inspection the administration, storage, safe disposal and recording of drugs was all in place. This included the controlled drugs. People living at the service were asked if they get their medication on time. Responses included “Yes, at the same time I used to have them at home”. We observed the morning medication round. A senior carer who has had training in the Safe Handling of Medicines in January 2007 administered the medication in a safe manner. The Medication Administration records (MAR) were filled out correctly and demonstrated that medication was administered appropriately. The temperature of the medication fridge was being monitored on a daily basis and was within acceptable parameters. The pre inspection questionnaire asked, “Do staff listen and act on what you say”. All ten people responded by saying yes, but a person commented Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 13 “Sometimes keep me waiting for the toilet for up to forty five minutes” A person we spoke to said, “Yes, staff are always available and they are all lovely”. Through observation of practice throughout the day it was evident that staff promote peoples respect and dignity. We observed people being assisted to have their meals in a kind, considerate and un-rushed manner. A visitor to the home said “I am always made welcome at the home and I am offered tea or coffee”. Winthorpe Hall Care Home DS0000024670.V370528.R02.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): 12,13,14 and 15 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Limited recreational activities are provided within the home and opportunities are not always available for people to interact within the broader community. People expressed concerns in relation to quality of food and the long duration between meals. EVIDENCE: Information received in the Annual Quality Assurance Assessment stated; “We are able to provide a varied and flexible routine for our service users. they are able to make choices with regard to their meals, activities, visits etc. We provide regular resident forums, entertainment and monthy lunch club outings”. The pre inspection questionnaire asked “Are activities arranged at the home that you can take part in? ”Four people said “always”, five people said “usually” and one person said “sometimes”. Comments made within the pre Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 15 inspection questionnaire included “Not enough, I need more to look forward to” and “ not always to my liking”. We asked people who use the service and staff at the home about the social activities provided. A person said “I went out a couple of times last year [2007] to Skegness and to a pantomime but there are not enough staff” and ”not much happens”. Staff said “planned activities include Bingo, quizzes and singsongs. Staff said that outings are reliant on staff volunteering and staff good will. Staff said “entertainers do come to the home sometimes”. One staff member said “there isn’t enough time to spend with people and I sometimes go home feeling guilty because I haven’t had time to talk to them”. We observed that Social Activities were advertised in the lounge area for each day of the week but activities recorded in the activities book showed very few activities had actually taken place. Staff said that this is because they do not always time to do the planned activities. Records showed that some people had been taken out on three occasions this year to a garden party, the local pub and a luncheon club in the local community centre. People told us that they go to bed when they want to and get up when they wish and said “staff are always kind, friendly and very helpful”. The pre inspection questionnaire asked “Do you like the meals at the home?” Four people said “always”, five people said “usually” and one person said “sometimes”. Comments within the questionnaire included “would like it to be better presented”, “preparation and cooking methods could be better”, “too long intervals in between courses” and “I feel the gap between tea at five p.m. and breakfast at eight or nine a.m. is a long time.” On the day of the visit people also expressed concerns that it is a long time between tea and breakfast and that snacks aren’t always available, comments included “well you just have to put up with it”. People also said that the portions are small and said “breakfast is boring, it’s always cereal and toast”. On the day of the Inspection the lunchtime menu consisted of Chicken and mushroom pie, potatoes and two vegetables, or Macaroni Cheese and salad. Desert was jelly and fruit. Winthorpe Hall Care Home DS0000024670.V370528.R02.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): 16 and 18 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are not effectively managed and not all staff have received training in Safeguarding Adults which could compromise the safety of people. EVIDENCE: The Annual Quality Assurance Assessment states that “We have a complaints procedure that works well and all service users and families are well aware of how to use it.” The pre inspection questionnaire asked, “Do you know how to make a complaint?” Nine people said “yes” and one person said “no”. The person, who said no, added “daughter aware”. We asked three people if they feel safe in the home and they said “yes” A complaints procedure is displayed in the foyer of the home and the procedure is also supplied in the service user guide in the foyer of the home. The Commission for Social Care Inspection has not received any complaints about the service since the last Inspection took place. Information supplied by the manager in the Annual Quality Assurance Assessment stated that no Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 17 complaints had been received within the last twelve months; the complaints record book did not have anything recorded since December 2006. Information provided by the manager in the Annual Quality Assurance Assessment states that “We have had most of our staff undertake the ‘adult abuse course’ to make them aware of all types of abuse.” The revised Nottinghamshire Safeguarding Adults policy was available at the home, but staff said that they had never seen it and were not aware of its location. A staff training matrix, provided by the manager, showed that more than half of the current care staff group have not had any training on Safeguarding Adults. Furthermore the staff induction process does not include any reference to Safeguarding Adult procedures. We spoke to staff to determine their level of understanding of their roles and responsibilities in relation to Safeguarding Adults. They were not able to demonstrate sufficient knowledge in this area to promote the health and wellbeing of people. The manager informed us that the training in ‘the prevention of abuse of vulnerable Adult’ had taken place in June 2007 and had been delivered to all staff except those on duty at the time or those who had other commitments. Additional training in this area had been booked for September 10th 2008 but the training provider had postponed it, additional raining has been arranged for the 22nd September 2008. Winthorpe Hall quality assurance documentation (resident surveys) from June 2008 showed that one person living at the service had said that they felt rushed in a morning and one person had asked to have a cooked breakfast occasionally. The manager said “No evaluation of the surveys had taken place” and there was no evidence to support that any action had been taken to act on peoples comments, concerns and preferences identified in the resident surveys. One relative had commented in the survey, “We are very happy with all the care mum is getting here and would like to thank all concerned with mums welfare.” Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 18 Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People benefit from a well-maintained environment, which is comfortable, clean and safe EVIDENCE: The pre inspection questionnaire asked “ Is the home fresh and clean?” Eight people said “always” and two people said “usually”. Information provided in the Annual Quality Assurance Assessment stated, “We strive to ensure that service users live in clean, hygienic and comfortable surroundings.” Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 20 We asked people if they are satisfied with the standard cleanliness in the home, they all said they were very happy and it is clean and comfortable. We spoke to visitors at the home who also said that they are pleased with the standard of cleanliness. We did a partial tour of the building, which included people’s bedrooms, communal areas and kitchen facility. All areas were well maintained, clean, fresh and warm. The temperature in the lounge area was a comfortable 72 degrees. People’s bedrooms were homely and had their personal belongings, such as photo’s, telephone and television in place. We sampled the water outlet temperatures in the bedrooms and they were satisfactory. Radiator covers, window restrictors and nurse call systems were in place to promote peoples safety. Staff said that gloves and aprons are worn at all times when appropriate to promote infection control, health and hygiene. We observed that gloves and aprons were available in bathrooms. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People are protected by the homes recruitment practices. Not all staff have received training in the work they are to perform, which could compromise the health and wellbeing of people. EVIDENCE: The pre inspection questionnaire asked people who use the service “Are the staff available when you need them?” Four people said “always” and six people said “usually”. On the day of the visit, nineteen people were in residency at the home who were being supported by one senior carer, two care assistants, the manager, a cook and a cleaner. People expressed concerns that there is not enough staff, particularly in the mornings, to meet their needs. One person said, “the staff are overworked” and “there are not enough staff”. Staff spoken with also expressed concerns about not having time to meet peoples needs and having to rush people as “half of the residents need two staff to assist them” Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 22 The Annual Quality Assurance Assessment states, “Our staffing ratios are determined according to the assessed residents needs and additional staff are employed during peak times of activity.” The staff we spoke to did not corroborate this. Staff files showed that recruitment processes are effective in promoting safety. Two staff files were examined and they contained, Protection of Vulnerable Adult checks, Criminal Record Bureau Checks, an application form and two written references, all of which had been obtained before employment commenced. We looked at the induction processes and found that one staff member had been employed at the home since 7th January 2007 but had not commenced her induction until the 11th September 2007. Another staff member of staff commenced employment on the 10th December 2007 and her induction started on the 10th April 2008 and had not been completed. The senior carer we spoke to said that she has been allocated the responsibility to induct new members of staff, but said she finds it difficult to perform the role due to time restraints. Staff confirmed this to be accurate information. The staff-training matrix provided by the manager on the day of the visit showed that five members of the staff team had received training in only two areas i.e. Moving and handling and Fire Procedures. A member of staff who had been in employment since January 2007, confirmed that she used moving and handling equipment but had not received any training in moving and handling whilst being employed at Winthorpe Hall. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Further developments are required to ensure that the current management structure is effective in supporting staff in promoting the health and wellbeing of people at the home. EVIDENCE: The pre inspection questionnaire asked people “Have you received a contract?” All ten people who responded said “yes”. The registered manager has worked at the care home for several years and has achieved a degree level Registered Managers Award (RMA). Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 24 We asked staff “How supportive is your manager?” Responses included, “I don’t feel supported” and “there is lack of leadership and direction”. We looked at staff files and there was no evidence of any staff supervision or staff meetings taking place, staff confirmed this. One senior carer did have an annual appraisal on her file and stated that she “needed this for her NVQ”. The manager confirmed that she does not provide staff with formal supervision. She said that she is always available and will offer advice and support on an ongoing basis, staff did not confirm this. Staff told us that they were aware that the policies and procedures are available in the home but are not aware of there location and they are not used. Furthermore the Annual Quality Assurance Assessment shows that Policy documents have not been up dated on an annual basis, which could compromise the health and wellbeing of people at the home. For example, the following policies have not been up dated since 2000. • • • • • • • • • Safeguarding Adults and prevention of Abuse, Missing Service Users, Bullying, Death of a service user, Equal opportunities, First Aid, Health and Safety, Racial Harassment occurring between service users; between staff; by staff; or by service users on staff, Sexuality and relationships There is a process in place to determine the satisfaction of people living at the home. Regular forums are held to give people the opportunity to express their wishes and to comment on the service they receive. People we spoke to confirmed this and said “we have meetings where we are asked what we want to do”. The manager told us that they have introduced a survey to ascertain the opinions of people living at the home. Records showed that the procedure had taken place but the manager told us that some concerns identified by people had not been addressed, for example the request to have a cooked breakfast. (OP15) The Annual Quality Assurance Assessment was not completed to a satisfactory standard by the manager and was not useful in informing the inspection process. In addition some information within the document, could not be substantiated at the inspection visit such as “ We have a more qualified workforce”. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 25 The Annual Quality Assurance Assessment also states, “The manager ensures that all staff are familiar with the fire safety procedures and undergo moving and handling, certain members of staff have undertaken a first aid course”. The staff training matrix supplied to us at the inspection, which staff confirmed as accurate, did not reflect this, furthermore as mentioned earlier in the report, a member of staff said that she has not received any manual handling training since she commenced employment in January 2007. The manager stated that secure facilities are available for people to store their spending money at the home. Records showed that financial transactions, for example, hairdressing and chiropody services are recorded and receipts obtained to ensure that people are protected from financial abuse. The health, safety and wellbeing of people who use the service is promoted by the provision of effective routine maintenance. Information provided within the Annual Quality Assurance Assessment shows that an up to date electrical circuit safety certificate and gas certificate is in place, this was verified on the visit. Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 2 x 3 1 1 3 Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 27 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 OP15 Regulation 16 Requirement To promote the health and wellbeing of people the registered person must provide people with adequate quantities of suitably wholesome and nutritious food, which is varied and properly prepared and available at such time as may be reasonably required by people at the home. To promote the health and wellbeing of people the registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate to the needs of people. To promote the health and wellbeing of people the registered person must ensure that persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such DS0000024670.V370528.R02.S.doc Timescale for action 27/11/08 2 OP27 OP28 18 27/11/08 3 OP30 18 27/11/08 Winthorpe Hall Care Home Version 5.2 Page 28 4 OP33 24 5 OP37 12 (1) (a) work. To promote the health and wellbeing of people the registered person must ensure that elements of concern identified by the consultation process are addressed. To promote the heath and well being of people the registered person must ensure policies and procedures are revised and updated effectively for the protection of people and for the effective and efficient running of the business. 27/11/08 27/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP32 Good Practice Recommendations To promote the health and wellbeing of people the registered person should ensure social activities are provided which meets the needs of people at the home. To promote the health and wellbeing of people the registered person should ensure that the registered manager communicates a clear sense of direction and leadership, which staff understand and are able to relate to the aims and purpose of the home. To promote the health and well being of people the registered person should provide staff with formal supervision which covers all aspects of practice, philosophies of care in the home and care development needs. 3 OP36 Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Winthorpe Hall Care Home DS0000024670.V370528.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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