Inspection on 20/11/08 for Winton Nursing Home

This inspection was carried out on 20th November 2008.

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

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

Other inspections for this house

Winton Nursing Home 30/04/08

Winton Nursing Home 01/05/07

Winton Nursing Home 21/11/06

Winton Nursing Home 31/01/06

Winton Nursing Home 18/08/05

Winton Nursing Home 23/11/04

Winton Nursing Home 17/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Winton Nursing Home Wallop House Nether Wallop Nr Salisbury Hampshire SO20 8HE Lead Inspector Kima Sutherland-Dee Unannounced Inspection 20th November 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Winton Nursing Home DS0000012032.V373272.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. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winton Nursing Home Address Wallop House Nether Wallop Nr Salisbury Hampshire SO20 8HE 01264 781366 01264 781623 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) Mrs Evelyn Mary Cornelius-Reid Post vacant Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45) of places Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th April 2008 Brief Description of the Service: Winton Nursing Home is one of three owned by Mrs Cornelius-Reid, two are in Hampshire and the other in Wiltshire. It is set in the village of Nether Wallop, a rural area, within easy reach of local amenities at Stockbridge and Andover. The home is registered as a care home providing nursing care and may accommodate up to forty-five service users who are older persons, or older persons with dementia. Accommodation is provided in two areas of the home, both on two floors with lift access to the first floor. The main house accommodates those who require assistance with personal and nursing care, whilst the annex accommodates those who have dementia and require assistance with personal and nursing care. There are thirty-five single and five double bedrooms and all have en-suite facilities. There is extensive communal space with several lounges, a garden room and dining room. There is a large landscaped garden. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included a site visit to this service on the 20th November 2008 when we reviewed a sample of the records and documents, spoke to the service users, staff and manager, as well as the registered individuals representative and a local visiting G.P. We also took information from the eight service users surveys and the one staff survey we received. The provider returned their AQAA after we sent a reminder letter and we have included the information about how the service assesses the outcomes for the service users. Current fees are between 2448.00 per calendar month to 3033.30 per calendar month. What the service does well: What has improved since the last inspection? The service has ensured that all of the service users or their representatives have signed a contract. This service has improved the care plans and how often these are reviewed. This means the staff have the most up to date information to care for each service user. The manager has improved the numbers of staff on duty and this has allowed for an increase in the choice and frequency of activities, including taking small groups of service users shopping. The staff are now supervised more frequently and this allows them to discuss their roles and for the manager to assess the staffs performance. The manager has increased the staffs awareness about treating each service user with respect and dignity, and the staff were seen to speak kindly to the service user throughout the site visit. The registered persons representative is now visiting the home at least monthly and producing a report. This enables the registered person to monitor Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 6 the management of the home and to plan improvements to the service for the benefit of the service users. 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. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is adequate. The service cannot supply up to date written information to prospective service users to enable them to make an informed decision about the home. Prospective service users can be assured that their needs will be assessed prior to them being offered a place at the home. New service users will be offered a contract to sign which confirms the homes terms and conditions. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home displays the Statement of purpose in the reception area. The information about the home and it’s services was written in 2003 and now contains out of date and inaccurate information. The home administrator agreed that the document needed to be updated and that this would be completed by January 2009. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 9 A sample of the service users contracts were seen and all of these had been signed by the service user or their representative. One pre admission assessment was seen in a care plan for a new service user. The assessment was complete and detailed; this demonstrates an improvement in the way the service assesses whether it can meet the needs of new service users before they move into the home. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 10 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): 7,8,9,10 Quality in this outcome area is adequate. The service users benefit from an improved care planning and review system. The service users are assured that their healthcare needs are met and that they will be treated with dignity and respect. The medication records are not maintained accurately at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of the care plans in the main home and the wing were seen. These have improved since the last key inspection. There was detailed information that the staff used daily to care for each person. This included information about the service users health, their history and how the staff can meet their Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 11 needs. The care plans are now reviewed monthly so the staff can record any changes and have the most up to date information. During a handover meeting when the staff change shifts the manager told the staff about any changes to peoples conditions and any other useful information. The staff said there are enough staff on duty to meet the service users needs. The staff knew the needs of each service user well and they spoke to the service users respectfully and kindly. However during our observations in the wing it was noted that no staff were available in the lounge for twenty minutes. The wing is where the service users with dementia or mental health needs live and there were eight service users in the lounge at the time. A hairdresser and a cleaner were in the area and the hairdresser dealt with several incidents between two service users. The hairdresser knew people well and spoke to them in a very caring manner. The staff were busy helping service users in their own rooms. This was discussed with the manager who said that although this had been a temporary situation an extra member of staff had been sent to this area to help the staff. The manager has increased the staff awareness of treating the service users with respect at all times and ‘Dignity and respect’ was used as the training topic for the month of November. The staff said they had discussed this at staff meetings and there was written information available on the office notice board. The manager also spoke about each service user during the handover meeting with great respect and with a detailed knowledge of individuals likes, dislikes and their preferred routines. The records demonstrate that the service users have their health care needs met. The service has strong links with a local G.P practice and a visiting G.P said ‘The home is second to none, I’ve been visiting here for 27 years and the staff are very good at caring for the residents.’ They also commented that ‘ The staff are able to improve the service users health through their excellent care. The nurses are very good and they communicate well with us about health needs and the service users condition’. The service users receive their medication as it is prescribed and the medication is stored securely. There were six separate gaps in the medication records, which would indicate that either staff have not administered the medicine or they have forgotten to sign that it has been given. The manager agreed that this was unacceptable and they would increase their audit of the records to once a week and also retrain the staff. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is good. An increase in the variety and frequency of available activities has benefited the service users. The service users benefit from being able to invite their friends and relatives to the home and visitors are made welcome. The service users receive a well balanced and nutritious diet that the majority of them enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been an improvement in the number, variety and frequency of activities that are available to the service users. The manager has organised staff numbers so that staff can accompany small groups of service users to go shopping. Two service users said they had really enjoyed their shopping trip the day before. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 13 Activities that the service users can choose to take part in include, dog petting, music for health, arts and crafts, and a quiz. The service users could also take part in crafts at the weekends. There is also a Christmas bazaar organised for December. The service users in the wing are encouraged to take part and the staff also spend time talking individually with service users when they have time. One of the eight returned surveys said there wasn’t enough activity for the service users in the wing especially exercises and physiotherapy. Since the surveys were returned the level of activity has increased. The staff are making efforts to introduce more individual activities based on the interests of the service users. One service user is compiling a history of the home and it’s listed building. Other service users are making calendars with photos of the home and gardens. The service users can also choose to attend regular religious services in the home. The service users said that their friends and relatives were welcome to visit them in the home and tehir are enough private areas where they can meet. The service users said they liked the food at the home. The service users are served by waiting staff when they eat in the dining rooms. The cook said they had recently had an inspection by the environmental health officer and the four requirements had already been rectified. The cook said they speak to each service user daily to discuss their choices and they have been at the home for seven years so they know each service users likes and dislikes. They said they don’t have a food budget, as they are able to buy what ever they need to provide the service users with a suitable and nutritious diet. The majority of the food is home cooked and the cook was making mince pies. Eight service user surveys were returned. Three said they usually or sometimes liked the food and five said they always liked the food. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is good. The manager is working towards improving the complaints procedure and staff training in protecting the service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated that the complaints procedure would be re written by the end of December 2008. Six completed surveys said that the service user or their representative knew how to make a complaint. One survey left this section blank and one relative said they had spoken to and written to the provider who had failed to reply to their concerns in writing. The manager has improved the way complaints are responded to and they will now be dealt with according to the complaints procedure. Seven staff said that although they have not had training in dealing with the protection of the service users and abuse, they knew how they would respond to any suspicions appropriately by reporting any concerns to the manager. The manager completed an improvement plan following the previous inspection in May 2008 and they said that all staff would be trained in the protection of vulnerable adults over the next twelve Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 15 months. New staff are instructed during their induction training in how to protect service users from abuse and report any concerns . The manager also stated that all the policies and procedures relating to protection would be reviewed and rewritten by December 2008. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 16 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, 24,26 Quality in this outcome area is good . The home is clean, comfortable and well furnished. The environment would benefit from some redecoration and items not belonging to service users should not be stored in their bedrooms. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is comfortable and well furnished. Areas of the home require redecoration and the responsible individuals representative said they are aware of this and had planned for a programme of decorating. Two service users said they liked their rooms and they had their own belongings around them. One large single room was well furnished, warm and comfortable. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 17 In one double bedroom on the ground floor there was a large amount of equipment being stored. This included a number of wheelchairs, other mobility equipment and a hoist. The manager said some of these belonged to the service users in that room but not all of it. The provider’s representative said that they were aware of the need to clear the home and store equipment and they would work with the maintenance staff to do so before Christmas. The home is maintained safely and equipment is serviced. All of the eight completed surveys said the home is always fresh and clean. The home employs cleaning staff and one volunteer comes to the home regularly to arrange and display fresh flowers. The staff have had infection control training and the equipment they need such as gloves and aprons are available throughout the home. The provider’s representative said that they and the manager are discussing ways of increasing the accessibility of the grounds particularly for those who use wheelchairs. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is good. The service users benefit from an increase in the number of staff. The staff are safely recruited, trained and supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider has agreed with the manager to increase the numbers of staff and the manager is currently trying to recruit staff. Seven new members of staff have started work since June 2008 and three have left in that time. Extra staff are provided to enable the service users to go out more often. The manager can use the provider’s agency to provide staff in the case of staff sickness or absence, they try to use the same staff so that they get to know the service users. The manager has developed a new system for ensuring there are enough staff on duty and this has improved the level of care to the service users. There are usually eight members of staff on each morning shift and five in the afternoons, with three covering night duty. The staff said there are enough staff to meet the needs of the service users but they said ‘of course sometimes we are busier’. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 19 The staff are trained and the homes training co-ordinator ensures that staff attend courses such as, manual handling, fire safety and first aid. The manager has introduced a topic for each month and they use this to raise the staff’s awareness and carry out training in staff meetings. Recent and future topics include, Diabetes, Parkinson’s and Dementia. A sample of the staff records demonstrated that all the checks are carried out prior to staff starting work. These are for the protection of the service users and they include a Criminal Records Bureau and a protection of vulnerable adults check as well as two references. During discussions with eight staff members they said that they are supervised more often and they now have yearly appraisals. This means they have an opportunity to discuss their role and any training needs. This was confirmed by viewing the staff records. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 20 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): 31,32,33,38 Quality in this outcome area is adequate. The manager has made improvements to the service for the benefit of the service users. The manager now needs to submit their application to register with the commission. The registered individual needs to ensure that they comply with their statutory responsibilities. The service does not have a formal system for seeking the views of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 21 The manager has been in post since June 2008 and they are qualified and experienced. The commission wrote to them, and the provider in September 2008 requiring the manager to apply for registration with the commission. The manager is now in the process of completing the application. The staff and four service users said the manager was approachable and supportive. The manager has made positive changes to the service and they continue to identify improvements that need to be made and to plan how these can be put into practice for the benefit of the service users. The commission wrote to the registered person in November 2008 regarding their failure to comply with requests for information within the required timescales. They returned their improvement plan over a month late, stating how they intended to meet the requirements following the last inspection, and they did not return their annual assessment until we wrote a letter reminding them that this was late. The registered person’s representative apologised for these failures and assured the commission that from this date the registered person would comply with their legal responsibilities. The previous inspection report made a requirement that the registered person or their representative visits the home at least monthly and produces a report. This report covers all aspects of the service including seeking the views of the service users. These reports are available in the home for August, September and October 2008 so the requirement has been met. The manager regularly speaks to the service users to seek their opinions, however the service do not have any formal ways in which the service users views are sought. The registered person’s representative is responsible for maintaining the safety of the home and the buildings. A new fire assessment has been completed and the staff are trained in fire procedures and health and safety. The equipment is maintained and serviced and there are risk assessments in place for the service users and the environment. Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 22 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X x X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 3 Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13(2) Requirement Timescale for action 30/11/08 2. OP24 13(4)(a) 2. OP33 24(1)(a)( b)(3) The registered person must ensure that the medication records are maintained accurately at all times. The registered person must store 30/12/08 equipment appropriately and only leave equipment that belongs to a service user in that service users bedroom. The registered person must 30/01/09 develop a system for regularly seeking the views of the service users and using these views to make improvements to the service. 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 Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Winton Nursing Home DS0000012032.V373272.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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