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Inspection on 30/04/08 for Winton Nursing Home

Also see our care home review for Winton Nursing Home for more information

This inspection was carried out on 30th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The service users and two relatives said the staff were kind and helpful. They also commented on how `lovely` the deputy Matron was. The staff meet most of the service users physical needs, by making sure that people are clean and tidy and that they have help to maintain their personal hygiene. The staff are good at providing food that meets peoples expectations. The service users that can eat their meals independently are served their food in a calm and caring way, they are offered choices and the dining room is a pleasant environment for meals times. The home environment is well decorated and people said they really liked their bedrooms. The home has beautiful well-maintained grounds.

What has improved since the last inspection?

The AQAA states that staff have all been trained to safely give medication and the staff confirmed that they have attended this course. The AQAA states that they have improved the service by employing more cleaning and laundry staff. The home was clean with no unpleasant odours.

What the care home could do better:

The registered provider needs to ensure that improvements are made to the outcomes for the service users, and that all statutory requirements are complied with: 1. That all prospective service users have their needs assessed prior to moving into the home so that they can be assured that their needs can be met. 2. That the registered provider ensures the care planning process is improved so the staff have the guidance they need to meet each individuals needs. These care plans need to be regularly reviewed to identify changes. 3. The registered person must ensure that the service users are always treated with dignity and respect. 4. The registered person must always follow the procedures for dealing with complaints. 5. The staff must be trained to respond to alleged abuse and the homes policy and guidance must be up to date. 6. The registered person must make sure that staff are appropriately supervised. The service users would also benefit from an increase in the availability of suitable activities that meets individual needs. The service users would also benefit from easier access to the grounds and the passenger lift. This would increase the service users ability to move independently around their home.

CARE HOMES FOR OLDER PEOPLE Winton Nursing Home Wallop House Nether Wallop Nr Salisbury Hampshire SO20 8HE Lead Inspector Kima Sutherland-Dee Unannounced Inspection 30th May 2008 08:40 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.V363766.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.V363766.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.V363766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st May 2007 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. The Fees for this home range from £2448 per month to £2751 per month. Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 5 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 inspection included a site visit to the home over a period of nine hours and 20 minutes, with a twenty-minute break. During this time we spoke with the Deputy Matron, staff and people who live in the home and their care was observed. Care plans, training records, policies and staff records were sampled. We also spoke to the registered provider over the telephone as they were abroad during the visit. Other information used to make judgements about the standard of care in the home included the last inspection report and information received from the home including their Annual Quality Assurance Assessment (AQAA) completed by the previous registered manager. This was received partially completed after a reminder letter from the commission. These have been referred to throughout the report. We also received four ‘Have Your Say’ surveys completed by three service users and one member of staff. What the service does well: What has improved since the last inspection? Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 6 The AQAA states that staff have all been trained to safely give medication and the staff confirmed that they have attended this course. The AQAA states that they have improved the service by employing more cleaning and laundry staff. The home was clean with no unpleasant odours. 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.V363766.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.V363766.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): 1,2,3,4,5. Quality in this outcome area is adequate. Prospective service users are given the information they need to make an informed decision about the home. People cannot be assured that the home can meet their needs until the assessment process is improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes own assessment (AQAA) says that the manager always visits prospective service users in their own homes or hospital to complete a pre admission assessment. Three assessments were seen and none of them had been properly completed. One gave more details than the other two but none of them could have been used to properly assess whether the home could meet a prospective service users needs. The AQAA states that the home’s plan Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 9 to improve over the next 12 months includes ‘Investigating ways of improving our pre admission assessment forms’. People are welcomed to visit the home and the administrator shows them around and they have a chance to talk to the nurse in charge. The administrator always gives people a service user guide and these are kept in people’s rooms. Each service user, or their representative, is asked to sign a contract if they are paying for themselves to live at the home, but where service users are supported by a local authority, the contract is between social services and the home. It is required that each service user is provided with a statement specifying the fees payable for services, including accommodation and food, nursing and personal care. This must be provided regardless of who pays the fees, so that people are clear about what they can expect the service to provide. Winton Nursing Home DS0000012032.V363766.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 poor. The care planning process remains poor despite previous requirements to improve, therefore the service users cannot be assured that their needs can be met. Service users do receive appropriate health care although the staff do not always monitor the service users health regularly. The staff are trained to safely administer medication. The service users cannot be assured that the staff will always treat them with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 11 Six care plans were seen and they were inconsistent and incomplete. Improvements have not been made despite the introduction of new forms and senior staff being allocated one day per month for the specific purpose of keeping the care plans up to date. This means the staff do not have the information they need to meet everyone’s individual needs. The staff say they have a good knowledge of peoples’ needs but this is not demonstrated in the records. The AQAA doesn’t record any information about the care plans apart from stating that any visiting medical professionals write in them. It was noted that the records did have information about G.P visits. The care plans had some basic details but failed to record anyone’s preferences, preferred routines or how the staff can meet their needs. The introduction in May 2008 of personal hygiene care plans was supposed to meet the previous requirements but these have not been fully completed. The staff fill in a daybook about the care they have given and the senior staff then transfer this to the care plans. Some of the daily information was useful but some staff were writing very brief notes that did not record what care had been given. The deputy Matron said that staff can use the care plans once they have attended a training session, and only four staff still needed to do the course. This was not borne out by discussions with the staff, as one member of staff said they had only seen the care plans once. The staff including trained nurses are not using the care plans effectively or reviewing and updating them properly. The last review date in one plan was May 2008, but other plans had not been reviewed for five of the last nine months. Other plans had last been reviewed in December 2007. Following the previous inspections on 21st November 2006 and 1st May 2007 requirements were made to improve the care plans and we asked for this to be complied with by both the 27th February 2007 and the 1st July 2007. This has not been complied with despite sending the home an improvement plan to which they did not reply. A statutory requirement notice will be served to ensure that there are improved outcomes for the service users and to secure compliance. All the service users looked well cared for with clean and tidy clothing and neat hair. Each person’s record had a family tree, which should provide the staff with useful information about the service users as individuals, however only one had been completed, the others were either incomplete or not started. Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 12 The plans did include risk assessments, which assess people’s likelihood of falling, or developing pressure sores for example. Not all of these had been reviewed every month to see if peoples’ needs or conditions had changed. The deputy Matron said that each service user should have their weight monitored monthly to monitor their health. It was noted that one person’s care plan described how they had lost weight during a hospital admission, but their weight was only recorded three times in the last five months. The administration of medication was observed in the dining room at lunchtime. The medication was stored and given correctly, and the records were being maintained as required. The trained staff also said that the home had a policy about when to give medication that is prescribed “as required” The AQAA states that staff have received training in safe handling of medication and two staff confirmed they had attended this course. It also says that the manager had reviewed the medication policy and this was seen in the policy file. The service users who need more support due to their dementia or mental health are accommodated in a separate wing of the home. During observation in this wing, it was noted that two staff including a trained nurse were standing in the lounge area discussing who needed help to go to the toilet, and this was being done without regard for people’s privacy or dignity. Other staff in the main part of the home were seen chatting to residents and offering care in a more sensitive way. Two service users said that the staff were very good. One visiting relative also said the staff did their best and were kind. One relative said that sometimes their family member had to wait for the toilet and the staff told them they were ‘stretched’. The deputy manager explained that the staff had been asked not to tell service users or relatives this when there was the normal number of eight staff in the morning and they were just busy meeting the needs of other service users. Two staff members said that they had enough time to do their job and to meet peoples’ needs. The provider uses agency staff and occasional staff (Bank Staff) to work when there are not enough permanent staff to be on duty. Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 13 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 adequate. An increase in suitable activities would be beneficial to the service users. Families and friends are welcome in the home at any time. Although the service users receive food that meets their needs and choices, the people who need support with their diet are not always assisted in an appropriate way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous inspection in May 2007 reported that staff are aware of peoples’ likes and dislikes but there was little documentation recording their preferences. During this inspection there had not been any improvement. The care plans and family trees were not completed, and the records to show what activities had taken place had not been maintained since February 2008. Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 14 The AQAA says that the service has improved by encouraging residents to go to church and by providing transport, but the records do not demonstrate whether this has been achieved. There are fortnightly religious services including hymn singing in the home. The last inspection also found that there were limited suitable activities for the people who live in the wing who either have dementia or a mental health diagnosis. The staff in charge of the wing said that there weren’t any activities for that day and sometimes people went to join in with the organised activities in the main house. When asked how people spend their day, the inspector was told that they get up, have breakfast and sit around, have lunch and sit in the afternoon. It was observed that after lunch people were repeatedly asked to sit or guided to their chairs and there was little interaction that did not involve a task such as taking someone to the toilet. After the level of activity was raised with the staff a member of the team started handing out books and magazines. Later one member of staff was seen sitting with two service users chatting. In the main house staff did spend time with some service users doing manicures. One member of staff said that people sit in the garden in warm weather and that they plan to take a few people to the Army Air museum in July. They said they could take 3 or 4 people out at a time. A physiotherapist comes in weekly to do group exercises. The deputy Matron said that a volunteer comes to read poems and they have a choir in to sing, but they also agreed that not enough was going on. Two relatives also commented that it would be nice to see more going on, to keep people busy and active. The AQAA states that visitors are welcome at any time and several visitors were seeing their relatives. They said they were made to feel welcome by the staff. Observation during lunchtime in the main house showed that people were served their lunch and they were offered choices and alternatives. It was quiet and peaceful during the meal and the staff were thoughtful and respectful of the service users wishes and needs. One service user said they had a special diet and this was catered for. Previous inspections reported that meal times met the service users needs and the service users liked the food. Providing a more flexible mealtime has been an improvement. During observation in the wing it was noted that a service user was managing to eat their meal independently even though it was taking time to do this. Staff approached this person and asked if they wanted pudding, then without Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 15 asking they proceeded to feed them two more mouthfuls of food. The staff member then gathered some food from the persons’ apron with their hand, put it back on the persons’ plate and fed it to the service user. This takes away the service user’s independence, is also poor food hygiene practice and it does not respect the person’s dignity. The service user was then given a short time to eat their pudding before staff again approached and started to assist the person. Winton Nursing Home DS0000012032.V363766.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): 16,18 Quality in this outcome area is poor. The service users and their relatives cannot be assured that their complaints will be taken seriously or addressed effectively. Service users are not properly protected from abuse, through a lack of staff training and up to date policy guidance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service offers people several ways to complain. They can approach staff or the provider or they can write a complaint in the complaints book in the reception area. There is a complaints procedure but the deputy matron and the administrator said they had not had any training in how to deal with and address complaints or concerns. It was noted that there were two main complaints in the reception book along with two anonymous complaints. None of them had any record that the complainant had been contacted or that any action had been taken. There was also a complaint that a member of staff had recorded in a person’s daily record, but again there was no evidence that this had been dealt with. There is a folder that contains complaint forms but these had not been used. Both Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 17 the staff and the provider are failing to follow their own policy on dealing with complaints. The deputy matron said that staff had been trained in abuse awareness in May 2007. The training records showed that 12 out of 74 staff employed had been on the course. The deputy matron did say that new staff have a brief section on how to report alleged abuse during their induction programme. One member of staff said they would tell the person in charge if they did suspect alleged abuse. The home’s policy that should guide the actions of staff on how to act if abuse is suspected or alleged, is out of date and needs to be updated and reviewed. The Hampshire County Council policy is available in the home, but is also out of date. Winton Nursing Home DS0000012032.V363766.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): 19,20,26 Quality in this outcome area is adequate. The service users benefit from a clean and well maintained environment. Improvements in access to the garden and lift would improve the service users independence and enjoyment of their home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service users and a relative commented on how nice the bedrooms were and that they could bring their own possessions. The previous inspection report from May 2007 said the environment was safe and well maintained. Comments were received about the grounds, people said although they were beautiful they were mostly inaccessible especially for people who use Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 19 wheelchairs, due to the lack of paths and hard areas. There were tables and chairs available on the grass. The deputy Matron said they do take people into the garden but it wasn’t easy. Comments were also made that the only lift that is wheelchair accessible is in the wing of the house. This means that people do not have the freedom to access their rooms without the help of staff or relatives because the wing is accessible through a keypad lock, which is designed for the safety of the service users with dementia. This means that service users, staff and relatives often have to use the lounge in the wing as a corridor to get to the lift. This could cause added confusion and disruption for the service users with dementia. The home was clean and the AQAA states that more domestic staff have been employed in the last twelve months. The AQAA also says that the staff have had training in infection control and health and safety. This was confirmed in the training records for some staff. Winton Nursing Home DS0000012032.V363766.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): Quality in this outcome area is adequate. Staff are recruited safely and they are trained to do their jobs. Despite an improvement in the number of staff employed at weekends not all of the service users are having all of their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy matron said that there are normally eight staff on duty in the morning and five or six in the afternoon, but this occasionally reduces to seven in the morning if staff are on sick leave. One survey that was returned to the commission said that sometimes there were not enough staff on duty and this could lead to delays. Relatives also commented that sometimes people had to wait for the care they needed. The deputy Matron said that with eight staff, people’s needs could be met but sometimes the staff were attending to other service users’ needs at the time. The provider employs bank staff (occasional staff) and staff from their own care agency when not enough permanent staff are available. Two members of staff said there were enough staff to meet people’s needs. Relatives commented that there were not enough staff, or the staff were unable to meet their family member’s needs at all times, and that rehabilitation had not been followed up. Relatives also commented that when they visited the staff had Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 21 not always made sure the service users could reach their drinks, glasses or television remote controls. Three staff files were seen and they contained the required recruitment documents to show that the home uses safe recruitment procedures. These included Criminal Records Bureau checks and references. One member of staff is responsible for co-ordinating staff training. The records showed that staff had attended a variety of courses, including first aid, dementia care and infection control. One member of staff confirmed they had achieved their National Vocational Qualification (N.V.Q) in care, which included information about dementia. The AQAA states that more staff have been trained in the last 12 months, and they intend to improve by having all the staff trained to N.V.Q level 2 within the next 12 months. Winton Nursing Home DS0000012032.V363766.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): 31,33,35,36,38 Quality in this outcome area is poor. The registered person has not ensured that the home has been managed effectively, or complied with all of their statutory responsibilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The provider and the deputy Matron advised that the registered manager was on sick leave at the time of the inspection and will not be returning to the home. The deputy Matron who is a trained nurse is temporarily managing the home until the providers can recruit a manager. The administrator did write to CSCI to inform them the manager had left the home. Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 23 The deputy matron was praised by the staff, the service users and two relatives, who said she were approachable, helpful and kind. The deputy matron has requested courses in management as she said the only training they have had was to shadow the previous matron. The registered provider was abroad at the time of the inspection, but they were available to answer questions over the telephone. They said they had relied on the previous manager to respond to the improvement plan and to meet the previous requirements, and they said they were surprised these had not been completed. The registered provider delegates the responsibility for the monthly visits and reports to a relative. That relative also spoke on the telephone and said that they had been ‘lax’ in completing the reports although they visited the home often. Monthly reports were available between August 2007 and January 2008 but none had been completed after that date. Following the previous inspections on 21st November 2006 and 1st May 2007’ a requirement was made to carry out monthly visits to the home and complete a report and make this available in the home after each monthly visit, and we asked for this to be complied with by both the 27th February 2007 and the 1st July 2007. This has not been complied with despite sending the home an improvement plan to which they did not reply. A statutory requirement notice will be served to ensure that there are improved outcomes for the service users and to secure compliance. The registered provider said that they felt it was most important to make sure the service users were fine, that they were spoken with and were offered a glass of wine and that took priority over the completion of records and other statutory responsibilities. When the provider was informed about failures to comply they said they were happy to work with the commission to put things right. When they were asked about the lack of suitable activity especially for those people with dementia, they said “what did we want them to do? Knit dishcloths?” This did not refer to the service users with dignity or respect and did not address the need to improve the outcomes for the service users. The deputy matron and the administrator said that questionnaires had been sent to the service users and their relatives in early 2007 but the results could not be found. The deputy matron said that the exercise to monitor the quality of the service had not been completed. They also said they were due to do another quality survey in June 2008. The Registered provider should be seeking the views of the service users and their relatives and using these to make improvements to the service. Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 24 The previous registered manager returned the homes annual assessment (AQAA) after they had been sent a reminder letter. The AQAA was brief and did not include all the detail we had requested. The registered provider apologised for the late return of the assessment. The previous report said that the service looked after money on behalf of a number of service users and this was done safely. The deputy matron said that staff supervision were carried out, and that senior staff were responsible for supervising the carers and the deputy matron supervised the trained staff. The records showed that six staff had been supervised between March and May 2008. The deputy Matron said she they had not supervised anyone in the eleven months they had been at the home, as the previous registered manager told them that annual appraisals would be sufficient. They also said that staff are informally supervised but no records are kept. The fire records in the home are up to date and regular staff drills are carried out. The AQAA records that the home has fire safety procedures and these were seen at the home. The previous report said that the home is well maintained and the providers employ staff to ensure maintenance issues are dealt with. Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 25 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 2 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 2 X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 3 Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(1)(c) Requirement Timescale for action 01/08/08 2. OP3 3. OP7 Each service user must be provided with a contract or a statement of terms and conditions that details the level of fees for the service and the facilities that the home provides. 14(1)(a)(c All prospective service users )(d) must have all their needs assessed. The provider must discuss with the service user or their representative the suitability of the placement. The provider must write to prospective service users confirming the ability of the service to meet their needs prior to admission. 15(2)(b)(c The registered person must )(d) review the care plans, revise the care plan after consultation with the service user or their representative and inform the service user or their representative about any changes 01/08/08 01/08/08 Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 27 4. OP10 12(4)(a)( b) 5. OP16 22(3)(4) 6 OP18 13(6) 7 OP36 18(2) 8 OP33&OP3 7 26&10(1) The registered person must ensure that the service users are treated with dignity and respect at all times, including when staff assist service users with their meals. The registered person must ensure that all complaints are fully investigated. The registered person must inform the complainant within 28 days or less, (of the complaint) about any actions that will be taken. The registered person must make arrangements through training or other methods, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person shall ensure that people working in the home are appropriately supervised. The registered provider must carry on or manage the home with sufficient care, competence and skill. In that they have failed to ensure effective management of the home and compliance with their statutory responsibilities. The reponsible person must carry out monthly visits to review the quality of the service and produce a report that that is available in the home. 01/08/08 01/08/08 01/08/08 01/08/08 01/08/08 Winton Nursing Home DS0000012032.V363766.R01.S.doc Version 5.2 Page 28 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.V363766.R01.S.doc Version 5.2 Page 29 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.V363766.R01.S.doc Version 5.2 Page 30 - 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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