Inspection on 01/11/06 for Wishing Well

This inspection was carried out on 1st November 2006.

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

Wishing Well 25/10/07

Wishing Well 26/01/06

Wishing Well 04/08/05

Wishing Well 25/11/04

Wishing Well 11/06/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wishing Well 37 Leven Road Dringhouses York YO24 2TL Lead Inspector Jean Dobbin Key Unannounced Inspection 1st November 2006 09:50 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 Wishing Well DS0000015835.V317790.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. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wishing Well Address 37 Leven Road Dringhouses York YO24 2TL 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) 01904 337566 01904 337566 DEDEPIP@aol.com Mrs Denise Mary Thompson Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: Wishing Well is a care home registered to provide personal care and accommodation for up to three older people of either gender. The home consists of a two-storey semi-detached house situated on a quiet road in a suburb of York and is within walking distance of local facilities and amenities including shops, cafes and pubs. The amenities of York city centre are also accessible by transport. All three bedrooms are for single use and are on the first floor, close to the shared bathroom. There are additional WC facilities on the ground floor. The home has a well-maintained garden and an area of hard standing for parking at the front. The registered person is the main carer and her husband and a part time care assistant assist. The registered person and her husband live on the premises. Details provided in November 2006 outline the weekly fees as between £340 and £350. This does not include hair perms, however chiropody services, a weekly shampoo and set, if required, and individual toiletries are included. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report follows an unannounced site visit to the home on 1st November 2006. The inspection lasted just over 5 hours, with extra time allowed for preparation work. The manager was present and was provided with feedback at the end of the inspection. During the visit all the residents were spoken with. There were no other visitors during that time and only the manager was available to speak with, and to observe talking with the residents. All the care records were examined to see how individual care needs were assessed. Other documents, written to show that the home is running properly, were also looked at. Prior to the site visit a questionnaire was sent to the home, which was completed and returned, as requested. Requests for views, in the form of a written survey, were sent to 3 next of kin chosen at random and 2 were returned. Forms were also sent to 3 health care services, and 2 were returned. Surveys were not sent to residents but discussions on the day provided their views about the home. What the service does well: What has improved since the last inspection? There has been continued refurbishment at the home. All three bedrooms have been redecorated. This ensures that the residents live in a pleasant environment. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 6 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. Wishing Well DS0000015835.V317790.R02.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 Wishing Well DS0000015835.V317790.R02.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): 3 and 6. Quality in this outcome area is good. The prospective resident receives an assessment of their needs, written information, and the opportunity to have a trial period at the home, to help them decide if the home is right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three service files each contained a pre admission assessment. This information is then used in the development of the care plan. The manager said that she visits a prospective new resident ideally at their home to discuss their needs and whether the home can meet them. The individual then moves to the home for a month’s trial period. This allows them to decide whether the home feels right for them, as well as ensuring that the newcomer fits in with the two established residents. These admission details are written in the home’s Statement of Purpose. A signed contract and terms and conditions document is in each of the service files and a Statement of Purpose and Service User guide is displayed in the hall. Intermediate care is not provided. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 9 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. Although the health and personal care needs are well met, there are some shortfalls in the medicines practice, which need addressing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents were tidily but casually dressed, and looked well cared for. The service files were all examined, and these showed that each had a care plan, which was reviewed monthly. These were all very person centred and contained specific details about residents’ likes and dislikes, and how they liked to spend their time. The residents do not require very much ‘hands-on care’ but do require support, guidance and prompting. For example one resident likes their bedclothes put out and the bedding ‘turned back’ each evening, and another requires some support and reassurance with dressing. There were records of annual reviews, with the resident signing their agreement, when possible, and records of how difficult issues were managed by the home. There were some risk assessments in place but none for moving and handling or risk of malnutrition. The manager explained that none of the Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 10 residents required any physical assistance with moving though it would still be good practice to assess the residents as being at ‘low risk’. The manager said that residents’ weights were recorded monthly, however these records were not easily accessible. Daily records were completed however to describe the residents’ day to day lives. There were also clear records of visits by healthcare professionals, and the manager showed, in discussion, that she understands individual healthcare needs very well. Two GPs, in response to the postal survey said that although the resident was ‘on their books’ they had required so little input from them, that they both felt unable to comment. Medication is stored in a locked cupboard in the dining room. The service uses the MDS (tablets in blister packs) system and the record sheets showed no omissions. It was observed though, that there were some tablets in medicine pots in the cupboard, and one large pill, loose on the shelf. The manager is the only person who dispenses the tablets and she said that she sometimes prepares them in advance when she’s ‘ahead of herself’. Although there is no evidence that this has adversely affected the residents, this system of secondary dispensing is very poor practice. This was discussed with the manager. All the bedrooms had a lockable drawer, and two of the rooms could be locked if the resident felt the need for more privacy. The residents though did not hold these keys and one individual said that they felt very safe at the home. There is a telephone downstairs with a large-touch dial pad, and upstairs is a cordless phone so that service users are able to speak in private from their bedroom if they wish. The manager by her interactions has an excellent relationship with her residents. There was lots of gentle humour and residents were assisted in a respectful manner as they ‘pottered’ around the house. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 11 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 good. The residents are supported in maintaining their day-to-day routines and they receive a varied and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager makes every effort to ensure that leisure activities are tailored to individual needs. She has ensured that musical and television tastes are well catered for, by buying specific items according to the residents’ preferences. There is an assortment of books, games, CDs and DVDs evident, though television is still a popular choice. Residents also are able to help in the kitchen, where they may choose to wash up a few dishes or fold some of the clean laundry. The manager feels it is important that the residents can still contribute to the running of the household if they wish. The manager has a large static caravan at the coast, and most summer weekends are spent there. If residents choose not to go there, then staff would be available to enable them to stay at home. This is detailed in the information provided to prospective residents and their families. The residents often go out locally, for example to the supermarket. There were details in the daily records of a recent trip to Tesco, where Christmas decorations and the home’s Christmas cake were chosen and purchased. Although these events are documented in Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 12 the daily records, this information will become more difficult to locate, as the weeks pass. It would be good practice to briefly record these events in a diary to easily evidence that they took place. There are lots of photographs in various parts of the home, which provide talking points about previous events. The manager says that because of the home’s position, local people often visit for a chat. The visitor’s book evidenced this. The home has a dog, two cats and a parrot, which also provide diversion and entertainment. There is no set menu, with meals being provided according to choice and available foods at the supermarket. Two of the residents were very complementary about the meals. One person who had lived at the home for just a few months had obviously regained some weight, when compared with a photograph, taken soon after admission. Fresh fruit and vegetables were noted in the kitchen. Although the manager could produce some records of recent meals these were from more than a month earlier. Similarly the manager said that the fridge and freezer temperatures were checked daily but these records were not easily located. A discussion was held as to how her record keeping in this area could be improved, in order to satisfy regulation. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 13 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 good. Whilst the manager shows good awareness of issues around abuse and the complaints policy is well displayed, she needs to continue to remind residents to tell her if they are not happy. Residents could be put at risk by recruitment systems that are not robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints to the home or Commission since the last inspection. The complaints policy is displayed in all the bedrooms, as well as in the Service User guide, which is given to residents and their families. Despite this, none of the residents were sure about what to do if they were unhappy. The manager, and her member of staff, however, sits and talks with the residents each day and enquires about any concerns. Family members, who are able to check on their welfare, also visit regularly. Correspondence from them confirmed that they would speak out to the manager if they had any concerns about the service. The manager demonstrated her knowledge and understanding by outlining what indicators might suggest one of the service users has been abused. She also outlined her responsibilities, as a manager, if this situation were to occur. One member of staff has been recruited recently. The recruitment process however is not robust, and residents could be at risk if new staff start work before police checks are completed. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 14 Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 15 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. The residents live in a safe, comfortable and warm home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is an extended semi-detached house on a housing estate in a York suburb. The internal layout is similar to neighbouring houses and the service provides a very domestic and homely environment. The home is clean, warm and well maintained. There is a lounge, dining room leading into a large kitchen and a conservatory, with residents generally eating in the dining room. There are ramps at both the front and back doors and there are level wellmaintained gardens with seating, and a bird table to provide interest and a talking point. There are three single rooms on the first floor and the shared house bathroom, which is only used by the residents. The bedrooms are all decorated individually and the soft furnishings are to a superior standard. These rooms contained individual photographs and other personal possessions. There is a cloakroom/WC downstairs and disposable gloves were noted there, Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 16 to enable staff to take precautions to prevent the spread of infection. Both bathrooms have extra grab rails fitted. There is no stair lift, so residents have to be able to manage the stairs. There is a made to measure safety gate at the top of the stairs, which is used at night and all bedrooms have a call bell, so that help can be summoned. The laundry is dealt with in a satisfactory manner. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 17 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 adequate. Although staff are well trained and motivated residents are potentially being put at risk by a recruitment process, which needs to be more robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager, with the help of her husband and one part time carer provide 24 hours support for the residents. Residents said that staff were available whenever they needed someone. Staff have time to sit and talk with the residents and discuss future events and meal preferences. The carer has only recently started work at Wishing Well and her recruitment process was discussed with the manager. This process had some shortfalls. One written character reference was obtained and the manager stated that she had received a verbal reference from a second person, whilst waiting for the written one. This could not be evidenced. An application form had not been completed, although the manager had seen proof of identity. Although a Criminal Records Bureau check (to show any previous offences) was requested, this clearance was not yet back. The PoVA first check, (to ensure that an individual isn’t barred from working with vulnerable adults), had not been returned, although this clearance was provided the day after the site visit. The manager said however, that she had not, nor would not leave the new carer alone at the home. This would not happen until she was Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 18 confident in their abilities, the residents were comfortable with the new person, and all the police checks were satisfactory. The new carer was attending an external induction course on the day of the visit. The manager showed the file that they were compiling, to evidence her learning about the home’s values and policies. The carer is keen to study for a National Vocational Qualification to improve her knowledge and understanding and the manager is happy to support them with this. The manager has attended a number of study sessions over the past two years and plans to update her knowledge alongside the new staff member. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 19 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 and 38. Quality in this outcome area is good. Although the home is well run and residents’ wishes are put first, the manager would benefit from an improved record-keeping system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has owned the home for several years and is very experienced in caring and supporting older people. She is studying for a Level 4 National Vocational Qualification award. She has a very good relationship with the residents and is able to anticipate many of their needs. She finds out their views about the service, and those of their family informally in conversation, but there is also a completed small questionnaire in their service files. The home does not have any responsibilities for holding service users’ monies, and if the manager buys items on a resident’s behalf, the cost is invoiced to Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 20 the family. Paper receipts are not issued when money is repaid and this would be good practice in order to maintain accurate records. The manager is aware that record keeping at the home is not as good as it might be. Whilst she is confident that all records required by regulation are kept, they cannot easily be found. These issues were discussed during the visit. The accident record was examined, which confirmed that there had been no incidents of note this year. The manager understood her responsibilities with regard to notifying the Commission of these events. Hot water temperatures, according to the manager, are monitored monthly, but again these records could not be found. The temperatures were checked during the visit and found to be within the expected parameters. There were risk assessments in place for the environment, however some steradent tablets were observed in the bathroom. There needs to be an assessment to show how the manager deals with the risk of these tablets being accidentally swallowed. The fire alarm is checked each week. Although there have been no fire drills this year, the manager discusses the fire plan with the service users whenever the alarm is checked. Gas and electrical safety certificates were up to date, but these again were not easily found. Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 22 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 Tablets must not be removed from the blister pack until the time the resident is due to receive them From receipt of this report and onwards the management must ensure that staff do not start working at the home until a CRB clearance is returned. If they have to start earlier than this then a PoVA first check must be carried out. Two written references must be obtained before appointing the staff member. Timescale for action 01/11/06 2 OP18 OP29 19(1)(4) Sch 2 reg 7, 9, and 19 01/11/06 Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 23 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. Refer to Standard OP15 Good Practice Recommendations The manager should consider keeping the record of what meals the residents eat, and the fridge and freezer temperature records in a diary for ease of access. The manager should continue to remind residents what they should do if they are unhappy about something The manager should complete an appropriate management qualification The manager should see if she can ‘streamline’ her records, in order to make it easier to both locate and update specific items 2 3 4 OP16 OP31 OP38 Wishing Well DS0000015835.V317790.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Wishing Well DS0000015835.V317790.R02.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!