Inspection on 01/08/07 for Wishmoor

This inspection was carried out on 1st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Wishmoor 02/11/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Wishmoor 21 Avenue Road Malvern Worcestershire WR14 3AY Lead Inspector Wendy Barrett Key Unannounced Inspection 09:20 1st August 2007 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 Wishmoor DS0000065693.V339781.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. Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wishmoor Address 21 Avenue Road Malvern Worcestershire WR14 3AY 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) 01684 569162 Wishmoor Limited Mrs Mary Helena Douglas Care Home 19 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (19) Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2006 Brief Description of the Service: Wishmoor is a detached house situated in a residential area of Malvern. It is close to community amenities. The home provides 19 places for older people who have personal care needs arising from general frailty of old age or physical disability. Six of the places can be used to accommodate older people who have care needs arising from dementia. The registered Provider is a limited company and a responsible individual maintains regular contact with the service on behalf of the Provider. A separate Care Manager is registered to manage the everyday care of residents. There are 15 single bedrooms and 2 double bedrooms. All these rooms are large enough to meet the National Minimum Standards’ space requirements. No en-suite facilities are available. Information literature e.g. Service User Guide is available at the home and all new residents receive an information pack. In November 2006 the fees ranged from £343-00p. to £389-00p. There are additional charges for newspapers, chiropody, dry cleaning and toiletries. Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written with reference to information supplied by the Provider, comments in survey forms received from a sample of residents and relatives, records about the service and held by the Commission and an unannounced visit to the service. What the service does well: What has improved since the last inspection? Staff have received more training to be sure they handle medication safely. Staffing levels have been increased where there was sometimes a shortfall at teatime periods. There is more evidence of consultation with residents and their families as part of the care planning work. The residents’ accommodation has continued to receive attention as part of the ongoing upgrading of the premises. Wishmoor DS0000065693.V339781.R01.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. Wishmoor DS0000065693.V339781.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 Wishmoor DS0000065693.V339781.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 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are well managed because potential residents have plenty of information to help them decide if the home will be suitable. The staff also know about the new resident’s needs and preferences so they can help them to settle into the home in a way that suits them. EVIDENCE: There is up to date information literature that describes the service and what it can offer. Although one resident survey form indicated there was not enough information provided on admission two other responses were positive-‘I found the information useful on the home before making my decision’, ‘my daughter told me everything I needed to know about the home’. Contracts of Residence Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 9 are provided so that residents understand the fee arrangements e.g. charges to be paid four weeks in advance. Senior staff at the home visit everyone before admission whenever possible. They gather as much information as possible about the potential resident’s needs and wishes and this is recorded for the staff to read. Examples of this work were seen at the home. Potential residents and their relatives are also encouraged to look around the home and spend a little time with residents and staff. This is described by the Provider as a ‘try before you buy’ approach. The assessment records addressed all the essential areas e.g. medication regimes, nutritional needs and preferences, mobility and continence issues. The record also referred to important aspects such as culture, religion and sexuality and a new ’social history’ record has recently been introduced This information will be particularly helpful in respect of those residents who are unable to describe this to the staff once they arrive. A relative commented ‘mother only been in 4 months-we haven’t had any problems and are very satisfied at this moment in time’. Wishmoor DS0000065693.V339781.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive good attention to their health and personal care needs, with consideration given to their wishes and best interests. Any risks or changes in condition are quickly identified. Involved health care professionals have confidence in the staff. EVIDENCE: Every resident has a written plan of care and they are consulted when these are written. A sample of plans had been signed by the resident to confirm their agreement with the plan. There was also reference to discussions with relatives when reviewing plans. All aspects of the residents’ lives are addressed in the care planning so it isn’t just the physical needs that receive attention e.g. one plan included reference to favourite music but also referred to the importance of giving lots of encouragement and moving Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 11 at the resident’s own pace when assisting to walk. Assessment tools are used to help the staff identify any potential risk areas e.g. nutrition, falls, skin care. The staff have been trying to encourage relatives to help them make sure the way they care for each resident will suit the individual’s needs and lifestyle choices. Sometimes relatives are not recognising how important their contributions can be-particularly for residents who have a dementia and may not be able to tell the staff about themselves. When the home was last inspected 4 G.P’s and a district nurse sent back survey forms that reflected confidence in the way staff deal with health care. Relatives express continuing confidence in this –‘they ask the G.P. to visit if necessary’. One relative was impressed with the attention of staff following an incident when a resident fell and had to go to hospital. The way that medication is managed has been strengthened. Staff have received additional training and new staff are being given earlier introduction to medication procedures. The amount of medication used is kept to a minimum and if it seems to be having a bad effect on a resident the G.P. is promptly consulted. The deputy manager has arranged for information about allergies is soon going to be printed on medication administration record sheets by the pharmacy rather than staff having to remember to complete it by hand each time a new sheet is brought into use. When medication is prescribed ‘as required’ the staff now have written guidance to help them make consistent decisions for those residents who rely on them to know when they need a dose of the medication. Wishmoor DS0000065693.V339781.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents feel happy with the support they get to enjoy their days. The way this is planned for each individual is included in a written care plan so staff know exactly what help is required. Meals are hygienically prepared and attractively served by staff who understand about good nutrition and who provide alternative choices to suit individual preferences or dietary needs. The residents and their relatives are pleased with the quality of the meals. EVIDENCE: Residents and relatives give lots of examples of staff support in helping residents enjoy their days - ‘we do exercises and also we have questions asked about years ago and quizzes’, ‘they have offered to take my father out so he could buy my mother a birthday present’, ‘staff try to make the residents keep some independence’. Walks out and attendance at a local club were mentioned so there are opportunities to get out into the local community. The variety of leisure opportunities is growing so that all Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 13 residents may find something that will suit them e.g. a relative had noticed that outside speakers were now coming into the home. Reminiscence cards were popular with residents who have dementia related needs and there were plans to buy more of this specialist equipment. Relatives describe a good relationship with the staff-‘they are very supportive of relatives’, and relatives are kept informed when there are any changes to a resident’s situation –‘the home has rung me to inform me of various things-no complaints in this direction’. One relative was pleased with the help staff gave in helping residents send letters and cards to family members. Staff recognise the importance of residents enjoying meals as well as providing them with a well balanced diet. The menu of the day is advertised in the dining room. Hygiene and safety systems are in place in the kitchen e.g. the Provider has implemented a ‘Safe Food Guide’ procedure recommended by the Environmental Health Officer. This includes procedures for checking food and storage temperatures, cleaning rotas etc. Residents and relatives make complimentary comments about the catering service. ‘they bent over backwards to make my mother’s birthday a happy event with a cake etc’. ‘the cooks are good-lovely cakes’. Wishmoor DS0000065693.V339781.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives know who to talk to if they have a problem. They feel confident that the staff will listen to them and take any necessary action to put things right. The staff have information to help them make sure residents are safe but they should obtain further information about the local arrangements for dealing with abuse allegations. There are plans in place to strengthen this essential knowledge with more training. EVIDENCE: The Commission has received one complaint about the service since the last inspection. This was about fee arrangements and the Provider promptly negotiated a satisfactory outcome with the placing authority and relative. The home has only received one complaint and this was from a resident about another resident who had sworn at him and staff. A record of action taken to address this complaint was seen. It reflected a prompt and satisfactory response. A relative commented ‘I was advised by the manager (of the complaints procedure)’ and other comments indicated that residents know who they can talk to about their concerns- ‘I’d speak to the manager or her understudy’. Survey forms confirmed that residents feel safe at the home – Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 15 ‘my parents say the staff are kind’, ‘I have not noticed anything that would alarm me’. The need for staff to receive more training in abuse awareness was identified after the last inspection. This had been arranged but was postponed due to the recent flooding. It was being re-organised for August. The Provider and a staff member were unaware of local multi-agency arrangements for dealing with abuse allegations. A recommendation is made to request information literature about this protocol from Worcestershire County Council. Wishmoor DS0000065693.V339781.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 and 26 this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a substantial amount of work done to make sure the accommodation is safe for the residents who live in it. The Provider is now starting to address the work needed to improve the cosmetic quality of the premises, and residents and relatives are pleased with the outcomes to date. Staff understand how to work hygienically and they are given the guidance and equipment they need for this. EVIDENCE: When the new Provider purchased the home the accommodation needed considerable investment to achieve a satisfactory quality. The amount of investment and time taken to deal with this is commendable. Initially the work Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 17 was focused on safety aspects and may not have been immediately evident e.g. new emergency lighting throughout the building, covering of heated surfaces. Sometimes, additional work has been identified e.g. having to replace floorboards. Having made the home much safer for the residents the cosmetic improvement of the environment has now started e.g. half the bedrooms have been refurbished. Residents and visitors have made positive comments about these improvements. Some work will have to wait until a planned extension is built in the near future e.g. replacement of ‘past their best’ corridor carpets, removing a staff filing cabinet from the residents’ dining room. A relative suggested that it would be useful to have more space for visiting residents in private. Most residents have a single bedroom but there will be more space for alternative visiting areas once the extension is complete. The Provider has a structured plan to achieve a high quality of accommodation as soon as possible and this takes into account the particular needs of the resident group e.g. special signage to help residents identify their bedroom and the toilets, raised flower beds. The premises were clean and tidy when the inspection visit took place. A resident commented ‘I am very pleased with the cleanliness of Wishmoor’. The staff have training to help them manage infection control and they are supplied with the equipment they need to deal with this e.g. liquid soaps, disposable towels, protective, disposable clothing. Wishmoor DS0000065693.V339781.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): Quality in this outcome area is good. 27,28,29 and 30 This judgement has been made using available evidence including a visit to this service. There are enough staff on duty each day to make sure the residents get the care they need. New staff are carefully selected to be sure they will be suitable to work with vulnerable adults. All staff receive the training they need to work safely with the residents and they are also being supported in obtaining a relevant care qualification. EVIDENCE: Staffing levels have been increased since the last inspection. There was a shortfall during some tea time periods but this has now been sorted out so that there are always enough staff out in the home caring for residents with a separate staff member in the kitchen to prepare tea. When new staff are recruited they are carefully checked to be sure they will be suitable to work with vulnerable adults e.g., criminal records bureau checks. Unfortunately these checks can delay things and sometimes the home has lost Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 19 potential new recruits because of this. However, it is essential that the checks remain in place so that residents will stay safe. A recruitment record was inspected and it was generally satisfactory. The Provider was reminded that she must obtain written verification of the reasons why an applicant has left any previous care positions. She must also be sure to check that applicants provide a full employment history on their application form rather than briefer details of their previous jobs. There has been good attention to training opportunities during the past 2 years and there are now half the care staff with a national vocational qualification (NVQ) level 2. Two staff are working towards level 3 and 2 senior staff are working on a level 4 award. Health and safety training is being provided once an induction programme has been completed. A matrix has been designed so that it is easy to see if any individual members of staff are falling behind and need to have more training. Wishmoor DS0000065693.V339781.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): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a management team who know what their responsibilities are and who run the home with the best interests of residents at heart. The overall quality of the service has improved since the new owners took over and they have clear plans to invest in further developments to this end. EVIDENCE: There is an open management approach at the home and all the management staff have considerable relevant experience and knowledge. Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 21 The Provider is very happy to share information with the Commission and other agencies so that she can get the best results for the residents e.g. any incidents or accidents are reported. When concerns are raised these receive prompt attention. This attitude is good because it is the most likely way to be sure of the best outcomes for the residents. The Provider recognises the importance of measuring the quality of outcomes for residents. There are already some procedures in place to help audit the quality of the service e.g. consultation exercises with residents and relatives, regular review of policies and procedures. This type of auditing work has helped identify plans for future developments e.g. the need to improve record keeping and meetings between management and staff at the home. The benefits of using the regulations, National Minimum Standards and Key Lines of Regulatory Assessment (KLORA) in identifying future aims for the service was discussed during the inspection visit. This may help in being more specific about future plans and being sure they have the best effect for the residents. When residents leave small amounts of cash for safekeeping in the office the staff keep a record of all transactions. A sample cash balance was checked and did match the balance shown on the resident’s recording sheet. The Provider was helping a resident who was experiencing some financial difficulty although relatives are usually encouraged to provide this type of support. A financial adviser was being consulted as a means of protecting the resident’s interests. Health and safety receives routine attention through a maintenance log and a programme of health and safety instruction for staff. There is also written guidance in various policies and procedures. Wishmoor DS0000065693.V339781.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 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 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 2 x 3 x x 3 Wishmoor DS0000065693.V339781.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP18 OP29 Good Practice Recommendations Obtain information about the local protocols for protecting vulnerable adults. Obtain written verification for the reasons job applicants have left previous caring posts, and insist on full employment histories as part of recruitment selection process. More reference to the Care Homes Regulations, National Minimum Standards and Key Lines of Regulatory Assessment (KLORA) when identifying specific areas of the service for further development as part of quality monitoring. 3 OP33 Wishmoor DS0000065693.V339781.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office The Coach House John Comyn Drive, Perdiswell Park Droitwich Road WORCESTER WR3 7NW 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 Wishmoor DS0000065693.V339781.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. 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!