CARE HOMES FOR OLDER PEOPLE
Wisteria House 9 Ayston Road Uppingham Oakham Rutland LE15 9RL Lead Inspector
Martin Hefferman Unannounced Inspection 13th April 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wisteria House DS0000006467.V362371.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. Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wisteria House Address 9 Ayston Road Uppingham Oakham Rutland LE15 9RL 01572 822313 01572 823651 geoffkirk@tiscali.co.uk 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) Mr Geoffrey Kirk Mrs Joanna Kirk Mr Geoffrey Kirk Mrs Joanna Kirk Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. To be able to admit the named person in category DE(E) subject of variation application V19363 dated 05/07/2005. The registered provider may accommodate a maximum of 13 service users in Wisteria House Care Home when a married couple occupies the double room. The registered provider may accommodate a maximum of 12 service users at Wisteria House Care Home when single persons occupy rooms. No rooms at Wisteria House Care Home should be used for double occupancy other than those stated. 18th May 2007 Date of last inspection Brief Description of the Service: Wisteria House is a small family-run home, registered to accommodate up to thirteen older people. The home is situated in the market town of Uppingham, close to shops and other local amenities. It is a detached house built in 1880 and retains many original features. The home has twelve bedrooms, the majority of which are spacious. Nine are over twenty square metres in size. The upper floors can be accessed by stairs or a passenger lift. There is a large open plan lounge / dining room, which overlooks a private patio garden. All areas of the home are accessible to people using walking aids. There is a car parking area to the side of the building. Information about Wisteria House is available for people who are considering moving to the home. At the time of the inspection, fees ranged from £475 to £500 per week. Wisteria House DS0000006467.V362371.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 2 stars. This means the people who use this service experience good quality outcomes.
A visit to the home took place on 13th April 2008, lasting approximately five hours. The main method of inspection used on that day was ‘case tracking’ which involved selecting two people who live in the home and tracking the care they receive through review of their records, discussion with them & staff members and observation of care practices. Five people who live in the home and one visitor were spoken to during the course of the visit. The registered providers were also present. The inspection took account of all information received since the date of the last visit, including the provider’s annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people who use the service. It also provides some numerical information about the home. Comment cards were received from eight people who live at Wisteria House, one relative and three members of staff. What the service does well:
The services that are provided by Wisteria House meet the needs of the people who live there. Staff members have the information they require to meet those needs. People who live at Wisteria House enjoy the daily life of the home and the social activities that are provided. They stated that they are able to maintain contact with their families & friends and that the latter are welcome to visit. One person commented upon the privacy afforded to her by having an area within her room where she could receive visitors. A second person stated that it is ‘as good a home from home as you can get’. People who live at Wisteria House enjoy comfortable and homely surroundings. They stated that the home is always kept clean and tidy. A number of them have furnished their rooms with their own possessions. People who live at Wisteria House stated that they are happy with the care they receive from staff members. The latter have received training on a range of issues that are relevant to their work. When asked what the home does well, the comments of staff members included the following:
Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 6 ‘Provide a good service to the service user. Comfortable rooms. Well cared for’; ‘We do our best to make sure the residents have everything they need and want … We have regular activities which the residents enjoy’. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wisteria House DS0000006467.V362371.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 Wisteria House DS0000006467.V362371.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, 3 & 6 Quality in this outcome area is good. Assessment practices are effective, ensuring that individual needs are identified before people move to Wisteria House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information about Wisteria House is available for people who are considering moving to the home. The registered providers agreed to amend a guide to the home to reflect an increase in the registered numbers and to remove references to the National Care Standards Commission. One of the people who were chosen for the purposes of case tracking had recently moved to the home. Records indicated that an assessment of her needs had been completed by a social worker before she moved in. Any needs that had been identified were reflected in her individual plan. The home does not provide intermediate care. Wisteria House DS0000006467.V362371.R01.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 & 10 Quality in this outcome area is good. Staff members have access to the information they require to meet individual needs. People who live in the home stated that they are treated with respect. The way in which a particular piece of equipment is used has the potential to put people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People’s individual needs were reflected in the care plans that were inspected. Each plan had been reviewed and had been signed by the person using the service, where possible. Risk assessments have been completed on issues such as manual handling, nutrition and pressure areas. The registered providers agreed to contact the authority responsible for placing a person identified at the time of the visit to clarify whether there was a need to continue monitoring aspects of his care plan as had previously been agreed. People who live at Wisteria House stated that staff would take action to ensure that any health care needs are met. A record is kept of all appointments with health care professionals. Staff members were observed transporting two people using a wheelchair. They did not use the footplate, which had been
Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 10 added to the chair since its manufacture. Inspection of the home’s accident records indicated that a person’s foot had been injured when using the wheelchair. None of the people who were chosen for the purposes of case tracking managed their medication. Records of the medication administered by staff met relevant requirements. Records indicate that staff members have received medication training. People who live at Wisteria House stated that they are treated with respect. They reported that staff members use their preferred form of address and that they knock & wait for a response before entering their rooms. One person commented upon the privacy afforded to her by having an area within her room where she could receive visitors. A second stated that it is ‘as good a home from home as you can get’. Wisteria House DS0000006467.V362371.R01.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 & 15 Quality in this outcome area is good. People who live at Wisteria House enjoy the daily life of the home and the social activities that are provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at Wisteria House stated that they enjoy the activities that are provided. A newsletter, which had been produced by a person living in the home and one of the registered providers, set out the activities that were planned for April. Two people attended a service at a local church on the day of the visit. Other people stated that they are able to attend regular services within the home. People who live at Wisteria House stated that they are able to maintain contact with their families & friends and that the latter are welcome to visit. A friend of one of the people who lives in the home stated that she comes round in the evenings and for dinner on Sundays. She was accompanied by her dog, whose presence was enjoyed by many of the people who were in the lounge at the time of her visit. People who live at Wisteria House stated that they generally enjoy the food that is provided and that the meals are suited to their individual requirements.
Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 12 Records indicate that a varied diet is provided and that alternatives to the main meal are available if required. Wisteria House DS0000006467.V362371.R01.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 & 18 Quality in this outcome area is good. People who live at Wisteria House are generally protected by the arrangements for dealing with complaints and for responding to allegations of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at Wisteria House stated that they would talk to staff members, the acting manager or the registered providers if they had any concerns. The home has not received any complaints since the date of the last inspection. The registered providers agreed to amend the complaints procedure displayed in the entrance hall to reflect changes to the regulatory authority. Details of an advocacy service are also available in the hallway. The home has a copy of the local multi-agency policies and procedures on the protection of vulnerable adults. The home’s policy on abuse does not reflect the role played by Social Services, although this is reflected in other guidance (e.g. the ‘whistle blowing’ policy). Staff members have received training on safeguarding adults. Rutland Adult Social Services, Health & Housing Department conducted a safeguarding adult investigation during January 2008 and found that the allegations of abuse that had been made were substantiated. The continuing residence of the person concerned has since been confirmed following a comprehensive review of his placement. Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 14 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 & 26 Quality in this outcome area is good. People who live at Wisteria House enjoy comfortable and homely surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at Wisteria House stated that they are happy with the environment in which they live. A number of them reported that they have furnished their rooms with their own possessions. They stated that the home is always kept clean and tidy. The areas that were inspected during the course of the visit were decorated and furnished to a high standard. It was noted that the downstairs toilet door did not have a lock and that a number of fire doors were wedged open. Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. The needs of the people who live at Wisteria House are met by the home’s staffing arrangements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at Wisteria House stated that they are happy with the care they receive from staff members. They reported that there are always enough members of staff on duty. The records relating to two members of staff were inspected. Whilst one of them contained two written references, a second contained only one. The registered provider stated that two references had been obtained and that one of them had been mislaid. He agreed to check that staff records complied with the requirements of Schedule 2 of the Care Homes Regulations 2001 (as amended). Criminal Records Bureau disclosures were available for the staff whose records were inspected. New members of staff complete induction training to the standards set by Skills for Care. Information provided by the registered provider prior to the visit indicated that five of the twelve members of staff have completed National Vocational Qualification level 2 or above and that two are working towards such an award. Records indicate that staff members have received training on issues such as care planning & risk assessment, person-centred care, dementia and sensory impairment in addition to medication, safeguarding adults and safe working practices.
Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 16 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 & 38 Quality in this outcome area is good. Wisteria House appears to be managed in the best interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both of the registered providers were present on the day of the visit, which took place on a Sunday. A full time manager is responsible for the running of the home during the week. People who live at Wisteria House have completed a survey of their views. The registered provider stated that he had not published the results. Records indicate that people who live at Wisteria House have been consulted on issues such as the purchase of a new television. The registered provider stated that the home did not handle any money belonging to the people who live there. Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 17 Staff members have received training in first aid, fire safety, food hygiene, the control of infection and moving & handling. Records indicate that fire tests and drills have been completed at the required frequency. Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A X X 3 Wisteria House DS0000006467.V362371.R01.S.doc Version 5.2 Page 19 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 OP8 Regulation 13 Requirement The registered providers must seek professional advice regarding a wheelchair identified at the time of the visit to ensure that the people who use it are protected from harm. An application for the registration of a manager must be submitted if the registered provider is not in full-time day to day charge of the home. Timescale for action 30/04/08 2. OP31 8 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP19 OP19 OP33 Good Practice Recommendations A lock should be fitted to the downstairs toilet door. Consideration should be given to fitting automatic closures to doors if people wish to keep them open. The results of any actions taken to measure the quality of the service provided at Wisteria House should be made available to the people who live there, their representatives and other interested parties.
DS0000006467.V362371.R01.S.doc Version 5.2 Page 20 Wisteria House Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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