Inspection on 19/07/06 for Wisteria House

This inspection was carried out on 19th July 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

Wisteria House 26/07/07

Wisteria House 08/12/05

Wisteria House 27/09/05

Wisteria House 09/02/05

Wisteria House 14/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Wisteria House Montacute Road Tintinhull Yeovil Somerset BA22 8QD Lead Inspector Jane Poole Key Unannounced Inspection 19th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wisteria House DS0000058877.V302450.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 DS0000058877.V302450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wisteria House Address Montacute Road Tintinhull Yeovil Somerset BA22 8QD 01935 822086 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 Siobhan Cecilia Wortley Mr Stephen John Wortley Mrs Siobhan Cecilia Wortley Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 2005 Brief Description of the Service: Wisteria House is a two-storey Hamstone building situated in the centre of the village of Tintinhull, local amenities are nearby. The home has been registered as a service for older people since 1985. Wisteria House is registered to provide care and accommodation for thirteen people. Due to the physical environment, Wisteria House is best suited to meet the needs of those with low to medium dependency. All rooms are for single occupancy. Mr and Mrs Wortley, have been the registered providers since March 2004. Mrs Wortley also shares the registered manager post with Maria Goodland. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 5.5hour period. The inspector was able to speak with staff and service users, tour the premises, observe care practices and view records. One of the managers was available for part of the day. 9 completed questionnaires were received from service users prior to the inspection and 2 from care managers. Some of the findings from these have been incorporated into this report. What the service does well: What has improved since the last inspection? The homes garden is at the front of the house and this has been improved since the last inspection making it a very pleasant place to sit. A new path has been laid to the front door meaning that people, including anyone using a wheelchair, no longer enter the home through the kitchen. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 6 The home has recently purchased a new induction programme, which all new staff will work through. The inspector viewed the documentation and found it to be comprehensive and appropriate to the home. At the last inspection concerns were raised about the heating in the home. Assurances were given that this will be addressed before the winter. There was a mixed response from service users about the activities provided by the home. A member of staff is now being employed to co-ordinate activities and to ensure that everyone living at the home has an opportunity to pursue their chosen interests and hobbies. 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. Wisteria House DS0000058877.V302450.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 DS0000058877.V302450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5. Overall quality in this outcome group is good. All prospective service users have their needs fully assessed before moving to the home. The home offers prospective service users adequate information and the opportunity to visit the home to enable them to make an informed choice about moving in. EVIDENCE: There have been no changes to the Statement of Purpose or the Service User Guide since the last inspection and they continue to reflect the services and facilities offered by the home. Many of the service users spoken to during the inspection stated that they and/or their families had been able to visit Wisteria House before making a decision to make it their home. One person, who completed a questionnaire Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 9 prior to the inspection, stated that they had had the chance to stay at the home for a period of respite before deciding to move in on a permanent basis. The inspector viewed the personal files of the two most recently admitted service users and noted that copies of full assessments completed by outside professionals had been obtained. The building itself is set on many levels with several steps and discussion with the manager revealed that she considers the physical environment and the location of vacant rooms when offering a place to a new service user. It was also clear that the manager considers the needs of existing service users when assessing a prospective service user. Staff spoken to felt that they had appropriate training and support to meet the needs of the service users. The home does not provide intermediate care. Wisteria House DS0000058877.V302450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Overall quality in this outcome group is adequate. Care plans are very personal to the individual and give clear information to enable staff to deliver appropriate care to each service user. Facilities for the storage of medication are poor. EVIDENCE: The inspector viewed 3 personal files in detail. The assessment of need carried out by the home is very detailed and personal to the individual. This assessment includes information about peoples’ likes and dislikes and also about their lifestyles and interests. It was pleasing to see that the assessment also contained details of peoples’ attitudes to their current situation and issues that may affect their well being, such as recent bereavements and family support. A basic care plan is devised from the assessment. The combination of the care plan and the assessment gave a very good holistic picture of the individual service user. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 11 One of the assessments had not been dated when completed and in one the information relating to religion and spirituality had not been completed. There was evidence that all care plans are regularly reviewed with the service user and many service users stated that they had an annual review with their care manager and the home. There were separate assessments in respect of tissue viability and pressurerelieving equipment was in place where a risk was identified. All service users are registered with local GP’s and the home has good links with other healthcare professionals in the area. Only one of the personal files seen demonstrated that service users are weighed and no nutritional assessments were in place. 7 of the 9 people who completed questionnaires prior to the inspection answered ALWAYS to the question “Do you receive the medical support you need?” the other two people answered USUALLY. Staff observed interacted with service users in a friendly and respectful manner. Service users spoken to stated that ‘most’ staff treated them with respect but they felt that some could be a little unthinking at times. This issue was discussed with the manager after the inspection. 8 of the 9 people who completed questionnaires answered YES to the question “Do staff listen and act on what you say?” Both care managers who responded to comment cards stated that they were able to see their client in private. Service users are able to spend time in communal areas or in the privacy of their rooms. The home uses the Boots Monitored Dosage System for medication. Staff have received training in the safe administration of medication including the administration of insulin. The inspector viewed the Medication Administration Records and found them to be correctly signed when administered or refused. All medication is currently stored in the laundry. There is a metal cupboard, drugs trolley and fridge within a large cupboard. The trolley cannot be moved out of the room due to steps and therefore all medication is dispensed from the laundry. This has obvious hygiene issues. On the day of the inspection the temperature inside the cupboard was 29 degrees centigrade, which exceeds the maximum recommended temperature of 25. There is a clear sign by the medication fridge which states that the correct temperature is between 2 & 8 degrees centigrade. Staff record daily the minimum and maximum temperatures and for some days prior to the inspection had been recording temperature far in excess of this without making any adjustment to the fridge. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 12 Wisteria House DS0000058877.V302450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Overall quality in this outcome group is good. The routines in the home are determined by the needs and wishes of service users. EVIDENCE: It was very clear by talking with staff and service users that all routines in the home are dictated by the needs and wishes of the service users. People are able to determine what time they get up, when they go to bed and how they spend their day. Once a month there is a trip out and on the day of the inspection many of the service users went out to lunch. There is a multi denomination vicar who visits the home on a regular basis and some organised activities. Some people also attend day centres outside the home. There was a mixed response from service users who completed questionnaires about the activities in the home. 1 person answered ALWAYS, 4 answered USUALLY and 3 answered SOMETIMES to the question “Are there activities arranged by the home that you can take part in?” This was discussed with the manager who stated that the home is in the process of employing a member of staff to co ordinate all activities and look at individual needs and wishes. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 14 One member of the care staff team stated that they had little time to provide activities. However due to the size and layout of the home there appeared to be a reasonable level of social interaction between staff and service users on the day of the inspection. All service users asked stated that they are able to have visitors at any time and many said that they enjoyed visits and trips out with family members. The home does not act as an appointee or power of attorney for any service user. All service users handle their own financial affairs, many with the assistance of family members. The home has access to independent advocates and some of the questionnaires completed for the CSCI were done so with assistance from an advocate. The main meal of the day is at midday. A cook is employed throughout the week and care staff cook at weekends. Service users spoken to during the inspection were happy with the quality of food in the home and stated that portions were ample. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Overall quality in this outcome group is good. The home has taken reasonable steps to minimise the risk of abuse to service users. EVIDENCE: The home has policies and procedures in respect of recognising and reporting abuse and making a complaint. There have been two complaints made in the last 12 months and the manager was able to evidence that these had been fully investigated. All service users spoken to stated that they would be comfortable to speak with a member of staff if there was anything that they were not happy with. Questionnaires received from service users reinforced this view. As previously stated the home has access to independent advocates. All staff are checked against the Protection Of Vulnerable Adults register before commencing work and all undergo an enhanced Criminal Records Bureau check. Service users were seen to move freely around the home and garden. Wisteria House DS0000058877.V302450.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 26. Overall quality in this outcome group is adequate. Many areas of the home would benefit from upgrading and refurbishment. EVIDENCE: Wisteria House is a large older style listed building. Service user accommodation is set over two floors but within the main floors there are several levels with steps making some areas of the home unsuitable for people with mobility difficulties. There is a passenger lift and stair lifts are in place on short flights of steps. Aids and adaptation such as raised toilets and hand-rails have been put in place to assist service users to retain their independence where possible. The inspector viewed the communal areas of the home and briefly sampled some private rooms. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 17 All communal areas of the home are on the ground floor they consist of a lounge and dining room. All bedrooms are for single occupancy and 4 have en-suite facilities consisting of a toilet and wash hand basin. All rooms have wash hand basins and there are toilets on each floor. Many service users have commodes in their bedrooms for use at night. When the inspector toured the building at around 10.30am it was noted that many commodes had not been emptied or cleaned. This was particularly concerning as many service users choose to have breakfast in their bedrooms. Service users are able to bring small items of furniture and personal possession with them when they move to the home, which gives rooms an individual homely feel. There is a communal bathroom on each floor, however the bathroom on the first floor is not used as it is inappropriate to meet the needs of the service users. This means that all 13 service users share one bath on the ground floor. At the last inspection, carried out in December 05, it was noted that there were problems with the heating system. The manager explained that this will be rectified before the winter. It was noted that some areas of the home would benefit from refurbishment and redecoration. Some carpets would benefit from cleaning or replacement, particularly the one in the lounge, which was shabby and stained. The manager gave assurances that all areas would be redecorated after the central heating system has been installed. At the last inspection concerns were raised about the access to the home. A new path has been laid to the front door meaning that there is no longer a need for people to enter the house through the kitchen. All service users who completed questionnaires answered ALWAYS or USUALLY to the question is the home fresh and clean. On the day of the inspection all areas seen were reasonably clean although as mentioned the lounge carpet was in need of cleaning. The homes laundry is sited at the rear of the dining room. There is one washer and one drier, which appears adequate for the size of the home. The laundry room is not large and is also used for the storage and administration of medication. Throughout the day of inspection clean laundry was piled on dining room tables. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 18 Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Overall quality in this outcome group is good. The home is adequately staffed to meet the needs of the current service user group. EVIDENCE: The home employs 14 care staff and 1 ancillary worker. 3 members of staff have a National Vocational Qualification in care and a further 5 are currently working towards the award. Staff and service users felt that there was adequate numbers of staff on duty. Throughout the day there are two members of the care staff team on duty and overnight there is one person with another member of staff on call. Monday to Friday there is a cook on duty. The management and domestic hours are in addition to this. Since the last inspection the manager has purchased a new induction programme which new staff will work through before registering for NVQ’s. The new induction programme is comprehensive and appropriate to the home. Staff spoken to were happy with the training opportunities in the home. In addition to statutory training some staff have undertaken training in infection control and dementia awareness. All staff training is recorded on individual sheets. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 20 Since the last inspection one new member of staff has been recruited. The manager gave evidence that all appropriate documentation had been obtained but the inspector was unable to view some items. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38. Overall quality in this outcome group is adequate. The overall management arrangements and responsibilities are unclear to staff and service users. Appropriate steps have been taken to ensure the health and safety of service users. EVIDENCE: The registered manager position in the home is shared by the joint owner, Siobhan Wortley, and Marie Goodland. Maria works 18.5 hours per week and was available on the day of the inspection. Maria’s hours are identified on the rota but there is no indication of hours worked by Siobhan. There is also a deputy manager and there is always a senior carer on duty. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 22 All staff receive regular formal supervision with the manager or deputy but the management are available for advice and guidance outside of these formal sessions. One member of staff stated that there was a lack of leadership in the home due to the disjointed management arrangements and the lack of leadership training for senior carers. One service users spoken said that it would be nice if the home had a full time manager. Staff stated that staff meetings are an opportunity to share ideas and information. The home also seeks the views of service users and other interested parties on a yearly basis. There are currently no service user meetings. As previously stated in this report the home does handle the financial affairs of any service user living at the home. All records seen by the inspector were up to date and well maintained. Steps have been taken to ensure the health and safety of service users and staff. Staff have received training in food hygiene, first aid, infection control and manual handling. One of the managers and the deputy are manual handling instructors. All accidents are recorded and audited on a regular basis to identify any service user at high risk of falling and any patterns of accidents. A fire log is maintained that gives up to date information about the location of each service users room and their mobility. It also gives evidence that alarms are tested on a weekly basis and emergency lighting is tested monthly. All staff are due to receive training in fire safety next month. Records show that equipment in the home is serviced by outside contractors on a regular basis. Hoists and stair lifts were tested in June 06 and all portable appliances were tested in November 05. A certificate of registration is displayed in the main hall. Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 23 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 2 X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 3 3 Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? 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 The home must review the practice of storing and administering medication in the laundry. An environmental refurbishment plan, with dates, must be drawn up and forwarded to CSCI. The home must ensure that the bathing/showering facilities are appropriate to the needs of service users. The home must review the management arrangements in the home to ensure that there are clear lines of responsibility and accountability at all times. Timescale for action 15/09/06 2 OP19 23(2) 31/08/06 3 OP21 23(2) [j] 30/11/06 4 OP31 OP32 10 (1) 18(1) [a] 31/08/06 Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 25 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 OP8 OP26 Good Practice Recommendations All service users should be regularly weighed and nutritional assessments put in place where appropriate. The lounge carpet should be cleaned or replaced as a matter of priority. All commodes should be emptied and cleaned early in the morning. 50 of care staff should have a National Vocational Qualification in care at level 2 or above. 3 OP28 Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 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 Wisteria House DS0000058877.V302450.R01.S.doc Version 5.2 Page 27 - 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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