Inspection on 26/05/06 for Wisteria House

This inspection was carried out on 26th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 06/10/09

Wisteria House 13/04/08

Wisteria House 18/05/07

Wisteria House 06/12/05

Wisteria House 06/06/05

Wisteria House 24/03/05

Wisteria House 13/01/05

Wisteria House 26/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Wisteria House 9 Ayston Road Uppingham Oakham Rutland LE15 9RL Lead Inspector Mrs Moira Mosley Unannounced Inspection 26th May 2006 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 DS0000006467.V297055.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. DS0000006467.V297055.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 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 Kirk Mr Geoffrey Kirk Mrs Joanna Kirk Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places DS0000006467.V297055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To be able to admit the named person in category DE(E) subject of variation application V19363 dated 05/07/2005. 6th December 2005 Date of last inspection Brief Description of the Service: Wisteria House is a care home registered to accommodate up to 12 older people. The home is a small family-run home. It is a detached house built in 1880 and retains many original features. There is a car parking area to the side of the home. Wisteria House is situated in the market town of Uppingham, close to shops and other local amenities. The home has twelve single bedrooms, the majority are spacious and nine are over 20 square metres in size. The upper floors can be accessed by the stairs or the passenger lift located to the centre of the home. There is a large open plan lounge/dining room, which overlooks a private patio garden. All areas of the home is accessible to people using walking aids. A new acting manager has been appointed and is applying to the CSCI to be registered. The current fees for the home are £400 per week with one slightly smaller bedroom at £390. DS0000006467.V297055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection by one inspector. The inspection process included the collation of information and pre-inspection planning to gather information and then five and a half hours were spent in the home. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents and their views of the service provided. This is achieved primarily through the process of ‘case tracking’ which involves reviewing the care of specific residents including looking at their records, talking to them and their families or representatives where possible and talking with the care staff who provide the personal care to those selected residents. The care of three residents was reviewed on this inspection to include care plans, risk assessments, medication and other records. In addition discussions were held with three residents and two members of staff with a period of observation undertaken. What the service does well: What has improved since the last inspection? There were 12 requirements made at the last inspection in December 2005 and all have been addressed. DS0000006467.V297055.R01.S.doc Version 5.2 Page 6 These included staff training, staff supervision and the implementation of policies and procedures to guide staff are all areas that needed to be developed to ensure that staff are fully equipped to meet the needs of residents. An awareness of complaints, adult protection and whistle blowing procedures by staff, residents and relatives was required to provide better protection for residents. Arrangements to be made to ensure that resident’s privacy and dignity is respected need to be reviewed and the implementation of a menu would enable residents to know what meals are to be provided and give the opportunity for choices to be made. What they could do better: The statement of purpose is a document that should be available in all homes, it outlines what the home is all about and how it aims to meet the residents’ needs, and it was not available and so restricts the information available to residents and their families. There are new care plans being introduced and these will contain more information about needs and give clearer direction to staff on what the need to do – it is recommended that these are a priority because at the moment there is a lack of detail for staff to follow in the current plans. Although there is good evidence of input from healthcare professionals for example the GP and district nurse being involved and several resident have equipment such as pressure cushions and mattresses to prevent them developing pressure ulcers, there is overall a lack of documented evidence of what they are doing to meet health care needs. There are assessments to check residents weight, nutritional needs, the risk of pressure ulcers and manual handling plans but none of these are being accurately completed or followed up to show what action they have taken when a risk is identified. Most of these have not been reviewed since 2005. It was not possible to fully account for all medication in the home as they are not documenting what is being received and there may be some errors in administration, which the manager needs to address to make sure medication is being given as prescribed. The health and safety of residents are not being fully met, there were no fire records available to show that regular checks are being made, in addition accident records are not being completed to monitor accidents within the home. DS0000006467.V297055.R01.S.doc Version 5.2 Page 7 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. DS0000006467.V297055.R01.S.doc Version 5.2 Page 8 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 DS0000006467.V297055.R01.S.doc Version 5.2 Page 9 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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s are being assessed to ensure their needs can be fully met prior to being admitted to the home, but the lack of a statement of purpose being available restricts information available for residents and their families. EVIDENCE: There have been no new admissions to the home since the last inspection however discussions with the acting manager demonstrated that there is a detailed procedure in place and she stated he would ensure liaison with the multi disciplinary team to ensure as much detail is assessed as possible and if any specialist training or equipment is required that this is provided to the home prior to any admission. The care plans for the resident’s whose care was tracked contained assessment details that demonstrated a full consideration of needs. The statement of purpose which outlines the details about the home and what it offers was not available at the time of this inspection, the acting manager DS0000006467.V297055.R01.S.doc Version 5.2 Page 10 stated it was with the owners of the home and it was discussed that it needs to be available in the home and be reflective of the current situation. National Minimum Standard (NMS) 6 was not assessed, as intermediate care is not provided in this home. DS0000006467.V297055.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of the residents are not being fully met, specifically with healthcare assessments not being accurately completed and updated and so putting residents at risk of not having all needs identified and met. EVIDENCE: The acting manager is in the process of introducing a new care plan format and the one seen that was completed was fairly comprehensive with better levels of information than was contained in the previous files. It was agreed that this process needs to be a priority to ensure all needs are fully identified with clear guidance for staff on what action is required to meet the needs. There was no evidence of resident or their representative’s input or agreement to the care plan although it was stated that discussions had taken place with relatives. Information found within daily notes was not always transferred to care plans, for example one residents notes stated concern that they had not passed urine for a few days and although there was evidence of the GP being informed there DS0000006467.V297055.R01.S.doc Version 5.2 Page 12 was no follow up plan to direct staff what action was needed, this could result in inconsistencies of care. The healthcare assessments were not up to date and there was a lack of evidence of action taken. Examples included one resident with a Waterlow score of 20 – which indicated a very high risk of pressure sore development, with no review since march 2005 and no evidence of action taken – on investigation it was found that the resident had a pressure mattress and cushion via the district nurse but no direction for staff on what they needed to do or to check to maintain skin integrity. A possible training need was identified as the nutritional and pressure sore assessments were not being kept up to date and the calculations did not appear to be accurate in relation to the residents’ current condition. Residents were not being weighed regularly and therefore weight loss was not being monitored. Manual handling plans were also out of date, with conflicting advice – one resident’s plan stated they were both immobile and walked with a frame within the same document. The majority of the medication is now in a weekly monitored dosage system (MDS) and this appeared to be working well. The mediation was crossreferenced to the Medication Administration records (MAR). There was a discrepancy between the number of tablets evident and the number signed for as being administered for one resident’s tablets which were not in the MDS. The acting manager agreed to investigate this further. There was no audit system to account for the number of tablets being received in the home and therefore it was not possible to accurately account for all medication received. One resident was prescribed a controlled drug and the records were not being accurately kept with pages torn out of the book – the acting manager agreed to start a new book and keep a closer record of all medication with regular audits to monitor administration. There was an effective system in place for the disposal of medication. Observations and discussion with staff confirmed that they are respectful of resident’s privacy and dignity. DS0000006467.V297055.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices and family contact is supported with some social interactions to provide daily interests and activities for the residents. EVIDENCE: Most of the residents currently in the home have been there for several years and generally remain on their own rooms. The acting manager discussed that she has tried to encourage some social activities but there is a reluctance to get involved and those spoken to confirmed this. However it was identified that there was a culture of isolation and the acting manager was keen to work at encouraging more interaction and she intends to develop this further over time. One resident spoken to was very independent and she felt supported by staff to make choices in her daily life. Another resident stated they were able to make choices about their daily activities including where they spent their time, what time they got up and went to bed. Individual likes and dislikes in relation to meals has now been recorded within care plans and the resident spoken to were overall satisfied with the meals provided. It was evident that choices are offered and one resident telephoned DS0000006467.V297055.R01.S.doc Version 5.2 Page 14 from her room to ask for a different lunch to be provided and this was a regular occurrence within the home. The kitchen was clean and well stocked with records available for cleaning, stock control and menu choice. DS0000006467.V297055.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an effective system for the home to respond appropriately to complaints made and residents are protected from abuse with their views listened to. EVIDENCE: There is a complaints procedure in place available to residents and displayed on the notice board with a complaints log maintained to evidence all complaints received and action taken. Staff training records showed that staff had received training on abuse issues and staff spoke to were clear on what they would do if they had any concerns raised about the care of the residents. There have been no allegations made since the last inspection. The resident spoken to said they felt safe and well cared for by the staff in the home and would speak to the owner or staff if they had any concerns. DS0000006467.V297055.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 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment is adequate providing service users with a homely place to live, however the lack of evidence of fire checks could put residents at risk. EVIDENCE: A tour of the premises was undertaken and the home was clean and maintained. The residents’ bedrooms were viewed and were clean, well furnished and decorated with good evidence of personalisation. The residents spoken to all stated they were happy with their rooms. The residents spoken to said they were happy with the facilities in the home and liked their bedrooms. There is a system in place for maintenance. The acting manager was not sure of the last visits by either the Environmental Health or Fire officers. The fire records for ongoing fire checks and drills were not available although she stated the owners did these regularly. DS0000006467.V297055.R01.S.doc Version 5.2 Page 17 There is a laundry system in place, which appears to meet the needs of the residents and there was gloves and aprons available for maintaining safe working practices. DS0000006467.V297055.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified and trained staff are provided in adequate numbers to ensure resident needs can be met. EVIDENCE: Staff training was of serious concern at the last inspection and significant improvements have been seen. Discussions with staff confirmed that a training programme is now in place with all staff currently up to date with statutory training including manual handling, fire and first aid, with other recent training including abuse and infection control. Staff files demonstrated a comprehensive recruitment procedure, which was confirmed by a newly appointed member of staff to include references and Criminal Record Bureau (CRB) checks to ensure staff are suitable to work within care. There was evidence in the files of an induction programme with staff receiving training and information as well as a period of ‘shadowing’ an experienced member of staff for a period before being expected to work independently. Staff confirmed regular supervision is now taking place and an appraisal system is being introduced. DS0000006467.V297055.R01.S.doc Version 5.2 Page 19 The acting manager is in the process of securing places for staff to commence their NVQ (National Vocational Qualifications) training, which at present no staff have achieved. Staff spoken to confirmed that they felt there were sufficient numbers of staff on duty to meet the residents’ needs and the rotas confirmed this. There is a very stable staff team with a low turnover, which ensures a consistent team to provide the care needed. DS0000006467.V297055.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and safety of residents is compromised with the lack of records for example accident and fire records. EVIDENCE: Since the last inspection an acting manager has been employed and has been in post for three weeks. The staff and residents spoken to were extremely positive about this appointment and feel positive changes have already been implemented. It was evident through observations of the positive relationship between the residents and the staff team including the manager. The quality assurance procedures could be further improved, a questionnaire was sent to the residents following the last inspection however there was no evidence of any collation of the results or a development plan being implemented. The inspector discussed with the acting manager how DS0000006467.V297055.R01.S.doc Version 5.2 Page 21 questionnaires could be expanded and the need for regular audits to be carried out to demonstrate a proactive approach to identifying areas of need. The home does not manage any of the residents’ money and all have their own bank accounts or family/representatives to manage their affairs. Accident records are not being completed every time a resident is found with an injury, for example one residents daily notes identified them being found with a cut to their arm and no accident record completed. Staff training records demonstrated that staff are currently up to date with statutory training. There are effective systems in place for health and safety issues to be addressed and there were no concerns identified at the time of this inspection. As identified earlier in the report the lack of fire records is of concern and these need to be available to demonstrate the monitoring of safety within the home. DS0000006467.V297055.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 2 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 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 X X X X 3 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 3 X 2 X 3 X X 2 DS0000006467.V297055.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. 1. 2. Standard OP1 OP8 Regulation 4 12(1)(a) Requirement The statement of purpose must be up to date and available in the home Residents’ nutritional needs and weights must be recorded and assessed with action identified where required. Residents must be assessed in relation to the risk of developing pressure ulcers and action taken when risk indicates it. Residents must have manual handling assessments with clear guidance for staff of action needed. All medication entering the home must be clearly traceable from receipt to administration or disposal. Fire records must be kept up to date and available in the home Accident records must be completed for all accidents/incidents in the home Timescale for action 30/07/06 30/06/06 3 OP8 12(1)(a) 30/06/06 4 OP8 13(5) 30/06/06 5 OP9 13(2) 30/06/06 6 7 OP19 OP38 23(4) 17(1)(a) schedule 3 (3)(j) 30/06/06 30/06/06 DS0000006467.V297055.R01.S.doc Version 5.2 Page 24 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 OP7 OP33 Good Practice Recommendations The new care plan documentation should be implemented for all residents with evidence of the resident or their representatives’ input and agreement. The quality assurance system should be further developed to identify areas of need and demonstrate action to be taken DS0000006467.V297055.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 DS0000006467.V297055.R01.S.doc Version 5.2 Page 26 - 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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