Inspection on 06/12/05 for Wisteria House

This inspection was carried out on 6th December 2005.

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 26/05/06

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 Kathy Jones Unannounced Inspection 6th December 2005 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.V264350.R01.S.doc Version 5.1 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.V264350.R01.S.doc Version 5.1 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 Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 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. 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 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. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over approximately three and a half hours on the morning and early afternoon of a weekday. Prior to the inspection the inspector spent two hours reading the last inspection reports, the homes service history and planning the areas to be inspected. Since the last statutory unannounced inspection in June 2005 two additional inspection visits to investigate a complaint and a further two additional inspection visits to monitor compliance with requirements have been made. During the inspection a sample of resident’s records was reviewed to check how their care is planned and supported. Discussions were held with residents, a visitor, staff and the registered owners and manager. Observations of the daily routines and interactions between staff and residents were made. Communal areas of the home were seen during the inspection. Progress in meeting requirements and improvements made were discussed with the registered manager during the inspection. What the service does well: What has improved since the last inspection? The complaint investigation highlighted several shortfalls in areas such as lack of staff training, staff supervision, movement and handling practice, management of medication, choices in relation to meals and the use of bed rails. Following the requirements made some staff training has been provided, the management of medication improved and advice sought from community nurses regarding the bed rails. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 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. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 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.V264350.R01.S.doc Version 5.1 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): This section of the standards was not reviewed during this inspection. EVIDENCE: This section of the standards was not reviewed during this inspection. Standard 6 one of the key standards not inspected during the previous inspection is not applicable, as the home does not provide intermediate care. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 The general care provided appears to be very good however failure to review and update care plans puts residents at risk of their current needs not being fully and consistently met. EVIDENCE: Records for two residents were reviewed during the inspection to see how their care is planned and supported. Residents spoken to were satisfied with the level of care provided. Review of the daily records for a resident who had become poorly, indicated that staff were providing a very good standard of care appropriate to the residents needs. Records detailed actions taken by staff to meet resident’s needs. Resident’s records show appropriate liaison with health professionals such as the District Nurse and General Practitioner. Care plans detailing residents needs were in place however they had not been reviewed and updated according to changing needs. Although not evidenced on this inspection the lack of up to date care plans and direction to staff has the Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 10 potential to put residents at risk of not having their needs met or of inconsistent care. Observations and discussion with staff confirmed that they are respectful of resident’s privacy and dignity. It was identified during discussion that there is no lock on the bathroom door, which leads directly off the lounge. Advice was given that a lock of the type that staff could access in an emergency should be fitted to protect resident’s privacy and dignity. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 Residents have a good level of choice and control over many areas of their lives however more consultation regarding food and the introduction of menu planning would enable more real choices in respect of meals. EVIDENCE: The policy on visiting is flexible however visitors are asked not to visit during meal times out of respect for residents. A visitor to the home confirmed that visitors are welcomed into the home by staff. Residents are able to receive visitors in the privacy of their rooms if they wish. The level of choice and control residents have over their lives is partially dependent on the individual abilities. Residents are able to choose if they spend their days in the lounge or in their rooms. On the morning of the inspection three residents were in the lounge, one was going out for lunch with friends and the others were in their rooms. The majority of residents eat their meals in the dining room. Staff advised that residents have choice over the times they get up and go to bed and that they are aware of individual preferences and routines. It was Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 12 clear from the care plans that consideration has been given to the need to promote and maintain residents independence as far as possible. Unfortunately these had not been reviewed, in one case for more than two years. Therefore they cannot be used to guide and instruct staff in providing the correct level of assistance creating a risk of residents not being given enough independence or enough support to meet their needs. Residents spoken to during the inspection were satisfied with the level of support that they are given by staff. They confirmed that staff spend time talking to them when they have time and a resident said that they liked the quietness. Two residents spoken to were happy with the meals provided and a third was not happy with the quality of food and lack of choice. Discussion with staff identified that there is no pre-planned menu in place and residents often do not know what the main meal of the day is going to be until it is served. Staff informed inspectors that residents are given a choice at tea time. Following a complaint in July a requirement was made that Residents must be consulted about their preferences in relation to meals and snacks in terms of content and quantity and that individual preferences must be recorded as part of their care plan. This requirement has not been met. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The lack of complaints, adult protection and whistle blowing procedures which are understood by managers, staff, residents and relatives puts residents at risk of concerns not being properly reported and acted on. EVIDENCE: The registered manager informed inspectors that there is a complaint procedure however this could not be located during the inspection. Brief information is included in the terms and conditions of residence. Adult protection and whistle blowing procedures were not available in the home and during recent inspection visits it has been apparent that staff have not been fully aware of adult protection and whistle blowing. The registered manager advised that there is no record of complaints in the home and that they have not received any complaints. Discussion indicated that there have been occasions where relatives have discussed concerns with staff and the registered owners however these have not been recognised and recorded as complaints. Advice was given to record all concerns raised regardless of the seriousness of the issue and keep a record of the action taken to address the concern. Since the last inspection two complaints have been referred through the protection of vulnerable adults procedures. The Commission for Social Care Inspection investigated one of the complaints. This complaint related to lack of staff training, lack of staff supervision, excessive hours worked by staff, Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 14 storage of medication, poor infection control, poor kitchen/food safety practices, food quantity and quality, care practices, bruising, shouting at residents and excessive stocks of incontinence products inappropriately stored. With the exception of food quality and bruising to residents the areas of complaint were founded or partially founded and requirements were made. Two additional inspection visits took place prior to this inspection to monitor compliance with the requirements made as a result of the complaint investigation. Some of the requirements have been met while others have only partially been complied with and will be subject to further monitoring. The second complaint was received by The Commission for Social Care Inspection and due to the nature of the compliant was referred through to the protection of vulnerable adults procedures (POVA). At the time of this inspection an independent investigation arranged by the registered owners following a POVA meeting had just been completed and a POVA meeting had been arranged to discuss the outcome and any required actions. The registered owners took appropriate action to safeguard residents during the investigation. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The standard of the environment is good providing Residents with a clean, comfortable and homely place to live. EVIDENCE: A full tour of the premises was not carried out during this inspection however the lounge/dining room was found to be clean, tidy and comfortably furnished. As detailed in a previous section of this report there is a bathroom leading directly of the lounge, which does not have a lock, and a requirement is made in respect of this. Disposable gloves and aprons were available for staff providing personal care to reduce the risk of transfer of infection. A training video on infection control has been purchased. A previous requirement has been made regarding the Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 16 need to implement an infection control procedure, this was not reviewed at the time of this inspection. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 30 Arrangements for ensuring that staff have adequate induction and training to meet the needs of residents are poor. EVIDENCE: There is no training programme or plan in place for staff. New staff learn what to do by being shown what to do by other staff. There is no structured induction or training programme to guide or support staff regarding the expected standards of care or systems to assess their competence. Some recent training has been provided for staff as a result of requirements that have been made and some staff have received some training prior to working at Wisteria House. The registered owner/manager informed inspectors that none of the current staff have a National Vocational Qualification (NVQ). In order to meet the National Minimum Standards 50 of the staff team should have achieved an NVQ by 2005 however it was confirmed that there is no training programme in place to meet this expectation. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 18 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, 36, 38 The registered managers reliance on the inspection process to identify shortfalls in standards has the potential to put residents at risk. EVIDENCE: The registered manager has managed the home for several years and is also joint registered owner of the home. The registered manager does not work set hours in the home, however staff confirm that he is contactable. During the inspection it was evident that the registered manager was not fully aware of the content of the National Minimum Standards implemented in April 2002 and his responsibilities in meeting them. The registered manager has however taken some action to address some of the issues where requirements have been made as a result of the complaint investigation however it is of concern that there appears to be a reliance on the inspection process to identify required actions. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 19 The registered manager confirmed that there is no quality assurance system in place. Advice has been given regarding the importance of this in ensuring the standards of care are satisfactory and also in providing opportunities to address any shortfalls. There is an outstanding requirement regarding the need to implement staff supervision. The registered manager has confirmed that guidance and a proforma have been obtained however the supervision sessions have not yet started. Discussion with staff identified that a movement and handling assessor has carried out some assessments of the handling needs of residents and has given staff some useful advice regarding the transfer of some residents. One movement and handling training session has taken place and the second part has been booked. Inspectors observed a resident being transferred on a wheeled chair which does not contain footplates. Risks associated with this have been discussed with the registered manager on previous occasions and a new chair had been purchased. The new chair was found by staff to be unsuitable for the needs of the resident however the registered manager advised that there is a wheelchair in the garage and he would check its suitability. Advice was given to request an occupational health assessment to ensure the equipment used is safe and suitable for the needs of the resident. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 21 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 OP7 OP10 Regulation 12 (1) (a & b) 12 (4) (a) Requirement Residents care plans must be reviewed regularly and updated to reflect current care needs. A lock must be fitted to the bathroom door to protect the privacy and dignity of residents and be of a type that would allow staff access in an emergency. Residents must be consulted about their preferences in relation to meals and snacks in terms of content and quantity. (These individual preferences must be recorded as part of the care plan) (A previous requirement with a timescale of compliance of 30.08.05 has not been met) The complaint procedure must be accessible to residents, relatives and visitors to the home. There must be evidence in the form of a record that all complaints have been properly investigated. Adult protection and whistle blowing procedures must be developed and made available to DS0000006467.V264350.R01.S.doc Timescale for action 01/02/06 01/02/06 3 OP15 16 (2) (i) 01/02/06 4 OP16 22 01/02/06 5 OP16 22(3) 17(2) sch.4.11 13 (6) 01/02/06 6 OP18 01/02/06 Wisteria House Version 5.1 Page 22 7 OP28 18 (1) (a & c) 18 (1) (a & c) 10 (1) 8 OP30 9 OP31 10 11 OP33 OP36 24 18 (2) 12 OP38 13 (5) staff. A staff training programme must be developed which enables staff to gain relevant qualifications and receive appropriate training. Staff must receive induction and foundation training, which complies with the sector skills council specifications. The registered manager must familiarise himself with the content of the National Minimum Standards and Care Homes Regulations 2001 and take action to ensure that they are met. A quality assurance system must be developed. A programme of formal Staff supervision must be implemented which includes monitoring and recording of individual practice and evidence that any concerns are addressed. (Previous timescales of 30.09.05 and 30.10.05 have not been met) A request for an occupational health assessment must be made to ensure that the equipment in use for transferring residents is safe and suitable for their needs. 01/02/06 01/02/06 01/02/06 01/03/06 01/02/06 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations It is strongly recommended that menus offering a choice of meal are developed to enable residents to know in advance what meals are offered. DS0000006467.V264350.R01.S.doc Version 5.1 Page 23 Wisteria House 2 OP28 A training programme should be developed which enables at least 50 of the staff team to achieve a National Vocational Qualification at level 2. Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 Page 24 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 Wisteria House DS0000006467.V264350.R01.S.doc Version 5.1 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. 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