Inspection on 06/10/09 for Wisteria House

This inspection was carried out on 6th October 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wisteria House 13/04/08

Wisteria House 18/05/07

Wisteria House 26/05/06

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 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Wisteria House 9 Ayston Road Uppingham Oakham Rutland LE15 9RL Lead Inspector Debbie Williams Key Unannounced Inspection 6th October 2009 09:00 DS0000006467.V378068.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Wisteria House DS0000006467.V378068.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 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.V378068.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 13th April 2008 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. A copy of the last inspection report was available at the home. Wisteria House DS0000006467.V378068.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 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place over one day on the 6th of October 2009. The main method of inspection used was ‘case tracking’ which meant selecting residents and tracking the quality of their care by checking records, discussion with them and with staff and observation of care practices. Since the last key inspection a safeguarding concern was raised and an investigation was conducted by social services. This was regarding care practice and staff attitudes at weekends. The providers have complied with requirements’ made by social services and have taken the action required to ensure that people living at Wisteria House are safe and protected from abuse. What the service does well: People who live at Wisteria House enjoy comfortable and homely surroundings. The home was decorated and furnished to a high standard, people had furnished and personalised their rooms with their own possessions. People spoken with said that the home is always kept clean and tidy. What has improved since the last inspection? Wisteria House DS0000006467.V378068.R01.S.doc Version 5.2 Page 6 Since the last inspection the acting manager had submitted an application to become registered as the manager at Wisteria House with the Care Quality Commission. The majority of people spoken with told us that staffing levels and care received at the weekend had improved. People also said that the quality and quality of meals provided had recently improved. All care staff working at Wisteria House had received training in caring for people with dementia. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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 Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (standards 1,3 and 4 were assessed) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they require to make an informed choice about moving in to Wisteria House. People have their needs assessed in order to ensure the service can meet people’s individual needs. EVIDENCE: A service user’s guide is provided to all prospective residents, this provides a description of the services provided. It is required that information regarding fees contained in this document should be changed in order to protect the Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 10 confidentiality of people living at Wisteria House. Rather than stating the weekly fee for individual room numbers, the range of fees applicable should be stated. Information provided within the service users guide and by the acting manager told us that a full needs assessment would be carried out before people moved in to Wisteria House, this is to ensure that the service can meet people’s needs. Assessment records were seen within individual care plans and these included risk assessments. The home does not provide intermediate care. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (Standards 7,8,9 and 10 were assessed) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Wisteria House did have their health and personal care needs met. Care planning and some medication procedures did not comply with regulations. EVIDENCE: We case tracked four people and this included looking at peoples care records. Care plans set out people’s personal care requirements and these included people’s individual needs and preferences. Care plans were not in place for all assessed needs and were not reviewed on at least a monthly basis, this is necessary in order to ensure that peoples changing needs are reflected in their care plans. A requirement for monthly reviews was made at the last two key Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 12 inspections. Staff spoken with however, did have a good awareness and understanding of peoples individual needs. Care records included individual risk assessments. Risk was assessed for moving and handling, nutritional risk and risk of developing pressure sores. Care records also stated that people had access to healthcare services as required. People spoken with told us they could see their GP whenever they needed to. We looked at medication management, administration records and storage. People were able to manage their own medication if they chose to and this was risk assessed. However, risk assessments should be carried out on a more frequent basis and a requirement was made regarding this. Records were maintained of all medicines received, administered and disposed of. Medication administration records seen appeared accurate and up to date. Stock levels for some medications were checked and audited on a daily basis. A requirement was made that controlled drugs must be stored in a controlled drug cupboard which complies with the Misuse of Drugs Safe Custody Regulations (1973 and 2007 amendments) Staff receive in house training for the management of medication from the acting manager. A requirement was made that all staff responsible for managing medication receive accredited training, this is to ensure that people living at Wisteria House are protected from harm. Interactions observed between staff and residents appeared positive and professional. People spoken with felt they were treated with respect and their privacy and dignity maintained by the majority of care staff. However, issues were raised regarding people feeling patronised by one person. Issues of professional boundaries were discussed and a requirement was made. People spoken with told us that staff maintained their privacy and dignity when providing personal care. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (Standards 12,13,14 and 15 were inspected) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Wisteria House, mostly has their lifestyle expectations and preferences met. EVIDENCE: People living at Wisteria House told us they were able to make decisions about their day to day lives and could choose how to spend their time. People spoken with regularly went out of the home for leisure and social activities or to attend their church. A staff member was employed to provide activities within the home and to take people out shopping. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 14 At the time of this inspection, residents meeting were not being held. A recommendation was made that this should be offered to people living at Wisteria house as this would ensure that the day to day running of the home did meet people’s expectations and preferences. People spoken with told us their visitors were made welcome by staff and they could see their visitors in private. The lunch time meal served during this inspection appeared appetizing and nutritious. We looked at menu records and saw that a varied and nutritious diet was on offer. While there was not a choice of meal on offer, an alternative could be supplied if requested. One person we spoke with told us they had asked for and received alternatives. People spoken with told us there had been an improvement in the quality of meals provided and confirmed there was a choice of hot meal available in the evenings. We spoke with the cook who told us the resources they required to provide a varied and nutritious diet were provided. A hot and cold choice of meal was on offer for the evening meal Monday to Friday, a cold buffet was provided for the evening meal during weekends. The acting manager told us that the kitchen was closed from 7:30 pm until 6. am and therefore people living at Wisteria House did not have access to snacks or drinks during this time. We discussed this with the acting manager and registered provider who agreed to change this policy. This is so that people have access to drinks and snacks at anytime and are able to exercise choice and have their preferences and expectations met. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (Standards 16 and 18 were assessed) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures in place regarding complaints and safeguarding minimised the risk of harm for people living at Wisteria House. EVIDENCE: We spoke with the providers about the need to involve a third party or an advocate in the event of any dispute with a resident or in any occasion where a resident may be given notice to leave. This is to ensure that people are safeguarding from harm. The registered providers had agreed not to participate in the day to day running of the home in a care giving capacity; this was agreed to as a part of the Social Services safeguarding investigation. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 16 People spoken with told us they would feel confident making a complaint to the acting manager and felt this would be taken seriously and appropriate action would be taken. Eight care staff had recently attended the local authorities safeguarding training. Staff spoken with were aware of the correct procedures to follow in the event of suspected abuse. The acting manager had recently attended training about professional boundaries and intended to disseminate this training to all care staff. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (Standards 19 and 26 were assessed). People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Wisteria House are provided with a safe, comfortable and homely environment. EVIDENCE: People spoken with told us that all areas of the home were kept clean and tidy. There was an unpleasant odour in one room; the providers told us they were working towards rectifying this. All other areas of the home seen were extremely clean and tidy. Peoples private rooms were personalised and Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 18 furnished with peoples own possessions. Furnishings provided were of a high quality and the environment provided was attractive, homely and comfortable. Staff employed had received training in infection control and this minimised the risk of cross infection for people living at Wisteria House. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (Standards 27,28,29 and 30 were assessed) People using the service adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Wisteria house, mostly have their needs met by the numbers and skill mix of staff. EVIDENCE: We looked at staffing rotas and spoke with residents and staff about staffing levels. There was only one member of staff on duty from 8:30 pm with one person on call. Two care staff are on duty during day time hours. The acting manager, one cook and one domestic are also on duty in the morning. A recent social services review had resulted in extra staffing requirements during the evening, the acting manager told us that they were working towards providing an extra care staff member during this time but this had not yet been achieved. Although the majority of people living at Wisteria House had low dependency needs, it was not clear whether staffing numbers met the needs of people Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 20 living at Wisteria House during the evening and at night. A requirement was made that staffing numbers be sufficient to meet peoples needs and ensure that routines of daily living are made flexible at all times. We spoke with staff and looked at staff training records. This confirmed that induction training was provided and that a programme of staff training and development was in place. However, one staff member had not received moving and handling training or any accredited training regarding the management of medication. We looked at staff files and found that all necessary recruitment checks had been carried out. This ensures that people employed at the home are suitable and reduces the risk of harm for people living at Wisteria House. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): (Standards 31,33,35 and 38 were assessed) People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, safety and welfare of people living at Wisteria House is protected. EVIDENCE: At the time of this inspection the acting manager was in the process of applying to become registered as the manager with the Care Quality Commission. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 22 The registered providers had agreed not to participate in the day to day running of the home in a care giving capacity; this was agreed to as a part of the Social Services safeguarding investigation. Staff told us that Mr Kirk visits the home on a daily basis to check if there is anything needed. Residents and staff spoken with praised the acting manager and said they found her supportive and approachable. While there was a staff training programme in place and this included all mandatory training, one staff member had not received moving and handling training. A facility was available for the safekeeping of small amounts of personal money for people living at Wisteria House. Records of all transactions are maintained and two signatures are used to witness this. This minimises the risk of financial abuse for people living at wisteria House. The providers told us that all routine maintenance and safety checks had been carried out. This minimises risk and promotes the health, safety and welfare of people living and working at Wisteria House. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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 3 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 5. Requirement Information within the service user’s guide regarding weekly fees should be changed in order to protect the confidentiality of people living at Wisteria House. Care plans must be reviewed on at least a monthly basis in order to reflect the changing needs of people living at the home. This was a requirement was made at the previous two key inspections. Care plans must be in place for all assessed needs. This is to ensure people have their needs met. Risk assessments for self administration of medication should be carried out on at least a three monthly basis or sooner if there is any change in the mental or physical wellbeing of the person self administering. This is to ensure that people are protected from harm. Staff responsible for managing medication must receive accredited training. DS0000006467.V378068.R01.S.doc Timescale for action 30/11/09 2 OP7 14. 30/11/09 3. OP7 15. 30/11/09 4. OP9 13. 10/11/09 5. OP9 13. 30/01/10 Wisteria House Version 5.3 Page 25 6. OP10 12. 7. OP27 18. Appropriate professional boundaries must be maintained by all staff members, this is to ensure that people are treated with respect and dignity at all times and professional relationships are maintained. The providers must ensure that staffing levels meet the needs of people living at the home at all times. Controlled drugs must be stored in a controlled drug cupboard which complies with the Misuse of Drugs Safe Custody Regulations (1973 and 2007 amendments) 30/10/09 30/10/09 8 OP9 13. 30/11/09 9. OP38 18 All staff must receive the training 30/11/09 they require to maintain the health and safety of residents and staff. 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. 3. Refer to Standard OP18 OP12 Good Practice Recommendations An advocate or third party should be used in the event of any dispute between the providers or staff members with people living at Wisteria House. Residents meeting should be offered to people living at wisteria House. This is to ensure that the day to day running of the home meets peoples expectations and preferences. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 Page 26 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Wisteria House DS0000006467.V378068.R01.S.doc Version 5.3 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!