Inspection on 08/09/08 for Wisteria Lodge Care Home

This inspection was carried out on 8th September 2008.

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

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Wisteria Lodge Care Home 25 Friars Road Friars Cliff Christchurch Dorset BH23 4EB Lead Inspector Gloria Ashwell Unannounced Inspection 8th September 2008 12:00 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 Lodge Care Home DS0000071528.V370807.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 Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wisteria Lodge Care Home Address 25 Friars Road Friars Cliff Christchurch Dorset BH23 4EB 01425 272718 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 Alexandra Waltham Mr Richard Charles Waltham Mrs Rhona Edwina Waltham Care Home 4 Category(ies) of Old age, not falling within any other category registration, with number (4) of places Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only (Code PC) to service users of either gender whose primary needs on admission to the home are within the following category: 2. Older people, not falling within any other category - (Code OP) The maximum number of service users that can be accommodated is 4. New Service Date of last inspection Brief Description of the Service: Wisteria Lodge is a new service; it was first registered during March 2008. Wisteria Lodge is a traditionally built house, set in its own grounds. The home is located in a residential area of Friars Cliff, close to the sea front and within walking distance of the local amenities including shops, and a doctors surgery. The registered parts of the house are all on the ground floor; the first floor comprises the owner’s accommodation. The home is registered to accommodate a maximum of 4 older people. All bedrooms are for single occupancy and each has en-suite hygiene facilities. Car parking spaces are available for visitors and staff. The weekly fee quoted in the service user guide at the time of inspection was £700. Up to date fee information may be obtained from the service. Additional charges are made for hairdressing and chiropody. Wisteria Lodge Care Home DS0000071528.V370807.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 was a statutory inspection required in accordance with the Care Standards Act 2000 and was the first inspection of this new service. The inspection was unannounced; the inspector arrived at 12:00 on 8 September 2008, toured the premises and spoke to residents, observed staff interaction with residents and the carrying out of routine tasks and together with the Registered Manager discussed and examined documents regarding care provision and management of the home. The duration of the inspection was 3 hours. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same residents were examined and the residents spoken with. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the service does well: People considering moving into the home receive a full assessment and are provided with the opportunity to visit and spend time at the home to make sure that it is able to meet their needs. The home is a well-appointed, suitably equipped and comfortable environment for elderly people. On the day of inspection the home was clean and adequately staffed. Meals are nutritious and appetising and variety is good. Residents are satisfied with the home; comments recently obtained via questionnaire included “a real home…unable to think of anything to improve it”. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wisteria Lodge Care Home DS0000071528.V370807.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 Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so St 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to admission, the needs of each proposed resident are assessed to ensure the home will be properly able to meet them. EVIDENCE: The records of 2 recently admitted residents included details of pre-admission assessments carried out by the registered manager visiting the prospective residents at their previous addresses. In advance of making the decision to enter the home the prospective residents or their representatives visited the home to view the premises and meet residents and staff. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 9 Following pre-admission assessment of each prospective residents needs and circumstances the home writes to them confirming the agreement and ability to provide accommodation and care. Wisteria Lodge Care Home DS0000071528.V370807.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 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 social care needs of residents are met by suitably trained staff and residents receive the medicines they have been prescribed but improvements to care planning and medicine handling processes are needed to ensure safe standards are maintained. EVIDENCE: Care records of 4 residents were examined and found to be of generally good standard, although there was insufficient evidence they were based on relevant risk assessments. Accordingly, the home is recommended to use established ratings tools to assess the nutritional and skin care conditions of residents. From discussion with residents, examination of records and conversation with the registered manager there was evidence that the health care needs of residents are properly met. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 11 From examination of a sample of Medication Administration Records (MARs) and discussion with the Registered Manager and residents there was evidence that medicines are administered in accordance with the instructions of the prescriber. However, processes associated with medicine handling must be improved to ensure that residents are properly protected from the harm and ill health that incorrect administration might cause. A recently admitted resident was self-administering some prescribed medicine but risk assessment of the person’s ability to safely do this had not been assessed by the home. Also, the closest relative of the person had dispensed various tablets into a container comprising separate sections for each day and part of day (e.g. morning, noon, afternoon, evening). In consequence, staff of the home could not be sure of the status of the medicines they were administering to the resident, because they were not dispensing them from the labelled containers into which the pharmacist had placed them. The home was unable to reliably account for all medicines, because there was no record of what had been received by the home. It is required that assessment be recorded for residents who manage their own medicines. Medicines must be administered directly from the container into which they have been dispensed by the pharmacy; medicines ‘double dispensed’ by the relatives of residents must not be administered by staff of the care home. Assessment must be recorded of all residents who choose to administer their own medicines, to ensure they are unlikely to place either themselves or other residents at risk of harm by incorrect administration or storage of the medicines. To ensure there is a clear audit trail, when a variable dose is prescribed (e.g. “give 1 or 2 tablets”) the amount actually administered on each occasion must be recorded. Each MAR should bear the allergy status of the particular resident; when there is no known allergy this must be recorded. When a prescribed medicine is omitted from administration the reason for omission must be clearly recorded. Handwritten instructions on the MAR should be signed and dated by the writer, and countersigned by a person who has checked the entry for accuracy. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 12 A Controlled Drug register should be available to ensure that in the event of such a medicine being prescribed, the home can comply with handling requirements. Medicines are stored in suitable cabinets; it is recommended that the maximum/minimum temperatures of these areas be monitored and recorded daily to ensure that medicines are not damaged by incorrect storage. In the presence of staff residents appeared relaxed, confident and at ease; staff interactions with residents were of a friendly and considerate manner and the atmosphere throughout the home was calm and unhurried. Wisteria Lodge Care Home DS0000071528.V370807.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to engage in social and recreational activities and are encouraged and supported to pass the time according to individual preference. A choice of menu is provided and meals are nutritional and appetising. EVIDENCE: The home does not display a weekly activity programme because the currently accommodated residents arrange their own social and recreational pastimes. However, the home does arrange local excursions and actively supports residents in their preferred lifestyles by enabling them to rise and retire at their preferred times, spend time in their bedrooms or the communal areas of the home, and as much as possible direct their own lives. Visitors are welcome at any time and those spoken to during the inspection said they are always made to feel welcome and placed at ease by the staff. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 14 Residents believe they are shown respect and properly treated; comments made during the inspection included “I am very happy here”. Meals provide good nutrition and are liked by residents. Most residents take meals in the dining room on the ground floor; others receive them in their bedrooms. Residents said they have plenty to eat and the quality of meal provision is very good. Wisteria Lodge Care Home DS0000071528.V370807.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to complain and are confident their complaints would be listened to. Service users are safeguarded against risks of abuse in its various forms. EVIDENCE: Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. The home has a complaints policy and procedure; no complaints have been received and there have been no allegations or investigations regarding the ‘safeguarding of vulnerable adults’. All staff receive training on the safeguarding of vulnerable persons and the home has a written policy and procedure for the protection of vulnerable adults, but information on reporting and investigating alleged or suspected abuse should be improved to ensure staff have appropriate guidance. Discussion with the Registered Manager confirmed her understanding of the correct procedure. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 16 Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, clean, well equipped and suited to the needs of residents. EVIDENCE: Wisteria Lodge is a traditionally built house, set in its own grounds. The registered parts of the house are all on the ground floor; the first floor comprises the owner’s accommodation. All bedrooms are for single occupancy and each has en-suite hygiene facilities. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 18 On the day of inspection the home was clean, tidy and comfortable throughout; there were no unpleasant odours. There are bathrooms equipped for the use of persons requiring assistance and comfortable communal rooms. The laundry room is equipped with equipment which complies with hygiene requirements, including a sluice cycle washing machine. Wisteria Lodge Care Home DS0000071528.V370807.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and maintenance of the good condition of the premises. EVIDENCE: Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. At present, during the day time a minimum of 2 staff are on duty; the home does not have wakeful night staff placing reliance on a sleeping staff member whom residents can contact via the installed call system. The home is recommended to keep a record of all night calls, to provide reliable evidence that the home promptly responds to all residents needs, and adjusts staffing levels in line with changing dependency levels. The records of 2 recently employed staff members were examined and found to contain all essential information including written references and evidence of identity. Criminal Records Bureau (CRB) disclosures are obtained for all staff in Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 20 advance of employment. To ensure the validity of records it is recommended that all records are signed and dated. The home has developed and implemented an induction process for all staff, designed to ensure their familiarity with all aspects of the home and a clear understanding of their responsibilities. The home is in the process of sourcing training in core subjects including fire safety, moving and handling, food hygiene and emergency aid. The registered manager said that at least 50 of the care staff hold a National Vocational Qualification in care, or an equivalent qualification; the home thereby meets the associated standard. Wisteria Lodge Care Home DS0000071528.V370807.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is properly managed and maintained in the best interests of service users. Processes of internal audit should be implemented to enable monitoring of standards. EVIDENCE: Mrs Rhona Waltham is the Registered Manager; she is supported by Mrs Alexandra Waltham who is soon to commence training for the Registered Managers Award. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 22 The home has recently sent out questionnaires to health and social care professionals to assist the home assess the quality of the service they provide. The response has been very positive with good comments being made about all aspects of the service but quality assurance monitoring has not been implemented as a core management tool; this report contains an associated recommendation. The home does not manage the finances of residents; residents who are unable to undertake this responsibility personally have nominated relatives, friends or other representatives to do this on their behalf. There are good processes for staff recruitment, induction and formal supervision. There was insufficient evidence that all accidents to residents are thoroughly investigated with findings reflected in the care plan, to ensure that future risks are minimised. A policy/procedure for the management of accidents should be developed and implemented, to include evidence of investigation and the periodic audit of accident details e.g. of time, place, person, activity, to identify any trends or high aspects of risk. Records indicated that fire safety equipment has not been recently checked and tested at the required frequencies but from discussion with the registered providers there was evidence that this work had been done although not properly recorded; this report contains an associated recommendation. A sample of records relating to the maintenance and safety of the premises and equipment were examined and found to be in good order, including those for the electrical installation and the periodic safety checking of portable electrical items. The registered providers stated that prior to the recent registration of the home all aspects of premises and equipment safety were confirmed. Wisteria Lodge Care Home DS0000071528.V370807.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Timescale for action The registered person shall make 01/10/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This means that: When a variable dose is prescribed (e.g. “give 1 or 2 tablets”) the amount actually administered on each occasion must be recorded. When a prescribed medicine is omitted from administration the reason for omission must be clearly recorded. Medicines must be administered directly from the container into which they have been dispensed by the pharmacy. Assessment must be recorded of all residents who choose to administer their own medicines. Requirement Wisteria Lodge Care Home DS0000071528.V370807.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. 3. 4. Refer to Standard OP7 OP9 Good Practice Recommendations Established ratings tools should be used to assess the nutritional and skin care conditions of residents. Each MAR should bear the allergy status of the particular resident; when there is no known allergy this must be recorded. When a prescribed medicine is omitted from administration the reason for omission must be clearly recorded. Handwritten instructions on the Medication Administration Record (MAR) should be signed and dated by the writer, and countersigned by a person who has checked the entry for accuracy. A Controlled Drug register should be available to ensure that in the event of such a medicine being prescribed, the home can comply with handling requirements. The maximum/minimum temperatures of all medicine storage areas should be monitored and recorded daily to ensure that medicines are not damaged by incorrect storage. The policy/procedure for reporting and investigating alleged or suspected abuse should be improved to ensure staff have clear and correct guidance. A record should be kept of all occasions of ‘night call’ i.e. when the ‘sleep in’ member of staff is contacted to attend to the care needs of residents. All recruitment/employment records should be signed and dated. There should be continuous self-monitoring of the service, using an objective, consistently obtained, reviewed and verifiable method and internal audit should take place at least annually. A policy/procedure for the management of accidents should be developed and implemented, to include evidence of investigation and the periodic audit of accident details e.g. of time, place, person, activity, to identify any trends or high aspects of risk. There should be reliable evidence that fire safety equipment is checked and tested at the required DS0000071528.V370807.R01.S.doc Version 5.2 Page 26 OP9 OP9 5. 6. OP9 OP9 7. 8. 9. 10. OP18 OP27 OP29 OP33 11. OP38 12. OP38 Wisteria Lodge Care Home frequencies. Wisteria Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Lodge Care Home DS0000071528.V370807.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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