Inspection on 29/07/08 for Withy Grove Care Home

This inspection was carried out on 29th July 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

Withy Grove Care Home 29/09/08

Withy Grove Care Home 08/08/07

Withy Grove Care Home 28/11/06

Withy Grove Care Home 26/05/06

Withy Grove Care Home 22/11/05

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

CARE HOMES FOR OLDER PEOPLE Withy Grove Care Home Withy Grove House Off Poplar Grove Bamber Bridge Preston Lancashire PR5 6RE Lead Inspector Mrs Marie Dickinson Unannounced Inspection 29th July 2008 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 Withy Grove Care Home DS0000065186.V364573.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. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Withy Grove Care Home Address Withy Grove House Off Poplar Grove Bamber Bridge Preston Lancashire PR5 6RE 01772 337105 01772 620158 withy.grove@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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 Janet Elaine Plummer Care Home 54 Category(ies) of Dementia (24), Old age, not falling within any registration, with number other category (30) of places Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 54 service users to include: Up to 24 service users in the category of DE - (Dementia). Up to 30 service users in the category of OP - (Old Age, not falling within any other category). Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 8th August 2007 2. Date of last inspection Brief Description of the Service: Withy Grove House is a residential care home providing 24-hour personal care and accommodation for 30 older people who have care needs and 24 older people who have care needs associated with dementia. Withy Grove House is a converted Manor House, which is set in its own landscaped gardens adjacent to parkland. The home is in a predominantly residential area, but within easy walking distance of Bamber Bridge centre. Bus and train services can be accessed to larger towns, such as Preston, Chorley, and Blackburn. Bedroom accommodation is on the ground and first floors. All bedrooms are used for single accommodation and 29 have en-suite facilities. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedroom and living rooms. There are sitting and dining areas sited on both floors and across the car park from the home is a private lawn area where residents are able to enjoy activities, weather permitting. Information about the service is available from the home. Weekly charges range from £326 minimum to £386; privately funded £445. Withy Grove Care Home DS0000065186.V364573.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. A key unannounced inspection was conducted in respect of Withy Grove on the 29th & 30th July 2008. The inspection involved getting information from the service history held at the Commission, an Annual Quality Assurance Assessment completed by the manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the operations manager, visitors, and an inspection of the premises. Written comments from five relatives and six residents was received giving their view of the service provided. A random inspection was also carried out at the home in February 2008. The reason for this inspection was to look at compliance of statutory requirements made in relation to health and personal care made during the inspection carried out on the 8th and 9th August 2007. A copy of this report is available at the home. The home was assessed against the National Minimum Standards for Older People. What the service does well: Before being admitted people had their needs assessed to establish if the service could provide the right care and support, before a placement in the home was offered. Records showed there was consultation with relevant people about the level and type of care required. Residents living in the home benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident’s also benefited from additional specialist support where needed, such as with healthcare needs. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 6 Residents were supported to keep in contact with relatives and friends. They had meetings to discuss what they would like to do and find out what was going on in the home. Written comments from relatives included, ‘The family is completely satisfied with all the aspects of care being given’. ‘Withy Grove seem to be very aware that people are different.’ ‘They do a good job looking after my mum. I have peace of mind, I know she is being well looked after, she’s happy, to me that is the main thing’. People using the service had confidence to raise any issue of concern they may have. Relatives commented, ‘we do not have any problems with the staff for either relative. They have been always been very helpful and very caring.’ ‘I have never seen anyone treated badly or ignored in Withy Grove’. The home is commended for the positive attitude to complaints and concerns raised in the home and at the Commission. Records held at the Commission show management respond quickly to vulnerable adult protection issues and follow correct safeguarding procedures when needed. They work well with other professionals to protect residents. Staff were trained in adult protection and knew their responsibility of care in this area. Recruitment practices were thorough and protected residents. Residents generally had a good opinion of staff. They said the ‘staff are very good’. Relatives written responses included, ‘The carers are dedicated people. My husband and I can’t praise them enough because they have looked after our relatives as if they were their own. God bless them all’. And ‘They have been always been very helpful and very caring.’ ‘The staff are lovely people, I can’t fault them at all.’ There is evidence some emphasis has been placed on improving the home in terms of outcomes for the residents. This has been with investment into the environment and more quality assurance in relation to service delivery carried out. The home has worked very well with the Commission by working towards meeting statutory requirements made at the last inspection. What has improved since the last inspection? To make sure residents are not at risk of poor nutrition, risk analysis and monitoring for the management of sustained weight loss, had been dealt with better for residents well being. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 7 The lighting provided in resident’s bedrooms had improved, and all emergency pull cords were available for residents at all times. The sluice rooms were kept cleaner to avoid the risk of cross infection. The residential unit was currently being upgraded and some new bedroom furniture was provided. Bedrooms were being decorated and new bedroom doors fitted. Residents who deposit money in Southern Cross Residents Account, now benefit from interest paid to them. Quality assurance has meant that more senior management has worked with residents, staff, and relatives to improve the service, and have taken more responsibilty for the homes overall performance. Information received regularly at the Commission over the past six months has shown improved risk management of the service, which is audited on a monthly basis by an operations manager of Southern Cross. This has meant the service has shown a steady improvement with plans made to ensure all standards are met. What they could do better: To make sure residents receive the right health and personal care, care plans should detail the level and type of support they need. More care is required with diabetic care to reduce the risk of complications. Resident’s should be asked how they want their medication to be managed and a formal consent to medication administration by staff should be obtained. This will show that they have been consulted as to the best option for them. Medication such as creams or lotions prescribed by GP’s must be administered according to instructions. Residents dignity must be respected at all times by making sure gender issues are considered for residents requesting or requiring this provision. Residents must be provided with a sufficient range of suitable activities that would meet their needs and expectations. In addition to this more care should be taken in the dementia unit to make sure music for recreation is better organised to maximise the benefit for residents. Residents should have a daily living plan linked to their assessed needs and support them to exercise choice and control over their lives. Residents requiring assistance at meal times must be given proper care and supervision. More care should be taken to routinely remove soiled bedding from beds, and make sure resident’s comfort and dignity is assured. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 8 Sufficient numbers of staff must be available to ensure the health, welfare, and safety of residents is protected, particularly during peak times in the home during the day and during the night. The skill mix of staff must be balanced so that at all times suitably qualified, competent , and experienced staff are on duty. To support this all staff must be given essential training that is appropriate for their work. The management team must take responsibility to ensure staff follow policies and procedures and best practice guidelines. A system should be in place to monitor staff compliance. Staff must be given regular formal supervision that will allow them to develop professionally and work towards Southern Cross vision for excellence in meeting standards. Good practice and staff training must be maintained to ensure the health, welfare, and safety of residents and staff. Individual risk assessments of residents should be completed for evacuation of the building to ensure staff will know who is at risk. 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. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 9 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 Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 10 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): 2,3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Assessment of needs completed prior to admission, helped decide if the home had the right facilities and staff resources to support people with every day living. Contracts issued, informed people of the terms and conditions of living at the home, and protected their legal rights. EVIDENCE: People admitted to the home found the information they had received very useful. Comments received from relatives included, ‘Care home very informative.’ And ‘They have been very helpful’. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 11 Several people had been admitted since the last inspection. The admission procedure involved visiting them in the community. This was to carry out an assessment of their needs and consider if the home had the right facilities, and staff expertise to meet those needs. The information recorded in the records was however brief. Whilst the use of tick boxes to indicate level of dependency and needs was informative, this could be improved on, with better written notes to use as the basis for writing a person centred care plan. Information recorded on the Annual Quality Assessment completed by the manager showed all residents had been issued with a contract. Residents placed in the home by the local authority were given a contract for financial arrangements for payment. This was in addition to the service user guide, that outlined the terms and conditions of residency in the home. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 12 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 care planning process needed to improve in detail given to staff, to ensure all residents health and personal care needs were met fully. Medication administration was not completed properly to ensure prescribed creams were used as required. EVIDENCE: Information received at the Commission indicated ‘By practising person centred care they are able to uphold equality and embrace diversity for all residents’. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 13 Care planning was evidenced. A brief record was made of residents past history. Needs identified such as personal care, mobility, communication, personal safety, medication, medical, and social were listed. How identified needs are to be supported was not always clear, as the instruction to meet needs did not identify the actual support required. Statements written were vague such as ‘to assist with personal hygiene’. This gave no indication what the level and type of assistance was required. Another example was: ‘to maintain independence’, with no reference to the individuals ability for selfcare. This meant care provided was sometimes generalised, rather than being person centred. Staff worked to a key worker system, having responsibility to personalise care for residents where possible. However gender issues were not always considered. One male residents care notes read ‘embarrassed when carers are present’, and although male carers were employed, he was allocated a female key worker. Observations during inspection showed personal care needs were met in private. Residents had access to health care services both within the home and in the local community. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. This included visits from the district nursing team. Healthcare needs were not always managed appropriately. For example, diabetic care must improve as records show one resident ‘recently had a blood sugar test which shows that diabetes is uncontrollable and blood sugars remains very high’. Medication had been prescribed but no plan of action for monitoring diet or blood sugar levels was in place. When an incident occurred involving a high intake of sugar this was not monitored. Pressure care was promoted and pressure-relieving aids were used where need was identified. Risk assessments had been completed for moving and handling and were used as guidance for staff to help care for residents safely. Observations were made of the hoist being used safely for one resident. However wheelchairs in use had no foot safety plates on. Visitors and residents interviewed thought some of the staff did a good job, however comments were made such as ‘At the moment they have been short staffed, so the carers haven’t had as much time to spend with the residents as normal’. Residents who were able to give their views said staff was usually available when needed. Information received at the Commission indicated ‘all senior staff are trained in medication administration’. Consent to medication was not always clear, but rather a statement ‘unable to manage own medication’. The home operated a monitored dosage system for the administration of medication, which was dispensed into controlled dose packs by the supplying pharmacist. An appropriate recording system was in place to record the receipt, administration Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 14 and disposal of medication. A random selection of medication checked showed prescribed creams were not administered, as they should be. Records showed creams and lotions left in resident’s bedrooms to be applied as directed, had not been signed for and seldom used. These creams were for various complaints such as a fungal infection and irritated skin. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 15 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 adequate This judgement has been made using available evidence including a visit to this service. Social, recreational activities, and lifestyle, did not always meet with resident’s needs and expectations. Catering arrangements were satisfactory in providing for individual taste, and choice, although resident support at meal times needs to improve. EVIDENCE: Information received at the Commission told us the home did well as meetings were held regularly with residents, relatives, and staff to discuss all areas of the home including activities. The hairdresser visited every week, and the home had links with the local community. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 16 An activity coordinator was employed and her job description was, ‘To plan and implement activities approporiate to client needs and requests. Assist homes manager to organise fund raising events.’ Records kept of the activities provided showed that for example two residents regularly went for a walk, two residents had attended the activity room and started making scrap books. Residents played dominoes and bingo, one resident had a hand massage and some residents went to a school play. However the people taking part in these activities were regular participants. Personal preferences in respect of social activities had been recorded as part of residents initial assessment. How this is included in a person centred way needs to be developed. For example one resident in the dementia unit had ‘likes gardening’ recorded, but no individual activity programme had been set up to accommodate this and provide meaningful mental stimulation. Residents’ choice for daily living had not been recorded sufficiently. Basic comfort needs such as getting up and going to bed, when they preferred to bathe, what they would like staff to consider such as, to be woken, not woken, have a cup of tea etc., had not been considered. Two male residents said they cannot get outside as one needed help to use the lift as he used a wheelchair and the other said the door was locked. Comments from residents stated they need to improve and focus more on what they wanted. The notice board showed what events were planned, and the home was currently preparing for a summer fair. One relative said ‘the problem is the level of staffing to support people doing meaningful activities’. Observations during inspection included old time songs, and whilst this is entertaining to a degree, it required modifying. The television noise, music, and everyday living noise combined together was potentially a barrier in allowing dementia sufferers an opportunity to experience possible lucid moments amid the confusion of sound. Comments from residents and relatives visiting showed visiting arrangements to be satisfactory. They all felt they could see their relative in private. The residents made varied comments about the food. The menus had been changed. One resident said “the food is ok, sometimes.’ ‘There was a choice, but tea could improve’. Residents said they did not always get a milky mid meal drink, such as coffee made with milk. Observations at lunchtime showed the way meals are organised and served in the dementia unit was a little chaotic. Residents were agitated waiting for the meal to be served and as a result staff time and energy was spent sitting them back at the table. Very dependent residents requiring assistance with eating was given one to one, however people who made little attempt to eat did not get the supervision they required. Staff were observed to be busy serving and Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 17 therefore not always available to provide suitable assistance for them. As a result people were seen eating food needing cutting up with their fingers, and other residents let their meals go cold. The cook said that fortified diets were catered for. Additional butter and cream was used, and there was always fresh produce bought. Diabetic foods were prepared. Soft diets were catered for showing different foods blended separately to provide colour and texture. Food served were generous in portion with ample foods left for second helpings. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 18 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. There is a complaints procedure, and relatives and residents were confident that their concerns are listened to, taken seriously, and acted upon. The homes vulnerable adults procedure and staff training supported people living at the home being protected from abuse. EVIDENCE: A copy of the complaints procedure was displayed and was included in the information given to current and prospective residents. The procedure gave clear directions on whom to make a complaint to, and the timescales for the process. The home had a recording system in place. There had been four complaints received at the home, with a 100 resolution within the timescale. One complaint was upheld. Relatives who provided written comments for this inspection said they knew how to make a complaint and were confident of getting a proper response. There had been complaints received at the Commission. These had been investigated and appropriate action taken. The operations manager said any Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 19 issue raised was taken seriously and welcomed people being open about problems they may have. Residents were encouraged to say what they wanted and were asked regularly if everything was all right. Residents and relatives were invited to meetings to encourage people to speak out about the service. There were policies and procedures in place to ensure a proper response to any suspicion or allegation of abuse. Staff were familiar with this and had received training. Staff interviewed knew their duty and obligation to report poor practice. Records showed response to protection issues was very good. There was evidence to support the management respond quickly to vulnerable adult protection issues and follow correct safeguarding procedures when needed. They work well with other professionals to protect residents. Staff contracts precluded them from financial reward or assisting in or benefiting from the service users’ wills. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 20 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): 19,20,23,24,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents were provided with a warm, comfortable, clean, safe, environment that suited their needs. EVIDENCE: The home is a large adapted detached property set in its own grounds in a residential area of Bamber Bridge. The front of the home is next to a park boundary, and a number of large trees gives the home privacy. Car parking is to the front of the home. Residents can sit outside at the back of the home during warmer weather. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 21 The home is divided into two units for residential and dementia care. Access to these units is via a controlled lock; push button to access and key pad to leave. Following a tour of the premises, the following observations were made. There continues to be an improvement made on the environment. New bedroom furniture was provided and the bedroom lighting had been upgraded for residents benefit. New bedroom doors were being fitted. The decoration in the dementia unit corridors was bright and corridors were themed for residents. The dining area and lounges were pleasant and resident benefitted comfortable chairs in recesses off the corridors. Smoking areas was controlled. The dining room was redecorated, and in the dementia unit the lounge and communal areas were changed to meet with residents needs. The residential unit still requires some upgrade in appearance but was adequate. Decoration in the home was in progress. Most residents said they liked their accommodation. The laundry was well organised and clean. Laundry management was the responsibility of one staff employed specifically for this. More care was required to make sure soiled bedding on residents beds is removed. Arrangements for domestic support to keep the home clean were satisfactory, and staff were provided with protective clothing such as disposable gloves and aprons. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 22 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 adequate This judgement has been made using available evidence including a visit to this service. The level of staffing, training given, and skill mix of staff was not satisfactory to meet the needs of residents. Recruitment practices were thorough in ensuring the right staff were employed. EVIDENCE: Written comments received at the commission considered, ‘The carers are dedicated people. My husband and I can’t praise them enough because they have looked after our relatives as if they were their own. God bless them all’. And ‘They have been always been very helpful and very caring.’ ‘The staff are lovely people, I can’t fault them at all.’ However people did express concern over the levels of staffing. Comments included, ‘I have always gone with relative when trips to hospital were needed. My preference but not enough staff at times to cover this anyway.’ ‘Sometimes attention retarded, through lack of staff. In my opinion there is never enough Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 23 staff’. ‘Could improve with ‘more staff’. ‘Staff, as in carers is often a problem, a shortage.’ Both units were staffed seperately and consisted of a unit manager and senior carers. The numbers of staff employed however did not make sure the needs of the residents were being fully met. Observations made during inspection found staffing levels did not always meet with residents needs for example during meals, and resident supervision. The skill mix of staff was not always balanced, with an agency staff, new starter and senior on duty at times. Rotas showed inexperienced staff were sometimes deployed on night duty. Records showed recruitment practice was thorough. Satisfactory references and Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. On appointment members of staff were issued with a contract of terms and conditions of employment. All staff were given a job description/specification outlining duties and expectations. Staff induction included philosophy in care, principles of care, protection, diversity, role of the worker, health, and safety at work, communication, and personal development. A training matrix was kept up to date. Information recorded showed gaps in training, although arrangements were made for some training to be provided. Better training opportunities must be provided for fire safety, food hygiene, health and safety, abuse and POVA, infection control, nutrition, safe handling of medication, and dementia care awareness. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home is managed to ensure residents and staff are generally protected, however some practices in the home were not in the best interest of residents, the staff, and the organisation. EVIDENCE: The registered providers Southern Cross have an active role in the management of the home. Interim arrangements have been made for an Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 25 operations manager to oversee the management on a daily basis until the registered manager has returned from special leave. The roles of the management team as a whole includes seniors, unit managers and deputy, who take responsibility for a number of residents and staff employed. There are clear lines of accountability, and the entire service is audited on a monthly basis. To ensure improvement in the delivery of services required, effective management is required by the management team to ensure the sound policies and procedures and best practice guidelines of Southern Cross is adhered to. This must include for example, supervision of staff, medication management, and resident supervision. Southern Cross organisation’s strategic and financial planning systems mean the home operates within corporate budgetary control. There is evidence some emphasis has been placed on improving the home in terms of outcomes for the residents. This has been with investment into the environment and more quality assurance carried out of service delivery. Results of the latest audit showed a general satisfaction in all areas of provision in the home. The operations manager has worked to continuously improve services. Work with staff and residents and relatives over the past six months have been to create an open and transparent environment in all areas and show some accountability for practice. From discussion with the operations manger, there is an awareness of the need to meet with good practice standards. The home has worked very well with the Commission by working towards meeting statutory requirements made at the last inspection. Minutes of the different meetings for example, heads of department meetings, care staff meeting, and residents/relatives meetings, evidenced a strong commitment to promote person centred care and effective outcomes for the residents. Staff supervision was not very good as it only occurred when staff had not carried out their duties in accordance with the homes guidelines, or had been off sick. There was no evidence the management followed the company policy of giving a supervision that took into account the organisations stance on good practice, areas for development, and future career planning. Furthermore the unit leader completed the supervision record for senior carers to follow. Senior carers did not get supervision often. Consequently there was no effective means for staff to express themselves, their concerns, and their plans for the future or to receive positive feedback on their performance. Six monthly appraisals had been carried out. The operations manager dealt with this immediately. She arranged a meeting with unit managers and seniors during inspection to discuss supervision, and to reinforce the organisations policy and procedure for giving supervision. Staff are given health and safety policies and procedures during induction and have training provided such as moving and handling, first aid, etc. Records Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 26 showed however, not all staff had benefited this training. There was evidence staff did not adhere to basic safe practices for example when using wheelchairs. Records maintained showed regular auditing of fire, water temperatures, wheelchairs and hoists etc. Fire risk assessment for the building had been completed. Individual risk assessments for resident response to the need to evacuate the building had not been done. Records kept were of a good standard and regularly completed. General risk assessments were completed and taken into account in planning the care and routines of the home. The home had access to professional business, legal, and financial advice and had all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 27 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 3 3 X X 3 3 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 2 X 2 Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 12(1)(a) Requirement The manager must make sure all health and personal care needs as outlined in residents care plans is provided. Previous timescale of 20/02/08 not met. Diabetic care must improve for residents well being. Healthcare needs must be managed responsibly, by ensuring all medication prescribed for a resident is administered as requested by a GP. Residents dignity must be respected at all times by making sure gender issues are considered for residents requesting or requiring this provision. Activities must be better arranged to take into account the needs of all residents in the home. Previous timescale of 20/02/08 not met. Residents requiring assistance at meal times must be given proper care and supervision. DS0000065186.V364573.R01.S.doc Timescale for action 30/08/08 2. 3 OP8 OP9 13(4)(c) 13(1)(b) (2) 30/08/08 30/08/08 4 OP10 12(4)(a) 30/08/08 5 OP12 16(2)(n) 30/08/08 6 OP15 12(1)(a)( b) 30/08/08 Withy Grove Care Home Version 5.2 Page 29 7 OP27 18(1)(a) 8 OP28 18(1)(a) 9 10 OP30 OP32 18(1)(c) 18(1)(2) (4) 18(2) 12(1) 13(4) 11 12 OP36 OP38 Sufficient numbers of staff must be available to ensure the health, welfare, and safety of residents is protected. The skill mix of staff must be balanced to ensure that at all times suitably qualified, competent , and experienced staff are on duty day and night. All staff must be given essential training that is appropriate for their work. The management team must ensure they are responsible staff follows policies and procedures and best practice guidelines. Staff must be given regular formal supervision. Good practice and staff training must be maintained to ensure the health, welfare, and safety of residents and staff. 30/08/08 30/08/08 30/09/08 30/08/08 30/08/08 30/08/08 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 5 6 7 Refer to Standard OP8 OP12 OP14 OP26 OP32 OP36 OP38 Good Practice Recommendations Formal consent to administration of medication should be sought. It is recommended that the use of music for recreation be better organised to benefit residents. Residents should have a daily living plan to support them exercise choice and control over their lives. More care should be taken to remove soiled bedding from resident’s beds. It is recommended a system be in place to monitor practice and compliance with plans, policies, and procedures. Supervision should allow staff an opportunity for personal development and be a positive experience. Individual risk assessments of residents should be DS0000065186.V364573.R01.S.doc Version 5.2 Page 30 Withy Grove Care Home completed for evacuation of the building to ensure staff will know who is at risk. Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Withy Grove Care Home DS0000065186.V364573.R01.S.doc Version 5.2 Page 32 - 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!