CARE HOMES FOR OLDER PEOPLE
Wolf House Wolf House Wolf`s Row Oxted Surrey RH8 0EB Lead Inspector
Pat Collins Unannounced Inspection 2nd December 2005 2:30 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 Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 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. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Wolf House Address Wolf House Wolf`s Row Oxted Surrey RH8 0EB 01883 716627 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) Ms Yvonne B Gomes Ms Yvonne B Gomes Care Home 13 Category(ies) of Dementia - over 65 years of age (2), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (13) Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to two of the service users accommodated may suffer from either dementia DE(E) or a mental disorder MD(E). 11th November 2004 Date of last inspection Brief Description of the Service: Wolf House is a care home for older people providing personal care. Registration conditions include two places for the care of service users with dementia or mental health disorder. The service aim is to foster an atmosphere of care and support, which both enables and encourages service users to live full, interesting and independent lifestyles as far as possible. The building is an adapted, detached residential house set in its own grounds. There is a small car park to the front of the premises with seating overlooking a pretty cottage garden. The home has a secluded rear garden with small patio area, set mainly to lawn. Though set in a rural location Wolf House is only a short distance by road from Oxted town centre where there is a good range of shops and community amenities. A number of villages and other larger towns are accessible. Accommodation at the home is arranged on three levels. Communal areas are on the ground floor, comprise of a lounge, interconnected dining room and small, pleasant sun lounge. Most of the bedrooms are single occupancy and two have en-suite facilities. The home has chairlift between the ground and first floor. A small number of bedrooms are suitable only for ambulant service users who can safely manage stairs. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a half - day period lasting almost four hours. At the outset of the inspection the senior care assistant in charge of the home was observed to be competent in discharging her responsibilities and in her response to the inspection. The provider/manager and deputy manager were present for most of the inspection having returned to the home when informed of the inspection taking place. The inspector spoke with all service users, four individually in their rooms and in a group meeting in the lounge. Service users participating in the group meeting were also offered opportunity to meet with the inspector in private. Consultation took place with management and all staff on duty and with three visitors. A tour of the home was carried out and a number of records examined. Four comment cards were received from visitors and service users after the inspection and this information used as part of the inspection process. The inspector would like to thank management and staff and all service users for their hospitality and cooperation at the time of this inspection; also all individuals who contributed information. What the service does well:
The home’s operation was established to be in accordance with the service aims ‘to provide quality services by caring, competent, suitably trained staff in a homely atmosphere’. The small staff team was observed to have a stable core group of staff that had worked at the home for many years and were suitably qualified and experienced. The management of the home ensured ongoing commitment to recruiting staff sharing the home’s values of fostering an atmosphere of care and support that enabled and encouraged service users to lead independent, fulfilling lives within individual capabilities. Staff recruitment and vetting procedures ensured service users’ protection. The ongoing commitment to staff training and development underpinned appropriate care practices. An individualised approach to care was evident ensuring assessments and care planning balanced staff’s duty of care with responsible risk taking and service users’ rights and wishes. The atmosphere of the home was warm and friendly and staff were caring and professional in their approach towards service users. The environment was safe, warm and comfortable and bedrooms were personalised. The shared bedroom had privacy curtains fitted and care practice at the home gave due respect to the privacy and dignity of service users. Care Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 6 staff maintained all areas of the home in a clean and hygienic condition and odour control was well managed. Service users’ personal appearance demonstrated due attention to personal care. Service users expressed overall satisfaction with their care and the dayto-day operation of the home. A sample of comments from service users at the time of the inspection were: “it’s a good home”, “ staff will do anything you ask”, “the service is good”, “ my visitors are made welcome”, “ rooms are clean and comfortable and the food is cooked beautifully”. A visitor attributed the very personal approach by staff to the care and attention of service users to its small size in terms of registered numbers. This person described a very genuine, family atmosphere fostered by staff. Examples of comments from visitors included “ I am very impressed with the general conditions in this home and in particular the warmth and attitude of staff”. “ The home provides an excellent standard of care and my relative is very happy here”. What has improved since the last inspection? What they could do better:
The care planning format would benefit from a review and further development. It is important to ensure that care needs are underpinned by care plans and record keeping systems. ID documentation and current photographs of staff must be available on all personnel files. A formal risk assessment must be in place in relation to the omission to fit a call bell in the en suite facility identified. In the event that this room is vacated in the future a call bell must be fitted before further occupation. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 7 Bedroom doors must not be wedged open. In the event this is necessary then the fire officer must be consulted to discuss alternative methods of holding these doors open. Headboards must be provided for all beds. 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. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 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 Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3,4, 5 The home was found to be operating effectively in respect of these standards. The quality of information about the home and open access to this information gave confidence that prospective service users and/or their representatives would be able to make an informed decision about the suitability of the home. Needs assessments ensured needs were known prior to admission to ensure these could be met. Opportunity was available for prospective service users to visit to assess the suitability of the home and admissions subject to a trial period. EVIDENCE: The Statement of Purpose and Service Users Guide was up to date and accurately depicted service provision. Copies were kept in the sun lounge for access by service uses, relatives or friends. Management demonstrates on the day of inspection that the home was able to meet the assessed needs of service users. The home’s records relating to a recent admission to the home and consultation with this service user at the time of the inspection demonstrated good practice admission procedures had been followed.
Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9. Service users personal and health care needs were well met. Discussed was the need for the care planning format to be further developed and further risk assessments implemented. Medication practices met statutory requirements. EVIDENCE: Service users were registered with a General Practitioner and had access to a full range of health care services including regular chiropody care. Medication practices were underpinned by the home’s medication policy and procedure and homely remedies policy. Medication records sampled were found to be accurate and the storage of medication was satisfactory. Pressure relieving equipment supplied by the primary health care team was in use for one service user who required total care. This included an alternating air mattress and cushion. A pressure sore risk assessment was not evident in the current documentation on this individuals file but would have been carried out by district nurses in the past who were involved in this individual’s care and treatment. Advice was given on ensuring pressure sore risk assessments and other assessments were implemented and regularly reviewed and the care
Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 11 plan for this individual developed. Discussed was the need to review and develop the home’s care planning format. Care practice at the time of the inspection gave due consideration to the privacy and dignity of service users. The disposition of two bedrooms on the ground floor in which access to one is through another is not ideal for promoting individual privacy. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 All standards were effectively met ensuring service users expectations were satisfied with suitable arrangements for meeting dietary and social needs. EVIDENCE: Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 13 The Inspector sampled the home’s menus and noted meals appeared to be balanced and wholesome. There were records maintained of changes to the main meal and an individualised approach to breakfasts offered choice for this meal to be served in bedrooms. Care staff had generic roles and assumed responsibility for food preparation. They had received training in basic food hygiene. No special diets were required at the time of the inspection. Service users expressed satisfaction with the day-to-day operation of the home, which they considered to provide suitable activities for social stimulation. At the time of the inspection service users were mostly sat in the lounge. Individuals were reading newspapers and others interacting with each other or with staff. They expressed interest in the inspection process and stated they were pleased to be consulted about their experience of life in the home. Information received confirmed that they liked living at the home. It was stated that they spent time watching television, listening to music and enjoyed visits from families and friends. Individuals stated they went out from time to time with visitors and one service user attended church every week with support from friends. A hairdresser visited weekly and visitors included members of a church. On occasions entertainers came in and at the time of the inspection a Christmas party was planned to which family and friends were invited. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Service users were protected by the home’s recruitment and training policies and adult protection procedures. EVIDENCE: The home had adult protection and whistle blowing procedures. The staff induction and foundation training programme ensured staff were fully aware of adult protection information and informed of what action they must take in the event of an allegation or suspicion of abuse or neglect. There had been no adult protection issues in this home in the last twelve months. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Standards were overall well met ensuring a safe and secure, clean and comfortable care environment, suitable for the stated purpose of the home. EVIDENCE: The home was warm, tidy and cleanliness and hygiene was of a high standard. Odour control was excellent. The small scale, domestic environment was traditional in character and ‘homely’ in atmosphere. A programme of redecoration and refurbishment was ongoing. Since the last inspection the hallway, stairs and corridors had been redecorated. A new development was a patio area overlooking the rear garden. The lawn had been levelled and made more accessible to service users. The kitchen had benefited from new work surfaces, tiles and floor covering. The provider had received guidance in the past from a private physiotherapist in relation to fitting suitable disability equipment i.e. handrails, grab rails and a stair lift. The home environment was not suitable for wheelchair users and service users were required to be ambulant on admission. Staff were able to meet the needs of individuals whose dependency had increased over the years
Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 16 since their admission, which had reduced their mobility. A hoist was being used for one service user to ensure safe moving and handling practices. The provider had fitted safety locks to some bedroom doors. Where these had not been fitted or keys not supplied, the reason was clearly recorded in care plans. Lockable petty cash boxes were available on request for service users to enable security of small amounts of money or items of personal value in bedrooms. Discussions with management included the need to fit a call bell in an en suite facility in a first floor bedroom before occupation by another service user. Currently this was not required on the basis that there was no risk to the current occupant of this room who was understood not to use this facility without staff assistance. Requirement was made for headboards to be fitted to beds not fitted with the same. Staff had access to protective aprons and gloves and standards of infection control appeared satisfactory based on observations at the time of the inspection. Soap dispensers and disposable towels had been provided in the communal toilets and bathrooms. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. These standards were being effectively met overall. Staff recruitment practices safeguarded service users. Service users’ needs were met by the numbers and skill of staff and underpinned by the home’s staff training policies. EVIDENCE: Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 18 The home’s management demonstrated ongoing commitment to staff development and training. The staff team comprised of seven care staff. All three senior care staff had NVQ Level 3 certificates (Vocational Training Qualification in Care). A recently appointed staff member had a BTEC qualification in care and was an NVQ Assessor. The manager, who was a Registered General Nurse, was a member of the local Registered Care Homes Association. A number of staff training courses were available through this route. It was noted that some staff had recently signed up to undertake an infection control training course. The home’s recruitment procedure was based on equal opportunities and all staff had Criminal Record Bureau Enhanced Disclosures. The record of staff Disclosures was well maintained. Management’s attention was drawn to the matter of Disclosures no longer being portable. The personnel records sampled confirmed use of an agency for recruitment of the three overseas staff employed since the last inspection. Vetting procedures included translated professional qualifications and references held on their files. Observations confirmed the need for copies of ID documentation to be held on the file of the staff member recently appointed and for all staff files to contain a recent photograph. The records demonstrated a comprehensive induction programme was operating. The deputy manager and all care staff had generic roles that included responsibilities for cleaning and catering. Staffing levels at the time of the inspection were three staff on the early shift and two staff on the late shift. Consultation with the deputy manager and senior care assistant on duty clarified their opinion that staffing levels were adequate. Night staffing levels were one waking care assistant and staff sleeping in accommodation on the second floor. Discussions with senior staff indicated this level of night cover adequately met current needs. The provider assured the inspector that staffing levels were continuously being monitored and in the event that two staff were required to meet needs at night, for example frequent turning and for moving and handling that two waking staff would be deployed at night. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 37, 38 The home’s management ensured effective leadership and direction to the team to ensure consistent delivery of quality care. The health, safety and welfare of service users was overall well promoted. EVIDENCE: The management of the home appeared open and transparent and the senior team was cohesive. The provider/manager was suitably qualified and experienced to competently manage and administer the home and ensure the assessed needs of service users were met. Feedback from service users consulted was very positive about the care they received and the home’s facilities and services. Visitors also expressed high levels of satisfaction with standards of management and care. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 20 The management confirmed that she had not yet registered for the Registered Managers Award and continued to explore various training courses to achieve this qualification. Accident prevention measures included regular safety audits; valves fitted to baths and washbasins for the control of hot water at a safe temperature and window restrictors were fitted. Radiator covers were in place throughout the home to reduce risk of burns from hot radiator surfaces. Secondary heaters had been wall mounted since the last inspection as an additional safety precaution. New developments also included provision of a non-slip, graduated pathway leading to the rear garden that had been levelled, enhancing accessibility and safety to this area. There was also a new patio in this area. Requirements of the fire safety officer made at the time of his last inspection had been met. Discussed was the need to discontinue use of door wedges on two ground floor bedroom doors. The fire officer should be consulted on alternative ways for maintaining these doors open and possible use of door guards. A recent visit by the Environmental Health Officer confirmed compliance with food safety and health and safety requirements. Record keeping ensured statutory records were in place, securely stored and maintained up to date. Care plans required further development. The Inspector reviewed the results of the last service user/relative satisfaction survey. The results had been discussed with service users and appropriate action taken to address comments. Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 21 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 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 x 17 x 18 3 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x x 2 2 Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP37OP8O P7OP 7, 8, 37 OP24OP 24 OP38OP24 OP 24, 38 Regulation 17(1)(a) Sch 1.1 16(2)(c) 13(4)(c) Requirement For review and development of care plans and risk assessments. To fit headboards to beds where these are missing in consultation with service users. To carry out a risk assessment for the service user occupying a bedroom without a call bell in the en suite facility. This must be fitted in the future when this room is vacated before further occupation. For ID and current photographs to be on all staff personnel files. For the practice of wedging bedroom doors to cease. Where this is necessary to ensure observation of service users spending their days in their rooms and to reduce feelings of isolation the fire officer should be consulted on the potential for fitting door guards. Timescale for action 02/03/06 02/03/06 09/12/05 4 5 OP37OP29 OP 29, 37 OP38OP 38 19 Sch 2 1.1 23(4)(a) 02/01/06 03/12/05 Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wolf House DS0000013835.V270391.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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