CARE HOMES FOR OLDER PEOPLE
Wolf House Wolf House Wolf`s Row Oxted Surrey RH8 0EB Lead Inspector
Pat Collins Unannounced Inspection 25th January 2006 14:15 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.V278459.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 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.V278459.R01.S.doc Version 5.1 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). 2nd December 2005 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 older people with diagnosis of dementia or a mental health disorder. The service aims to foster an atmosphere of care and support, enabling and encouraging 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 from Oxted town centre. Here there is a wide range of shops and community amenities. Accommodation is arranged on three levels. Communal areas are on the ground floor, comprising 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.V278459.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in the afternoon over a four-hour period. The provider/manager and deputy manager were in attendance coming in for the inspection. The inspector spoke with six service users in the lounge and observed them engaging in a group activity facilitated by staff. Discussion also took place with three service users in private in their rooms and with six visitors. The inspection process included consultation with management and all staff on duty, a partial tour of the premises and random sampling of records. 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 who contributed information including two feedback comment cards received from relatives/visitors. What the service does well:
The day-to-day operation of the home continued 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 well established and stable. It comprised of suitably qualified and experienced individuals including staff who had worked at the home for many years. Staff recruitment procedures ensured appointment of staff that shared the home’s values. Primarily these foster an atmosphere of care and support, enabling and encouraging service users to lead independent, fulfilling lives within individual capabilities. On the day of the inspection the atmosphere of the home was warm and friendly and appropriately stimulating. Positive interaction between staff and service users was observed and relationships between staff and services and their relatives was evidently very good. Staff were caring and professional in their conduct and attitude and demonstrated empathy and understanding towards service users. They were all very aware of service users individual needs. Feedback from visitors confirmed a high level of satisfaction with all staff that were described as “very approachable”, “always friendly, helpful, welcoming and very caring”. Due care and attention had been given to the personal appearance of service users’ who without exception expressed the view that they received a good standard of care. They considered their need to be well met. A visitor attributed the personal approach by staff to the care and attention of service
Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 6 users to the home’s small size in terms of registered numbers. This person described a very genuine, family atmosphere fostered by staff. The environment was safe, warm and comfortable and bedrooms were personalised. Care staff maintained all areas of the home in a clean and hygienic condition. The interior and exterior of the home including the garden was subject to an ongoing maintenance and development programme. 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. Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Signed statements of the home’s terms and conditions were maintained on service users files containing all statutory elements. Minor changes were necessary to update these documents. EVIDENCE: Contracts had been signed by or on behalf of service uses and a copy was held on individual files. This document included details of rooms to be occupied, rights and obligations of service users and of the provider, terms and conditions of occupancy, responsibilities for fees and what is covered by the fee also additional fee charges. Other information contained in this document included the complaint procedure and reference to insurance cover. Discussed was the need to ensure that reference to Surrey County Council as the regulator is deleted from contracts. Additionally service users or their representatives need to be informed of the maximum amount of insurance cover included in fees in order that arrangements can be made for private cover if required. Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 11 Service users personal and health care needs were well met. Use of risk assessment tools had been extended and the format of care plans revised and improved, demonstrating a holistic, comprehensive approach to identifying and meeting needs. This action had served to enhance record keeping practices, ensuring a full audit trail of care delivery. Observations confirmed good practice in the care of the dying ensuring death is managed with dignity and propriety and spiritual needs observed. EVIDENCE: All service users and relatives and friends of service users present at the time of the inspection spoke highly of the standard of care. Service users were registered with a General Practitioner and had access to a full range of health care services including regular podiatry/chiropody provision. Since the last inspection the care planning format had been revised and further developed. This was a very positive development and was being implemented to replace the existing care plans. Consultation with a relative confirmed in the past this person had been involved in the care planning process. The deputy manager confirmed the intention to ensure involvement of service users where
Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 10 practicable and/or their representative in this process at the time of reviewing needs and implementation of new care planning documentation. Suitable provision of equipment and care was evident where required, for prevention of pressure sores. It was positive to note the new development of use of a pressure sore risk assessment tool as part of the homes’ prevention strategy. Areas of discussion included the need to implement use of a recognised risk assessment tool for prevention of falls. Ideally this should be introduced routinely and be subject to regular review. Also, for consideration to be given to enhancing the equipment inventory with bedrails and bed-bumpers for use if necessary. Use of this equipment must be subject to written consent from service users and/or their representatives and in consultation with health professionals and other agencies responsible for funding placements. Robust risk assessments must be carried out specific to use of bedrails and be regularly reviewed. Observations confirmed the need to carry out a falls risk assessment for a service user recently admitted; also to review with this individual his needs and wishes specific to the bedroom environment in order to promote and enhance independence relevant to daily activities of living. Mitigating circumstances explained the delay in establishing this information and for developing a preliminary care plan for this individual. Discussions with staff relating to illness and death of service users concluded that the home’s policy, procedures and practices, also staff’s attitude ensured a sensitive, dignified approach in accordance with individual wishes. Management confirmed that families and friends, as appropriate, were involved in discussions in these matters. The home’s policy and procedure for care of the dying was observed to require amendments however. Specifically for updating the name of the regulator in this documents and clarify requirement for notification of all deaths to CSCI. The need to incorporate addressing religious needs in the care of dying document was also discussed. Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 All standards were effectively met ensuring service users expectations were satisfied with suitable arrangements for stimulation and meeting social needs. EVIDENCE: At the outset of the inspection a group activity was taking place in the lounge facilitated by staff. This promoted interaction between all concerned, humorous exchanges and much fun and laughter. Rapport between service users and staff was evidently very good and staff demonstrated a genuine interest in service users as unique individuals. A programme of regular activities was in place. Discussion took place with other individuals who were in their bedrooms, some receiving visitors in private. They expressed positive views about the home’s management and its operation. Visitors were observed to be made very welcome. Service users confirmed that they had enjoyed a stimulating programme of activities and entertainment over the Christmas period. The inspector spoke with two other service users sat in their bedrooms through personal choice. One individual was watching television and the other was reading. Links with the local community were evidently maintained in accordance with service users expressed wishes. At the time of the inspection Lay Visitors from a local Church called in. In discussion with them it was noted that one of these
Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 12 Visitors regularly called at the home to administer Communion to two service users. She spoke with high regard of standards at the home observed at the time of these visits. Staff were described as always friendly and helpful and very welcoming and caring in their approach towards service users. It was stated that the home was always clean and tidy. Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Policies, procedures and practices at the home ensured operation of an accessible and effective complaint procedure. The complaint procedure required some revision and updating. EVIDENCE: The complaint procedure was issued as part of the admission procedures to service users and/or their representative as appropriate. The complaint procedure was also referred to in the home’s terms and conditions document. Complaint forms were available for use at any times. Examination of the complaint record confirmed no formal complaints received in the last twelve months. Additionally the Commission during the same period had received no complaint. The complaint procedure was noted to be in need of minor amendments, which were discussed and agreed with management. These were for a reference to referring complaints to the community physician to be deleted. The complaint procedure must also include the statutory timescale for responding to all complaints within 28 days. Finally it must contain a statement that at any stage of the procedure complainants may refer complaints to CSCI. Consultation with service users and family and friends on the day of inspection confirmed an open culture within in the home that enabled and welcomed suggestions and complaints without fear of reprisal. Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 14 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): These standards were not assessed on this occasion other than for following up requirements of the last inspection, which had been met. Observations confirmed that the environment was overall ‘fit’ for purpose, clean and secure. EVIDENCE: Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 15 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): These standards were not assessed on this occasion. At the time of the last inspection they were overall effectively met. Staff recruitment practices at that time safeguarded service users. Their needs were being met at that time by the home’s staffing levels and staff competencies ensured by the home’s training and development policy. EVIDENCE: Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 16 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, 34, 36, 38 The home’s management ensured effective leadership and direction to the team to ensure consistent delivery of quality care. Service users were safeguarded by accounting and financial procedures and other arrangements for safe working practices. EVIDENCE: The management of the home appeared open and transparent with positive professional relationships. A cohesive management team was evident. The provider/manager was a registered general nurse with a relevant background of clinical and management experience. The management structure included also a full time deputy manager and senior care assistants. The management and administration of the home was observed to ensure that the assessed needs of service users were adequately met. Feedback from service users 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.V278459.R01.S.doc Version 5.1 Page 17 Financial safeguards included employers and public liability insurance and accounting and financial procedures that demonstrated effective and efficient business management. A business and financial plan evidently underpinned the rolling programme of development and upgrading services and facilities. It was stated by management that the home did not hold money on behalf of service users. This was the responsibility of advocates, family members or professional agents. Additional services contracted for service users, for example chiropody or hairdressing charges were paid by the home and charges passed on to service users or their advocates who received itemised invoices. In the event that service users required incidentals purchased on their behalf, examples of which were stockings or toiletries, senior staff would purchase the same, retaining receipts and be reimbursed by service users representatives at the time of their next visit. A secure facility for the safekeeping of small amounts of money or personal possessions in bedrooms was stated to exist. Management stated that this was offered to service users at the time of admission. A formal staff supervision structure was operational and staff were stated to have all received a recent 1:1 supervision session. These were not evidenced though the home’s record keeping systems however. Records of previous formal supervision sessions were available and on inspection highlighted the need to increase the frequency of formal staff supervision sessions. Management was of the view that four times per year would be adequate though aware that the standard was for this to be six times a year. The small size of the staff team however ensured regular opportunity for 1:1 discussion between management and staff on a day-to-day basis on topics covered in formal supervision sessions. The safety of the environment was inspected at the time of the last inspection. In following up requirements on this occasion the provider/manager advised her understanding that the practice of wedging open two ground floor bedroom doors had been acceptable to the fire officer in the past. This was on the basis of having fitted an additional fire door and a fire door guard, which activated on sounding the fire alarm. It was agreed that the provider/manager would consult the fire officer in this matter. Since the last inspection secondary heaters had been delivered for individual bedrooms but awaited being fitted on walls. In the interim management must review risk assessments for floor standing secondary heaters and implement risk management strategies where necessary. The provider was aware of the need to fit a call bell in the en suite facility in a first floor bedroom if this room becomes vacant. At the time of the last inspection this omission was not a risk to the current occupant of this room. Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 18 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x 3 3 2 x x Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 19 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 OP31 Regulation 17, 18 Requirement For care staff to receive formal supervision at the frequency prescribed by these standards and for a record to be maintained. Timescale for action 25/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wolf House DS0000013835.V278459.R01.S.doc Version 5.1 Page 20 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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