Inspection on 11/12/08 for Wolfeton Manor

This inspection was carried out on 11th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wolfeton Manor 15/12/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wolfeton Manor East Hill Charminster Dorchester Dorset DT2 9QL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hale     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Wolfeton Manor East Hill Charminster Dorchester Dorset DT2 9QL 01305262340 01305257915 info@wolfetonmanor.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wolfeton Manor Healthcare Limited care home 31 Number of places (if applicable): Under 65 Over 65 31 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 Wolfeton Manor provides 24 hour care and accommodation for up to 31 older people. The home is located on a hill overlooking the Cerne and Frome rivers to the south and west, one mile north of Dorchester and on the edge of Charminster village. There is ample car parking at the front of the Manor.There is a separate house adjacent to the home that contains three self-contained flats, which are not registered. The accommodation is arranged over three floors. Apart from 8 rooms, all accommodation is at ground floor level situated in the main house and in a north and west wing. There are 23 residential rooms all with en-suite facilities and 5 assisted living suites, a total of 3 of the rooms/suites may be used for double occupancy. The suites comprise a hall, bedroom, lounge, bathroom and hideaway kitchenette. The upper floors can either be accessed by stairs or by a lift which is suitable for people who use wheelchairs.The current weekly fees range from 450 pounds to 750 pounds. Fees include all care and accommodation costs, including meals, laundry and activities. Additional charges are Care Homes for Older People Page 4 of 33 Brief description of the care home made for hairdressing and chiropody. People are expected to pay for their own personal items such as private telephone, toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place over the course of one day in December 2008 and was undertaken by one Inspector. An expert by experience accompanied the inspector for part of the day and they spend their time having a look round the home and talking to people who live and work there. Their findings are incorporated into this report. The focus of the inspection was to look at relevant key standards under the Commission for Social Care Inspection Inspecting for Better Lives 2 Framework. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good, adequate and poor. There have been many changes at the home in recent months. The previous Care Homes for Older People Page 6 of 33 management company are no longer involved in the running the home and this role is now undertaken by Affinity Care. The registered manager has left their post since the last inspection and there is a manager designate in post who has applied to the Commission for registration. People who live and work at the home told us that they had been unsettled during the recent changes in the way the home is organised and staffed and this has naturally caused them some anxiety in recent months. The home completed and returned within the required timescale the Annual Quality Assurance Assessment ( AQAA) and this is referred to in the report. We sent out surveys to staff , residents and health care professionals. We received responses from eight health care professionals, three residents and five members of staff . Their responses are included into this report. The inspector looked at four selected residents care files and three staff files, talked to staff and people who live at the home, undertook a tour of the building and looked at all the documentation relevant to the running of the care home. The current fees range from 450 to 750 pounds per week. What the care home does well: The manager designate was very clear that people from all sections of the local community would be welcomed into the home, they would be seen as individuals and that the home was aware of equality and diversity issues in relation to care practice. Three residents completed our surveys all of whom described themselves as British and having a Christian faith.The manager designate assured us that people who followed other religions ( or no religion) or belief systems would be made welcome and their views respected. Procedures are in place to encourage prospective residents and their families to visit the home and to look at information about the services offered before they make a decision about whether they want to move in. Pre admission assessments are undertaken and the home confirms that peoples needs can be met before they move in. All residents are given an individual terms and conditions of residency so that they know what services are included in the fees and are clear about their own and the homes legal obligations. All residents have a care plan that contains general information about the care they may need and some information about their individual needs.Reference material had been obtained by the manager designate about peoples specific medical conditions such as epilepsy to give staff up to date information about such conditions. Risk assessments were in place and these had been regularly reviewed to reflect peoples current health and circumstances. Appropriate equipment and aids had been provided to individuals according to need. People have access to medical and health care professionals whenever necessary. A health care professional commented that they thought that the home offered very good overall care. People living at the home are treated with respect by staff and their right to privacy was part of daily care practice.The routines of the home were as flexible as possible to meet the choices and preferences of residents. A monthly activity programme was in place that takes into account seasonal events such as Trafalgar Day, Christmas, Easter, this was enjoyed by many people. visitors to the home are encouraged and welcomed and people able to see their visitors in private if they want to. Medication was administered by trained staff following policies and procedures in a way that makes sure that people receive their prescribed medication in a safe manner. Polices and procedures are in place to make sure that people are able to raise concerns or complaints and to safeguard residents from the risk of abuse. The home was clean, tidy and free from odours. It is generally well maintained and offers a high standard of accommodation for people who live there.Residents are encouraged to bring in their own personal possessions including furniture and are supported to make their private room homely and reflective of their own lifestyle and preferences. There are landscaped gardens that are well maintained and accessible to people who live in the home. Care Homes for Older People Page 8 of 33 Residents were very positive about the staff that look after them, one person commented that all members of staff are very kind, helpful and hard working. A professional who completed our survey said that the staff were friendly and efficient and appear to have the residents well being foremost in their minds. A member of staff surveyed told us that although recent months had been challenging to everyone( due to management changes) that they were proud to be a member of the staff team. The manager designate is setting up a training programme to make sure that staff have the necessary skills and experience to meet peoples needs. What has improved since the last inspection? What they could do better: Care plans should be more person centred and tailored to individuals needs, all records should be fully completed dated and signed. Care planning and reviews should be done with the residents and they should be asked to sign their agreement to the care being provided. People should be offered more opportunities to go out of the home for activities including visits to the sea as desired by many residents. Activities should also be a mixture of passive and interactive to provide a stimulating environment. All the radiators must be guarded or guaranteed low surface temperature to reduce the risk of scalding and injury to people who live at the home. Minor improvements in infection control practice would reduce the risk of cross infection for people who live and work at the home. The staffing levels should be reviewed to see if there are enough staff to meet residents need for unhurried positive interaction with staff during personal care and as part of the daily routine of the home. The range of staff training should be increased to make sure that staff have the necessary skills and knowledge to meet the needs of people who live at the home. All staff must undertake training in fire safety to make sure they would know what to do in the case of a fire. Care Homes for Older People Page 9 of 33 Routine maintenance should be carried out promptly to make sure that equipment such as showers, taps and the platform lift at the home are safe and able to be used by staff and residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All residents are given a copy of the terms and conditions of residency so that they are clear about their own and the homes legal obligations. Robust assessment procedures are in place to make sure that peoples needs can be met before they move into the home. Prospective residents are involved with all stages of the potential admission process. Evidence: All people are delivered the home are given a contract and a terms and conditions of residency which includes the majority of the information required but does not make clear who was responsible for paying the fee.Three residents compelted our survey, two of whom said that they had been given a contract one said that they had not received one.All three people comfirmed that they received enough information before they moved into the home. Care Homes for Older People Page 12 of 33 Evidence: We looked at the selected care files of people who had moved into the home since the last inspection. Pre admission assessments had been completed and prospective residents and their families are encouraged to visit the home and spend time there before they make a decision about moving in. People spoken to during the visit confirmed that they had been able to visit the home if they wanted to so they could see what it was like and have a look at any vacant private rooms. All admissions are on a four week trial basis, so people are able to have experience of living in the home before making a final decision about residency. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people living in the home have a generic care plan which details general care needs for older people with some specific additions made for some individuals.Not all documentation had been completed to make sure that all of peoples needs had been identifed so that action could be takne to meet such needs. Appropriate risk assessments were in place to make sure that any risks are identified so appropriate measures can be put in place to reduce them wherever possible. Residents are treated with respect and their right to privacy respected by staff. People living at home have access to medical and health care professionals whenever necessary and suitable equipment is provided to meet peoples health needs. The way that medication is administered is well organised and safeguards are in place to make sure that peoples health care needs are met. Care Homes for Older People Page 14 of 33 Evidence: We looked at the care records of four people in detail. The care plans were generic and covered the recommended topics with some additional information relating to individuals needs. Some care planning records including continence assessments, weight records and personal care records were blank or only partially completed. For example on one plan looked at there the medical history, social profile, mental health needs and elimination had not been completed. On a second care plan looked the personal hygiene record had only been completed sporadically and the recreational activity form and weight record were blank. It was clear from talking to staff and observation that staff were familiar with individuals peoples needs and how they needed to be met. However, please also refer to outcome group six in relation to staffing levels. Risk assessments in relation to pressure sores, nutrition and moving and handling were in place and had all been reviewed and updated as necessary to reflect peoples current circumstances. Some but not all care plans had been signed by the residents to say that they had been consulted about the plan and had signed their agreement with the way their care was to be given. Two members of staff who completed our survey said that they were always given enough information about the people they look after and three said that they usually were. The daily records looked at generally included good detail of the care given and the persons well being during the day and night. However, there were some days when nothing had been recorded although night records were generally better completed. The care plans checked clearly showed that people saw their GP or a district nurse whenever necessary. In one care plan looked at the person was currently seeing a district nurse twice-weekly and there were good records of this and how staff were working together with health care professionals.Pressure relieving equipment such as cushions and mattresses are provided following assessment of need by health care practitioners. Information about peoples medical conditions such as Parkinsons and epilepsy were kept on individuals care files so that staff had access to reference material to make sure they were able to meet peoples needs. Seven health professionals completed our survey, five people said that the home always sought advice when necessary, two said that they usually did and one person said that the home sometimes did.Five professionals said that the home always met peoples care needs, two said that they usually did and one response was blank. Two residents who completed our survey said that they always received the medical support that they needed and one person said that they sometimes did. We looked at how medication is administered in the home and found that the Care Homes for Older People Page 15 of 33 Evidence: controlled drugs register was up-to-date and all records checked were correct. The manager designate audits the medication monthly,a staff sample signature list was in place, patient information leaflets readily available for each medication prescribed, a photograph of each resident was on the medication administration record (mar) and there was good information about each persons GP and any allergies they may have. All staff that administer medication have undertaking training. Many of the residents are prescribed creams and ointments there were gaps on some of the records so it was unclear if they had been applied as prescribed. Staff were observed throughout the day to treat people with respect and to make efforts to respect their right to privacy. Staff were seen to knock on the door of peoples private rooms and not to go in until asked to do so by the residents.Seven professionals surveyed said that the home alway respected peoples dignity and privacy and one said that the home usually did. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are able to participate in a range of activities but would like the opportunity to go out on trips or engage in local community activities. Visitors to the home are welcomed and no restrictions placed on their visits. The menu is varied and offers a choice of meals in a very pleasant dining room, but the quality of some of the food served should be reviewed. Evidence: The cook has undertaken training in the nutritional needs of older people including those with dementia and is aware of how to enrich food to make sure that people are not at nutritional risk. The menus are varied and changed four weekly and the cook told us that they take into account residents likes, dislikes and dietary needs. Residents are able to have their breakfast in their rooms and a cooked breakfast is available to those who want one every Friday. One person was observed being assisted to eat by a member of staff, the interaction between the resident and the member was poor with no explanation of what the food was ( although the resident was visually impaired) and very little verbal interaction . The majority of residents Care Homes for Older People Page 17 of 33 Evidence: spoken to were generally satisfied with the standard and variety of food served at the home but some people commented that the meat is often chewy and poor quality. One person described the food as good but boring. Three residents completed our survey one said they always liked the meals, one said they usually did and one said that they sometimes did.One person commented that the chef changed several times and the food went down a lot, it has improved again recently. A monthly activity calendar is on display and Decembers included a pantomime, the visit of a storyteller, a Nativity concert, Christmas shopping and film shows.Some people were doing a crossword together in the lounge.The previous months activity record showed that there had been music and movement sessions, an entertainer and a celebration of Trafalgar Day.Several residents told us that they would like to go out more and particularly would like to go to the sea. The atmosphere in the home on the day of the visits was flat with little positive interaction by staff toward residents unless undertaking tasks. People are able to continue practising their own religion if they want to and records showed that some people had chosen to attend church services and see a member of the clergy of their own choice. People told us that they are encouraged and supported to maintain contact with their family and friends and that visitors to the home are made welcome.Two visitors spoken to confirmed that there are no restrictions on visiting and that they were alway made welcome by staff. Three professionals surveyed said that the home always supported people to live the life they choose and four said that the home usually did. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to safeguard the interests of people living at the home. Evidence: The home has a complaints policy which makes it clear that complainants are able to contact the commission at any stage of complaint.One complaint had been received since the last inspection relating to lack of activities, poor quality of food and not enough staff to meet residents needs. The record of the complaint was not available as it had been taken from the home by the previous management company. The manager designate told us that they had not been informed about the investigation or the outcome of the complaint. Three residents who completed our survey said that they knew who to speak to if they were unhappy and they all knew how to make a complaint if they wanted to. People spoken to on the day of the inspection were all clear that they could raise any concerns or complaints with staff or the manager designate and were confident they would be taken seriously. Five members of staff who completed our survey said they knew what to do about any concerns that may arise about residents care or well being. An adult protection policy and procedure was in place which referred to locally agreed policies and included contact details of the commission and social services. Care Homes for Older People Page 19 of 33 Evidence: The home has a policy in place to make it clear that staff must must accept gifts from residents and cannot give advice all benefit from their wills. A policy on managing aggression by service users is in place but this was not person centred and does not make clear that there is a difference between deliberate aggression and the behaviour of some people with dementia or who are ill. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and provides an attractive environment for people to live in. There is ample indoor and outdoor space. People are able to personalise their own rooms to reflect their own lifestyle and preferences. Not all radiators are guarded or guaranteed low surface temperature to reduce the risk of scalding and injury to people who live in the home. Laundry services were generally well managed and peoples clothes well cared for. Infection control practice would benefit from further measures to reduce the risk of cross infection. Evidence: The home was very clean and tidy and free from odours on the day of the visit. There is a variety of communal space including a lounge, large sun lounge, large dining room and a conservatory.There are twenty three bedrooms, eight of which are large enough to accommodate two people. The home also has five suites which have their own private internal entrance, patio doors to a terrace, bedroom, a lounge with a mini kitchen built into a cupboard and an assisted shower room. Care Homes for Older People Page 21 of 33 Evidence: People who live in the home are encouraged to bring in personal possessions to make their room more homely and reflective of their personal choices and lifestyle. Three people completed our survey, one of whom said that the home was always clean and fresh and two said that it usually was. The homes garden are landscaped and accessible to all residents. On the day of the visit repairs were being carried out to the heating system and portable heaters had been supplied to individual residents rooms. It was clear from looking at records and talking to staff that repairs to the fittings and equipment were not always carried out promptly to make sure they are fit to use and safe. We were told that some taps and showers had been dripping for some time and the platform lift had been out of order for some weeks. The laundry has suitable equipment to cope with the volume of laundry. People spoken to told us that they received their clothes back from the laundry well cared for and in a timely manner. The training matrix showed us that fifteen members of staff have undertaken training in infection control but this leaves over half the members of the staff team not having done so. Waste bins in communal toilets and bathrooms were not foot operated to reduce the risk of cross infection and hand wash was not provided in all places where staff would need to wash their hands. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels mean that care is provided in a task centred way that allows little positive or social interaction with residents. Robust recruitment checks are in place to make sure that people living the home are safe. The number of staff with at least NVQ level 2 qualifications is currently less than 50 but plans are in place to increase this by registering staff to undertake training. There is a training programme in place, mainly by long distance learning but the range of topics is limited and may not cover issues necessary to meet residents needs. Evidence: A staff rota was in place which included the manager and the designation of each member of staff. Several residents told us during the visit that whilst staff were very good they were so busy that they didnt have time to talk to them or to have contact with them other than when carrying out care tasks. This was particularly commented on by people who choose to spend time in their rooms and have little positive social contact with staff.Some staff who completed our surveys and who we spoke to on the day of the visit confirmed that they felt that the home could do with more staff and Care Homes for Older People Page 23 of 33 Evidence: one person said that carers do a fantastic job but are often too busy just to chat to residents.Two residents surveyed said that there were always staff available when they needed them and two said there was usually staff available. Two people said that the staff always listened and acted on what they( the residents )said. None of the staff surveyed said that there was always enough staff on duty. Two said that there usually was and three said that there sometimes was. Two people felt that they always had the right support, experience and knowledge to meet peoples needs, one said they usually did and one said they felt that they didnt have these skills or support. We looked at the staff files of three people who had started working at the home since the last inspection. All the files included the documentation required and appropriate checks had taken place before people started working at the home. Two professionals surveyed said that the staff always had the right skills and experience to support residents and five said that they usually did. Five members of staff completed our survey. Two said their induction had covered aspects of the job very well, two said it had covered most of the issues and one said they felt that it had not covered relevant information Five staff said that they had access to relevant training with four saying that the training helped them to meet residents needs and kept them up to date. One person said the training did not provide this information for them. The home provided a training matrix which showed that some staff are registered on long distance learning courses for topics including food and nutrition, palliative care, infection control and medication.It also showed that only two staff, ( one of whom is the manager designate) has completed training in dementia care.The range of training available is very limited and does not include topics such as continence management or specific medical conditions. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good communication systems in place to find out what people who live in the home think about the service and keep them informed about what is happening at Wolfreton Manor. Monies held on behalf of residents were kept securely with safeguards in place to protect residents interest. All supervision programme is in place to make sure that all staff are given support and their practice monitored to make sure they meet the expectations of the home. Regular staff meetings are held and staff encouraged to attend and openly contribute to meetings. Health and safety is generally taken seriously to make sure that people who live and work in the home are safe but not all staff have had training in fire safety. Care Homes for Older People Page 25 of 33 Evidence: The registered manager has left the home since the last inspection and a manager designate is in post who has made an application to the Commission for registration. Several residents commented on the number of management and staff changes in recent months with one resident telling us that they didnt know the names of all the current members of staff. The manager designate had completed and returned the AQAA as required and this gave us information about how the home was being managed and their plans on how to improve the services offered to residents. Regular staff meetings are held and minutes taken staff spoken to confirmed that they are encouraged to attend and are able to openly contribute to meetings.Four staff surveyed said that the manager designate regularly had discussions with them, one person said that they did not. One member of staff said that communication in the home always worked well, three said it usually did and one said it did not. One member of staff commented that the manager( designate) was a good manager who really cares about the service users and her staff. The home has a residents committee which meets regularly with the homes manager and represents the views of the people who live there. The last committee meeting had been held in September 2008 and topics discussed included the menu, fire safety information, activities, and an explanation of what was involved in care planning and reviews. However, one resident told us that things discussed at residents meetings were not always acted on.The manager designate told us that there were plans to discuss this with the committee and to change this to an open meeting so that all people living at the home could attend. We checked the homes finance policy which states that they dont handle any money on behalf of people live at the home. However, the home was currently holding some money on behalf of one resident. The records were checked , they were well-kept, included two staff signatures and were correct. A staff supervision programme was in place with care staff being offered for more supervision at least six times a year in line with good practice and housekeeping staff offered team supervision on a regular basis. Fire safety records were well-kept with equipment regularly serviced and tested to make sure it worked properly. The fire risk assessment needed updating to reflect current fire safety legislation and this was due to be done by an external contractor later this month.The training matrix showed that sixteen staff had not completed fire safety training. Care Homes for Older People Page 26 of 33 Evidence: The training matrix showed that all but one member of the care team had completed training in moving and handling.Twenty staff had completed food hygiene training and fifteen staff had completed training in infection control. An accident book was kept and accidents seen on care files looked at had been correctly recorded. Accidents were not formally evaluated by the manager designate and they told us that plans to do this were in place and would start in January 2009. However, one person had had several falls and there was clear evidence on their file that efforts had been made to reduce the risk by changing the layout of the room, referral to an Occupational Therapist, consideration of bed rails and a mattress on the floor. The AQAA told us that the equipment in the home had been serviced and maintained to make sure it was safe to use. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person shall after consultation with the service user,prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. To make sure that all needs have been identified , care plans reflect peoples current circumstances and clear guidance is available to staff on how to meet identified needs. 30/05/2009 2 19 23 The registered person must ensure that the fittings and equipment are kept in a good state of repair. This refers to leaking showers, taps and the platform lift This is to make sure that fittings and equipment are fit for purpose and safe to use. 30/05/2009 3 25 13 The registered person must ensure that all parts of the 30/05/2009 Care Homes for Older People Page 29 of 33 home to which service users have access are so far as reasonably practicable free from hazards to their safety. This refers to unguarded radiators. To reduce the risk of injury by scalding. 4 26 13 The registered person shall 30/05/2009 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (This refers to the provision of hand wash and paper towels for staff, the bins being foot operated). To reduce the risk of cross infection. 5 27 18 The registered person must 30/05/2009 ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. To make sure that service users health, social and care needs are met. 6 38 23 The registered person must make arrangements for persons working at the home to receive suitable training in fire prevention. To make sure staff know what to do in the case of a fire. 30/05/2009 Care Homes for Older People Page 30 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 2 7 The contract should be revised to make sure that it is clear who is responsible for paying the fees. Care plans should be person centred and tailored to include individuals social, health and medical needs. All care plans and assessments should be fully completed, dated and signed. 3 7 Daily records should be completed daily to be able to give a clear picture of the care given and the persons well or ill being. Serious consideration should be given to providing sit on scales so that people who cannot weight bear can be weighed. A record should be kept of all applications of prescribed creams and ointments. Serious consideration should be given to providing the opportunity for people living in the home to go out on trips and engage in social activities outside the home. Serious consideration should be given to training staff in how to assist people with eating and drinking so that it is a positive experience for the residents concerned. Urgent consideration should be given to reviewing the quality of the meat served in the home. Consideration should be given to consulting with the residents about the menu. 4 8 5 6 9 12 7 15 8 15 9 18 The management of aggression by service users policy should be reviewed and updated to reflect current good practice advice and be more person centred. Soiled items should not be left to soak in bowls in the laundry. Urine bottles should be kept in residents own private rooms not in the laundry. 10 26 11 27 Consideration should be given to employing a kitchen assistant. Care Homes for Older People Page 31 of 33 12 13 28 29 Efforts must continue to increase the numbers of staff with at least NVQ level 2 qualifications. The application form should be reviewed to make sure that it complies with current equal opportunity employment legislation. Serious consideration should be given to increasing the range of training available to staff. All policies and procedures should be reviewed and updated to include the contact details of the current management company. Accidents should be audited and evaluated to identify trends and patterns so efforts can be made to reduce the risk of falls whenever possible. 14 15 30 33 16 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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