CARE HOMES FOR OLDER PEOPLE
Wolston Grange Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ Lead Inspector
Lesley Beadsworth Unannounced Inspection 16th August 2007 11:00a 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 Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wolston Grange Address Coalpit Lane Lawford Heath Rugby Warwickshire CV23 9HJ 02476 540482 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) wolston@pinnaclecare.co.uk Pinnacle Care Ltd Ms Andrea J Hall Care Home 33 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (1) of places Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Rooms numbered 5 and 16 should not be used to accommodate service users with a sight impairment. All staff, including the manager, must undertake a minimum of one day each year refresher training at a level that accords with their role and responsibilities within the home. During the residents waking hours care staffing levels must be at a minimum ratio of 1:5 residents. There must be a minimum of three waking night staff. Cleaning, catering and laundry duties must be covered by designated staff (not staff also carrying out personal care) seven days a week. Wolston Grange may, within its existing places care for the person named in the application for variation dated 23/08/06 The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:dementia - over 65 years of age, DE(E), 32; old age, not falling within any other category, OP, 1. The maximum number of service users to be accommodated is 33. 4. 5. 6. Date of last inspection 7th November 2006 Brief Description of the Service: Wolston Grange is one of seven homes owned by Pinnacle Care Limited. It is a large detached dwelling set in extensive grounds. The building was formerly a hunting lodge and there are a number of small outbuildings surrounding the main courtyard. The home is set in a rural location, a short drive away from Rugby Town Centre and the villages of Dunchurch and Bilton. The home is located along a country lane with smaller domestic dwellings as neighbours. There are no local facilities or public transport close to the home. It is registered to care for up to 33 older persons over the age of 65yrs with dementia. The accommodation is over two floors. There are two lounges, a dining room, a large sun terrace, a conservatory and a sitting room upstairs. All bedrooms have ensuite facilities and there are two communal toilets on the ground floor and one on the upper floor. There are two assisted bathrooms and three shower facilities (one shower room not being used) within the building.
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 5 The Service User Guide advised that the accommodation fees were £508.00 a week. Extra charges are made for hairdressing, chiropody and bus trips. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection undertaken by us (Commission for Social Care Inspection) considers the home’s capacity to meet the standards and to determine that the home is meeting the needs of the residents. As part of the inspection visit three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. The Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers, will be sent to the home later in the year. However other information was considered as part of this inspection including regulation 37 notifications, complaints, and adult protection issues. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 11.00am and 8.30pm. What the service does well:
The home is attractively decorated and furnished and retains several features of the original hunting lodge. Observations made, discussion with residents and the registered manager showed that diversity issues among the people living at the home are recognised, respected and supported. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. All residents observed or spoken with during the visit were well groomed and looked well cared. Those spoken with made such comments as, “Staff here are kind and respectful.”
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 7 “They treat you very well.” “ Everything here is hunky dory.” Residents were cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Terms of preferred address were on the residents care plan and heard to be used by staff. Relatives were seen to be made to feel welcome and there was a comfortable rapport between staff and visitors at the home at the time of the visit. Most residents have their meals served in the attractive, oak panelled dining room. This is pleasantly furnished and decorated. Residents spoken with afterwards said that they enjoyed their lunch. Comments from them about food at Wolston Grange included, “The food is reasonable.” “Lovely food.” “I enjoy the mealtimes.” Staff spoken with said that the manager was approachable and that they felt supported by her. One resident spoken with said, “The manager will do anything for you.” Some of the comments made by relatives were included in the Service User Guide and included, “Wolston Grange is a lovely home with a warm and friendly atmosphere.” “thank you so much for making *****’s birthday a happy one.” What has improved since the last inspection?
Following pre-admission assessment prospective residents are now sent a letter to inform them of the outcome of the assessment. Sixteen care staff having attended a one-day or a three-day dementia training course. There had been a great deal of work carried out in the home in order to transfer all care plans onto a new format. The new plans were a big improvement on the previous plans with information being easily accessible to enable staff to provide the appropriate care and the headings for all needs included in the format. Following observations made and discussion with the residents that were case tracked the plans appeared to address all the needs of those residents. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 8 The home has been provided an appropriate controlled drug cupboard for the safe keeping of these drugs. Staff have been provided with a description of all medication used in the home so that they are aware of their uses and any contraindications. Progress had been made in the signage and directions for residents with most of the bedrooms and the toilets and bathrooms being clearly labelled to assist those residents with dementia. The registered manager advised that long-life bulbs had been purchased for the hard to reach light fittings of the new extension and that the maintenance person now includes weekly bulb checks in the working programme and replaces them as required. Staff had undertaken health, safety and welfare training as discussed in the previous section, ensuring that the home was a safe place for the people living and working at the home. What they could do better:
Care plans had not been signed by residents, or staff. There is therefore no evidence of whether the resident was involved in the care plan or if they agreed or approved of the care that was to be provided. Only one of the three care files included a risk assessment regarding the occurrence of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). All residents need to have this risk assessment carried out so that appropriate action can be taken to prevent these sores developing. The medication administration process is a time consuming procedure, which is open to error and thereby is a potential risk to the welfare of residents. A safe and effective system must be in place in order to protect residents. Only the manager and two other members of staff had completed medication training and were familiar with the home’s policy and procedure for medication. This does not seem a viable number if annual leave, and rest days, or any sick leave, are taken into account and it is suggested that more staff need to be trained to carry out this task. However following the inspection the registered provider advised, and provided evidence to support, that eight staff had undertaken this training but that only three senior staff were generally responsible for the medication. The new deputy manager was left in charge of the home on the evening of the inspection visit, which meant that she was responsible for the administration of medication for the first time at Wolston Grange. As she was not familiar with
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 9 the policy and procedure or the residents this was a high risk to the residents’ welfare. An audit was carried out randomly showed that not all tablets had been administered or recorded accurately indicating that the Medication Administration Record Sheets had been signed when a tablet had not been given on seven different occasions. There continued to be busily patterned carpets in the communal areas of the home causing residents with dementia to think that there were ‘bits’ to be picked up off the floor. A resident was seen to be trying to do this creating a very real risk of falling. The notices for staff pinned to the wooden wall panelling gave an institutional appearance and a place away from the residents’ living areas should be considered. The registered provider has chosen not to provide disposable towels for residents’ use in communal hand washing areas because of institutional appearance concerns. The practice of changing the fabric towels twice a day was said by the registered manager to continue. This does not eliminate the risk of cross infection between residents and if fabric towels are to be used they need to be changed after each use. However there were no towels seen at all in these areas during the visit. There was no soap available again for hand washing purposes in the laundry. A fly was seen in the pantry, which could be a source of contamination possibly leading to disease. Fly screens are not used in the organisation’s homes so other steps must be taken to minimise the risk of flies entering the kitchen, as the insectacutor (ultra violet light fly trap) will only kill flies or other insects that come into contact with it. The home continues to have only three to four care assistants during the day and two, occasionally three, at night. There continues to be a cook employed until only 2pm, which means that care staff would be required to assist with the teatime and suppertime catering, taking them away from spending time with residents. The rota also showed only one domestic assistant who worked a morning shift but not every day of the week and on some occasions covered care assistant shifts instead. These figures indicated that there are insufficient staff available given the number of residents, and their type and level of care needs. Three staff files were examined. One of the files did not contain evidence of a Criminal Records Bureau clearance, although the registered manager was sure that it had been received. A Criminal Records Bureau check is necessary to ensure that the employee is suitable and to protect the people living at the home. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 10 The lounge and dining room doors were wedged open during the visit. This would create a risk to the people in the home in the event of a fire. These doors should be left closed or be linked to the fire alarm system to allow them to close automatically when the fire alarm sounds. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 11 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 Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 12 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is adequate. Information required to make a decision about choice of home is available when needed although there are shortfalls in the Service User Guide. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Religious and sexual orientation needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager advised that there was a Statement of Purpose available in the home for residents and visitors to look at and that a copy was available for them on request. The home also has a Service User Guide that the registered manager printed off the computer for inspection. A summary of the Statement of Purpose was included in this and advised readers that a full copy of the Statement of Purpose was available on request. The Service User Guide was examined and some required elements were not included; for example the complaints procedure, the method of payment of fees and our Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 13 address and telephone number. Residents spoken with could not recall having received a copy of either document, possibly due to limited understanding. Prospective residents are visited and a pre admission assessment carried out prior to the home agreeing to any admission and the registered manager advised that a letter is sent to the resident regarding the outcome of the assessment although a copy of this letter was not on file. All care files looked at contained a copy of the assessment, which consists of a score box format. Although there is some space for additional notes it is difficult to give details and to form a care plan from this type of information recording. The assessments covered all the required areas of assessment. Apart from 16 staff having attended a one day or a three day dementia training course and one member of staff having attended training regarding diabetes there was no evidence of any other specialist training having been undertaken in order to meet any specialist needs of residents, such as sensory impairment, physical disability or continence management. Observations made, discussion with residents and the registered manager showed that diversity issues among the people living at the home are recognised, respected and supported. In one particular circumstance two residents had a very positive outcome due to the importance of equality being recognised and put into practice. Church services are held in the home each month. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 14 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. Although care plans have improved there are still some shortfalls. Residents have access to health care professionals and are cared for in a respectful manner. There are concerns around the medication process that could mean risks to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a great deal of work carried out in the home in order to transfer all care plans onto a new format. Three care files were looked as part of the case tracking process. The registered manager explained that one plan had not yet been transferred to the new format due to the complexity of the needs of this person. The new plans were a big improvement on the previous plans with information being easily accessible to enable staff to provide the appropriate care and the headings for all needs included in the format. Having more than one heading/need per page makes it more difficult for changes to be made but is much more manageable and accessible than the previous plans.
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 15 Following observations made and discussion with the residents that were case tracked the plans appeared to address all the needs of those residents. Care plans had not been signed by residents, or staff. There is therefore no evidence of whether the resident was involved in the care plan or if they agreed or approved of the care that was to be provided. Only one of the three care files included a risk assessment regarding the occurrence of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area). All residents need to have this risk assessment carried out so that appropriate action can be taken to prevent these sores developing. However some pressure relieving equipment, including mattresses and cushions were in use at the home. Care plans are kept in residents’ bedrooms in a ‘safe’ place and out of sight. The registered manager explained that this made them more accessible to staff when carrying out personal care, and therefore more likely to be referred to by them. Risk assessments were in place for Moving and Handling, falls, and nutrition. There were also risk assessments in place for individual needs, for example a resident with diabetes had a risk assessment related to the occurrence of a drop in blood sugar levels where the symptoms were clearly described and the action to take to minimises the risk; a further risk assessment was provided regarding residents using the kitchen. Nutritional screening and regular weighing of residents were carried out, and recorded, to ensure that residents’ nutritional needs are met. There was evidence in residents’ care files that their on going health care needs were being met by visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse. Medication is dispensed in a multi dose bubble pack system, although some tablets and all liquid medication cannot be dispensed this way and are received in their original containers. On receipt the amounts are recorded on the relevant Medication Administration Record Sheet and stored in the medication storeroom. This room also houses the newly provided controlled drug cupboard. The procedure at the home is that medication must be administered for one person at a time by one member of staff and taken from the store cupboard in a medicine pot to wherever the resident is at the time. This is a time consuming procedure and is open to error and thereby being a potential risk to the welfare of residents. Staff spoken with discussed the tablets being transported in named pots on a tray without realising that this was an unacceptable and risky practice. The registered provider does not wish to have
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 16 medication trolleys to transport medication in the homes because of their institutional appearance but a safe and effective system must be in place in order to protect residents. The registered manager advised that besides her only two members of staff had completed accredited medication training and who could therefore administer medication. Whilst the manager said that she and a team leader, who lives in the home, ensure cover this does not seem a viable number if annual leave, and rest days, or any sick leave, are taken into account and it is suggested that more staff need to be trained to carry out this task. However following the inspection the registered provider advised, and provided evidence to support, that eight staff had undertaken this training but that only three senior staff were generally responsible for the medication. A deputy manager had taken up her appointment two days prior to the inspection visit. Whilst she had undertaken the necessary medication training at her previous place of work she had not been assessed as competent at Wolston Grange; she did not know Wolston Grange’s medication policy and procedure; she was not familiar with the residents’ names and faces; not all Medication Administration Record Sheets had residents’ photographs as a means of identification. On the evening of the visit she was to carry out the medication administration. The team leader living at the home eventually came to assist once it was pointed out to the deputy that she should not be carrying out this procedure unsupervised and unassisted. The registered manager, who had needed to leave shortly after her designated time, advised after the visit that a trained member of staff had been instructed to assist the deputy manager with the medication but this had not happened. This very unsafe situation had the potential to put residents at great risk and left a new member of staff unsupported. An audit was carried out randomly showed that not all tablets had been administered or recorded accurately. Antibiotics received during the medication cycle had not been recorded on the Medication Administration Record Sheets that they had been received. Three people all had more tablets left than the Medication Administration Record Sheets showed that there should have been, indicating that the Medication Administration Record Sheets had been signed when a tablet had not been given on seven different occasions. Staff are required to sign to say that the have read and agreed to the medication procedure. As a reference for staff there was a list of each individual person’s medication and their uses and side effects with each Medication Administration Record Sheet. Leaflets from the medication packages were retained for future reference. These should be received from the pharmacist with all medication including those in the multi dose system. All residents observed or spoken with during the visit were well groomed and looked well cared. Those spoken with made such comments as,
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 17 “Staff here are kind and respectful.” “They treat you very well.” “ Everything here is hunky dory.” Residents are cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. Terms of preferred address are on the residents care plan and heard to be used by staff. There is a cordless phone available to residents if they want to make a call in private The registered manager advised that all staff were aware of the home’s procedure for care of a resident after death. However on two occasions staff had not complied with this, which had led to complaints being made. Disciplinary action had been taken and the policy and procedures reinforced with staff. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents said they were occupied. Visitors were made welcome. Residents had choices and control over their daily lives. Residents enjoyed the varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The post of activity organiser had been deleted in the organisation. The manager said that this post had not been effective in the home. All care staff were therefore responsible for activities and occupation. An activity programme was in place that was said by the manager to be flexible and to be used as a guide in order to meet the wishes of residents on the day, but the registered manager also said that frequent short activities were carried out on an impromptu basis. The home also offered weekly bus trips in the vehicle owned by the organisation. The member of staff and the residents going out decide the venue on the day of the trip. Special occasions such as birthdays were also celebrated. Residents spoken with who were able to communicate said that they had enough to do during the day. One resident said that she gardened; two residents went out for a walk during the afternoon; other residents were seen
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 19 chatting one to one with staff. There was an ample supply of board games and cards in the lounges. Relatives visiting the home were made to feel welcome and there was a comfortable rapport seen between staff and visitors. Staff and the Service User Guide advised that visiting was at any time. Residents are able to make choices about their daily lives. The registered provider is anxious that the organisation’s homes do not have institutional rules and routines. Residents spoken with said that they could get up and go to bed when they wished. They were encouraged and assisted to make their own choices about what meals they had and where to take the meal, with some residents seen to have their meal in their bedroom. Most residents have their meals served in the attractive, oak panelled dining room. This is pleasantly furnished and decorated. Food was brought into the dining room in a heated trolley and residents were asked individually which choice of meal they wanted. Those residents who found verbal communication difficult were shown the plated meals to help them to decide the one they would prefer. Care plans also recorded likes and dislikes of individuals and this was available to the catering staff. The meals provided for lunch were well presented and looked nutritious. Residents spoken with afterwards said that they enjoyed their lunch. Comments from them about food at Wolston Grange included, “The food is reasonable.” “Lovely food.” “I enjoy the mealtimes.” The kitchen was visited and appeared in good order. Most of the recommendations had been addressed by the home and the organisation apart from some minor maintenance tasks that were to be carried out by the Maintenance person. A fly was seen in the pantry, which could be a source of contamination possibly leading to disease. Fly screens are not used in the organisation’s homes so other steps must be taken to minimise the risk of flies entering the kitchen, as the insectacutor (ultra violet light fly trap) will only kill flies or other insects that come into contact with it. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 20 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 Quality in this outcome area is adequate. The home has appropriate policies and procedures but the manner in which complaints and allegations are dealt with and the recruitment practice does not safeguard people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been five complaints since the last inspection. One complaint was related to the way in which a relative had been informed of a resident’s condition and a second related to general care. Three of the complaints resulted in adult safeguarding referrals. One of these three was withdrawn. A second was related to the care of two residents after death and resulted in staff being disciplined for not carrying out the correct procedure in responding to the death of a resident and for not carrying out the correct procedure when informing a relative of the death of a resident. There was also concern that at least one member of staff involved had not received the appropriate induction training at the time of their appointment to enable them to have dealt with the sudden death in an appropriate way. The third referral was about several issues regarding care of a resident and the home’s environment. There are further concerns in the defensive and sometimes unhelpful way in which the home has dealt with complaints. This leaves residents and visitors unable to feel confident that their concerns are taken seriously or that they will be dealt with appropriately.
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 21 A staff file examined contained no evidence of a Criminal Records Bureau check having been carried out before commencement of employment. There was therefore nothing to show that the person was suitable to work with vulnerable people. A complaints procedure is available in the home and there is a policy and procedure in regard to prevention of abuse. The complaints records were initially not available in the home as the registered provider was using them at the head office, but were brought for inspection before the end of the visit. Residents said that they knew who to go to if they had any concerns. Training records and discussion with staff showed that training related to adult protection had been undertaken and staff spoken to said that they would report any suspicion or allegation of abuse to the senior person on duty. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 22 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25, 26 Quality in this outcome area is adequate. The home offers the people living there comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained but with some shortfalls in infection control. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was attractively decorated and furnished and maintains many original features. There continued to be busily patterned carpets in the communal areas causing residents with dementia to think that there were ‘bits’ to be picked up off the floor. A resident was seen to be trying to do this creating a very real risk of falling. The lounges were comfortable and were suitable for grouping of armchairs in a homely manner. The notices for staff pinned to the wooden wall panelling gave an institutional appearance and a place away from the residents’ living areas should be considered. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 23 Progress had been made in the signage and directions for residents with most of the bedrooms and the toilets and bathrooms being clearly labelled to assist those residents with dementia. All bedrooms looked at had been personalised with pictures, ornaments and photographs. The Service User Guide advised that personal furniture could also be brought into the home. Residents bringing in their own belongings add to the homeliness and familiarity of the surroundings. One resident spoken with about what they thought about the home said, “My room is just right, very comfortable. I love the surroundings, especially the original features.” All areas of the home visited were clean and free of any offensive odour. No lights were found not to be working although one complaint made about the home included there being no working light bulb in an ensuite bathroom. The registered manager advised that long-life bulbs had been purchased for the hard to reach areas of the new extension and that the maintenance person now includes weekly bulb checks in the working programme and replaces them as required. Staff continue to be without an area for them to take their breaks away from the workplace although a member of staff spoken with said that the could go outside for short periods. The registered provider has chosen not to provide disposable towels for residents’ use in communal hand washing areas because of concerns of an institutional appearance. The practice of changing the fabric towels twice a day was said by the registered manager to continue. This does not eliminate the risk of cross infection between residents and if fabric towels are to be used they need to be changed after each use. However there were no towels seen at all in these areas during the visit. Staff hand washing areas in the laundry, kitchen and sluice had disposable towels in an attempt to minimise cross infection by staff and alcohol gel is available in bathroom cabinets in all communal bathrooms and toilets. A fly was seen in the pantry, which could be a source of contamination possibly leading to disease. Fly screens are not used in the organisation’s homes so other steps must be taken to minimise the risk of flies entering the kitchen, as the insectacutor (ultra violet light fly trap) will only kill flies or other insects that come into contact with it. The laundry was clean and tidy. The washing machine had the appropriate programmes required to prevent cross infection. However there was no soap available again for hand washing purposes in the laundry. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 24 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are insufficient care staff available to meet the needs of the residents and the low numbers of ancillary staff also impact on this. There are shortfalls in the staff records. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff rotas were provided for inspection that showed little progress from the last inspection. The home continues to have only three to four care assistants during the day and two, or occasionally three, at night. There continues to be a cook employed only until 2pm, which means that care staff would be required to assist with the teatime and suppertime catering, taking them away from spending time with residents. The rota also showed only one domestic assistant who worked morning shifts but not every day of the week and on some occasions covered care assistant shifts instead. These figures indicated that there are insufficient staff available given the number of residents, and their type and level of care needs. The home is on target for 50 of the care staff to achieve National Vocational Qualification (NVQ) Level 2 in Care indicating that they had been assessed as competent to carry out their role. Other training undertaken by staff included the health, safety and welfare subjects of moving and handling, food hygiene, first aid, health and safety, infection control and adult protection and fire
Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 25 safety. Specialist training related to dementia, had also been undertaken by the majority of staff but further training to meet specialist needs of people living at the home should be considered. Three staff files were examined. One of the files did not contain evidence of a Criminal Records Bureau clearance, although the registered manager was sure that it had been received. A Criminal Records Bureau check is necessary t o ensure that the employee is suitable and to protect the people living at the home. All other required information was in all three files, including two references and evidence to support that an overseas employee had the right to work in the UK, further ensuring that only appropriate staff are employed. The file of a new member of staff included evidence that induction training had taken place in order for the employee to have the knowledge and skills to do their job. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 26 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. A person with the appropriate qualification and who has previous management experience manages the home. There is satisfactory monitoring and auditing of the service and practices to ensure that all they operate in the best interests of residents Some actions are required to address health and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been at the home for almost two years and as well as having a nursing qualification has the appropriate management qualifications. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 27 Staff spoken with said that the manager was approachable and that they felt supported by her. One resident spoken with said, “The manager will do anything for you.” The home has a Quality Assurance programme that includes regular audits and circulation of surveys to relatives to obtain their views of the services at the home. Relatives meetings are also held at regular intervals. Some of the comments made by relatives were included in the Service User Guide and included, “Wolston Grange is a lovely home with a warm and friendly atmosphere.” “thank you so much for making *****’s birthday a happy one.” Unannounced visits are made monthly by a representative of the registered provider and are followed by a report, which is then forwarded to us and a copy sent to the manager. These visits and reports should demonstrate that the registered provider is monitoring the service to that it is acting in the best interests of the residents however there are some issues around staff training and training related to dealing with death and communication with relatives. The home does not handle residents’ money and any purchases made for the resident, including chiropody and hairdressing, are invoiced by the organisation to the person responsible for the resident’s finances. Staff had undertaken health, safety and welfare training as discussed in the previous section, in order that the home be a safe place for the people living and working at the home. The lounge and dining room doors were wedged open during the visit. This would create a risk to the people in the home in the event of a fire. These doors should be left closed or be linked to the fire alarm system to allow them to close automatically when the fire alarm sounds. As the registered provider feels that it is institutional there is not a visitors book available for visitors to complete. The policy regarding recording who is in the building in the event of a fire is that staff complete the visitors book, kept in the office, when visitors enter and leave the building. However this is not effective, particularly if staff are busy or distracted. On the day of the visit the inspector and other visitors coming to the home were not entered in the book for this reason. All health and safety check records that were inspected were in good order. There was evidence that equipment was being services and that in house health and safety checks were up to date. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 28 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 X 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 X X 2 Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 5 (1) Requirement The Service User Guide contain all of the required information prior to making this available to service users. (The previous timescale of 31/01/07 was not met) Where practicable care plans need to be signed by the resident and/or their representative. This will demonstrate that they have been involved in the drawing up of the plans. A safe and effective procedure for administering medication to the residents must be implemented. This will protect the welfare of the people living at the home. Only staff who are competent to do so must administer medication. This will protect the welfare of residents. Steps must be taken to ensure the prevention of cross infection in the communal hand washing areas of the home. This will safeguard residents. Systems must be in place to
DS0000062012.V349613.R01.S.doc Timescale for action 15/10/07 3. OP7 15 15/10/07 4. OP9 13(2) 30/11/07 5. OP9 13 30/09/07 6. OP26 16(2)(j) 15/11/07 7. OP26 16(2)(j) 15/11/07
Page 30 Wolston Grange Version 5.2 8. OP27 18 prevent the contamination of flies and other insects in the kitchen. This will safeguard residents from the risk of disease. Sufficient staff in both number 30/10/07 and skill mix must at all times be available to meet all the needs of the residents. (The previous timescale of 31/12/06 was not met.) All staff records must include evidence that a Criminal Records Bureau check has been carried out. This will protect residents from the employment of inappropriate employees. (The previous timescale of 31/01/07 was not met.) Doors must not be held open unless there is a closure device fitted that is activated by the alarm system. This will safeguard residents in the event of a fire. (The previous timescale of 31/01/07 was not met.) 30/10/07 9. OP29 19 11. OP38 13 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP4 OP8 OP16 Good Practice Recommendations The staff should undertake training in subjects related to specialist needs. Assessments related to the risk of pressure sores should be implemented for all residents and appropriate action taken to prevent their occurrence. Complaint should be addressed in a manner that assures residents and visitors that there concerns have been
DS0000062012.V349613.R01.S.doc Version 5.2 Page 31 Wolston Grange 4. OP19 5. 6. OP36 OP38 listened to and notice taken of them. Consideration should be given to there being a designated area for staff to take a break away from the workplace, where information can be displayed and where personal belongings can be safely stored. Care staff should be appropriately supervised at the required intervals. There should be an effective system in place for recording who has entered and left the building to safeguard people in the event of a fire. Wolston Grange DS0000062012.V349613.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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