CARE HOMES FOR OLDER PEOPLE
Wordsworth House Care Home 2 Belle Vue Road Swanage Dorset BH19 2HR
Lead Inspector Amanda Porter Unannounced 18 April & 10 May 2005 09:30 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 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. Wordsworth House Care Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Wordsworth House Care Home Address 2 Belle Vue Road, Swanage, Dorset, BH19 2HR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01929 423614 01929 423614 Wordsworth House Care Home Ltd Mrs Jennifer Frances Herring Care Home with Nursing (N) 51 Category(ies) of OP - 51 registration, with number of places Wordsworth House Care Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15 December 2004 Brief Description of the Service: Wordsworth House is a large, detached, three storey property situated in the Durlston area of Swanage town. It is in an elevated position, with many rooms and the gardens, offering views over Durlston Park and the sea. Off road parking is available at the front of the house. Residents at Wordsworth House have the benefit of the local seaside town and the amenities it offers including shops, restaurants and a post office. The garden is attractive, well maintained and easily accessible by having ramps and rails in place. The home is registered with the Commission for Social Care Inspection to accommodate a maximum of fifty one older people with nursing needs and personal care needs. Accommodation is provided over the three floors with two double and six single rooms on the first floor; three double and fourteeen single rooms on the second floor and two double and seventeen single rooms on the second floor. At the time of inspection five of the double rooms were being used as singles. The main communal areas consist of a lounge and a dining/sitting room. There are a further three small lounges, that are also used for some service users as dining areas.The home has assisted bathing facilities on each floor and two passenger lifts. Wordsworth House Care Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the mornings of the 28th April and the 10th May 2005 and took a total of 5.5 hours. On the first morning Ms Weekes, Company Director of Wordsworth Care Homes Ltd, was on hand to aid the inspection process. During the second morning of inspection the registered manager, Mrs Herring, was on duty and she and her staff gave their full cooperation to the inspector. The purpose of the inspection was to review the requirements and recommendations made in the last report, to assess outstanding key standards and to investigate an anonymous complaint, which was not upheld as a result of the inspection. Six residents and seven members of staff were spoken with and asked their views on the services provided at Wordsworth House. Some documentation was reviewed, including care files, policies and procedures. A tour of the premises was undertaken. What the service does well:
The home ensures access to health care services to meet assessed needs and liaises with a variety of health care professionals. Residents say that the staff are kind and look after them well. Wordsworth House cater for dietary needs very well. The menu offers choice and residents say they enjoy the food provided. Meals can be taken wherever the resident chooses but most people opt to eat in the dining room. The home protects the residents from abuse by ensuring staff are trained to follow the robust procedure which is in place to respond to suspicion or evidence of abuse or neglect. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. Wordsworth House Care Home Version 1.10 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Wordsworth House Care Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Wordsworth House Care Home Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 5. Standard 6 is not relevant as the home does not provide intermediate care. The home’s statement of purpose and service user guide provide prospective residents and their families with details of the services the home provides enabling an informed decision about admission to be made, they are also welcome to visit Wordsworth House to decide if the home suits them. EVIDENCE: The home’s service user guide is well laid out, clear and readily available to the residents and their families. Residents confirmed that they and/or their family were invited to visit the home prior to admission and they were given a copy of the service user guide. Wordsworth House Care Home Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 Even though each resident has an individual plan of care, which contains relevant information to enable staff to meet assessed needs, systems for resident consultation are poor with little evidence that resident’s views are sought or acted upon. Residents’ health needs are met through visits from doctors and other health professionals as required. EVIDENCE: The care documentation for five residents was seen. Files contained care plans, which accurately reflects the care given to the individual service users. However there was no evidence that service users and/or their representatives are involved in drawing up and reviewing their plans of care. Service users say that they are well care for but are not involved in care plan reviews. Relevant risk assessments such as moving and handling, nutrition, the risk of pressure sore development and continence are undertaken on admission and are reviewed regularly. Where risk assessments identified a need for specialist equipment this was provided.
Wordsworth House Care Home Version 1.10 Page 10 Visits from GP, district nurse, dentist, optician and chiropodist were recorded in the care files. One resident said that she was particularly grateful to the manager, Mrs Herring, for the lengths that she had gone to ensure that hospital appointments and consultation with medical staff were attended. Although standard 9 was not fully assessed on this occasion the manager confirmed that the medication policy has been revised and clear guidance is available on the use of homely remedies. Wordsworth House Care Home Version 1.10 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 The social, cultural and recreational activities provided by the home meet the expectations of residents. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: A member of staff is employed to organise activities within the home. Each resident is given a timetable of events and can choose whether to attend or not. Activities included: • Music • Bingo • Gardening • Birthday parties • Games and quizzes • Church services Residents spoken with confirmed that they could decide how to spend each day and they enjoyed the activities. They also said that they enjoyed the food provided. They could choose where they ate their meals and most elected to have their main meals in the dining room. The chef is well aware of the residents’ dietary preferences and his menu offers choice.
Wordsworth House Care Home Version 1.10 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 &18 The written complaints procedure made available to staff does not give any clear guidance as to how complaints would be processed, therefore residents could not be confident their concerns would be listened to or acted upon. The staff’s knowledge and understanding of Adult Protection issues provides a safe environment to protect residents from abuse. EVIDENCE: Two complaints procedures were seen. The one held in the service user guide gave clear guidance as to how complaints would be processed. The second was held in the staff’s policy and procedure manual. This did not give clear instruction to staff on how to deal with complaints. Staff confirmed that they were unsure of the procedure. Since the last inspection the Commission for Social Care Inspection has received an anonymous complaint, which was investigated during this inspection. It has not been upheld. Wordsworth House has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. On the first day of inspection the training officer gave a training session on this topic to a number of staff. Through discussion staff demonstrated knowledge of the Department of Health Guidance “No Secrets” and local protection of vulnerable adults procedures. Wordsworth House Care Home Version 1.10 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 The bedrooms at Wordsworth House provide residents with a comfortable, homely environment that enables them to have their own possessions around them. EVIDENCE: The bedrooms seen during the inspection were tastefully decorated and personalised by their occupants with items of furniture, pictures and mementos. Door locks were in place for those residents wishing to have them and lockable storage was available for those service users self-medicating. Residents spoken with were happy with their rooms. Wordsworth House Care Home Version 1.10 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 & 30 The deployment and number of available staff is sufficient to meet the needs of the residents. Procedures for the recruitment of staff are robust and protect service users from risk. Staff are well trained and able to do their jobs, resulting in residents being well cared for. Wordsworth House Care Home Version 1.10 Page 15 EVIDENCE: Three months of duty rotas were seen during the inspection and they showed that sufficient numbers of staff were employed to meet the needs of the residents. Four • • • • • • • • staff files were seen. Each contained: A completed application form Interview record Offer of employment letter Work permits where necessary Terms and conditions of employment Two written references Documentary evidence of any relevant qualifications CRB check The training officer confirmed that he gave each member of staff a copy of the code of conduct and practice set by the General Social Care Council. Through looking at training records and discussion with the training officer it was evident that staff were receiving induction and foundation training, which met the National Training Organisation workforce training targets. Staff spoken with confirmed this and said that they found the training very helpful for the work that they were doing. Standard 28 was not assessed on this occasion, therefore the recommendation made in the last report with regard to NVQ training has been brought forward into this report. Wordsworth House Care Home Version 1.10 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff are not formally supervised as often as they should be potentially affecting the running of the home and compromising the care of the residents. EVIDENCE: The registered manager and training officer confirmed that not all staff were receiving formal supervision on a regular basis. They, themselves, had not received supervision either. A requirement to rectify this shortfall has been made. Wordsworth House Care Home Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x 3 x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x x x x 1 x x Wordsworth House Care Home Version 1.10 Page 18 YES Are there any outstanding requirements from the last inspection? 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 OP36 Regulation 18(2) Requirement All care staff must receive formal supervision at least six times a year. Timescale for action 10/08/05 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. Refer to Standard OP16 OP7 Good Practice Recommendations The complaints procedure given to staff should give the same information as the one available to service users. Care files should hold some documentary evidence that service users and/or their chosen representative are invited to participate in the drawing up and review of care plans. A minimum of 50 of care assistants should hold the NVQ level 2 award in care. 3. OP28 Wordsworth House Care Home Version 1.10 Page 19 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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