CARE HOMES FOR OLDER PEOPLE
Wordsworth House Care Home 2 Belle Vue Road Swanage Dorset BH19 2HR Lead Inspector
Amanda Porter Unannounced Inspection 10:00 23 & 28th July 2008
rd 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 Wordsworth House Care Home DS0000050583.V365002.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. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 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 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) 01929 423614 01929 423614 trisha@wordsworth-house.co.uk Wordsworth House Care Home Ltd Ms Trisha Roselina Ashby Rudd Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 51. 12th July 2007 Date of last inspection Brief Description of the Service: Wordsworth House is a large, detached, 3-storey property situated in the Durlston part of Swanage town. It is in an elevated position, with many rooms and the gardens offering views over Durlston Park and the sea. The garden is attractive, well maintained and easily accessible by having ramps and rails. 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 home is registered with the Commission for Social Care Inspection to accommodate a maximum of 51 older people with nursing or personal care needs. Accommodation is over 3 floors with 2 double and 6 single rooms on the first floor; 3 double and 14 single rooms on the second floor and 2 double and 17 single rooms on the second floor. The main communal areas consist of a lounge and a large dining/sitting room. The home has assisted bathing facilities on each floor and there are 2 passenger lifts. Off road parking is available at the front of the house. Wordsworth House Care Home Ltd owns the home and the Registered Manager is Ms Ashby Rudd. Weekly fee rates are from £462 - £800, extra amounts are charged for chiropody services, hairdressing, daily papers /magazines. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for
Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 5 Money and Fair Terms in Contracts). Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes.
This unannounced key inspection was carried out over approximately seven hours on the 23rd and 28th July 2008. This was a statutory inspection and was carried out to ensure that the residents who are living at Wordsworth House are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were also reviewed. The Registered Manager, Ms Trisha Ashby Rudd, and the Responsible Individual, Ms Jan Weekes, were on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • The annual quality assurance assessment completed by the home. • 10 questionnaires completed by residents, 12 by relatives and visitors, 2 from visiting GPs and 3 from a health professionals. • A tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. During the course of the inspection six residents and six members of staff were spoken with and asked their views on the service provided at the home. Comments received through the questionnaires and discussion included: “I am satisfied with all aspects of care. The staff are friendly, helpful and caring.” “The home offers a caring, stimulating supportive environment with well trained staff to cope with complex needs.” “We are happy with the care and attention to our friend and they do pay attention to any comments we make. The staff are friendly and they have lots of different activities for residents and their families and friends.” “So far as I can judge Wordsworth does pretty well all round!” “I like it here. It is very comfortable.” Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection?
Since the last inspection Ms Ashby Rudd has been registered as manager with the Commission for Social Care Inspection. She has proved to be a competent manager and is supported by a competent caring staff. Improvements have been made to care documentation and staff have sufficient information to be able to carry out their caring duties appropriately. A training programme has been developed and some staff have received training in palliative care and dementia care. However further staff still need to attend this training so that residents can be assured they are being care for by well trained staff.
Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 9 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 Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 10 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): 3 & 4. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admissions procedure enables prospective residents, and/or those acting on their behalf, to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: The care files for new residents were inspected. These showed that the home had improved the admission procedure. Prior to anyone moving into the home a full assessment of needs was undertaken with the prospective resident. Sufficient information was obtained so that a care plan could be drawn up and made available to staff. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 11 Residents spoken with confirmed that they or a family member had visited to the home and were given sufficient information about the home before making a decision as to whether to stay. Since the last inspection staff had received further training and therefore were more able to meet the needs of the residents living at the home. This training included dementia care and palliative care for some staff. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Since the last inspection the standard of written assessment and care planning had greatly improved. The care documentation for five residents was reviewed and it contained the relevant assessments and care plans needed so that staff had the information to be able to give a good standard of care. The care plans were evaluated on a monthly basis. However there were still some shortfalls in recording that were noted. One care file did not contain a care plan relating to wound care. Generally the daily written statements in the care files lacked
Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 13 detail about what sort of day the resident has had, how they have been occupied and whether they were in a state of well or ill being. Where the need for specialist equipment was identified it was provided. It was clear from discussions with staff and residents that they have access to the health services they need. There was evidence to show that residents get support from General Practitioners, district nursing services and chiropodists. Two GPs returned comment cards and said that they were satisfied with the overall care provided at Wordsworth House. One said, “A general improvement in care from this home and their communication.” A healthcare professional stated, “Each client appears to be treated as an individual and their needs considered.” The medications policies and procedures were reviewed. The home has a medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. It includes information about the use of homely remedies however there was no stock of them available, which meant that a resident could expect a delay in receiving treatment for minor ailments because a GP would have to be consulted prior to any minor treatment being given. Medicines were stored securely. However there was no clear audit trail to identify how much medication was held by the home. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Residents spoken with were happy with the care they received and confirmed that staff treated them with respect and were supportive and kind. Comments received included: “Staff are always available in the day.” “Some night staff are noisy before 6am.” “Sometimes I have to wait if I ring my bell at night.” Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 14 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. This judgement has been made using available evidence including a visit to this service. The home provides individual and group activities and opportunities, which includes links with relatives and family members and respect for individual preferences promoting a good quality of life for residents. EVIDENCE: Since the last inspection more staffing hours are dedicated to activities for residents. This meant that there was more opportunity for staff to give one to one attention to residents who did not want to join in group activities. A newsletter and activities programme is sent to residents and relatives on a regular basis. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 15 Residents spoken with said they were happy with the lifestyle that living at the home afforded them. Some chose to spend time on their own but knew they could join in with any organised activities if they so wished. Activities included: • Gentle exercise class • Bingo • Flower arranging • Trips out in the home’s minibus • Weekly visit to local market • Birthday parties. One resident said that suitable activities were available if they wanted to join in. Another said, “The young lady who arranges activities works miracles.” One healthcare professional stated, “The recent appointment of an activities co-ordinator has greatly improved communication and follow up to my instructions.” Residents are able to attend church services if they wish. Visiting clergy are made welcome. There was evidence from residents and visitors that visitors are made welcome at any time and that they are able to spend time privately in residents rooms if wished. Rooms viewed were personalised with pictures, some ornaments and items of furniture. People said they enjoyed the food provided. Records showed that residents’ likes and dislikes with regard to food were known and residents were aware that alternatives to the main menu were always available. Residents said: “Excellent attitude of owners and cooks to the provision of fresh food.” “If you tell the chef you especially enjoy a meal he is very good and you get what you want. All kitchen staff are very good.” “There are always options on request.” Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 16 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. EVIDENCE: Residents and their representatives have access to the complaints procedure. Residents said that they knew how to complain and felt confident that if they had concerns or complaints they will be listened to and taken seriously. One visitor commented, “I think the management would respond positively to any complaint to them directly.” Since the last inspection Wordsworth House had received two complaints, both of which had been investigated and action taken in accordance with the home’s complaints procedure. The home has developed and implemented written policies and procedures for the protection of residents from abuse or neglect and provides all staff with training in the understanding of abuse and their role in protecting residents from abuse in its many forms, including neglect. Care staff spoken with during the inspection confirmed that they had received such training.
Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 17 Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Wordsworth House is good providing residents with an attractive, homely and safe place to live. EVIDENCE: A tour of the premises and review of maintenance documentation showed the home is well maintained inside and out. There was evidence that equipment is serviced regularly. The home has an ongoing programme of maintenance and refurbishment. However one bathroom on the middle floor needed attention. The enamel on part of the bath was worn away and the underneath of the bath hoist appeared rusty. This increased the risk of cross infection for anyone using the bath. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 19 Some concerns have been raised about the availability of hot water for residents. The Registered Manager confirmed that work was due to begin in September, which would rectify this situation. Residents have easy access to all communal areas. The well-tended garden is attractive and easily accessible. A new gazebo has been erected in the garden. Residents were seen to be enjoying sitting out in the garden in the sunshine during the first day of inspection. Resident’s rooms were furnished appropriately. Bedrooms were personalised with a variety of mementos, pictures and small items of furniture. All areas of the home seen during the inspection were clean, bright and free from any unpleasant odours. Surveys completed indicated that the home was always kept clean. The laundry was well managed. Adequate supplies of clean linen were seen to be available. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Sufficient care staff are employed to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are given the training and support so that they can give a good standard of care to the residents living at Wordsworth House. EVIDENCE: At the time of inspection staff rosters demonstrated that there are sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents. Residents spoken with confirmed that staff were available when they needed them and they were not kept waiting during the day but sometimes had to wait at night. The home has an ongoing training programme, which includes NVQ level 2 in care but at the time of inspection less than the recommended level of 50 of care staff hold this award. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 21 Four staff recruitment files were reviewed. The files were well ordered and contained all the information required by law. POVA first and enhanced Criminal Record Bureau checks had been obtained for all new staff. Training files demonstrated that staff were receiving induction training. Staff confirmed that they were encouraged them to take up training opportunities provided. A healthcare professional made the comment, “The trained staff need to consolidate their knowledge and have training in the following: venepuncture, catheterisation (urethral and suprapubic) and wound care. Management are aware and are in the process of arranging it.” Some staff have received training in palliative care and dementia care. Further training in these areas is being organised. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 22 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, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well organised and the daily management and running of the home centres completely round the care of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 23 Since the last inspection Ms Ashby Rudd has been registered with the Commission for Social Care Inspection as manager at Wordsworth House. Through discussion it was evident that residents and staff enjoy the way the home is run and find the Registered Manager is very approachable. Ms Ashby Rudd demonstrated throughout the inspection that she runs the home well. She has recruited new members of staff in a robust manner and has a good and competent workforce to support her. There is a quality assurance and quality monitoring system in place. The home takes steps to review its performance regularly and residents’ views are sought and suggestions put forward are acted upon. The home does not manage the finances for any resident. Residents either deal with their own finances or elect a representative to do it for them, often a family member or solicitor. The Registered Manager confirmed that staff supervision had just started. Staff spoken with confirmed this. Records showed that staff had received recent training in fire safety and manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and appropriate action was taken as necessary. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 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 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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. 4. 5. Refer to Standard OP7 OP9 OP9 OP19 OP28 Good Practice Recommendations Daily records should reflect the wellbeing of the resident. There should be a clear audit trail for all medications coming into and leaving the home. In accordance with the home’s medication policy there should be provision for homely remedies recommended by a GP. All baths should be kept in a good state of repair. A minimum of 50 of care assistants should hold the NVQ level 2 Award in care. All nursing and care staff should receive dementia care
DS0000050583.V365002.R01.S.doc Version 5.2 Page 26 6. OP30 Wordsworth House Care Home training. Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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
© 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 Wordsworth House Care Home DS0000050583.V365002.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!