CARE HOMES FOR OLDER PEOPLE
Wren House 32 Vicarage Street Warminster Wiltshire BA12 8JF Lead Inspector
Thomas Webber Unannounced Inspection 7th February 2006 10:40 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 Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Wren House Address 32 Vicarage Street Warminster Wiltshire BA12 8JF 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) 01985 212578 Wren House Ltd Mrs Anne Elizabeth Anderson Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st September 2005 Brief Description of the Service: Wren House is a private residential home offering accommodation and personal care to a total of 13 residents over the age of 65 who require care primarily through old age. Short-term care places can also be offered. In addition, there are two sheltered flats in an adjacent building with a further number of sheltered flats having been built to the rear of the home. However, these do not form part of the registered accommodation although the people here may have the opportunity to move into the care home at a later time, should their needs change. The home is situated close to the centre of Warminster, which offers a full range of amenities. The service is privately owned and registered as Wren House Limited. Mr Twinn and Mrs Anderson, the registered persons, who have constant involvement with all aspects of the home, run the home and they divide their responsibilities according to their own particular areas of expertise. Residents are provided with their own bedrooms and twelve of them have ensuite facilities, providing either a bath or a shower. The remaining bedroom has a private bathroom directly adjacent to it. Residents bedrooms are located on the ground and first floor levels and stair lifts have been installed on two flights of stairs, which enable easier access to the first floor for people with reduced mobility. A call bell system with an added speech facility is installed in each room, which is used by residents to call for staff assistance. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, undertaken during the course of one day from 10:40 to 12:55. The inspection primarily focused on the direct care provided to the residents and the views of eight of the eleven residents in situ were sought on an individual basis. In addition, a check was carried out with regard to the requirement and recommendation previously identified at the last inspection together with a range of core standards not previously assessed. Standards assessed included residents’ privacy, dignity and choice, food menus, complaints, staffing levels, style of management and health and safety. A tour of the premises was also undertaken. What the service does well:
The home is run and managed by persons who are appropriately qualified and who have sufficient experience within the care setting and residents continue to benefit from the leadership, ethos and atmosphere of the home. The home continues to provide sufficient numbers of staff on duty at all times to meet the individual and collective needs of the residents. Residents spoken to commented very favourably about the level of care and services provided by the staff. They stated that the staff are excellent, very good, kind and caring. Residents also confirmed that they are treated very well by the staff, are well cared for and feel very lucky and fortunate to be living at the home. Some residents described the home as being a home from home, which is exceptionally well run, and residents appreciate the warm and caring atmosphere provided by the home. One resident also described the home as being a non-institutionalised environment and other residents endorsed this comment. Information is provided to residents on how to complain should they wish to and residents are confident that any complaints/concerns would be listened to, taken seriously and acted upon. Residents continue to live in a warm, welcoming, safe and comfortable environment, which is maintained to a very high standard and meets the residents’ individual and collective needs. Residents are provided with their own individual bedrooms which they have personalised to their individual wishes. Residents have access to safe, comfortable and suitably furnished and decorated communal facilities together with sufficient toilet, shower and bathroom facilities. The home is maintained to a good standard being clean and tidy and provides suitable laundry facilities. Residents’ clothing is labelled to ensure that garments are appropriately returned. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 6 Residents commented that they were extremely happy with the level and comfort of accommodation provided to them as well as the standard of cleanliness maintained. Residents also commented very favourably about the laundry arrangements in place, stating that their clothing is returned the following day in very good condition. Residents’ privacy and dignity are respected at all times and they can exercise choice and control over their lives. Residents receive a varied, appealing and balanced diet, which caters for their needs and preferences. Residents spoken to were extremely complimentary about the quality and quantity of food provided. They confirmed that the food is excellent, they receive plenty of food and careful attention is given to the presentation of meals served. They also confirmed that alternatives are provided to meet their individual preferences. The health, safety and welfare of the residents and staff are promoted and protected. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These Standards were not assessed during this inspection, as the core Standards had been satisfactorily assessed at the last inspection. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10 Residents’ privacy and dignity are respected at all times. EVIDENCE: The outstanding requirement and recommendation from the last inspection have been complied with. The requirement referred to ensuring that the record of medication clearly shows if medicines are given to residents which they will take later and whether the medication is then taken later or returned for destruction. The recommendation referred to the update sheet that care staff sign at the beginning at each shift should be kept as a record of changes in care. Observations and discussions with residents confirmed that they are provided with their own bedrooms where they can conduct all their personal affairs in complete privacy, including medical examinations and any treatment. Residents can also choose whom and where to see any visitors, mail is given directly to them unopened and staff knock before entering residents’ bedrooms. Residents are provided with a telephone line in their bedrooms and each has their own telephone, which enables them to make and receive calls in the total privacy of their bedrooms.
Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 and 15 Residents exercise choice and control over their lives and they receive a varied, appealing and balanced diet, which caters for their needs and preferences. EVIDENCE: Observations and discussions with the residents confirmed that they can and do exercise personal autonomy and choice. Residents have brought items of furniture and personal possessions to make their bedrooms more homely, they choose how and where to spend their time, where to eat their meals, what time to get up and go to bed. Residents handle their own financial affairs in the privacy and comfort of their own bedrooms. The home is keen to offer a ‘hotel’ service and meet all reasonable requests/wishes of the residents. A satisfactory and varied menu is in operation, which provides a choice at breakfast, which includes the option of a cooked meal and all residents eat their breakfast in their bedrooms. Residents are provided with a range of choices for their evening meal, although a set main meal tends to be provided at lunchtime. However, alternatives are provided for this meal, if required, to meet residents’ preferences. Management reaffirmed that residents, to a large extent, determine what they have to eat. Residents’ special dietary needs are well catered for and there is also flexibility with regard to mealtimes where residents can choose where and when to eat their meals. A range of drinks
Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 11 and snacks are available on request at any time day and night. Residents spoken to were extremely complimentary about the quality and quantity of food provided. They confirmed that the food is excellent, they receive plenty and careful attention is given to the presentation of meals served. They also confirmed that alternatives are provided to meet their individual preferences. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 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 the following standard(s): 16 Information is provided to residents on how to complain should they wish to and residents are confident that any complaints/concerns would be listened to, taken seriously and acted upon. EVIDENCE: The home’s complaints procedure is written into the agreements drawn up with residents. To date, there has not been an occasion to use this. The complaints procedure provides contact details of the Commission for Social Care Inspection and this is also included within the residents’ guide. Residents spoken to stated that they had no complaints but felt confident that if they did have any concerns these could be discussed with the proprietors and staff who would listen and deal appropriately with them. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 21, 24 and 26 Residents live in a warm, welcoming, safe comfortable environment, which is maintained to a very high standard and meets the residents’ individual and collective needs. Residents are provided with their own individual bedrooms which they have personalised to their individual wishes. Residents have access to safe, comfortable and suitably furnished and decorated communal facilities together with sufficient toilet shower and bathroom facilities. The home is maintained to a good standard being clean and tidy and provides suitable laundry facilities. EVIDENCE: The home is situated only a short distance from Warminster town centre where residents can access the variety of amenities, should they wish to do so. The home offers high quality accommodation and continues to be kept clean, tidy and well maintained. The premises provide sufficient heating, lighting and ventilation and the standard of furnishings, fittings and decoration is maintained to a high standard. There is an ongoing maintenance programme within the home and maintenance staff are employed to undertake minor jobs with contractors being engaged, when necessary, for larger projects.
Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 14 The home provides a dining room, a main drawing room, and a couple of smaller sitting areas off the ground floor corridor. These are attractively furnished and decorated to a high standard. Residents enjoy spending time in the garden, weather permitting and a number of residents’ ground floor bedrooms have French windows, which offer them direct access to the garden. Twelve of the home’s thirteen bedrooms have en-suite facilities, providing either a bath or a shower. The remaining bedroom has a private bathroom directly adjacent to it. Residents are very appreciative of these facilities. Residents’ bedrooms are suitably furnished and equipped to ensure comfort, privacy and meet their assessed needs. Residents are provided with a lockable storage space if they wish this facility to store their personal effects such as money and valuables. Residents have brought items of furniture and personal possessions to personalise their bedrooms to their individual wishes and to make them more homely. Most residents choose to spend much of their time in their bedrooms, which are large enough to entertain visitors in comfort. Residents commented that they were extremely happy with the size of accommodation, the facilities available to them as well as the standard of cleanliness maintained. Residents’ bedrooms are redecorated and re-carpeted when there is a change of resident. The home continues to be maintained to a high standard being clean, tidy and comfortable and free from offensive odours. The laundry room provides suitable facilities to meet the needs of the home with staff undertaking the washing and ironing duties. Residents’ clothing is labelled to ensure that garments are appropriately returned. Residents commented very favourably about the laundry arrangements in place, stating that their clothing is returned the following day in very good condition. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The home continues to provide sufficient numbers of staff on duty at all times to meet the needs of the residents. EVIDENCE: The deployment of staff continues to ensure that during the week there are three carers on duty in the mornings with two in the afternoons and evenings. These staffing levels exclude those hours worked by a supervisor, normally undertaken by the manager or deputy manager. At weekends a helper substitutes a morning carer. There is one waking night member of staff on duty with one member of care staff sleeping in each night. The manager or deputy manager also provides an on call service. The deputy manager reported that currently the home has one weekend carer vacancy whose hours are being covered by existing staff. This post has been advertised. Residents spoken to commented very favourably about the level of care and services provided by the staff. They stated that the staff are excellent, very good, kind and caring. Residents also confirmed that they are treated very well by the staff, are well cared for and feel very lucky and fortunate to be living at the home. Some residents described the home as being a home from home, which is exceptionally well run, and residents appreciate the warm and caring atmosphere provided by the home. One resident also described the home as being a non-institutionalised environment and other residents endorsed this comment. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 and 38 The home is run and managed by persons who are appropriately qualified and who have sufficient experience within the care setting and residents continue to benefit from the leadership, ethos and atmosphere of the home. The health, safety and welfare of the residents and staff are promoted and protected. EVIDENCE: The manager has considerable management and supervisory experience in the care setting she manages but as yet she has not gained the NVQ 4 Registered Managers’ Award. However, the manager is complimented and supported by her deputy manager in the day to day management of the care provided to the residents and she has achieved the NVQ 4 Registered Managers’ and NVQ Assessors’ Awards. Residents are seen daily by management or a supervisor and have the opportunity to comment regarding the care and services provided. In addition, all current and prospective residents together with their
Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 17 relatives are able to access, should they wish, a copy of the home’s recent quality assurance survey undertaken regarding the care and services provided. The home ensures that there are safe working practices which comply with the relevant legislation and a tour of the premises did not denote any areas of concern with regard to health and safety issues. The deputy manager reported that the West Wilts District Council Health and Safety Officer inspected the home on 13th December 2005. There were only two recommendations made which related to the introduction and implementation of a new accident book, which has already been actioned, and the need to produce a risk assessment relating to the handiman’s maintenance of equipment. The latter is reported to be in the process of being established. Radiator covers have been fitted to all radiators for the protection of residents. Examination of the fire log book showed that it is being suitably maintained with various tests and drills being carried out within the agreed timescales, staff receiving regular instruction. Although window restrictors have not been fitted to residents’ bedroom windows located on the first floor, the manager had previously reported that the present group of residents have declined to have window restrictors fitted. Their risk asessments have been updated accordingly and residents’ families have also been consulted. The manager has also reported that should the residents to these rooms change, then this will be reviewed. However, since the home does not cater for mentally ill persons, the home feels this is an acceptable risk especially since all of these windows except one, which has bars in place already, are not such that a resident could fall from them. Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 3 X X 4 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 3 Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. Refer to Standard Good Practice Recommendations Wren House DS0000056886.V278633.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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