Inspection on 12/09/06 for Wrottesley Park House Nursing Home

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 55 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wrottesley Park House Nursing... 12/08/09

Wrottesley Park House Nursing... 12/06/07

Wrottesley Park House Nursing... 08/01/07

Wrottesley Park House Nursing... 19/05/06

Wrottesley Park House Nursing... 26/01/06

Wrottesley Park House Nursing... 16/12/05

Wrottesley Park House Nursing... 15/11/05

Wrottesley Park House Nursing... 14/07/05

Wrottesley Park House Nursing... 17/03/05

Wrottesley Park House Nursing... 15/07/04

Wrottesley Park House Nursing... 19/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Wrottesley Park House Nursing Home Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN Lead Inspector Rosalind Dennis Key Unannounced Inspection 12th September 2006 09:00 Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 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 Wrottesley Park House Nursing Home DS0000036983.V311381.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 Adults 18-65. 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. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wrottesley Park House Nursing Home Address Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902 750040 01902 755510 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) Abbey Healthcare Homes (Wrottesley Park) Ltd Care Home 57 Category(ies) of Learning disability (57), Physical disability (57), registration, with number Terminally ill (57) of places Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2006 Brief Description of the Service: Wrottesley Park House is a care home providing accommodation, personal and nursing care to 57 adults. It is registered to offer services to people with physical disabilities, learning disabilities and people who require palliative care. It is owned by Abbey Healthcare (Wrottesley Park) Limited. It is located on the main A41 Albrighton/Telford road out of Wolverhampton on the Wergs Road, half a mile past Tettenhall Village Green. It is a purpose built home with three residential areas on the ground floor, each having fifteen private bedrooms and communal areas. The first floor has twelve bedrooms. All bedrooms have en-suite facilities and include a shower. Services such as catering, laundry and cleaning are provided in-house. There is a passenger lift for accessing the first floor. There is extensive car parking facilities, and easily accessible gardens. The home has recently increased the number of bed rooms within the property, however these six bedrooms have not yet been registered for use via CSCI. The range of fees charged by the home varies according to the dependency and needs of service users. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first day of this inspection was unannounced and was conducted by three inspectors for the duration of one day. Two inspectors returned a week later to complete the inspection and the manager was aware of the planned date for the return visit. The second day of the inspection also lasted for one day. On both days the inspectors spoke with staff, service users, visitors, examined records and observed practice and the environment. As at previous inspections the inspectors focused on individual areas but have crossreferenced their conclusions where appropriate to build a picture of how the home is functioning. The judgements reached within the body of the report reflect the collective view of the inspection team. The responsible individual and regional manager were present for the second day of the inspection; both were keen to seek information in respect of any improvements. Poor record keeping, conflicting and contradictory evidence and the fact that serious concerns in respect of fire safety and home security were identified by the inspectors at the end of the second day of the inspection meant that it was not possible to state during feedback which, if any requirements had been achieved. Two immediate requirements were issued as a result of this inspection. In 2005 CSCI became increasingly concerned with how this home was operating which in December 2005 resulted with the serving of four statutory notices in line with Regulation 43 of The Care Homes Regulations 2001. This section of the regulations is intended to notify service providers that CSCI believes that an offence has been committed through failure to comply with regulations. The notices served were in relation to; failure of the Home to provide good assessment and care planning documentation; the unsafe use of bed rails; excessive hot water temperatures; and the lack of induction training for staff. CSCI did not receive any communication written or otherwise from the Registered Provider in response to the Statutory Requirement Notices within the timescales given. At the end of this inspection two protocols in relation to bed rails and water temperature monitoring were handed to the inspectors; scrutiny of these protocols shows that they do not provide in sufficient detail how the home intends to protect the health and safety of service users in relation to bed rail safety and water temperature monitoring. Inspections, additional visits to the home and concerns expressed by residents, relatives and health/social care professionals and the ongoing and repeated failures of the Registered Provider to comply with requirements and the nature of the breaches of the Regulations has led CSCI to proceed with a Notice of proposal to cancel the registration of Abbey Healthcare Homes (Wrottesley Park) Ltd. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? This inspection identified that the home has now achieved four requirements:• The home has reviewed its key working system and each service user has a named nurse in addition to a designated key worker. A new key worker list has been devised and the system very recently implemented. • Improvements have been made to en-suite facilities, “communal” bathrooms and stained carpets and other flooring has been replaced. Some parts of the home have been redecorated. • An application to register the manager has now been received by CSCI. • The home has also removed faulty bedpan macerators, however this does mean that the home has one sluice disinfector serving the whole home and it was not discussed at this inspection whether staff consider this sufficient. Four requirements have been assessed as partly met, these are in relation to areas where the home has shown signs of improvement but further attention is still necessary to fully achieve the requirement, these are as follows:• Minutes of the service user meetings demonstrated that service users are starting to be consulted with and involved in decision-making processes relating to the service provided. It was of note that some relatives were attending alongside residents who could not voice their opinions. The number of planned community activities has increased and since the last inspection some people have been to the cinema, theatre, shopping, a farm trip, the coast and garden centres. Improvements to the complaints process ensures that residents and/or their representatives are listened to and their concerns acted upon. The home has removed all but one of the heat sources that were not fixed or guarded. The manager reported that the one remaining heater, is awaiting collection by the service user’s relative. • • • Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 7 Discussions held with one member of staff clearly evidenced that he is committed to his work, is very service user focused and enjoys working at the home. Several other staff members that were seen attending to service users appeared sensitive and caring in their approach. A newly employed staff member said she had applied for a permanent position at the home after working at Wrottesley Park for a few shifts and was looking forward to helping to ‘get things put right’. Staff reported that staffing ratios had improved due to a decrease in service user numbers. What they could do better: The home continues to place service users at risk through inadequate staff recruitment, training procedures, poorly maintained care documentation, ineffective communication channels and failure to ensure safe working practice. Areas requiring improvement that are documented throughout the report include: The statement of purpose is not an accurate reflection of the home; this means that individuals are not presented with clear, relevant information of the services provided at Wrottesley Park House. Discussions held evidence that the current service users do not access educational opportunities provided through local colleges. One service user reported that they would love to attend a college course but has not been provided with the opportunity. Although there is some evidence of increased service user consultation, further effort must be taken to ensure that service users are provided with the opportunity to lead positive lifestyles. The home does not have robust processes in place to ensure that the personal and healthcare needs of service users are met; this means that service users continue to be placed at risk of not receiving adequate care. Staff have not responded appropriately to incidents of injury sustained by residents, furthermore the high level of injuries and unexplained bruising suggests that residents are receiving a poor standard of care. Policies and procedures are not in place or being followed to ensure good hygiene practice. Recruitment practices are poor with appropriate checks not being carried out with the potential to put service users at risk. This inspection identified that the manager, deputy manager and other members of staff have been appointed prior to the receipt of a full CRB Disclosure. The responsible individual and associated management team have not safeguarded people living at the home. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 8 The collective skills, experience, training and support of the staff group are insufficient to meet the needs of the service users accommodated at this home. Staff spoken with considered that the team would benefit from undertaking service specific training in order to meet the diversity of the needs of the people accommodated. Inaccurate staff training and planning records show lack of managerial awareness of the staff team’s training needs. The home is not well run and does not promote the health, safety and welfare of residents and continues to place residents at significant risk of harm. Two immediate requirements were issued at this inspection in respect of the home failing to ensure the safety of service users with regards to fire safety and security of the premises. To repeat previous reports, there is a serious need for the provider to take urgent action to meet requirements and work towards the home being “fit for purpose” 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. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. The statement of purpose is not an accurate reflection of the home, this means that individuals are not presented with clear, relevant information of the services provided at Wrottesley Park House. EVIDENCE: A copy of a “draft” Statement of Purpose for the home was forwarded to CSCI via a consultancy organisation following the inspection undertaken of the home in November 2005 with an accompanying comment that the home would need to edit the document. The registered person made no attempt to discuss the draft document with CSCI or confirm that this was the document to be used by the home. During the key inspection in May 2006, copies of the home’s Statement of Purpose and Service User Guide were seen held in service users own bedrooms. The Service User Guide had not been developed in an appropriate format for service users with communication difficulties and the Statement of Purpose was not a true reflection of the service provided. At the end of this inspection the inspectors were handed a large, 49 page document, which serves as both statement of purpose and service user guide and goes beyond the information required by the standard and the schedule to the regulations. It was found that this version was incomplete in some areas Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 11 and inaccurate in other areas. For example, the home states that it provides services for people with “physical and/or sensory learning disabilities” and continues to state that male and female clients with “significant sensory” disabilities can be accommodated. The home is not registered to care for individuals who have sensory disabilities. The document also describes how it is the home’s aim for half the staff to complete NVQ3 by 2005 and for all “employees to receive the training appropriate for their work, for example food hygiene training”. This inspection found that less than half the care staff have attained NVQ Level 2 or 3 qualifications and that food hygiene certificates for two of the six staff employed to work in the kitchen were out of date. The service users handbook describes how the home will “support you in gaining access to suitable education and training courses in the community”, during this inspection one service user spoke of how they would love to attend a college course but have not been provided with the opportunity. Concerns regarding how this home is functioning and protection of vulnerable adult issues resulted in relevant local authorities taking the decision some time back to suspend all new placements at the home. An action plan recently received by CSCI in response to the May 2006 key inspection details that the provider voluntarily suspended admissions to the home on the 17th July 2006. Consequently as the home has not had any new admissions to the home for sometime, the home’s pre-admission assessment process cannot be fully assessed and therefore it is not possible for CSCI to reach a conclusion on the outcome for National Minimum Standard 2. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. Care planning processes do not provide an accurate reflection of service users’ needs, have significant omissions and contradictions, which place people at risk. The home does not involve services users in all decision-making processes and people at the home are not fully protected by the risk management strategies that are in place. EVIDENCE: A statement from a friend of one service user, dated 14.11.05 indicated that they had contributed to the service users care plan. Although a signed statement was available on the file of the other service user case tracked confirming that she had contributed to her plan of care, the person was unable to recall contributing to her plan or reviews undertaken. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 13 Two other care plans looked at for people with communication and behavioural challenges lacked any recent information to show regular and ongoing involvement of the resident or a designated third party acting on their behalf. Since the last key inspection a member of staff has been involved in the development and implementation of new key worker files. The files are sectioned into day care, life history, social history, family/friends, preferred activities, likes/dislikes, surroundings and communication. The staff member responsible for their implementation reported that all designated key workers were given a timescale of 30.06.06 to complete these with service users and their representatives; however it was reported that a number still require completing in full. Staff have been provided with guidance on how to complete the new documentation. Three of the seven files seen were detailed and provided staff with information in relation to service user’s routines and preferences. The other files contained basic information and were not yet fully completed. This included the records of a person who has close family members who visit every day- the ‘Life History’ section of this individuals records was blank. The keyworker notes for an individual who cannot communicate verbally with staff clearly state that this person dislikes staff using oral swab sticks to clean her mouth and that she prefers soft dry wipes with mouth wash and luke warm water. It also states that the person ‘becomes in distress when oral swab sticks used’. When the service user was introduced to the inspectors it was of concern that there were oral swab sticks placed beside her for staff to use, the swabs were laid out on a tray, which was visibly soiled. Staff had therefore not followed the guidance provided by the key worker and were caring for this individuals mouth in a way that is recorded as causing distress. In addition, the care records of a person with a sensory impairment did not provide staff with information on how best to support her sensory needs or how the environment and equipment could be better suited to accommodate her impairment. This individual was case tracked at an inspection in July 2005, it is therefore disappointing that this information is still lacking from this individuals care file. Risk assessments to support the use of equipment such as hoists wheelchairs, bedrails and fridges in bedrooms were available on four care files reviewed for this purpose, however the information lacked appropriate details for staff to safeguard service users as much as possible, this has also been identified at previous inspections. Risk assessments to support all individualised activities were not available and the assessments did not reflect the care practices that were observed or described by staff. For example: In the care records of a person with a weight management challenge, it was stated that there had been a weight gain of 28kg in one month. This meant Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 14 that the person exceeded the safe working load for the mechanical hoist described in the care records to transfer the individual in and out of bed. The weight increase had not been taken into account when the moving and handling assessment was evaluated and signed by a staff member on the same date. When this was discussed with two different experienced carers, it was confirmed that the care team did not follow what was written down, and used a hoist that could still manage the person’s increased weight gain. Minutes of the service user meetings dated 12.07.06 and 07.08.06 were available and demonstrated that the home is now consulting with service users and involving them in decision-making processes relating to the service provided. It was positive to see relatives had attended a meeting in August to support two of the residents who have communication challenges. A copy of a letter sent with the minutes of a recent meeting to a relative who lives some distance away, showed the home was making an effort to communicate with resident’s next of kin/significant others. Despite the above improving practice in respect of service user consultation, there was no evidence to demonstrate how the majority of individuals who are unable to communicate their preferences are supported in decision-making processes. During an additional visit to the home in August by CSCI, the manager stated that staff and management had made the decision to use a bed rail bumper to “stop a service user from climbing out of bed”, it was discussed at this visit that this decision should not have been made without full consultation with the service user, their advocate and other members of the multi-disciplinary team. The manager was also informed that preventing a service user from moving independently could be viewed as a form of restraint, therefore the decision to use the bed rail bumper prior to consulting with all interested parties was considered inappropriate. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. Service users are not provided with opportunities to lead a positive lifestyle. EVIDENCE: The minutes of a service user meeting held on 12.07.06 indicate that the meeting focused on future activities and events and personal preferences of the people in attendance. Discussions held with a number of service users and records seen evidence that the number of planned activities has improved and since the last inspection some people have been to the cinema, theatre, shopping, a farm trip, the coast and garden centres. A member of staff that provided written feedback to an inspector via a questionnaire commented that there are now “a much wider variety of activities which the residents enjoy”. A log is kept of all community activities undertaken and by whom. A service user and staff member confirmed that service users are supported to handle their finances when out in shops and on trips. Records show that eight people have not been out in the community since February 2006 and this was Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 16 acknowledged by the activity organiser who appears committed to improving opportunities to enable all service users to be involved. The activity organiser reported a church service is also provided in-house, in addition to a singer who visits the home once every five weeks. She also stated that evening activities such as bingo sessions are also provided and a ‘raffle day’ was recently held, which was confirmed by service users. A hairdresser visited the home during the inspection and attended to the hair care needs of several service users who appeared happy with the service. A requirement for service users to be provided with opportunities to learn and use practical life skills has been made at previous inspections. Care documentation reviewed and observations made evidence that the requirement remains outstanding. A section on communication is included in the new key worker files however further work needs to be developed in supporting individuals who are unable to communicate their needs and preferences to include the use of signs and symbols and objects of reference. Discussions held with staff and service users indicate that people have opportunities to fulfil their spiritual needs. It was reported that a church service is provided at the home once a month and that a small number of service users are supported by their relatives to attend external church services. The requirement for service users to become part of, and participate in the local community is partly achieved. Opportunities to access the community for a number of service users have improved with people being provided to make use of services, facilities and transport is provided to enable this process. However a staff member reported that the team are unable to support individuals with going out for a walk or to the shops at their request unless it is planned in advance due to staffing resources. A requirement was previously made for service users to be enabled to take part in age, peer and culturally appropriate activities. The people living at the home are unable to access paid employment or work experience. It was reported that five people currently attend external day service provision on various days of the week. Discussions held evidence that the current service users do not access educational opportunities provided through local colleges. One service user reported that they would love to attend a college course but has not been provided with the opportunity. An action plan recently received by CSCI in response to the May 2006 inspection documents that “there are relationships with Trinity College”, discussions with staff, including senior staff evidenced that this is in fact an organisation providing training for staff working at Wrottesley Park House and not service users. Requirements have been made at previous inspections for service users to have access to a range of appropriate leisure activities. The home employs two part-time activity organisers providing 41 hours activity time per week. One activity organiser was on annual leave on the first day of the inspection Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 17 and her hours during leave are not covered. Discussions held with the other organiser evidenced that she was previously employed as a care assistant at the home prior to being appointed to her current post in July 06. This employee has not been offered training courses to support her new role, the individual considered that she would benefit from this in order to provide activities that are relevant and appropriate to the individual needs of the people accommodated. This member of staff was not aware of the budget available for activities and organisers continue not to have an allocated base in which to store equipment and materials from. On the second day of the inspection the other activity person was able to confirm that a budget has not been made available but the manager will make available funds as required. A timetable of activities was seen displayed and during the afternoon of the inspection four people were being supported with an art and craft session and completed Halloween pictures. One person was taken to Telford Shopping Centre with a member of staff as part of her designated contractual additional funding for one to one care. The manager reported that the home is in the process of using one lounge as a sports area and numerous pieces of equipment are on order. The manager was advised to review the location due to health and safety reasons, supervision and privacy of service users whose bedrooms are located immediately off the lounge area. The action plan returned to CSCI following the last key inspection states that ‘The home has a snooze room fitted out with a range of differing lighting, other stimulation and calming stimuli’. This room was seen during the inspection and found very disorganised and contained numerous walking frames and other equipment in addition to physiotherapy records that were left on the couch and not securely stored. Discussion with the manager at the end of the inspection identified her intention to develop this room, therefore the information provided on the action plan is not considered to be an accurate description of this room. This inspection identified that a number of individuals were observed left unsupervised for long periods of time in the lounges, their own rooms or outside. One individual had information in her keyworker file which detailed the parts of the home that she could be located in at different times of the day to enable her to observe and interact with other residents. On both inspection days this person was sat in her chair outside her bedroom door with little or no stimulation or company. During the inspection a number of relatives visited the home in addition to a person conducting a needs assessment. A visitor’s book is held in the reception and this evidenced that friends and family regularly visit the home. It was reported that a party was recently held and all families were invited to attend and service users spoken with reported that the event proved successful. One person reported that she does not receive visitors and would Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 18 welcome the opportunity to speak with friends and staff from her previous placement where she lived for many years. The people case tracked receive visitors and the friends of one person take her for pub lunches and for trips out on a regular basis. It is difficult to ascertain if daily routines promote independence, choice and freedom of movement given the dependency levels, diversity needs and resources available. Routines and preferences were documented on the key worker files reviewed however one service user reported that she would like greater flexibility of mealtimes, as she is not always ready for a meal at 12.00 noon. Some individuals were seen having breakfast at 10.30am prior to having lunch at noon. One person reported that the majority of staff knock on her door prior to entry although privacy is not always maintained when staff provide personal care. Bedrooms are lockable and one person reported that she would like a key to her room. The meals at lunchtime were well presented and people offered a choice of three meals and a selection of dessert. Individuals requiring assistance were seen being appropriately supported in a sensitive manner. The majority of service users spoken with reported that they enjoy the meals provided. A current menu was not available as it was reported that the home is in the process of changing menus, with the intention that service users will contribute to menu planning and this is evidenced in the minutes of a service user meeting. The home introduced a food diary as a way of recording dietary intake for service users, each diary clearly states that the record is a legal document and must be completed daily. A review of food diaries evidenced that staff are failing to record and monitor meals eaten and therefore inspectors were unable to ascertain if individuals are provided with nutritious, varied and balanced meals. Records for one individual over a period of one month consisted of fluids only on three days and for the majority of other days only fluids and one meal were found recorded. The persons weight monitoring record stated that the person refuses to be weighed. The nutritional risk assessment provided a score of 24 indicating a low risk and stated the person’s appetite as having a full diet and fluids. The risk assessment was updated on 18.08.06 and stated ‘no change’. The persons nutritional care plan also updated on 18.08.06 stated ‘No concerns regarding nutritional status’. This was not an accurate reflection of the food diary held. A number of food diaries available for other people were also incomplete. The cook in charge confirmed that the home is able to meet the dietary needs of the people accommodated including through the provision of meals that meet the cultural needs of residents. The kitchen cupboards, fridges and freezers were well stocked and the home receives regular deliveries. The home’s statement of purpose describes how “ meals are prepared on the premises from fresh produce produced locally”, however discussions held Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 19 evidence that potatoes are the only fresh vegetables purchased and the rest provided are frozen. One service user with a weight management problem was provided with high fat foodstuffs at lunchtime, this meal would not therefore promote weight loss Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have robust processes in place to ensure that the personal and healthcare needs of service users are met, this means that service users continue to be placed at risk of not receiving adequate care. EVIDENCE: Findings at this inspection for this outcome group were generally similar to those reported in previous inspection reports and more recently in the May 2006 report where it is recorded ‘Care planning systems continue to be inadequate, potentially placing service users at significant risk’. CSCI remain concerned about this issue, as new staff start working at the home are placed in charge of people’s care with relatively little experience and require such paperwork for guidance and support. Although CSCI recognise some changes to care plan records have been made, the desired impact has not been achieved, and as a result, the care records remain inconsistent and contain conflicting guidance for staff. The content of Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 21 the care records checked do not offer complete reassurance to service users and significant people involved in their well being that the care team know how to care for them in the way they need and desire. Examination of five sets of service user records were looked at in depth to see if they provided staff with appropriate guidance to safely care for people in the way they preferred. The people whose records were looked at had a range of complex care needs, including behavioural, communication and physical challenges, which meant they were completely reliant on the staff team to meet all of their care needs, including specialist tube feeding (PEG feeds.). The people case tracked also need specialist equipment to keep them safe and mobile. Basic care need assessments using a tick format were available on the files of four people case tracked, in addition to a plan of care. Observations of the way these people were being cared for as well as discussion about their care needs with more than four different staff members on duty showed that what was written down in the care plans did not accurately describe for the peoples actual care and support needs, and were not being followed by staff. Files evidenced that care plans had been reviewed on a monthly basis and updated wherever necessary, but still did not reflect all details of the individual’s complex care needs. One person who had recently been discharged form hospital did not have their care plan updated to take into account changes that had occurred. The individual had been discharged to the home with a urinary catheter in place – there was no care plan to manage this, and the continence assessment had not been updated to take this change into account. The same person had been diagnosed with cellulitis of both legs, and although it was reported that the person’s legs were ’grossly swollen’ and ‘leg oozing’ – there was no care plan to ensure staff cared for this condition appropriately. At this inspection it was identified that there was no care plan for a person who had developed a facial rash, which required a GP prescription for ointment to treat it. This was raised in discussion with two carers observed to be involved in the person’s care. Both individuals recalled parts of the body where the individual had cream applied, however these were not listed in the plan of care and both members of staff were not aware of the type of cream the person was having on the facial rash. An incident occurred during the inspection when the tube connecting a service user to a specialist feeding pump was observed by the inspectors to be clamped off, the machine pump had not alarmed, which was a cause for concern for inspectors and this was pointed out to a member of nursing staff who released the clamp. When the service users records were checked to see if it could be calculated if the pump was running efficiently, this was not possible. The entries on the chart used to record the specialist feed, did not correspond to the number of times within the daily report where it was recorded that the machine had been turned off when the person was Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 22 nauseated. This was identified as a regular occurrence. When the Medication Administration record sheet for the specialist feed was checked, the times it was signed for to confirm administration did not match the entries made on the person’s feeding chart. This clearly identifies lack of competency and awareness of several team members looking after the person. A requirement was made at the previous inspection that service users must be provided with the technical aids and assistance required. It was reported that a number of new slings for the hoists had been purchased. An assessment of falls was seen on the file of one service user and this stated that on one occasion the person fell from her wheelchair when being transferred to a shower chair on 30.06.06 and the individual slipped from a hoist sling when being transferred on 16.07.06 resulting in bruising. These incidents were looked at by CSCI during an additional visit to the home on 14.08.06. During this inspection two staff reported that following the falls a new sling was purchased but was found not appropriate as it caused the person too much stress and anxiety, therefore the home has reverted to using the former sling. The moving and handling risk assessment dated 27.08.06 stated ‘Continue to use oxford hoist, large sling for transferring’ but had not been updated to reflect that the home has reverted to using the half sling in the interim. Managers reported that the person is due to be reassessed on 15.09.06 and that hoist training has been booked for six staff during September and October. The requirement for service users’ preferences with regard to their care to be identified and respected is improving through the provision of new key worker books that have recently been implemented but these “books” require completing with all individuals accommodated. The phrase ‘needs assistance’ continues to be used on some care documentation, with little explanation of the level of assistance required. One staff member based in the ‘yellow’ unit had a clear understanding of people’s individual needs. Multi-disciplinary team notes were seen on one file and in the service users room in relation to gender care requesting ‘female staff only’ however during the inspection a male member of staff was seen attending to her. The staff member concerned reported that the service user and her representative were happy with him attending to her needs however this was not recorded. A requirement made at previous inspections was for consistency of care to be provided through key working (with the involvement and choice of service users). Since the last inspection the home has reviewed its key working system and each service user has a named nurse in addition to a designated key worker. A new key worker list has been devised and the system very recently implemented. One service user stated that they were not provided with a choice of key worker and that it was too early to comment if the new Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 23 system was effective. The minutes of a service user meeting held indicate that the role of the key worker was discussed. Previous inspections and additional visits to the home have identified that service users health has not been monitored adequately, and potential complications and problems have not been identified, actioned or reviewed. For example observation of a service user’s records during a recent additional visit to the home had identified that whilst attending a Day Centre, the service user had appeared to have a seizure. It is documented that the day centre had telephoned the home to inform staff of this, however the home had failed to initiate monitoring the service user for further seizures, a process considered necessary especially as the service user was not known to have previously suffered from seizures. Inspections and visits to the home have identified a lack of consistent recording within care files, this has lead to failure to provide information within care records of medication changes or information in respect of visits by health and social care professionals, it has also created difficulty for staff in providing accurate information during inspections. At this inspection, entries on the daily record sheet describe regular input provided by the physiotherapy assistant and two other entries indicate that a general practitioner has recently seen one person. Observation of another person’s records indicated that the home has spoken with the placing authority and a social worker has visited, other entries include a hospital admission in addition to a refusal to attend hospital and the person’s refusal to take prescribed medication, which was appropriately followed up with the general practitioner. There is a lack of consistency in where staff record visits by professionals or appointments and the managers were advised to develop a system to enable staff to record all healthcare appointments, professional visits and outcomes, and this should assist staff with planning and implementing changes to care. The CSCI pharmacist inspector has visited Wrottesley Park House Nursing Home four times in sixteen months and each visit has identified new concerns and found little evidence of improvement. The last visit by the pharmacy inspector was carried out on the 12th June 2006, during which it was found that medication was not being stored, handled or recorded properly which could put at risk the health and wellbeing of people who use the service. This led to the pharmacist inspector issuing a number of immediate requirements in respect of serious concerns identified. The pharmacist inspector judged the quality outcome as poor; the judgement was based on the available evidence including the visit to the home. During the two days of this inspection creams were found in service user bedrooms that had not been prescribed, a bottle of sterile water was found connected to a feed pump and the name on the bottle was different to the service user to whom it had been administered and bottles of sterile water Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 24 were found without prescription labels in other service user bedrooms. These deficits are not acceptable and indicate the homes continued failure to ensure that medication is administered safely. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 25 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. Improvements to the complaints process ensures that residents and/or their representatives are listened to and their concerns acted upon. Staff have not responded appropriately to incidents of injury sustained by residents, furthermore the high level of injuries and unexplained bruising suggests that residents are receiving a poor standard of care. Systems for protecting service users require immediate improvement to protect the people living at Wrottesley Park from possible risk of harm or abuse. EVIDENCE: The complaints log was not available at the time of the inspection on the 19th May 2006 and this was examined during an additional visit to the home in June 2006 and again at this inspection. The complaints log details the complaint, the response and any action taken and is well organised. Complaints seen recorded within this log include; • One from a social worker regarding an individual that had been placed at the home in December 2005 who did not receive an initial GP assessment until March 2006 following the social worker raising the complaint. • A complaint from another social worker in respect of an individual with learning disabilities and details concerns including; the TV being on all Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 26 • • the time, lack of consistent approach from staff members and a loss of the individual’s toys. CSCI recently received a complaint from an individual whose relative had resided at Wrottesley Park until January 2006. The complaint listed many areas of concern prior to January 2006 and was referred by CSCI for the provider to investigate. A complaint from a service user regarding another service user smoking. It was seen that the manager has responded to all complainants. Copies of the home’s complaints procedure were seen in service user bedrooms, the procedure is written in a standard typed format and it was not established at this inspection whether service users consider this to be an appropriate format. When the issues of financial arrangements for service users was explored it was seen that the current management systems in the home do not offer adequate protection to safeguard individuals living there, or the staff team involved in their care. It is of note that the administrator has a robust system for managing resident’s pocket monies kept in the home safe. However, issues of concern remain to be resolved, including; • It was confirmed that the home keeps almost £8000 in its bank account on behalf of a service user. It appears that no effort has been made to set up an individual bank account for the person the money belongs to, although the person’s social worker is known to be a regular visitor to the home. There have been no arrangements made by the home to repay or account to the person any interest accrued by this money in the home bank account. The possibility of the need for this matter to be discussed with the local adult protection team manager and for the home to liaise with the individual’s social worker was discussed with the manager. There has been no progress in the home resolving the issue of a staff member acting as “Power of Attorney for one of the residents, which is a breach of the home’s policies and terms and conditions of employment and for which the registered person was strongly advised by CSCI to seek appropriate guidance. Staff do not have access to a place for safekeeping for any monies or valuables when the office is locked. A management team member confirmed that the drug cupboard is used for this purpose – thus challenging the safe storage of medication guidelines. The home does not have a robust system to evidence it holds and returns any valuable possessions or lost property held in the home safe. Examination of the policies and procedures for this important matter confirmed there was a lack of official guidance for staff to follow. • • • The Responsible individual, regional manager, home manager and administrator were all present when the above issues were being explored. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 27 The manager said she had not been involved in any of the financial aspects of the home, this is considered inappropriate, as it is a responsibility of the manager to ensure that policies and procedures are implemented and adhered to. The manager was not sure how to resolve the issues. The inspection in July 2005 established that some of the resident’s money at this time was being pooled into one account and a requirement was made for the home to ensure that individual savings accounts were established. It was noted in the July 2005 report that this had already been identified for action at an inspection in 2004 and is therefore a longstanding issue. Concerns were identified in the November, December 2005 and the January and May 2006 inspection reports that residents had sustained injuries that had not been professionally acted upon and staff were failing to follow correct procedures. Since the inspection in May 2006 the home has introduced a new ‘skin integrity’ form to use in care records for staff to keep a record of any injuries a person may have. It has been communicated to the manager, deputy managers and responsible individual that individuals should not be sustaining bruising/injuries of unknown origin, however if they do then skin integrity charts can be useful tools, but appropriate action/investigation still needs to be undertaken to establish possible reasons for the bruising/injury. This inspection and recent additional visits to the home show that service users continue to sustain injuries/bruising of unknown origin with a lack of effective processes for investigating or addressing the cause. Although the manager has initiated some appropriate referrals to the adult protection team, this has not been consistent. For example a recent incident communicated to CSCI via Regulation 37 notification described how a service user had slipped off the end of a bed. On examination of the service users care records by CSCI during an additional visit to the home it is documented that it was not until the evening that the nurse in charge of this unit was informed by the carers that the service user had fallen out of bed that morning and sustained a significant bruise. There was no evidence contained within any of the service users records to suggest that the service user had been assessed for injury at the time of the fall in the morning, the nurse in charge of the unit did document an assessment of the injury at the time he was informed. The manager was informed that an adult protection referral should have been made in view of the fact that a resident had sustained an injury, without an adequate explanation into the circumstances behind the injury. The service users social worker had not been informed of the incident. It is also concerning that a senior staff member failed to report or record the incident initially. Another additional visit to the home by CSCI was triggered as a result of a notification describing that a service user had been found trapped between the bed rails on her bed. It was identified that the home had failed to re-assess the individual regarding the safe use of bed rails, the service users GP and Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 28 social worker had not been contacted and the home had failed to initiate an adult protection referral, despite the individual sustaining quite significant documented injuries. The adult protection process is yet to be concluded regarding an incident where a service user received an excessive amount of PEG feed in a short period of time. Upon examination of the staff training matrix, it was seen that less than half of the care staff have been provided with adult protection training. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 29 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 29 and 30. The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. Although some redecoration and refurbishment has commenced, continued investment is required to improve and enhance the environment. Policies and procedures are not in place or being followed to ensure good hygiene practice. EVIDENCE: Since April 2006 significant improvements have been made to residents bathing and showering facilities, and service users that were able to communicate their needs appeared pleased with the newly refurbished en-suite facilities, a view shared by their relatives. Carpets and hard floor covering previously noted to be stained and shabby in appearance have also been replaced and several new armchairs have been purchased. During the inspection decorators were observed painting service user bedrooms. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 30 Although improvements have occurred to the environment, the home continues to demonstrate poor infection control practices and a failure to ensure service user safety. An audit conducted by the local infection control nurse specialist in January 2006 had identified areas where the home needed to make improvements to its infection control practices. Some of the problems that were identified at the time of the audit have been addressed, however observations made at this inspection also show that the home has failed to act on other problems and new issues were also identified. On the first inspection day on 12.09.06, the management were informed that a tour of the home showed that some parts of the home were unclean, including; • The electrical feed pump for one person was visibly stained with liquid feed, which had dried hard on the apparatus –an issue raised at previous inspections. When this matter was explored further it was found written down in the person’s records that this equipment must be cleaned every day, however a ‘pump cleaning rota’ form had not been signed to confirm it had been cleaned daily. The entry port to the persons feeding tube was also observed to be dirty and congealed with feed. • The bedrail protectors for the same person were stained with dried on spillages of the liquid feed and the control box for the specialist mattress was dirty. On return to the home eight days it appeared that this equipment had not been cleaned, as it was still dirty. In one of the communal bathrooms, a shower hose attachment was stained with what appeared to be dried on faeces. A staff member working in that part of the home confirmed that the bathroom had not been used that morning, indicating the shower had been like that for some time. This was cleaned when checked on the second inspection day. Some of the hoists seen in use had been repaired at some point with heavy duty tape, this was worn and badly frayed, making effective cleaning of this equipment hard to achieve. Hoist slings seen stored with the equipment were visibly soiled although some slings were seen being washed in the laundry. Liquid soap containers in some areas were empty, other dispensers in high risk areas such as sluices were observed contaminated by old congealed soap debris. Clinical waste bins seen in sluices were also badly stained and in need of a thorough clean. Bed-pan macerators previously identified as faulty have now been removed this means that the home has one functioning sluice disinfector, housed in a small room-it was not discussed with staff whether this is considered sufficient. During a tour around the outside of the building, three bins for the purpose of storing clinical waste were found unlocked. The lid to one of these containers was not in place meaning that bags of clinical waste were exposed and closer observation revealed that not all waste had been sealed effectively. All of the containers were overfull. An excessive amount of flies were present in this Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 31 area and this spoiled the overall effect of the flowering tubs and newly installed water feature provided for residents living in close proximity to this area. It was noted in the November 2005 inspection report that an overflowing clinical waste container had been observed and the home had been required to take action at that time. Syringes which are designated as single use were found next to two individuals requiring PEG feeds, suggesting that staff are re-using these syringes, observation of the sharps box demonstrated that a number of insulin syringes had been re-sheathed and one sharps box had not been labelled correctly. Specialised equipment for the care of a service users airway was seen stored on the toilet cistern in their room on both inspection days, reflecting poor infection control practice. A notice attached to a fridge in service users bedroom stating “check weekly” documented that the fridge was last checked on 18.7.06, when this was discussed at the end of the inspection the inspectors were informed that cleaning schedules for fridges are now kept in a different area; these schedules were not checked during this inspection. The home recently submitted an action plan, which states that “all furniture is safe and meets the needs of the current service users”, the responsible individual also conveyed this information at the start of the second day of the inspection, informing the inspectors that damaged chairs had been replaced. Observations made on both days of the inspection confirmed that furniture is not safe, the protective covering to one chair was damaged leaving a considerable amount of foam padding exposed and an attempt to repair the protective covering with parcel tape had been made. Other chairs were also seen with damaged coverings and the foam padding exposed, this compromises service user safety in that the exposed foam poses a fire and choking risk and the chair cannot be effectively cleaned. The responsible individual informed the inspectors at the end of the inspection that the damaged chairs had been removed; however it was observed by the inspectors that at least three other damaged chairs were still in use in other areas of the home. In contrast to the new floor coverings, the large communal areas appeared sparsely furnished, and tables and seating seen in use were worn and stained. The regional manager confirmed that service users had been involved in the choosing of the new décor, however a discussion with service users and staff about the new décor suggested that service users had not been involved in the choice of the colour scheme. Similarly, residents commented they had not been invited to choose the colour of their bedrooms, which were in the process of being decorated. Bed tables were showing signs of wear and tear as the laminated surface was peeling off, exposing areas of wood that has the potential to splinter. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 32 A coded lock fitted to the entrance door helps to provide a safe main entrance to the home, however serious deficits with the security of the home were identified during the second day of the inspection and these are recorded in the “Conduct and Management” section of this report. It was observed that service users that require a wheelchair for mobility purpose were unable to summon assistance of staff when they wished to access the home after being outside, two service users were heard knocking on the main entrance door for sometime, the door bell is positioned at eye level and thus out of reach of individuals that are wheelchair bound. This shows that little consideration has been made to meet the needs of service users and visitors with a disability. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 33 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment practices are poor with appropriate checks not being carried out with the potential put service users at risk. The collective skills, experience, training and support of the staff group are insufficient to meet the needs of the service users accommodated at this home. EVIDENCE: The manager confirmed that 37 service users are currently residing at the home, however on both inspection days the manager did not know how many staff were on duty at the time the question was posed. When the minimum number of staff expected to be on duty was discussed with the manager, she could not confirm exactly how many carers needed to be on duty. Observation of an “allocation list” confirmed that 8 carers were on duty on the morning of the first day of the inspection and 9 carers on the second day. Previous inspections, additional visits to the home and this inspection continue to show that service users are left without supervision for long periods of time, although staff reported at this inspection that staffing ratios had improved due to a decrease in service user numbers. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 34 During a recent additional visit to the home it was observed that a service user, who is alleged to have recently hit another service user was able to go up to the same service user, unsupervised by staff and take his sweets and drink from his glass in front of him. This appeared to distress the service user, and it was only when a member of staff was located and informed of the incident by the inspector that the situation was resolved. On examining staffing rotas for the past two weeks it was extremely difficult to see which shifts staff members worked due to a lack of surnames, agency staff names, the use of “Liquid paper” and crossings out; the rota had to be clarified with the timesheets staff complete at the end of their duties. The rotas did not identify when new starters were working in a supernumerary capacity, and who was supervising them. On the first day of the inspection the manager confirmed that two nurses and a carer had been successfully recruited to the home since the last CSCI inspection. Observations were made of these records as well as the records for the manager, deputy manager and another carer. In depth examination of these records showed that all of the records lacked some necessary information in their pre- employment checks, and the individuals had not received appropriate supervision and induction to working in the home. It was identified that the home is routinely appointing staff on the basis of a POVA first check, without waiting for the receipt of the full CRB Disclosure. There was no documentary evidence on any of the files seen to confirm how the home had reached the conclusion that the new employees were suitable for the work they are to perform, such as an interview proforma or copies of job descriptions. When this was discussed at the end of the inspection the manager and deputy manager spoke of their intention to devise some questions for use at interview. Observation of the manager and deputy manager’s personnel records show that both had been appointed prior to the receipt of a full CRB disclosure. Although a POVA First check had been obtained in both instances, there was no documentary evidence to confirm that an appropriately qualified and experienced staff member had been appointed to supervise them. Clear guidance exists in respect of appointing staff prior to receipt of a full CRB Disclosure, there was no evidence to confirm that the home has followed this guidance. In the recruitment records of a nurse, the information provided on the application form did not match the employment history provided on her curriculum vitae. The individual had not given the name of her last employer as a reference, and the home had failed to notice this. On 12.09.06, this person was reported to be on day two of her induction, a POVA First check had been obtained by the home, but it had not been confirmed at this time that her CRB had been processed. The individual was seen working unsupervised, and was holding the drug keys for the home. Although the person informed an Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 35 inspector the deputy manager was ‘supervising her,’ the deputy manager was writing care records in another part of the home. There was no record of any induction being recorded on her file, and on 20.09.06, the second inspection day, when this was requested, induction forms given to inspectors did not provide any evidence to show the new employee had been involved in this process. The employee had informed an inspector the deputy manager was ‘supervising her,’ although the induction records had been ticked and signed by the manager. Examination of rotas and staff time sheets confirmed this new employee was delegated to be in charge of the home for a 12 hour shift after working for only two days as a permanent staff member. Although the individual spoke of how she had worked some shifts at the home as an agency worker, it was not known how many or in what capacity. It was of additional concern that the only other trained nurse support on duty that day was another new nurse on the morning shift, (who did not have appropriate CRB clearance) and a bank nurse for the six hour afternoon shift. No management team members were on duty in the building on that day. The above incident describes a management action that did not safeguard the well being of the people living in the home and shows that the home has not achieved the requirement to deploy an additional nurse for the purpose of ensuring service users clinical and health needs are fully met. The records used for the induction of the manager were noted to be the same as the induction records used for other staff. The manager’s induction record is signed and dated by the regional manager on the 13.3.06 (the managers first day at the home), with an accompanying statement by the regional manager on this date “over a period of times, couple of weeks”, rather than a clear account of the date specific topics were covered. When it was discussed at the end of the inspection that there was no evidence to confirm who had supervised the manager during the period between her commencing employment and the receipt of the CRB Disclosure, the inspector was informed that the previous acting manager had provided supervision. The training matrix shows that since appointment the manager has attended adult protection and health and safety training. It was seen that the newly appointed manager was responsible for the induction of the new deputy manager a month after commencing her own employment which does not seem appropriate in that the manager is unlikely to have consolidated her own induction. Induction for a member of care staff had been completed by a senior carer, the induction checklist had been signed by both staff members which was positive, however subjects covered included areas that the senior carer had not received training in. Although some files showed evidence of completed “Skills for Care” induction programmes, they were not present in all files seen. Following the inspection in December 2005 a statutory notice was served as a result of continued inadequate induction of new staff and failing to ensure that Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 36 suitably qualified, competent and experienced persons are working at the care home at all times; this inspection demonstrates ongoing failings in these areas and CSCI has not received any communication from the registered person to indicate how the home will comply with the notice. The inspectors were informed that one of the newly appointed deputy manager’s responsibilities is to reorganise the training needs of the staff team. For this purpose it was seen that a matrix, to show all the training staff have undertaken, has been devised. This monitoring tool dated 14/09/06 was seen on display on the office wall, however discrepancies in the way some training was listed made this information challenging to understand. Furthermore, when this was examined and compared to the contents of the staff training files several inaccuracies were apparent. For example: Under the heading for Food hygiene training, 56 out of the 60 staff for whom it is considered necessary to achieve this training had the abbreviations N/A (not applicable) entered in the training date column for this topic. Although training dates for 3 kitchen staff members were listed, certificates for two of the six staff employed to work in the kitchen were out of date. The certificates of attendance to this training could not be located in the training file it was meant to be in. When this was discussed with the Deputy manager she confirmed that she had not seen the certificates and had copied the dates off an old training list. This confirmed that the matrix had not been developed as evidence based exercise, and is thus an unreliable source of information. Managers confirmed that food hygiene training has been sourced and they are waiting dates for forthcoming courses. Examination of staff files including those of the management team confirmed that many staff have not received all of the mandatory training expected. When fire safety training was explored, it was seen that not all staff have completed this training, including the manager. A total of 15 out of 64 appear to have had this training in the past 18 months. The training matrix recorded that only two people have had this training in 2006. Only two thirds of the staff team appear to have received moving and handling training. Since the May 2006 inspection some staff have attended training in areas such as falls prevention, Huntington’s Disease and dementia training, which is positive. It was reported that training in the management of individuals with PEG feeds had been planned but was postponed by the trainer. It was established through discussion with the deputy manager that nurses check the competencies of carers to connect/disconnect PEG feeds, however there is no written documentation made to confirm that the carer has been assessed as competent on that date. The deputy manager acknowledged the need for written assessment of competence. As the training matrix did not identify how many staff including nurses had received training in PEG feed administration, it Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 37 could not be established when staff last received training and updates in this area. Staff spoken with considered that the team would benefit from undertaking service specific training to include learning disability, sensory impairment, depression, managing behaviours that challenge, communication and makaton in order to have a greater understanding of the diversity of the needs of the people accommodated. Observations made demonstrate that staff still appear to lack the basic skills for communicating with service users who are unable to verbally communicate. The deputy manager was not aware if any staff had received induction training specifically geared to meeting the needs of people with learning disabilities. It was reported in the May 2006 inspection that the majority of care staff have attained or are in the process of attaining NVQ Level 2 in care. At this inspection it was established through discussion with the deputy manager and observation of the training matrix that 11 staff in total, including the two new managers have an NVQ level 2 or 3 qualification. This means that less than half of the care team have had this training. It was seen that a matrix to monitor staff supervision had been devised to account for the remainder of this year since July. The information listed on the matrix could not be confirmed, as many staff files did not contain the information. The information was reported to be in a large pile of filing which contained in excess of 25 sets of staff records. It is disappointing that despite the managers being made aware of the date for the second day of this inspection that not all information in respect of training was available at the home. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 38 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. The quality outcome for this area is poor. This judgement has been made using available evidence including a visit to this service. The home is not well run and does not promote the health, safety and welfare of residents and continues to place residents at significant risk of harm. Poor record keeping systems potentially place service users at risk. EVIDENCE: The home has operated without a registered manager for over two years. The new manager was appointed in March 2006 and is the fourth person to be appointed as manager in the past two years. An application to register the manager has now been received by CSCI. Observation of the manager’s personnel file at this inspection confirms hospital acquired managerial experience at “junior sister” level, rather than residential care experience. The manager has no particular experience or qualifications in the care or management of people with a learning disability. Inspections and additional Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 39 visits to the home suggest a lack of effective guidance and direction from a senior level to support the manager, given her lack of knowledge of Care Homes Regulations and National Minimum Standards. Staff spoken with during the inspection were complimentary regarding the improvements made to the service under the new manager and stated that she is approachable and fair. This was also evidenced in the minutes of a service user meeting held and several service users spoken with during the inspection were also positive regarding the manager’s approach. However the ongoing shortfalls in the safe working systems demonstrate lack of robust direction and awareness in managing a registered social care service. On the second day of the inspection a tour of the premises undertaken by the inspectors revealed deficits with fire safety practices and the security of the home. It was found that • The door to a bedroom on Green Unit could not be re-opened once closed, unless considerable force was used. This was of great concern as in an emergency situation staff may have encountered difficulty in opening the door to attend to the service user who resides in this room. • The metal plate to the base of a bedroom door on Blue Unit, was identified as loose. This was secured during the visit, however it was observed that there was a significant gap between the small partition door and the main door to this room. There was no suitable smoke seal on this area of the door. • The top of the door to a bedroom on Brown Unit, was splintered and a significant gap was observed. The above deficits were shown to the responsible individual, regional manager and home manager who were informed that it is concerning that staff had failed to notice and act on these deficits. The inspectors were informed that contractors had inspected the doors the day before the inspection. During the tour of the home it was also identified that not all points of entry to the home were secure. The external fire door from the laundry area was propped open with a stone, a large box of matches was left unattended at the outside seating area by the laundry and what appeared to be a bin for the purpose of extinguishing cigarettes had paper towels in it. Further observations of the outside area, identified that 5 sheds used for the purpose of storage were unlocked, 4 did not have locking facilities. The sheds were observed to contain paint, varnishes, tools and one was observed to contain two orange coloured cylinders. The external fire door to the kitchen was open and the inspectors were able to enter the kitchen from outside via this door unnoticed by staff and access an unlocked drawer containing sharp implements. The inspectors were unable to close this fire door and parts of the chain fly guard by this door were found broken, potentially causing a slip hazard. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 40 The fire door by the stairwell next to the dining room was propped open by a chair, which enabled the inspectors to enter the home from outside and access upstairs, again without being noticed by staff. Observation of staff questionnaires showed that one staff member had already raised concerns in respect of security, from observations made by the inspectors it appears that little had been done to address these concerns. It was identified that the home does not maintain a signing in/out register for staff, and it was discussed with management whether this is acceptable as it would not be known who was in the building in the event of fire. The manager informed that the staffing allocation would be used for reference, however as this does not take into account all staff working in the home the manager was advised to contact the fire officer for guidance. The inspection in May 2006 identified that the fire safety risk assessment contained little detail and the manager was required to contact the fire officer for guidance and approval. A visit conducted by the fire officer in June 2006 and the subsequent fire officer’s report confirmed that the fire safety risk assessment was not suitable and sufficient, the report also identified areas within the home that required attention within a three month timescale. A copy of the new fire risk assessment was handed to the inspectors at the end of the inspection, the assessment has been completed by the manager and is dated 21.07.06. the manager has documented “yes” to a question “is every point of entry really secure against intruders” – observations made at this inspection confirm that this is not the case. As documented earlier in this report an incident occurred at the home recently where a service user had become trapped between bed rails. During an additional visit to the home in August 2006 it was observed that the clamp to secure a bed rail was loose and care records for two service users that were examined described incidents involving bed rails. On both days of this inspection all bed rails that were observed were fitted correctly and it is positive to report that the home has purchased new bed rails and bumpers. However during observation of one service users records it was documented on 12.8.06 ‘resident found by husband- uncomfortable bedrails not in place’ and on 17.8.06 it was written ‘husband noticed persons foot caught under ’cot side cushion’ slight redness when checked. The manager had not been made aware of any of these issues. One of four statutory notices issued in December 2005 required the registered provider to provide a protocol in line with Medical Devices Agency guidance which would: • assess and document the need for bed rails • assess and minimise the risk presented by the provision of bed rails, supported by relevant documentation Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 41 provide, monitor and maintain bed rails in order to promote the safety of service users • ensure that all of the above is conducted by appropriately trained and competent staff At the end of this inspection, a protocol document dated 1 September 2006 was given to inspectors. The protocol provides little detail of the circumstances in which the provision of bed rails will be considered, how the need for bed rails plus the risks presented by their provision will be assessed/balanced and fails to describe clear lines of responsibility for the tasks of assessment, provision, monitoring and addressing bed rail safety. The document is not specific in terms of source, frequency or how competence is evaluated. Water temperatures that were checked during the inspection from a random selection of outlets such as wash hand basins and baths, were found to have temperatures ranging from 37 °C to 40 °C and records seen show that temperatures are checked and recorded on a regular basis by the maintenance person. The manager was informed that the temperatures should be close to 43 °C and that action should be taken to address the lower range temperatures. Evidence was available to describe the action taken when a temperature that was checked exceeded 43 °C, which is good practice. Temperatures were not checked on Green Unit as it was reported that a new pump for the hot water was being fitted on this unit. There were no records to confirm the management of water sources in areas, which are not used regularly, such as empty bedrooms, and although the home managers stated that this was done, a recommendation was made to maintain records of these checks. It was suggested that staff keep a record of the temperatures of baths prior to being used by service users. One of the statutory notices issued in December 2005 required the registered provider to provide a procedure, which identified how the home will effectively monitor, maintain and remedy deficits with regard to hot water temperatures. A protocol dated 1 September 2006 was handed to inspectors at the end of this inspection. The protocol fails to identify clear lines of responsibility for ensuring bath water safety and makes no mention of the responsibility of nursing and/or care staff to check temperatures on use. The systems set up to monitor accident and incidents in the home demonstrated that some of the information recorded in these records was being actioned appropriately. The manager provides information in respect of incidents and accidents to CSCI in the form of Regulation 37 notifications and CSCI is generally notified promptly. On the first day of the inspection analysis of the accident/ incident book confirmed there had been no accidents recorded since 19/08/06. In two sets of records case tracked there was evidence written in daily reports of injuries of unknown origin, and a ‘near miss’ incident involving bed rails that is described above. • Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 42 One service user had an entry in daily care records on 4.8.06 stating ‘bruise on back of left hand’ and on 3.9.06 stating ‘Leg bleeding. Bed changed. Nurse in charge informed.’ – neither injuries had been recorded on the person’s skin integrity chart. The other service user had entries in daily records on 7.8.06 describing ‘Bruise on right thigh’ Incident form filled – this could not be located, and on 16.8.06 ‘Bruise on upper arm’. There was nothing written down to show that the reasons for the bruising had been investigated. This same person had an entry on a ‘skin integrity chart’ dated 13.8.06 also describing bruising to the thigh. These examples highlight the ongoing communication problems in the home, and that although changes to record keeping have been made, and new paperwork has been introduced, important information is not filtering through to the management of the home. Events where staff have failed to report or record incidents of injury shows that the home is not safeguarding the wellbeing of people. Ongoing shortfalls in record keeping in the home clearly identify the home has failed to achieve the requirement to ensure that records are well maintained, up to date and accurate. Observations of how the staff team deal with an emergency situation was observed during the second day of the inspection. The emergency bell sounded and staff responded quickly to the call buzzer and were seen providing reassurance to the affected service user. It was noted that all staff had gone to attend, leaving other parts of the home unattended and several service users appeared upset by this. It was discussed with the manager whether systems needed to be introduced to ensure that in the event of emergency situations some staff were allocated to remain with service usersthe manager felt that the current process was acceptable. The manager reported that questionnaires have recently been sent out to service users and/or their relatives and is awaiting their return. Five completed questionnaires that had been returned included responses that were marked as excellent, good, and satisfactory and one questionnaire included negative responses. Examples of comments from two questionnaires are as follows “pleasing to note the improvements in all aspects of the management of the home, tremendous improvement” and “some staff are good, while others are not helpful, I do not know who the key worker is so cannot comment, I have not been involved in care planning”. A relative that was spoken with during the inspection commented, “there have been improvements with the environment but the care issues remain the same”. In view that only a small number of questionnaires have been returned the home’s quality assurance process will be revisited at a future inspection. Recorded visits (as per Regulation 26) have been undertaken by the regional manager. Observations of these records indicate that the regional manager has had regular contact with named staff, relatives and service users, although one staff member was unable to recall this contact. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 43 Not all servicing and maintenance records were checked at this inspection although the kitchen cleaning schedules were found appropriately maintained in addition to food, fridge and freezer temperature checks. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 44 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 X 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 2 27 3 28 X 29 1 30 1 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 1 X LIFESTYLES Standard No Score 11 1 12 2 13 2 14 1 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 2 X 1 1 2 Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 45 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 YA1 Regulation 4 Requirement The registered person must complete the statement of purpose for the home, ensuring that it is an accurate reflection of the service actually available 20/9/06-The statement of purpose that has been devised is not a true reflection of the service provided. (Previous timescales of 21/07/04, 1/09/05, 13/01/06, 01/08/06) Timescale for action 01/12/06 2. YA2 14 unable to demonstrate compliance as no new admissions (Previous timescale of 20/01/06) New service users must only be admitted on the basis of a full assessment which concludes that their needs can be met by the home 20/09/06-home has been 01/12/06 3. YA2 14 Full assessments of each service user must be conducted prior to DS0000036983.V311381.R01.S.doc 01/12/06 Wrottesley Park House Nursing Home Version 5.2 Page 46 unable to demonstrate compliance as no new admissions (Previous timescale of 1/09/05, 15/12/05 and 20/01/06) admission, which must take into account specific condition related needs, specialist needs and management of risk and revised at any time when necessary to do so 20/09/06-home has been 4. YA2 14 unable to demonstrate compliance as no new admissions (Previous timescale of 1/09/05, 13/01/06) The registered person must confirm in writing to the service user that the care home is suitable for the purpose of meeting their needs 20/09/06-home has been 01/12/06 5. YA3 14 The registered person must not admit people whose needs it cannot meet or with whom it cannot develop effective communication 01/12/06 (20/09/06-home unable to demonstrate compliance as no admissions) 6. YA6 15(1)17(1) The registered person must ensure that there is an individual plan for each service user, with their consultation wherever possible, which sets out how the needs of the individual are to be addressed by the home and provides effective individualised procedures for staff to follow. 20/9/06-Not met 01/12/06 Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 47 (Statutory requirement notice issued following December 2005 inspection) 7. YA6 15(1) Care plans must set out how current and anticipated specialist requirements will be met. 20/9/06-Not met 01/12/06 (Previous timescale of 24/02/06 and 1/07/06) 8. YA7 12(3) Staff must provide service 01/12/06 users with the information, assistance and communication support they need to make decisions about their own lives and demonstrate how individual choices have been made 20/09/06-Not met (Previous timescales of 24/02/06 and 01/08/06) 9 YA8 12(5) 20/09/06-Partially met (Previous timescale of 24/03/06 and 1/08/06) The registered person must consult with service users regarding all aspects of life at the home 01/12/06 10 YA9 13(4)(b) Service users must be enabled to take responsible risks within a risk assessed framework, which is a comprehensively recorded and regularly reviewed and updated. Action must be taken to minimise risks and hazards 20/09/06-Not met (Previous timescales of 21/07/04, 1/09/05, 24/03/06 and 01/07/06) 01/12/06 11 YA11 16(2)(m)(n) The registered provider must provide opportunities for service users to learn DS0000036983.V311381.R01.S.doc 01/12/06 Wrottesley Park House Nursing Home Version 5.2 Page 48 and use practical life skills 20/09/06-Not met (Previous timescales of 24/03/06 and 01/08/06) 12. YA12 12(1) The registered provider must enable service users to take part in age, peer and culturally appropriate activities e.g. educational opportunities 20/09/06-Not met (Previous timescales of 1/10/05, 24/03/06 and 01/08/06) 01/12/06 13 YA13 16 (2)(m) The registered provider must enable service users to be come part of, and participate in, the local community. 01/12/06 20/09/06-Partially met (Previous timescale of 24/03/06 and 1/08/06) 14 YA14 16 (2)(m)(n) The registered person must ensure that service users have access to, and choose from a range of appropriate leisure activities. 01/12/06 20/09/06-Not met (Previous timescale of 24/03/06 and 1/08/06) 15 YA15 16 (2)(m) The registered person must ensure that service users are enabled and supported to maintain family links and friendships (Previous timescale of 24/03/06 from December 2005 report)) 01/12/06 16. YA16 12(1)(b) The registered person must ensure that daily routines of the home promote choice and independence 20/09/06-Not met (Previous timescales of 24/02/06 and 01/08/06) 01/12/06 17 YA17 16 (2)(i) Service users must be DS0000036983.V311381.R01.S.doc 01/12/06 Page 49 Wrottesley Park House Nursing Home Version 5.2 18 YA17 19 YA18 14 (2) Schedule 3 (3)(m) Schedule 4 (13) 12(1)(b) offered a choice of suitable menus, which meet their dietary needs, respect their individual preferences and meals must be offered three times daily including at least one cooked meal and food eaten recorded. Service users nutritional 01/12/06 needs must be assessed and regularly reviewed and updated. The registered person must ensure that service users’ preferences with regard to their care are identified and respected 20/09/06-Not met (previous timescales of 27/01/06, 24/02/06 and 01/08/06) 01/12/06 20 YA18 12(1)(b) Service users must be 01/12/06 provided with the technical aids and assistance required 20/09/06-Not met (Previous timescale of 27/01/06, 24/02/06 and 1/08/06) 21. YA19 12 The registered person must ensure the healthcare needs of service users are assessed and robust procedures are in place to address them. 01/12/06 20/09/06-Not met (Previous timescale of 24/03/06 and 1/07/06) 22. YA19 12 Service users’ health must 01/12/06 be monitored and potential complications and problems are identified and actioned and kept under regular review. 20/09/06-Not met DS0000036983.V311381.R01.S.doc Version 5.2 Page 50 Wrottesley Park House Nursing Home (Previous timescale of 24/03/06 and 1/07/06) 23. YA20 13(2) The registered person 01/12/06 must ensure service users receive all drugs prescribed to them without fail and comply with all requirements identified by the CSCI pharmacist inspector. 20/09/06-Not met 24 YA22 22(2) 20/09/06-Partially met (Previous timescale of 24/02/06 from January 06 report) The home must provide service users and/or their representatives with an effective complaints procedure. 01/12/06 25 YA23 20 (1)(a) The registered person 01/12/06 must facilitate service users with a bank accountsavings for service users must not be pooled. (Previous timescale of 31/05/04, 1/10/05) 26 YA23 20 (3) (Previous recommendation-no action has been taken) The registered person must seek guidance and review the situation in respect of one staff member acting as Power of Attorney for a resident. 01/12/06 27. YA23 12(1)(13(6) The registered person must ensure that any injuries sustained by service users are fully investigated and appropriate action taken 01/12/06 20/09/06-Not met (Previous timescale of 24/02/06 and 1/07/06) 28 YA24 23 (2)(d) A programme of routine maintenance and renewal of the fabric and DS0000036983.V311381.R01.S.doc 01/12/06 Wrottesley Park House Nursing Home Version 5.2 Page 51 decoration of the building must be produced, implemented and records kept 20/09/06-Not met. (Previous timescale of 13/01/06, 24/02/06 and 1/08/06) 29. YA26 16(2)(c) The registered person must provide furniture for service users which is safe and meets their needs 01/12/06 20/09/06-Not met (Previous timescale of 24/03/06 and 1/08/06) 30. YA30 13(3)18(1)(c )(i) The registered person must ensure that staff are aware of and follow Health Protection Agency guidelines 01/12/06 20/09/06-Not met (Previous timescale of 24/03/06 and 1/08/06) 31. YA30 13(3) The registered person must implement appropriate action to address the deficits identified in the infection control audit 01/12/06 20/09/06-Not met (Previous timescale of 24/03/06 and 1/08/06) 32 33. YA30 YA32 13 (3) 18(1)(a) Clinical waste containers must be kept secure. The registered person must ensure that service users are supported by staff competent to undertake the tasks they do 01/11/06 01/12/06 20/09/06-Not met (Previous timescale of 24/02/06 and 1/08/06) 34. YA32 18(1)(a) The registered person must ensure that staff DS0000036983.V311381.R01.S.doc 01/12/06 Wrottesley Park House Nursing Home Version 5.2 Page 52 have the specialist qualifications, skills and experience to support the service user group 20/09/06-Not met (Previous timescales of 21/07/04, 1/10/05 and 24/02/06 and 1/08/06) 35. YA33 18 (1) (a) The registered person must review staffing levels regularly to reflect service users’ changing needs and ensure that there are sufficient numbers of staff on duty to meet service user needs. 01/12/06 (previous timescale of 13/01/06 -ongoing requirement with which the home must demonstrate compliance) 36. YA33 18 (1) (a) The registered person must continue to deploy an additional nurse to ensure that the clinical and health needs of service users are fully met 20/09/06-Not met 01/12/06 37. YA34 19 (4) Schedule 2 20/09/06-Not met (previous timescales of 15/7/04, 1/9/05, 24/02/06 and 1/07/06) The registered person must obtain two written references before allowing a person to work at the care home-one of these references must be from the person’s last employer. 01/11/06 38. YA34 18(2)(a)(b) 19 Schedule 2 The registered person must ensure that full and satisfactory information is available in respect of individuals that are permitted to start work following a POVA First DS0000036983.V311381.R01.S.doc 01/11/06 Wrottesley Park House Nursing Home Version 5.2 Page 53 check and prior to receipt of the full CRB Disclosure. The registered person must ensure that the new worker is closely supervised by an appropriately qualified and experienced worker until the full CRB Disclosure is obtained. 39 YA34 19 The registered person must ensure that staff are aware of company policy regarding CRB disclosures. 01/11/06 20/09/06-Not met (Previous timescale of 24/02/06 and 1/07/06) 40. YA35 18 (1) (c) 01/12/06 The registered person must ensure that all staff receive training appropriate to the work they are to perform, and create a training and development plan to demonstrate this, linked to service users’ needs 20/09/06-Not met (previous timescale of 21/07/04, 1/09/05, 13/01/06 and 1/08/06) 41. YA35 18(1)(a)18(1)(c) (i) 20/09/06-Not met Wrottesley Park House Nursing Home The registered person must ensure that all staff are provided with structured induction training within six weeks of appointment and that staff have the skills and experience necessary for the tasks they are expected to do, and provide to the commission, a procedure which identifies how the home will comply with the above requirements 01/12/06 DS0000036983.V311381.R01.S.doc Version 5.2 Page 54 (Statutory requirement notice issued following December 2005 inspection) 42 YA39 24 20/09/06-Not met (Previous timescale of 1/08/06). The registered person must ensure that the quality assurance system is robust and that appropriate action is undertaken in response to negative feedback 01/12/06 43 YA39 26 (Ongoing requirement with which the home must demonstrate compliance) The registered person must monitor the quality of the service provided, at least on a monthly basis and provide a written report to CSCI 01/12/06 44 YA41 17 The registered person must ensure that all records required by regulation are well maintained, up to date and accurate 01/12/06 20/09/06-Not met (Previous timescale of 24/03/06 and 1/07/06) 45 YA42 13 (5) Safe systems for moving and handling service users must be established and adhered to 01/12/06 20/09/06-Not met (Previous timescale of 27/01/06 and 1/07/06) 46 YA42 23 (4) 20/09/06-Home reports fire safety risk assessment submitted. The home must consult with the fire officer to ensure that the fire safety risk assessment meets the approval of the fire officer. 01/11/06 Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 55 47 YA42 23 (4) 48 YA42 23 (4) 20/09/06-Immediate requirement notice issued. The registered person must ensure that the fire safety risk assessment is regularly reviewed and any deficits actioned. The home must comply with the fire officers report dated 23/06/06. 01/11/06 23/09/06 49 YA42 13(4) Heat sources must be fixed and guarded 01/11/06 20/09/06-partially met. (Previous timescale of 27/01/06, 24/02/06 and 1/07/06) 50 YA42 13(4)(c)23(2) (c) The registered person must provide to the commission, a protocol in line with Medical Devices Agency guidance, which identifies how the home will effectively assess and minimise the risk associated with the use of bed rails. 01/12/06 20/09/06-Not met (Statutory requirement notice issued following December 2005 inspection) 51 YA42 13(3),13(4c)23(2j) The registered person must provide to the commission, a procedure which identifies how the home will effectively monitor, maintain and remedy deficits with regard to hot water deficits 01/12/06 20/09/06-Not met (Statutory requirement notice issued following December 2005 inspection) 52 YA42 13(4)(a),(c) 23 The registered person must ensure that a full audit of the home is undertaken to ensure that all parts of the home that service users have access DS0000036983.V311381.R01.S.doc 01/11/06 Wrottesley Park House Nursing Home Version 5.2 Page 56 to is well-maintained and safe-this includes outside areas. 20/09/06-Not met (Previous timescale of 24/03/06 and 1/07/06) 53 YA42 17 Schedule (3)(j) 20/09/06-Not met (previous timescale of 24/03/06 and 1/07/06) The registered person must ensure that staff are aware of their responsibilities to report and record all accidents and incidents. 01/12/06 54 YA42 13(4)(c)18(1) The registered person must ensure that all staff receive appropriate training and are assessed as fully competent in respect of the equipment in use at the home. 20/09/06-Not met (previous timescale of 01/08/06) 01/12/06 55 YA42 13 (4),(5) (6) 23 (4) (d) All staff must receive mandatory training relating to safe working practices and these be updated at the required frequency. 01/12/06 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 YA6 YA19 Good Practice Recommendations It is recommended that staff attend training in person centred planning (PCP) and a PCP be developed with each individual service user. The home is advised to develop a system to enable staff to DS0000036983.V311381.R01.S.doc Version 5.2 Page 57 Wrottesley Park House Nursing Home 3 4 5 YA35 YA42 YA42 record all healthcare appointments, professional visits and outcomes. It is recommended that appropriate courses be sourced for activity organisers. It is recommended that the home maintain a record of the management of water sources in empty rooms. The home is advised to contact the fire officer for guidance in respect of maintaining a record of all staff on the premises at all times. Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 58 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 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 Wrottesley Park House Nursing Home DS0000036983.V311381.R01.S.doc Version 5.2 Page 59 - 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. 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