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Inspection on 14/07/05 for Wrottesley Park House Nursing Home

Also see our care home review for Wrottesley Park House Nursing Home for more information

This inspection was carried out on 14th July 2005.

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 but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides spacious accommodation that is personalised according to resident`s wishes. The home provides meals that offer variety and meet nutritional needs.

What has improved since the last inspection?

Fire doors within the home have been replaced and a new central heating system heating fitted. Training for staff in the care of people with learning disabilities has commenced. Following a period without a registered manager the acting manager has applied to be the registered manager of Wrottesley Park House and is currently awaiting assessment of her suitability via CSCI. One comment card received from a relative prior to the inspection, documents "since the appointment of the acting manager we have seen a big improvement in the way the home is run". The home now documents the dietary intake of residents.

CARE HOME ADULTS 18-65 Wrottesley Park House Nursing Home Wergs Road Tettenhall Wolverhampton WV6 9BN Lead Inspector Rosalind Dennis Announced 14th and 15th July 2005 09.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Wrottesley Park House Nursing Home Address Wergs Road, Tettenhall, Wolverhampton, WV6 9BN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01902 750040 01902 755510 Abbey Healthcare Homes (Wrottesley Park) Ltd Care Home with Nursing 57 Category(ies) of Learning Disability registration, with number Physical Disability of places Terminally Ill Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 06/05/05 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. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place over two days; two inspectors were present on the first day and the lead inspector for the home returned on the 15th July to complete the inspection. The acting manager, deputy manager and staff offered their fullest co-operation throughout the inspection. The director was present on the first day of the inspection. The inspection involved a tour of communal and individual bedrooms, observing activity within the home, looking at care records and observation of documents. The inspectors spoke with eight residents that could communicate their needs effectively, nine relatives/visitors and nine members of staff. The inspectors were unable to ascertain the views of all the residents living at the home due to the nature of their illness and associated conditions. Seven relatives/visitors comments cards and twenty-seven resident’s comments cards were received prior to the inspection; all resident’s comment cards had been completed by staff on behalf of residents. During the past twelve months the home has received frequent visits from CSCI in addition to the two statutory inspections. These additional visits have been in response to complaints made to CSCI regarding the home What the service does well: What has improved since the last inspection? Fire doors within the home have been replaced and a new central heating system heating fitted. Training for staff in the care of people with learning disabilities has commenced. Following a period without a registered manager the acting manager has applied to be the registered manager of Wrottesley Park House and is currently Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 6 awaiting assessment of her suitability via CSCI. One comment card received from a relative prior to the inspection, documents “since the appointment of the acting manager we have seen a big improvement in the way the home is run”. The home now documents the dietary intake of residents. What they could do better: The home has not progressed in meeting outstanding requirements from the previous inspection and as a result of this inspection a further 21 requirements have been made; there are 42 requirements in total. Five relatives spoke with the inspector and identified that there has been no significant improvement in the services provided by the home and care provision in the past twelve months. In summary: The home must provide information for prospective residents and/or their representatives about the services provided by the home and the services that are included with the fees charged. The care planning and risk assessment system must provide staff with the information they need to meet resident’s needs. The home is required to review the provision and frequency of activities and ensure that residents with complex multiple disabilities are offered specialist interventions by suitably qualified staff. The home must implement training in adult protection/abuse awareness and provide an adult protection policy that is available for staff to read and follow. The complaints procedure must be reviewed and made accessible for residents; the current procedure does not meet legislative requirements and is not accessible for residents. The home must provide training to meet resident’s needs, as the majority of staff do not have the required skills and competencies that are required to meet resident’s needs. One comment card received prior to the inspection states “ far too much time and energy is wasted by staff looking for further instruction, seemingly unable or reluctant to find work within the scope of their ability”. The home is required to implement a quality assurance system in order to monitor the quality of the service provided. The home does not fully promote and safeguard the health, safety and welfare of people using the service and immediate requirement notifications were made during the inspection. Two cupboards containing cleaning solutions and the lift motor room were found unlocked. Incidents and accidents that had Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 7 occurred within the home had not been reported to CSCI and there was no evidence of any follow up action following each incident and a bed rail risk assessment had not been completed. Risk assessments in safe working practice topics must be undertaken and training provided for all staff in these areas. 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 E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 1, 2, 3, 4 and 5. The home does not have a Statement of Purpose and Service User Guide, therefore prospective residents and/or their representatives are not provided with information to make an informed choice about where to live and whether the services provided by the home will meet their needs. The home does not provide residents with an agreed individual written contract with the home therefore the resident and/or their representative are not aware of the terms and conditions of occupancy and the services that are included with the fees charged. The majority of staff working within the home are not equipped with the skills and experience to deliver the care that the home offers to provide. EVIDENCE: The home does not have an up to date statement of purpose and service user guide. A leaflet that the acting manager reports is shown to prospective residents and or their significant others was observed to be clearly outdated. The regional director discussed that a statement of purpose will be drawn up once the new bedrooms have been registered. However it is noted that the home has been required to review the statement of purpose/ service user guide since the inspection conducted in July 2004. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 10 Trial visits are encouraged and one family of a prospective resident were observed to visit the home during the inspection. The home has not had many recent admissions therefore it is difficult to confirm with residents whether they consider the admission procedure to be effective. Observation of pre-admission assessment documentation for two prospective residents confirms that pre-admission assessments are conducted, although the acting manager confirmed that emergency admissions are occasionally admitted. One of the pre-admission assessments had not been fully completed and the pre-admission assessment documentation used by the home is basic and requires amendment to take into account for example; specific condition related needs, specialist needs and the assessment and management of risk. A letter sent to residents that are to be admitted for respite confirms the date of their admission. However this does not contain sufficient information to confirm that the home will meet the individual’s needs. Observation of individuals residing at the home and observation of care records demonstrates that a number of residents have complex needs. Although training has commenced in caring for individuals with a learning disability, individual training records identify that staff have not received training in caring for individuals with physical disabilities and other conditions such as acquired brain injury or sensory impairment. The acting manager has a recognised qualification in palliative care however the home has chosen not to admit individuals for the purpose of offering this specialised service until other staff are appropriately qualified. Discussion with the director and acting manager confirmed that the home does not issue any form of terms and conditions/contracts for residents and it is noted that this was identified as a requirement at the inspection in July 2004. The director arranged for an example of a contract to be sent through during the inspection and although this appears to meet the standard it is not currently in use by the home. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 6, 7, 8 and 9. The care planning and risk assessment system that is in place does not provide staff with the information they need to satisfactorily meet resident’s needs. EVIDENCE: Six residents care files were examined and all care plans showed evidence of monthly review by staff. However one residents care plan had been reviewed on the 4th July 2005 and it was documented that the resident had not had any recent falls. Observation of the incident file and daily record sheet identified that this resident had fallen on the 17th June 2005; therefore the care plan review was not accurate. Daily record sheets are kept in a separate file from the care plans and staff indicated that it is easier for handover purposes. In view that what is documented on the daily report sheets should be crossreferenced with the care plan the home is advised to review this procedure. Visitors for one resident that is partially sighted spoke of their concern that some staff do not appear to be aware of her visual impairment. Observation of this residents care file found that there was no information detailing her visual impairment on the front sheet of the file (admission details), and a communication care plan contained limited personalised information to provide staff with the information to meet her needs. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 12 Through discussion with staff, residents and observation of care files it was identified that some residents exhibit aggressive and challenging behaviour, however there was limited information within care files to provide staff with the information they need to manage or diffuse these situations. Risk assessments such as pressure area risk, falls, nutrition and moving and handling assessments were up to date and available on all files seen. Other more individualised risk assessments were observed not to be in place. Some residents were observed to be mobilising around the home in wheelchairs without the footplates attached and one resident observed to have bed rails in place did not have a documented risk assessment in place. This led to an immediate requirement notification being made for a bed rail risk assessment to be completed and permission for use obtained from either the resident or their representative. The main focus of care plans was in meeting healthcare needs with very little emphasis placed on personal and social support. Social profiles/life stories are not routinely completed for individual residents, these would assist staff in finding out more about each resident enabling care to be given in a personalised way. Social activity plans were not available and in one file a “social plan” reviewed on a monthly basis just contained the information “no changes” or “ongoing care continues”. There was no evidence within the files seen to demonstrate that residents and/or their representatives are involved in the care planning or review process. Some residents within the home are contracted for one to one support. Little information was available within the care files seen detailing the actual one to one care element, for example in one file it is documented “one to one care given” with no description as to what this entailed. The home is strongly recommended to provide a description of the actual one to one care provided. There was no evidence to demonstrate that residents are enabled to contribute to the development and review of services within the home and this is covered in the section “Conduct and Management of the Home” of this report. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 12, 13, 14, 16 and 17. Although activities are provided these are limited due to insufficient time allocated for the provision of activities including specialist therapeutic interventions. The meals in this home are good offering choice, variety and catering for different nutritional needs. EVIDENCE: The home has one activities organiser that is employed for sixteen hours per week. Relatives and residents that were spoken with praised the enthusiasm that the activity organiser shows in her work and in trying to involve all residents in a range of activities. Discussion with the activities organiser during the inspection confirmed her enthusiastic approach and also her willingness to learn new skills as she acknowledged that her skills in providing activities in some areas were lacking. Residents, visitors and staff discussed that not enough hours are contracted for the provision of activities. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 14 The home has access to its own transport, enabling residents to access the wider community such as theatre trips, visits to garden centres or for the purpose of shopping. Two residents spoke of their enjoyment at being able to visit the local pub. The activities diary provides a record of residents that choose to attend or refuse activities. One resident spoke at length with the inspectors that some care staff do not appear to want to assist in the provision of activities and that activities only happen when the activities organiser is on duty, this view was supported by two members of staff who also spoke of a lack of initiative shown by other members of staff in providing activities. The inspectors observed that some staff demonstrated limited interaction with residents and appeared uncomfortable performing tasks such as feeding residents. It was observed during the inspection that residents with more complex needs were seated unaccompanied in front of a television or in other parts of the home for long periods of time. This has also been observed during other visits to the home by CSCI. The home is required to review the provision and frequency of activities to ensure that all residents including those with complex needs and/or sensory impairment are offered age appropriate activities and residents with complex multiple disabilities must be offered specialist interventions by suitably qualified staff. The home must ensure that lounge areas are not left unsupervised. Residents that were able to communicate their needs spoke of the excellent meal choice and one resident described the food as “always lovely”. The home has now commenced recording residents dietary intake and observation of a selection of menus demonstrate that nutritional needs are met. Nutritional risk assessments were present in all the care files seen with evidence of regular weight monitoring, review and any action taken. The main home kitchen was not seen on this occasion. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 18 and 19. Although resident’s basic healthcare needs appear to be met, specialist healthcare needs appear to be lacking with little evidence of good multi disciplinary working taking place on a regular basis. EVIDENCE: Observations of care files indicate that most basic healthcare needs are met. Files contained risk assessments for moving and handling, pressure area risk and nutritional risk. Five visitors discussed their concerns that there appears to be a deficit in meeting specialist healthcare needs; specialist healthcare professionals visiting the home such as occupational therapists have previously raised this concern. It was identified through discussion with the acting manager, staff and visitors that not all specialist equipment such as wheelchairs has been appropriately assessed on an individual basis, which is potentially putting residents at risk of injury. One relative had documented on the comment card prior to the inspection that “ my relative does not know if she has a designated key worker”. The acting manager confirmed that a key worker system has only recently commenced and that one member of staff has taken responsibility for overseeing the Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 16 implementation for the allocation of key workers for each resident. Key worker allocation lists were seen during the inspection. The CSCI pharmacist inspector visited the home in May 2005 to review medication practices. Twenty-nine requirements were made as a result of his inspection and the report is available as a separate document. A further inspection is to be undertaken by the pharmacist inspector to monitor progress in meeting the requirements made. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 17 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 standard(s) 22 and 23. The complaints process in the home is not satisfactory with little information available to residents and/or their significant others on the complaints process. The home does not have an adult protection procedure for staff to follow to ensure a proper response to any suspicion or allegation of abuse. EVIDENCE: A complaints procedure that is in the main reception area does not contain sufficient information to meet legislative requirements and is not accessible to residents. On the comments cards received prior to the inspection, three residents had commented that they would not know who to speak to if they were unhappy with their care and three relatives had commented that they are not aware of the complaints procedure. The acting manager informed the inspector that there have been no complaints made direct to the home. The complaints file was observed to contain complaints that had been sent direct to CSCI that required intervention from the home, the file was observed not to be well organised. The acting manager is advised to devise a system of logging complaints, detailing the complaint and any action taken in response to the complaint. It is recommended that the home commence auditing complaints. The home currently has three different policy and procedure files in the main office. Discussion with the acting manager and director identified some confusion as to which documents should be in use and it could not be ascertained which adult protection policy and procedure was in use by the home. The home does not have a copy of the local area policy. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 18 Four members of staff were unable to confirm where the adult protection policy for the home is located and two members of staff were unable to define the term whistle blowing. All members of staff confirmed that they wouldn’t hesitate to report any suspicion of abuse or neglect. The acting manager identified that provision of training in adult protection/abuse awareness is currently being addressed; the home is required to ensure that all staff receive training in adult protection procedures. Financial records for three residents were checked and were found to be accurate. Through discussion with the director it was established that some resident’s money is money pooled into one account and that the home has investigated opening individual savings accounts but has experienced difficulty. The home is required to ensure that individual savings accounts are established and it is noted that this was identified for action at the inspection in January 2004. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 19 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 standard(s) 24,25, 26, 29 and 30 Recent investment has improved the appearance of this home, however systems need to be put in place to reduce the risk of infection. EVIDENCE: All bedrooms are single rooms with en suite facility that includes a shower. The home has large spacious corridors and a variety of communal spaces. Level access is provided throughout the home and to the garden. A recent refurbishment programme has improved the internal appearance of the home and a selection of bedrooms observed had been redecorated. Five residents spoke of their satisfaction with their bedrooms. Fire doors that were identified as needing repair/replacement by the fire officer in December 2004 and in the subsequent CSCI report in March 2005 have now been repaired/replaced. The fire officer visited the home in May 2005 and is satisfied with fire safety provision within the home. Two visitors reported that their friend had encountered difficulty with the new style doors due to their limited vision, this was discussed with the acting manager in the presence of the inspector and an alternative bedroom was offered. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 20 Due to the replacement of bedroom doors, keys have not yet been issued to those residents who request a key to their rooms however the acting manger confirmed that this is in hand and all the new keys were observed. During a tour of the premises it was observed that in some en suite facilities the marking on the top of the tap to indicate whether the tap was hot or cold was missing. The home has recently had a complete new central heating system however records of hot water temperature recordings throughout the home in June 2005 showed that hot water outlets at wash hand basins ranged from 37 to 40 degrees centigrade. On the day of inspection temperatures from a random selection of hot water outlets were found to range from 34 degrees to 46 degrees centigrade. The registered person is required to ensure that temperatures are maintained close to 43 degrees centigrade. The temperature from a cold-water tap in Room 12 (Yellow wing) was recorded by the inspector at 32 degrees centigrade and the registered person is required to establish the reason for this temperature deviation. Although it is acknowledged that all bedrooms have en suite facilities, two members of staff did report that residents sometimes require bedpans. Bedpan macerators are fitted in three sluice rooms however these were all observed to be out of order. This was identified for the registered person to take immediate action to either repair or replace these macerators during a visit to the home by CSCI in December 2004. Residents have unrestricted access around the home and the grounds and this was observed during the inspection. The main reception area was observed to be regularly left unattended and this has been previously been identified by CSCI for action by the home. The home must provide a safe and secure entrance to the home and establish a system of monitoring which residents are in the building. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36 The majority of staff do not have the skills and competencies that are required to meet residents needs. EVIDENCE: Discussion with care staff and observation of the home’s training matrix confirms that care staff have attained or are in the process of attaining NVQ Level2 and some care staff are studying for Level3. Recent observation of staff training records by CSCI identified deficits with staff skills and competencies. Although the home has started to address deficits in training such as in the provision of training to meet the needs of people with a learning disability, further training is still required in other specialised services offered. Observation of the training matrix confirms that staff receive regular training in caring for people with Huntington’s disease and that training provided by the British Institute of Learning Disabilities (BILD) has commenced. Three staff members spoke positively of the training provided by BILD and that they had learnt a lot. Staff have not received training in caring for individuals with physical disabilities or with acquired brain injury. Four relatives were satisfied with care provision and one relative had documented on their comment card “ my Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 22 relative is treated well by management, seniors and carers”. However five relatives expressed concern to the inspector that some staff do not appear competent in their role and one comment card received prior to the inspection stated “ far too much time and energy is wasted by staff looking for further instruction, seemingly unable or reluctant to find work within the scope of their ability.” Several members of staff also spoke of their concerns regarding the abilities of some members of staff. The inspectors observed differing staff competencies during the inspection with some members of staff appearing competent and confident in their work, demonstrating empathy and kindness in their approach with residents. Other staff members appeared less competent and appeared to lack motivation. Relatives praised the abilities of one particular member of care staff and this was fedback to the individual during the inspection. Observation of care files and the incident file show that some residents exhibit challenging and/or aggressive behaviour and staff are required to receive training in this area. Staffing levels within the home have previously been discussed with CSCI and observation of the staffing rotas confirms that levels on the rota meet the previously agreed minimum levels. Five residents that were able to communicate their needs felt that staffing levels were appropriate to meet their needs. However four relatives that had completed comments cards prior to the inspection had indicated that there were not always sufficient staffing levels and one relative had commented, “Call bells are not answered quickly enough”. On the day of inspection the home was not full, however as previously identified in this report lounge areas were frequently left unsupervised. The registered person is required to keep staffing levels under review and that levels are based on the need and dependency of service users and the layout of the home. This standard will be assessed again at the next inspection The acting manager provided induction documents that have recently been acquired by the home, however a newly appointed member of staff was unable to confirm that they had received this induction programme, therefore this standard will be assessed at the next inspection. Supervision records show that formal supervision has recently commenced for carers but has not yet started for registered nurses. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 40, 41 and 42. The home does not fully promote and safeguard the health, safety and welfare of the people using the service. The system for resident consultation is poor with little evidence that the views of residents and/or their representative are sought or acted upon. EVIDENCE: The acting manager has applied to be the registered manager of Wrottesley Park House and is currently awaiting assessment of her suitability via CSCI. It was established through discussion with visitors and the acting manager that relatives and residents meetings have not been held. Eighteen residents had indicated that they wish to be more involved in decision making within the home on the comments cards received prior to the inspection. The acting manager was advised to consider different forums to enable residents and Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 24 relatives to voice any concerns such as allocating a specific afternoon per week to be available to deal with relative’s queries or concerns. The acting manager confirmed the staff meetings have been held, however minutes of these meetings could not be located during the inspection. The director and acting manager confirmed that the home does not have a quality assurance system in place therefore there is no system in place to monitor the quality of the service provided other than monthly visits by the director. Introduction of a quality assurance system was identified for action at the inspection in July 2004. Due to negative feedback received from relatives/visitors and one resident both before and during the inspection regarding the home’s owners it is strongly recommended that the registered person arranges to meet with friends and families of residents. As previously identified earlier in this report the home has policy and procedure files from three different companies and there was some confusion between the acting manager and director as to which documents should be in use. Discussion with four members of staff identified that staff are not aware of where to locate policies. During a tour of the premises entries from old care records were located in files that were not kept securely on Brown wing and it is noted that an immediate requirement notification was made during a visit to the home in April 2005 regarding secure record keeping. All risk assessments contained within a file marked “ Risk Action Assessments for Wrottesley Park, September 2004” were found to be specific to another named care home and did not relate to Wrottesley Park House, this was brought to the attention of the acting manager and director. Therefore the home does not have any up to date risk assessments regarding safe working practice topics. Observation of a bed rail risk assessment that is used by the home documents that “bed rails are fitted with their own unique number”, however observation of bed rails during a tour of a premises found this not to be the case. One incident documented in the incident file indicates that bed rails were not fitted correctly to a resident’s bed and one bed rail observed in use during the inspection was observed to be bent. The home must ensure that staff that are involved in the fitting of bed rails receive appropriate training and that the general maintenance of bed rails is incorporated into a general planned preventative maintenance programme. Two cupboards used for the storage of cleaning fluids and the lift motor room were found unlocked and were therefore accessible to residents; an immediate requirement notification was issued during the inspection. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 25 Observation of the maintenance file demonstrates that most equipment has been serviced recently. However the director was requested to forward to CSCI a copy of the most recent Gas Safety Certificate as this was not available and provide written confirmation that remedial works identified on the lift service report have been completed. Observation of the incident file identified that accidents and incidents had not been reported to CSCI and there was no evidence to identify follow up action taken after each incident. The system for the recording of accidents does not conform to the Data Protection Act and the home is required to obtain an accident book that conforms to the legislative requirement. The home is advised to include the auditing of accidents as part of its quality assurance monitoring. Discussion with staff confirmed that fire safety training has been provided via a self-assessment and video package and the acting manager provides moving and handling training. The training matrix identifies that not all staff have received training in first aid and food hygiene and the acting manager confirmed that training in infection control has not been provided. . Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 26 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 2 2 3 1 Standard No 22 23 ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 x x 2 1 Standard No 11 12 13 14 15 16 17 x 2 3 2 x 2 3 Standard No 31 32 33 34 35 36 Score x 2 2 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wrottesley Park House Nursing Home Score 2 2 x x Standard No 37 38 39 40 41 42 43 Score x 2 1 1 1 2 x E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA 1 Regulation 4, Schedule 1 Requirement The statement of purpose must be reviewed at regular intervals to ensure that the document reflects the current situation and includes all of the information as outlined in Regulation 4, Schedule 4. (Previous timescale of 21/07/04 not met) The service user guide must be readily available for current and prospective service users and their representatives. The guide must be available in an appropriate format. ( Previous timescale of 21/07/04 not met) New service users are only admitted on the basis of a full asessment, the assessment must take into account specific condition related needs, specialist needs and management of risk. The registered person must confirm in writing to the service user that the care home is suitable for the purpose of meeting needs. The registered person must ensure that all staff have the necessary skills, knowledge and understanding to offer a quality Timescale for action 1/09/2005 2. YA 1 5 1/09/2005 3. YA 2 14 (1) 1/09/2005 4. YA 3 14 (1)(d) 1/09/2005 5. YA 3 YA 32 18 (1)(a)(c) 1/10/2005 Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 28 6. YA 5 5 (1) 7. YA 6 15 (1) 8. 9. YA 6 YA 6 16(m) 15 10. YA 9 13 (4)(b)(c) 11. YA 9 13 (4)(b)(c) 12. YA 9 13 (4)(b)(c) 16 (n) 13. YA 14 service to all service users (Previous timescale of 21/07/04 not met). Each service user must be given a written contract/statement of terms and conditions with the home. This must be developed and agreed with each service user ( Previous timescale of 21/07/04 not met). The registered person must ensure that all assessments and care plans are accurate and do not include inconsistent and conflicting information ( Previous timescale of 21/07/04 not met). Care plans must include all aspects of personal and social support. The registered person must involve the service user and/or their representative in the care planning and review process. Risk assessments must be completed for service users that are assessed as requiring bed rails. Permission for use must be obtained from the service user and/or their representative. Identified risks and hazards must be adequately assessed and include the strategies needed to minimise risk.(Previous timescale of 21/07/04 not met) Service users that choose to mobilise in wheelchairs without footplates must have a risk assessment completed. The registered person is required to review the provision and frequency of activities to ensure that all residents including those with complex needs and/or sensory impairment are offered age appropriate activities. Residents with complex multiple disabilities must be offered specialist interventions by 1/09/2005 1/09/2005 1/09/2005 1/10/2005 Immediate. 1/09/2005 1/09/2005 1/10/2005 Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 29 suitably qualified staff. 14. YA 16 YA 26 12 (4)(a) All service users must be offered a key (or suitable locking device) to their own bedroom. The reason not doing so must be recorded in the care plan (Previous timescale of 29/07/04 not met- observed to be in progress). The home must ensure that the lounge areas are not left unsupervised. Aids and adaptations must be assesed by a suitably qualified person such as an occupational therapist. Service users consent to medication must be obtained and recorded in the individulas plan of care.(Compliance not assessed-previous timescale of 29/07/04). Risk assessments must be undertaken for all service users receiving medication where there are identified problems swallowing (Compliance not assessed-previous timescale of 29/07/04). The service users wishes concerning terminal care and death are discussed and carried out, a record must be kept on the care plan ( Previous timescale of 29/07/04 not met). The complaints procedure must be reviewed and updated and in a format suitable for the service user group. A written copy of the complaints procedure must be given to every service user and/or their representative. The registered person must ensure that the home has an adult protection policy and a copy of the local adult area policy. All staff must receive 1/10/2005 15. 16. YA 16 YA 18 18 (1)(a) 14 (1)(a) 23 (2)(c) 12(2) 1/09/2005 1/10/2005 17. YA 20 1/09/2005 18. YA 20 13 (4)(a)(b) 1/09/2005 19. YA 21 12 (2)(3) 1/09/2005 20. YA 22 22 1/09/2005 21. 23 13(6) 1/10/2005 Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 30 22. YA 23 20 (1)(a) 23. YA 24 13(4)(c ) 24. YA 30 13(3) 13(4)(c ) 25. YA 30 13(3) 26. YA 32 18(1) 27. YA 32 18(1) 28. YA 33 18(1) 29. YA 31 12(1) training in adult protection/abuse awareness. The registered person must facilitate service users with a bank account for their savings. Savings must not be pooled (Previous timescale of 31/05/04 not met). The home must provide a safe and secure entrance to the home and establish a system of monitoring which service users are in the building. The registered person must ensure that hot water outlets temperatures are maintained as close to 43 degrees centigrade and establish the reason for the deviation of the cold water temperature in Room 12 (Yellow Wing).Taps in service user bedrooms must indicate which is hot and cold. The registered person must ensure that the bedpan macerators are either repaired or replaced (Compliance not metprevious immediate requirement). The registered person must ensure that all staff have the skills and competencies to meet residents needs, including specialst needs ( previous timescale of 21/07/04 not met). The registered person must ensure that all staff receive training in dealing with violence and agression. The registered person must ensure that staffing levels are kept under review and that levels are based on the need and dependency of service users and the layout and purpose of the home. All staff must be issued with a job description linked to 1/10/2005 1/10/2005 1/10/2005 1/09/2005 1/10/2005 1/11/2005 1/10/2005 1/09/2005 Page 31 Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 30. YA 34 19 Schedule 2 (5) 31. YA 34 Schedule 2: (7)(a)(b) 32. YA 35 18(1)(c ) 33. YA 36 18(2) 34. 35. YA 38 YA 33 YA 39 21(2) 24 36. YA 40 Schedules 1 and 4 achieving the service users indivdual goals (Compliance not assessed -previous timescale of 21/08/04). The registered person must ensure that two satisfactory written references are obtained prior to indivdual commencing employment ( Compliance not assessed-previous immediate requirement). All CRB Disclosures must be scrutinised following receipt and appropriate action taken if convictions and cautions become evident (Compliance not assesed-previous immediate requirement). All staff must have an individual training and development programme and the appropriate courses arranged (Previous timescale of 21/07/04 not met). All staff must receive formal recorded supervision at least 6 times per year (Previous timescale of 21/07/04 not met) Regular staff meetings must take place these must be recorded and actioned. The registered person must ensure that effective quality assurance and monitoring systems are in place. An annual development plan can then be implemented for the planning , action and review of the service (Previous timescale of 21/07/04 not met). The registered person must ensure that staff have up to date copies of, and understand and apply all policies and procedures and codes of practice. To avoid any confusion the registered person must identify which policies and procedures are in use by the home. 1/09/2005 1/09/2005 1/09/2005 1/10/2005 1/10/2005 1/10/2005 1/09/2005 Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 32 37. YA 41 17 38. YA 42 13(4) 39. YA 42 18 (c )(i) 23(2) (c ) 40. YA 42 13(4) 41. YA 42 37 42. 43. YA 42 YA 42 17 12(1) 18(1) 13(4) 44. YA 43 25 The registereed person must ensure that all individual records are kept secure (Compliance not met-previous immediate requirement 8/04/05) The registered person must ensure that risk assessments are conducted on all safe working practice topics, these must be kept under review and actioned. The registered person must ensure that staff involved in the fitting of bed rails receive appropriate training and that the general maintenance of bed rails is incorporated into a general planned preventative maintenance programme. The registered person must ensure that cupboards containing cleaning solutions and the lift motor room are kept securely locked. All accidents, injuries, incidents of illness or communicable disease or death must be recorded and reported to CSCI (Compliance not met-previous immediate requirement). Accidents must be recorded in a format that conforms to the Data Protection Act. All staff must receive induction and foundtaion training to meet TOPPS/Skills For Care specification on all safe working practice topics.(Previous timescale of 21/07/04 not met) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home( Not assessed-previous timescale of 21/07/04) 1/09/2005 1/10/2005 1/09/2005 Immediate. Immediate. 1/10/2005 1/10/2005 1/09/2005 Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard YA 6 YA 6 YA 22 YA 30 YA 38 YA 39 YA 40 YA 39 Good Practice Recommendations The home is advised to review the procedure for recording daily care needs. The home is strongly recommended to provide a description of the actual one to one care provided within the care plan. The home is advised to devise a system of logging complaints detailing the action taken and outcome. The home is advised to commence regular monitoring of cold water temperatures to ensure that temperatures are maintained below 20 degrees centigrade. The acting manager should consider different forums to enable residents, relatives and staff to voice any concerns. The registered person is strongly recommended to meet with the friends and families of residents. It is recommended that staff sign to acknowledge that they have read policies and procedures. It is recommended that the home includes audits of accidents, complaints as part of the quality assurance monitoring. Wrottesley Park House Nursing Home E56 000036983 Wrottesley Park House v229897 AI 140705 Stage 4.doc Version 1.40 Page 34 Commission for Social Care Inspection 2nd Floor, St Davids Court Union Street Wolverhampton WV1 3JE 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. 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