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Inspection on 19/05/06 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 19th May 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 49 statutory requirements (actions the home must comply with) as a result of this inspection.

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

There was nothing apparent to inspectors during this visit to indicate that anything is being well.During an additional visit to the home in April 2006 one resident described the home as "ten out of ten" and stated that he "wouldn`t find a better home", at the same visit two residents were clearly not happy with the level of care. At this inspection five residents approached inspectors and reported that they wanted to move out of the home as soon as possible, describing various instances within the home that have made them unhappy.

What has improved since the last inspection?

What the care home could do better:

It is considered that the failure to assess residents needs adequately, the lack of effective care planning sufficient for the specialist requirements of the people accommodated at the home and the lack of competent and well trained staff means that people living at Wrottesley Park are not receiving a quality service or one which meets minimum standards. Service users continue to speak of a lack of consultation regarding their care and daily routines; there is a lack of stimulation and people are not assisted to develop independence or social skills. Although it is apparent that the activity person is clearly committed to her role she can only work within the very limited resources available and with the support of other staff members; it does not appear to be recognised that it is a team responsibility to ensure people living at the home receive the stimulation, support and encouragement to pursue individual and communal social interests.The home is currently placing service users at risk through inadequate staff recruitment, training procedures, poorly maintained care documentation, ineffective communication channels and failure to ensure safe working practice To repeat previous reports, there is a serious need for the provider to take urgent action to meet requirements to work towards the home being "fit for purpose" and able to meet its stated aims and objectives as a "specialist" nursing provision for younger adults.

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 19th May 2006 09:15 Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 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.V293723.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V293723.R01.S.doc Version 5.1 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.V293723.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 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.V293723.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted by three inspectors for the duration of one day. As at previous inspections the inspectors focused on individual areas but have cross-referenced 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. Inspectors spoke with staff, service users and visitors, examined records and observed practice and the environment. The acting manager and regional manager remained on the premises throughout the day and were present for feedback at the end of the inspection. Although it was identified that some improvements have occurred to the environment and in particular the bathrooms and en-suites, CSCI remain concerned about the home’s performance and for the safety, welfare and quality of life of the people placed there. In 2005 CSCI became increasingly concerned with how this home was operating and following an inspection to the home on 16th December 2005, four statutory notices were served 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. An inspection in January 2006 and a visit to the home in April 2006 evidenced that service users were being placed at significant risk of harm and confirmed that the Registered Provider had not complied with the notices. 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. What the service does well: There was nothing apparent to inspectors during this visit to indicate that anything is being well. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 6 During an additional visit to the home in April 2006 one resident described the home as “ten out of ten” and stated that he “wouldn’t find a better home”, at the same visit two residents were clearly not happy with the level of care. At this inspection five residents approached inspectors and reported that they wanted to move out of the home as soon as possible, describing various instances within the home that have made them unhappy. What has improved since the last inspection? What they could do better: It is considered that the failure to assess residents needs adequately, the lack of effective care planning sufficient for the specialist requirements of the people accommodated at the home and the lack of competent and well trained staff means that people living at Wrottesley Park are not receiving a quality service or one which meets minimum standards. Service users continue to speak of a lack of consultation regarding their care and daily routines; there is a lack of stimulation and people are not assisted to develop independence or social skills. Although it is apparent that the activity person is clearly committed to her role she can only work within the very limited resources available and with the support of other staff members; it does not appear to be recognised that it is a team responsibility to ensure people living at the home receive the stimulation, support and encouragement to pursue individual and communal social interests. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 7 The home is currently placing service users at risk through inadequate staff recruitment, training procedures, poorly maintained care documentation, ineffective communication channels and failure to ensure safe working practice To repeat previous reports, there is a serious need for the provider to take urgent action to meet requirements to work towards the home being “fit for purpose” and able to meet its stated aims and objectives as a “specialist” nursing provision for younger adults. 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.V293723.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 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 the following standard(s): 1, 3, 4 and 5. The quality outcome for this area is poor. The statement of purpose that has been supplied to service users does not reflect the current service provided to the people in residence. The home is unable to meet the diverse needs of the people accommodated. 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. The registered person has made no attempt to discuss the draft document with CSCI or confirmed that this is the document to be used. During the case tracking activity undertaken as part of this inspection it was noted that service users have been provided with a copy of the Statement of Purpose in addition to a Service User Guide and these were seen held in service users own bedrooms. The Service User Guide has not been developed in an appropriate format for service users with communication difficulties. A perusal of the documents and observation made by all three inspectors evidence that the Statement of Purpose and Service User Guide are not a true reflection of the service currently offered. For example the admission criteria within the Statement of Purpose states that Wrottesley Park House Nursing Home admits clients with “significant sensory, learning, and physical disabilities”-the home is not registered with CSCI to admit individuals with sensory impairments without first formally applying to CSCI for consideration Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 10 to vary their registration to offer this specialist service. Previous visits to the home have identified that individuals have been admitted outside their category of registration and without a full needs assessment being undertaken. The statement of purpose documents that; “The home works with the current philosophies of care using a person centred approach to address issues such as choice, privacy, independence… these principles should be respected in the service users plans and in the way that the care is delivered’ and the home aims to “recognise the individual need for personal fulfilment and offer individualised programmes of meaningful activity to satisfy that need of service users and staff”. This report and previous inspections identify that individuals placed at the home are not receiving a service that is person-centred and individual wishes, choices and aspirations are generally not respected or met, thus the statement of purpose is not a true reflection on the service provided. The length of trial stay documented in the service user handbook states ‘The first month of stay is on a trial basis’. This is not in line with National Minimum Standard 4.3, which states a minimum three month ‘settling in’ period of residence is offered for long-term placements followed by review. Contracts between the home and each individual were seen on the files of the people case tracked and these were signed and dated by the service user or their representative and the management. There have not been any new admissions to the home for sometime, therefore the home’s pre-admission assessment process could not be fully assessed and the admissions procedure could not be discussed with residents to establish their views on the process. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 8 and 9. The quality outcome for this area is poor. Care planning systems continue to be inadequate, potentially placing service users at significant risk. The home is failing to involve services users in decision-making processes and people at the home are not protected by the risk management strategies currently in place. EVIDENCE: Since the last inspection the home has implemented a fluid intake/output and positioning chart called “daily care and intervention”, which has replaced some of the carers daily record books with the intention of providing clearer information. Of the people case tracked it was evident that these forms are being inappropriately used and demonstrates training issues need to be met when new systems are launched. The forms were also noted to be in place for some individuals who do not require such clinical documentation. Entries recorded included ‘out to the shops, ‘up and about’, ‘out with social worker’, ‘walking around’, ‘blood sugar low’ pad changed,’ ‘checked,’ ‘sat in lounge,’ ‘Showered’. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 12 There was clear evidence that one individual admitted to the home in November 2005 had been regularly reviewed by the placing authority and minutes of the reviews held at the home were available. Minutes of a review held in December 2005 evidence that the service user, a representative from the home, advocate, social worker and health care professionals attended the reviews. The minutes highlighted a number of concerns and shortfalls in relation to lack of activities, community presence and participation and that the home was failing to meet the communication needs of the individual concerned. It was also stated that concerns were raised as to whether the service user is getting the care and attention she needs. A further review was held in February 2006 and concerns were raised regarding the TV in the lounge being constantly on, no social interaction between peers and that the service user is ‘sucking on her clothes and cuddly toys which may be as a result of boredom’. Various suggestions of modifying the behaviour were given and advice on contacting the Behaviour Support Service should the behaviour not improve. Observations made during the inspection evidence that the behaviour had not improved. The care plan developed and implemented by the home was not consistent with the Community Care Assessment and review documentation and lacked essential information in relation to the individual’s personal preferences, communication and social needs. The care plan of another person case tracked was reviewed in December 2005. A Waterlow risk assessment was found in place with evidence of monthly review. The person was assessed as scoring 12 which is classed as ‘high risk’ however there was nothing stated in the action to be taken. There was poor evidence of monitoring of specific health related needs and the person’s dietary intake resulting in a number of recent hypoglycaemia incidents. It was reported that the home has a residents committee to air “their views” however observations made and records seen demonstrate no evidence of how service users are enabled to participate in decision making processes particularly the individuals who are unable to communicate their preferences. It was clearly identified in a “communication passport” compiled by the placing authority that the person does not like wearing shoes or slippers unless going out. However the person, who is unable to verbally communicate, was observed during the inspection to be wearing shoes. A number of risk assessments were seen on the files of the people case tracked however a risk assessment for an individual who makes hot drinks was unavailable nor was an assessment completed for footwear that one person chooses to wear that has resulted in an accident. Records evidence that not all activities accessed by individuals has been assessed. An in depth look at the care records of three people with changing complex needs was carried out. Although there was evidence that the care plans had been reviewed since the last inspection, significant shortfalls were found in care assessments. What Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 13 was written down did not match what was observed to be the peoples’ actual needs or how the person was actually being cared for. Although the management team confirmed that assessments of people at the home needed to be carried out as people’s needs changed, this in fact is not happening. From observation of care delivery, the rooms where these people were accommodated, and equipment seen used for such people, many shortfalls in care practice and delivery were seen. For example: • The records of an already overweight resident who had gained over four stone since November 2005 did not have a care plan to manage this issue. The Feeding assessment for this person was ticked ‘no’ in the not gaining too much weight section. Although a specific hoist was identified to move her, there was no reference to her wheelchair requirements to enable her to socialise safely. • The care delivery of a person with a deep pressure sore was seen to be compromised by a lack of appropriate pressure relieving equipment when sat out in the chair. • Poor needs assessment and monitoring of a person who had to be hospitalised for vomiting and severe constipation show the person did not have a care plan to monitor the episodes of regular vomiting experienced at least two months prior to admission to hospital. There was no specific care plan for this matter, nor was there written information seen to show that the home closely monitored the weight and dietary intake and output of the person during this time. Although the daily report documented attempts to liaise with the dietician for this person, this information was hard to follow as it was not written in chronological order, some entries had been defaced, and on two occasions there were no entries at all for the care the person received. Furthermore, when the person was discharged from hospital, there was no evidence to show the care records had been updated to monitor the new bowel management regime advised by the hospital. Further examples of inadequate practices are recorded throughout this report Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 14 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. Service users are not provided with opportunities to lead a positive lifestyle. EVIDENCE: The National Minimum Standards covering ‘Lifestyles’ were assessed at the inspection undertaken on 16th December 2005. A review of the requirements made, discussions held with a number of service users and observations made evidence minimal improvements in providing people with a positive lifestyle. Although a second part-time activity organiser has been appointed she was off sick at the time of the inspection. Discussions held with the other activity organiser indicate that she is clearly committed to her role but can only work within the very limited resources available and with the support of other staff members. She continues not to be provided with a base to work from. A budget allocated for activities and resources is still to be formally agreed by senior management however it was reported that the new manager is committed to ensuring the availability of a budget. Discussions held with a number of service users, examination of care records and observation throughout the day of inspection evidenced there continues to be minimal opportunities for life skills development. It is evident that staff lack Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 15 the basic skills for communication with non-verbalising service users. Staff were unable to locate a communication book for one individual case tracked that had been developed by a professional from the placing authority. The book enables the person to make basic choices using a pictorial format. Concerns were also expressed by the persons advocate during a review and recorded in the minutes of the meeting. Assessments and care plans continue to lack sufficient information for staff to enable service users to maintain or develop social, emotional, communication or independent living skills. A small number of service users attended a church service held at the home on the morning of the inspection and a large group of people participated in a lively game of skittles in the afternoon with the activity organiser. The staff member supported individuals with a variety of needs and demonstrated patience and a good sense of humour to keep people engaged in the activity. Although the activity organiser was able to share events and activities that people have opportunity to access, it is evident that she is unable to meet the huge diversity of needs of the people accommodated within the time allocated. It does not appear to be recognised that it is a team responsibility to ensure people living at the home receive the stimulation, support and encouragement to pursue individual and communal social interests. Observations evidence that the care staff do not have the time to socially interact or provide stimulating activities. One service user spoken with stated “I am climbing the walls here with boredom”. Many service users were seen left wandering around the home or sat in front of the TV unsupervised for long periods of time. The Service User Guide states ‘Service users will be enabled to achieve their potential capacity. Individuals will be given support and freedom to realise personal aspirations and abilities in all respects of personal life’. One staff member spoken with commented; “Quality time is lacking”. Service users do not appear to have had an annual holiday outside of the home as specified in National Minimum Standard 14.4. Discussions held with visiting relatives indicated that improvements have been made under the new manager and that staff appear happier. However two relatives expressed their concerns in relation to lack of activities and people being left unsupervised for long periods of time. One person said that she is made welcome by some staff and that she is able to make a drink if required. It is stated in the homes Statement of Purpose that ‘Contact with family and friends is strongly encouraged this is done by letters home and phone calls where appropriate’. One service user spoken with felt more could be done in maintaining relationships with friends from her previous placement. Observations indicated service users are able to see their visitors in the shared areas or in the privacy of their own room. One service user reported that she had made some friends in the home. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 16 Staff were observed to knock on doors to service users rooms prior to entry and mail was delivered unopened to the people who required no assistance in this area. As previously stated observations made and discussions held evidence that daily routines do not promote independence and that the home is failing to adopt person centred approaches as stated in the homes Statement of Purpose. Service users are provided with unrestricted access to the home and grounds and rules regarding smoking are documented and a risk assessment was available on one of the files reviewed. One service user stated ‘Mealtimes are a riot with people shouting and swearing and the food needs to be improved’. Observations made over lunch indicated room for improvement. One person was seen to throw a plate and glass across the room smashing the glass and was then removed from the dining room screaming and swearing. This obviously caused anxiety to a number of people eating lunch. The inspector was advised that the person does not like to be kept waiting for her lunch. The individual concerned was later returned to the dining room. Staff failed to offer one individual lunch until 1.20 pm. The person requires assistance with eating and when eventually offered assistance the individual declined because there was nothing left that she liked. She reported that she often purchases her own food as she dislikes some food offered. Another service user stated “I would love a curry”. As previously stated the home is failing to effectively monitor individual’s dietary needs in relation to specific conditions such as diabetes and obesity. Other service users who required support from staff with their eating were assisted appropriately in the dining room. When a nurse introduced a resident being case tracked to the inspector, in the main lounge, the individual’s teeth were seen to be coated with dried on debris. The nurse immediately noticed this and assisted the lady back to her room to clean her mouth. This issue highlighted shortfalls in ongoing monitoring of care delivery throughout the day. However, in various parts of the home where residents were being cared for in bed, there was no evidence of quality time being spent with these people. Observation of one lady’s lack of well being triggered inspectors to have an in depth look at her care records to explore what lifestyle she had in the home The person was seen to be lying in bed staring at the ceiling. Bare walls were adjacent to her bed space and although a miniature TV was turned on – it was a long distance from her bed. The lady was not wearing her glasses even though her care plan stated they must be worn at all times. Discussion about this individual with the management team at the end of the inspection confirmed this person had only recently been transferred to that particular bedroom – this shows lack of planning by the care team to prepare the room to meet the needs of this person. Discussion with staff members, observations Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 17 from care delivery as well as from examination of her records confirmed that the individual stays in bed until early evening to have some quality time in her chair for a few hours when visitors came. Several other individuals were seen sitting around the home not being engaged or encouraged to participate in pastimes they might be interested in. Residents who were completely reliant on the staff team for their personal safety were seen to demonstrate negative body language when they were in the presence of other residents who were demonstrating disruptive challenging behaviour. However, it is positive to comment that one male carer was seen to sensitively assist an individual to rearrange her clothing to preserve her dignity. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 18 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 and 19. The quality outcome for this area is poor. Personal support is not offered consistently in such a way as to promote and protect service users privacy and dignity. Current poor practices are having a detrimental affect on the health and wellbeing of service users. EVIDENCE: Although some satisfactory practice was observed, inadequate care practices were also seen being carried out. For example two members of staff were observed on separate occasions using inappropriate techniques for transferring service users from a chair to wheelchair. There appears to be a marked difference between the care that it is needed and what is actually carried out. • For instance, people with complex needs do not receive necessary care to prevent pressure areas. Records of one person show that on three separate occasions staff had written concern about deterioration in the person’s skin condition on her bottom. Although recordkeeping also confirmed that she was at very high risk, no pressure relieving equipment was seen identified for use or actually being used to prevent any sores from occurring. The outcome of discussion of this issue with the management at the end of the inspection confirmed that this shortfall had not been recognised, as the person’s assessment was not Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 19 • • correct. This does not justify lack of actions carried out by the care team who observed deterioration of skin integrity on three separate occasions. Not enough detail in care records and guidance for staff means the individuals seen were not being safely cared for, or have all their current medical conditions fully met. In two sets of records some of the written information conflicted with itself in different parts of the care plan, especially with regard to weight monitoring. When contact with a resident had been made through a visiting consultant to the home, it was seen that this event had not been managed effectively. The consultant’s letter dated March 20th to account for the visit, stated the person’s weight was stable, when in fact the person had lost a considerable amount of weight in the previous month – 5kg. Furthermore, the person who had recorded the visit in the Multi disciplinary Team management sheet had recorded ‘no changes’ when in fact the consultant recommended medication adjustment. There were no further entries in the person’s records to confirm the consultants written instructions were carried out. This reflects similar incidents reported at the inspection of January 2006. Although some satisfactory initial information for moving and handling assessments was seen recorded in care plans, when this information was reviewed, necessary details were not included to ensure people would continue to move and handle people safely. Furthermore, in the records of a resident weighing over 26 stone, there was no emergency strategy to safely lift the person should she experience a fall, or if the hoist designated to safely move her, broke down. The records for a person that had fallen from a shower chair were looked at during an additional visit to the home in April 2006 and these records were looked at again during this inspection. It was found that the records had not been amended to provide clear guidance to staff on the correct equipment that should be employed for the purpose of showering this individual; this is despite verbal feedback to the acting manager at the time of the visit and written communication to the registered person. There was a lack of evidence seen in records to show that contact with specific professionals or resources had been made to maximise peoples potential for living with life long conditions. There was no specific information in the records for people who had Huntington’s Chorea and Multiple Sclerosis. Care plans did not account for how the full impact the medical conditions these people had affected them. Furthermore there was a lack of documented support for the person and families from specialist organisations for such medical conditions, to ensure all needs were being met. Out of all the various entries of care delivery seen, the management team were informed that written entries made by two particular members of staff were very informative and clear. This demonstrates that some staff have positive awareness of their roles and responsibilities. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 20 The CSCI pharmacist inspector visited Wrottesley Park House Nursing Home three times in 2005 due to concerns regarding medication practices and he will be returning to the home to establish whether improvements have occurred. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 21 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): 23. The quality outcome for this area is poor. Staff have not responded appropriately to recorded 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 file was not available at this inspection or at the recent additional visit to the home and it was reported that the registered person currently has the file. A recorded monitoring visit by the regional manager in March 2006 details that two complaints received by the home have been investigated with a satisfactory response by the manager; due to the file not being available the outcome of these complaints was unable to be explored during the inspection. Residents, relatives and other healthcare professionals continue to raise concerns with CSCI regarding how this home is operating. A copy of the local area adult protection procedure was readily available and discussions with the acting manager confirmed her awareness that this protocol is currently being updated. Despite some staff receiving training in adult protection/abuse awareness, observations made at this inspection indicate that this has not heightened their awareness in reporting incidents of injury such as bruising. During this inspection it became apparent that residents continue to sustain injuries that are not professionally acted upon, staff do not follow correct Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 22 procedures or establish how injuries, such as bruising, has occurred. These concerns are similar to those identified in the November, December 2005 and January 2006 inspection reports. For example, when the variety of care records used by staff for one individual were looked at, in the time between February 1st 2006 and the day of the inspection, a total of 10 separate incidents of ‘injury of unknown origin’ were accounted for. Only two out of the 10 had been documented in the home’s accident/incident log. One particular incident of concern recorded in the daily report of the persons care describes that ‘there was extensive bruising to the back’ - which was not brought to the attention of the management team. Body maps/records of bruising as seen in other care plans case tracked had not been completed for this person. CSCI continue to be extremely concerned that the home has such a high level of recorded injuries sustained by residents, accompanied with no effective processes for investigating or addressing the causes. Furthermore, recordkeeping at the home showed that a major adult protection investigation had been triggered about one frail highly dependent person. CSCI had not been kept fully informed about this matter, despite regular contact with the home. Social Services had alerted the Commission to the issue. This is not the first occasion CSCI have not been notified of serious events affecting this particular resident’s well being. Since the last inspection in January additional visits have been undertaken following concerns that have been raised to CSCI. A recent event investigated as part of the adult protection process was triggered by concerns that a resident had been “dropped” in the shower. Observation of the individuals care records evidence that the individual had in fact fallen from a shower chair, the acting manager had initiated an investigation which evidenced that the staff providing the care had been unaware that a safety strap needed to be used when the person was seated in the shower chair. Another concern that had been expressed in respect of this individual related to unexplained bruising, a wound to one foot and lack of intervention by staff in caring for the individual’s hand and nails. Further examination of this persons care records evidenced that an investigation to establish how the bruising had been sustained had not been conducted, a wound care plan had not been initiated and a care plan to describe care of hands and nails was not present. Although financial arrangements for service users were not checked in full at this inspection, a resident has reported to an inspector that a member of staff acts as his “Power of Attorney”. In one of the policies sent to CSCI in conjunction with the home’s draft Statement of Purpose it is documented that “to avoid possible conflicts of interests, no employee may witness (sign) any Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 23 documents for a service user”. The registered person is strongly advised to seek appropriate advice regarding this particular resident and staff member. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 24 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. 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: Previous visits to the home identified that a lack of investment and refurbishment of the home had created an environment that was not pleasant and placed service users at risk from harm, of particular concern had been the state of residents bathing/showering facilities which included chipped and broken wall tiles in en-suites, offensive odour from drains, damaged floor covering, leaking shower hoses and excessive hot water temperatures. Inspectors arrived on the premises to find contractors on site and work in progress in bathrooms. It is positive to report that improvements to resident’s bathing and showering facilities has now occurred. During the inspection it was observed that the damaged flooring in the en-suites seen has been replaced and contractors were observed, replacing flooring in bathrooms. New shower hoses have been fitted and loose and broken wall tiles that had Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 25 previously posed a health and safety risk to residents have been replaced. There was no odour apparent within the en-suite facilities seen and a bedrooms was in the process of being decorated. Despite these improvements further investment is still required to improve the living accommodation. Carpets in some bedrooms remain badly stained; one room appeared to have several pieces of carpet joined together creating a particularly shabby appearance. Hard floor covering in the communal area on Yellow Unit has patches of mould growth and as mentioned in the December 2005 report is not anti-slip. One room observed during the inspection had extensive damage to the plasterwork on the walls and external brickwork immediately outside a newly built bedroom continues to have a significantly large area of damp. It was seen that some people had recently moved bedrooms. Little preparation was evident to show cosmetic efforts had been made to welcome people and help them settle in to their new rooms. Several rooms were littered with untidy boxes of medical equipment. Observations on a tour of the home confirmed that many bedrooms were seen to still be in disarray in the middle of the afternoon. Many parts of the home were untidy and demonstrated poor infection control standards. All feeding pumps in use by the home were observed to be dirty. Some residents have their own fridges in their rooms, however there appears to be no up to date cleaning schedule for these fridges and documentation attached to one fridge evidenced that the last recorded temperature check was in 2004. One resident was seen emptying bins from bathrooms and toilets into a bin liner and the individual described to the inspector how he likes to help the staff. Little consideration appeared to have been given to the potential health and safety risks for this individual especially as he was observed performing these tasks without wearing protective clothing. It was positive to see that a low level bed had been obtained for a person who previously slept on a mattress on the floor. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 26 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. 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: A requirement was made at the inspection in November 2005 for the home to deploy an additional nurse to ensure that the clinical and health needs of service users are fully met. Although the home has continued to deploy an additional nurse on a supernumerary basis, this appears to have had little impact as observations made at this inspection and during additional visits to the home evidence that service users health and clinical needs are not fully met. On the day of this inspection 41 individuals were residing at the home and staffing levels have been maintained at the same level as when the home is occupied at maximum capacity. Despite the home currently having a greater staff to resident ratio, residents continue to be observed in different areas of the home unaccompanied for long periods of time. Relatives and residents commented that there remains insufficient staff to attend to needs and as Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 27 previously mentioned in this report a member of staff commented, “quality time is lacking”. One resident reported to an inspector that they are not receiving 1:1 care for the amount of hours that the placing authority is funding for. At a recent additional visit to the home the acting manager had commented that none of the residents are in receipt of contracted 1:1, however at this inspection observation of this residents file showed that the placing authority is funding for 1:1 care. During previous inspections call buzzers have been heard ringing for significant periods of time, at this inspection it was apparent that call buzzers were answered promptly. This was discussed with the acting manager who commented that this was not necessarily due to a higher staff to resident ratio but described how she monitors call buzzers and that staff are aware that she will investigate if a call buzzer is left ringing. The staff files for three newly appointed members of staff were examined. Two of these files were complete and all the necessary pre-employment checks had been undertaken. One staff file was not complete and it was found that the individual had been appointed prior to a CRB disclosure/POVA First check being made, the application form was incomplete and it could not be established who the referees were and in what capacity they were known to the individual. Considering that deficits with the homes recruitment practices have previously been identified and for which the home was required to demonstrate compliance, the shortfalls described above show a lack of adherence to policy and place residents at risk from the employment of inappropriate staff. 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 suitably qualified, competent and experienced persons are working at the care home at all times; CSCI has not received any communication from the registered person to show how the home will comply with the notice. During the inspection in January 2006 the acting manager at this time was advised where she could locate examples of induction programmes. It is pleasing to note that at this inspection copies of completed “Skills for Care” induction programmes were present on the staff files seen. However the registered person will need to establish what proportion of staff should receive induction training specifically geared for meeting the needs of people with learning disabilities. The acting manager confirms that the majority of care staff have attained or are in the process of attaining NVQ Level2 in care and some care staff are studying for Level3. Observations made at this inspection and at other inspections to the home evidence that the staff group do not have the skills, competencies and experience to care for the diversity of the needs of the people accommodated. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 28 Although some training in awareness of the needs of people with learning disabilities has been provided, staff still appear to lack the basic skills for communication with non-verbalising service users, for example staff were unable to locate a communication book for one individual case tracked and appeared unaware that this communication aid enables the individual to make basic choices. Staff have received training in safe working practice topics and a list of training undertaken and planned includes; dementia, care planning, falls prevention and care of individuals with Huntington’s disease. As identified at previous inspections some members of staff appear competent and confident in their work, demonstrating empathy and kindness in their approach with residents. It is also evident that the competencies and qualities of some staff do not reach required standards. During a recent additional visit to the home one resident spoke of the helpful staff and described the home as “ten out of ten”, at the same visit two residents were clearly not happy with the level of care provided the home. At this inspection five individuals that were not part of the case tracking activity individually approached inspectors and reported that they wanted to move out of the home as soon as possible, describing various instances within the home that have made them unhappy. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 29 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. 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 two years. Since the last inspection a new manager has been appointed to the home, this individual is the fourth person to be appointed as manager in the past two years. An application form has not yet been received by CSCI in respect of this individual. The ongoing major shortfalls in the safe working systems in the home demonstrate lack of robust direction, motivation and monitoring of care delivered in the home. Poor recordkeeping in the care records seen shows inconsistencies that have not safeguarded the wellbeing of people. Necessary equipment seen in use to care for people was not being used appropriately and had not been maintained effectively such as: Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 30 • • • All mechanical feeding pumps were visibly soiled, and a half full bottle of sterile water was not dated to show how long it had been opened. As there was no signature on the MAR sheet for the water, there was no way of establishing if it was satisfactory to use. A pressure relieving mattress had been installed with its large control box upside down, which meant staff could not ascertain if it was working properly or appropriately set up for the person who was using it. Records for one person case tracked identified that inflatable bed protectors were in use, when in fact foam padding was seen in place on the bed. There was no information in the records seen to guide staff how to safely use much of the specialist equipment in use. It is noteworthy that the acting manager reports that efforts are being made to obtain operating instructions for many of the specialist chairs seen in use. However, this information was not seen reflected in care records looked at. As seen at earlier inspections, residents were observed being ‘taxied’ around the home in what the care team refer to as ‘sunken armchairs.’ Often the chair has the footstool attached making movement of this equipment more hazardous. This is an ongoing concern as this process is especially hazardous when carried out single-handed by a staff member. One resident was seen being transferred out of the dining room back into the lounge in this manner at unnecessary speed. 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. However, case tracking of people’s records highlighted this was not an accurate reflection of all accidents and injuries that had occurred in the home. • From February 1st 2006 it was written in a persons care records that 10 separate incidents of unknown injury were documented. Only two of these had been reported and recorded in this log. This means that possible serious injury has occurred to an individual who is not able to verbally communicate. On 9th February it was recorded that this person had ‘extensive bruising to her back’. Similarly, on another occasion in 21st March 2006, it was seen that this person had slipped from her chair as a result of her safety belt being loose. There is no information written down to show that preventative measures had been implemented to ensure the same accident did not happen again. • Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 31 • The manager had initiated an investigation following an incident where a resident had fallen out of a shower chair. It is disappointing to note that there was no documentary evidence available to indicate that an investigation had been undertaken following another incident involving the same individual falling out of a different chair. A written entry in the care record describes that the individual slipped out of chair “due to a fault with the belts which attaches the two pieces together”. When this was explored with the acting manager it was initially reported that the chair had not been fitted together properly, later during the inspection the deputy manager informed that someone may have knocked the chair causing the resident to fall out. There was no indication on this residents file to show that preventative measures had been implemented to ensure the same accident did not happen again. One resident’s records contained a “body map” dated 14th March 2006 showing an outline of bruising the length of the person’s inner aspect of her upper arm. There were no entries in the accident/incident book for this person at all. There was no evidence in the person’s records to show how this had been investigated. • During the additional visit to the home in April 2006 it was identified that the manager was not fully aware that CSCI must be notified regarding incidents and accidents in accordance with Regulation 37 of The Care Homes Regulations 2001; an inspector provided guidance in respect of this regulation. Since this visit the acting manager has been prompt in communicating with CSCI. The inspection on the 16th December 2005 described continued failure by the home to ensure the safety of service users particularly in the areas of access to hot water and the provision of bed rails. This led to statutory notices being served under Regulation 43 of the Care Homes Regulations 2001;the Registered Person failed to comply with both notices. During visits to the home in September, November and December 2005 and January 2006, inspectors measuring hot water temperatures at various outlets accessible to service users recorded temperatures in excess of 43°C. During an additional visit to the home in April 2006 a total of 96 hot water temperatures from outlets directly accessible to service users such as baths, showers and wash hand basins were checked. The temperatures from 64 of these outlets were recorded at more than 44°C, including 27 outlets that had temperatures in excess of 50°C, six showers had hot water temperatures in excess of 60°C and outlets from three baths had hot water temperatures in excess of 50°C. Six showers were found to have a spanner in place where the temperature regulator (thermostatic mixer) should be, which resulted in there being no means of adjusting the water flow or increasing/decreasing the hot water temperature. It is pleasing to report that at this inspection, a total of 31 hot water temperatures were checked and were found to have temperatures ranging from 38 to 45 °C -a significant improvement on previous inspections. New thermostatic mixer valves had been fitted to the showers, including those, Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 32 which previously had a spanner in situ. Some bathrooms were not checked, as work was clearly underway to replace damaged flooring in these areas. As previously mentioned a statutory notice was served following the inspection in December 2005 in respect of the unsafe fitting of bed rails. At the inspection in January 2006 bed rails that were observed were fitted correctly. During an additional visit to the home in April 2006 a significant number of bed rails checked had not been fitted in accordance with Medical Devices Agency and Health and Safety Executive guidance and had the potential to cause harm to the resident. At this inspection observations were made of twelve beds with bed rails attached. One set of bed rails observed had been fitted with a significant gap (22cm) between the end of the bed rail and the headboard, creating a potential entrapment hazard. At the time this deficit was observed the service user, who is highly dependant, was in bed with no staff present. The regional and acting manager were both informed and shown the incorrectly fitted bed rails. These were then attended to and re-adjusted by the maintenance person. Another set of bed rails were observed to be bent and slanting inwards, this was discussed with the acting manager who informed that the service user often pulls on the rails causing this to happen. Alternative systems need to be explored to ensure this residents safety whilst in bed. The Regulation 43 notice that was issued in respect of bed rails, required the registered person to provide, to the commission, a written protocol in line with Medical Devices Agency guidance which would ensure consistent application of guidance and safe provision - this has never been received. Staff have previously received training in the safe fitting of bed rails, therefore this continued failure to recognise incorrectly fitted bed rails suggests a lack of staff competence in being able to link theory with practice, poor monitoring systems and lack of guidance from senior management. Since the last inspection a smoke detector has been fitted in the new sluice room, a call buzzer has been fitted in the resident’s smoking room and a door guard fitted to the door of this room. As identified at the last inspection and at a recent additional visit to the home, the door to this room is kept open whilst residents are smoking and when no one is in the room. Residents report that this is because the fan is not efficient in this room, however this leads to the lounge area smelling of cigarette smoke and is a potential fire risk. Previous inspections have noted that numerous freestanding heaters were seen throughout the home, at this inspection only one heater was seen in a resident’s room, this had reportedly been provided by their relative due to the home being cold. Additional heating systems should not be necessary, as the home should provide suitable and sufficient heat. Staff appear more aware of the importance of asking for identification of visiting professionals on their arrival at the home and a coded lock fitted to the entrance doors, helps to provide a safe entrance to the home. The acting manager reports that the fire officer has approved the lock. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 33 Servicing and maintenance certificates that were checked during an additional visit to the home in April 2006 included portable appliance testing, servicing of passenger lift, emergency lighting, fire alarm and servicing of hoists. The Gas Safety Certificate was not available during this inspection, however a copy was faxed through following the inspection; this has previously not been available at inspections to the home. A fire safety risk assessment was observed but contained little detail and the manager was requested to contact the local fire officer for guidance and approval. The acting manager was advised to label feeding pumps with the name of the individual for whom they are intended and that it is good practice to include the type of pump/manufactures details within the care records. The home should also establish who takes responsibility for maintaining this type of equipment and the expected frequency for servicing. Recorded visits (as per Regulation 26) by the registered provider or nominated individual were not undertaken between October 2005 and March 2006: a significant omission considering the concerns raised during this period. Questionnaires had been sent out by the acting manager to residents and/or their representatives in March 2006 and results had been collated. Where respondents had provided negative feedback the acting manager reported that she had held discussions with these individuals, however there was no documentary evidence to support this. The acting manager was subsequently advised to record all discussions and processes employed to act on negative feedback. Recorded comments from the March survey echo similar feedback obtained during CSCI inspections including; “lack of interaction by staff-others excellent”, “lack of activities”, and a comment was made by an individual that indicated a lack of monitoring of their relative’ s bowel movements which created problems. Staff questionnaires have reportedly been sent out. Copies of staff minutes evidence that the acting manager has followed up on concerns, for example the minutes for a meeting held in April 2006 document that staff are not allowed to sleep on duty, on the morning of this inspection the manager had come in early for the purpose of conducting a “spot check” to ensure that this was not happening. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 34 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 1 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 1 30 2 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 X X 1 X 2 X 1 1 X Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 35 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 The statement of purpose that has been devised is not a true reflection of the service provided. (Timescale of 13/01/06 from November 2005 report not met-previous timescale of 21/07/04 not met) Timescale for action 01/08/06 2. YA2 14 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 (previous timescale 20/01/06-home has been unable to demonstrate compliance as no admissions) 01/08/06 3. YA2 14 Full assessments of each service user must be conducted prior to admission, which must take into account specific condition related needs, DS0000036983.V293723.R01.S.doc 01/08/06 Wrottesley Park House Nursing Home Version 5.1 Page 36 specialist needs and management of risk and revised at any time when necessary to do so (previous timescale of 15/12/05 not met; home unable to demonstrate compliance as no admissions) 4. YA2 14 The registered person must confirm in writing to the service user that the care home is suitable for the purpose of meeting their needs 01/08/06 (timescale 13/01/06 from November 2005 reporthome unable to demonstrate compliance as no admissions) 5. YA3 14 The registered person must not admit people whose needs it cannot meet or with whom it cannot develop effective communication 01/08/06 (ongoing requirement with which the home must demonstrate compliance) 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. (Statutory requirement notice issued following December 2005 inspection) 01/07/06 7. YA6 15(1) Care plans must set out how current and anticipated specialist requirements will be met. 01/07/06 (Timescale of 24/02/06 from December 2005 report not met) Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 37 8. YA7 12(3) Staff must provide service 01/08/06 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 (Timescale of 24/02/06 from December 2005 report not met) 9. YA8 12(5) The registered person must consult with service users regarding all aspects of life at the home (Timescale of 24/03/06 from December 2005 report not met) 01/08/06 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 (Timescale of 24/03/06 from December 2005 report not met) 01/07/06 11. YA11 16(2)(m)(n) The registered provider must provide opportunities for service users to learn and use practical life skills (Timescale of 24/03/06 from December 2005 report not met) 01/08/06 12. YA12 12(1) The registered provider must enable service users to take part in age, peer and culturally appropriate activities (Timescale of 24/03/06 from December 2005 report not met) 01/08/06 13. YA13 12(1) The registered provider must enable service users DS0000036983.V293723.R01.S.doc 01/08/06 Wrottesley Park House Nursing Home Version 5.1 Page 38 to be come part of, and participate in, the local community (Timescale of 24/03/06 from December 2005 report not met) 14. YA14 16(2)(n) The registered person must ensure that service users have access to a range of appropriate leisure activities 01/08/06 (Timescale of 24/03/06 from December 2005 report not met) 15. YA16 12(1)(b) (Timescale of 24/02/06 from December 2005 report not met) The registered person must ensure that daily routines of the home promote choice and independence 01/08/06 16. YA18 12(1)(b) The registered person must ensure that service users’ preferences with regard to their care are identified and respected (previous timescale of 27/01/06 not met) 01/08/06 18. YA18 12(1)(b) Service users must be 01/08/06 provided with the technical aids and assistance required (previous timescale of 27/01/06 not met) 19. YA18 12(1)(b) The registered person must ensure that consistency is provided through key working (with the involvement and choice of service users) (carried forward from December 2205 inspection) 01/08/06 20. YA19 12 The registered person must ensure the healthcare needs of service users are assessed and robust procedures are in place to address them. (Timescale of 24/03/06 from January 2006 not met) 01/07/06 Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 39 21. YA19 12 Service users’ health must 01/07/06 be monitored and potential complications and problems are identified and actioned and kept under regular review. (Timescale of 24/03/06 from January 2006 report not met) 22. YA20 13(2) The registered person 01/07/06 must ensure service users receive all drugs prescribed to them without fail and comply with all requirements identified by the CSCI pharmacist inspector (Not assessed at this inspection-previous timescale of 24/02/06) 23. YA23 12(1)(13(6) The registered person must ensure that any injuries sustained by service users are fully investigated and appropriate action taken (Timescale of 24/02/06 from January 2006 report not met) 01/07/06 24. YA24 23-(2),(d)5, 16-2,j A programme of routine maintenance and renewal of the fabric and decoration of the building must be produced, implemented and records kept 16(1)(c) 01/08/06 (Timescale of 13/01/06 not met) 25. YA26 The registered person must provide furniture for service users which is safe and meets their needs (Timescale of 24/03/06 from January 2006 report not met) 01/07/06 26. YA27 12(1)(a,b)23(2)(d) The floor covering in shower rooms, ensuite facilities, communal bathrooms and showers must be cleaned and/or DS0000036983.V293723.R01.S.doc 01/07/06 Wrottesley Park House Nursing Home Version 5.1 Page 40 replaced, and the wall tiles attended to where necessary (Work clearly in progress at this inspection- previous timescale of 28/02/06 from November 2005 report) 27. YA30 13(3)18(1)(c, i) The registered person must ensure that staff are aware of and follow Health Protection Agency guidelines (Timescale of 24/03/06 from January 2006 report not met) 01/07/06 28. YA30 13(3) The registered person must implement appropriate action to address the deficits identified in the recent infection control audit (Timescale of 24/03/06 01/08/06 from January 2006 not fully met) 29. YA30 13 (3) immediate requirement not fully met) The registered person must ensure that the bedpan macerators are either repaired or replaced (one sluice disinfector now fitted). (Compliance with previous The registered person must ensure that service users are supported by staff competent to undertake the tasks they do 01/08/06 30. YA32 18(1)(a) 01/08/06 (Timescale of 24/02/06 from December 2005 report not met) 31. YA32 18(1)(a) The registered person must ensure that staff have the specialist qualifications, skills and experience to support the service user group 01/08/06 (timescale of 24/02/06from December 2005 report-not Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 41 met. Previous timescale of 21/07/04) 32. YA33 18 (1) (a) The registered person must review staffing levels regularly to reflect service users’ changing needs 01/08/06 (timescale of 13/01/06 from December 2005 inspection – ongoing requirement with which the home must demonstrate compliance) 33. 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 (Additional nurse deployedongoing requirement with which the home must demonstrate compliance) 01/08/06 34. YA34 19 (4) The registered person must obtain two written references before allowing a person to work at the care home (previous timescales of 15/7/04 and 1/9/05 and 24/02/06 not met) 01/07/06 35. YA34 19 (4) 01/07/06 The registered person must not allow someone to work at the home without obtaining a POVAL/CRB disclosure. (Compliance not met) 36. YA34 19 (4) The registered person must ensure that staff are aware of company policy regarding CRB disclosures. (Timescale of 24/02/06 not met) 01/07/06 37. YA35 18 (1) (c) The registered person 01/08/06 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 (timescale of 13/01/06 from DS0000036983.V293723.R01.S.doc Version 5.1 Page 42 Wrottesley Park House Nursing Home November 2005 report not met) 38. YA35 18(1)(a)18(1)(c) (i) (Statutory requirement notice issued following December 2005 inspection) 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 01/07/06 39. 40 YA37 YA39 8 24 41. YA39 26 An application to register the acting manager must be submitted The registered person must ensure that the quality assurance system is robust and that appropriate action is undertaken in response to negative feedback. The registered person must monitor the quality of the service provided, at least on a monthly basis and provide a written report to CSCI (Ongoing requirement with which the home must demonstrate compliance) 12/07/06 01/08/06 01/08/06 42. YA41 17 The registered person must ensure that all records required by regulation are well maintained, up to date and accurate 01/07/06 (Timescale of 24/03/06 not met) 43. YA42 13 (5) Safe systems for moving and handling service users DS0000036983.V293723.R01.S.doc 01/07/06 Wrottesley Park House Nursing Home Version 5.1 Page 43 must be established and adhered to (timescale of 27/01/06 from December 2005 inspection not met) 44 YA42 23(4) 45. YA42 13(4) The home must consult with the fire officer to ensure that the fire safety risk assessment meets the approval of the fire officer. Heat sources must be fixed and guarded 01/08/06 01/07/06 (timescale of 27/01/06 from December 2005 inspection not met) 46. YA42 13(4)(c) 23(2) (c) (Statutory requirement notice issued following December 2005 inspection) 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. 01/07/06 47. YA42 13(3), 13(4c) 23(2j) (Statutory requirement notice issued following December 2005 inspection) 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 01/07/06 48. YA42 13(4)(a) 23 (Timescale of 24/03/06 from January 2006 report) Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc 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 to is well-maintained and safe 01/07/06 Version 5.1 Page 44 49. YA42 17 37 (Timescale of 24/03/06 from January 2006 inspection not met) The registered person 01/07/06 must ensure that staff are aware of their responsibilities to report and record all accidents and incidents and provide written notification to CSCI 50 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. 01/08/06 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 YA23 YA42 Good Practice Recommendations The registered person is strongly advised to seek guidance in respect of one staff member acting as “Power of Attorney” for a resident. The home is advised to label feeding pumps with the name of the individual for whom they are intended and to include the type of pump/manufactures details within the care records. The home should also establish who takes responsibility for maintaining this type of equipment and the expected frequency for servicing. Wrottesley Park House Nursing Home DS0000036983.V293723.R01.S.doc Version 5.1 Page 45 Commission for Social Care Inspection Wolverhampton Area Office 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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