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Inspection on 26/01/06 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 26th January 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 58 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

Once again, there was nothing apparent to inspectors during the visit to indicate that anything is being done well. Some service users and visitors did once again indicate that some of the staff are motivated and committed to their work, but also identified that this was not the case overall.

What has improved since the last inspection?

Inspectors found that the soiled bed linen had been replaced. The home`s acting manager had contacted the infection control nurse specialist who had visited the home and highlighted areas for improvement, and these now need urgent attention. Other than the requirements made in the previous report relating to these two matters, all other requirements are carried forward into this report. This lack of progress is of serious concern to CSCI.

What the care home could do better:

The findings of this inspection, consistent with those from inspections conducted in November and December 2005, are that significant improvements are needed across most aspects of the home`s operation and the national minimum standards. It is considered that the failure to assess need 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. The absence of a manager with the capacity to effect change and improvement is an additional concern. The home fails to focus on service users` needs comprehensively and generally the individual wishes, choices and aspirations of service users are not respected or met. Service users have spoken of their 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. The home is considered to be placing people at risk through lack of adequate training and lack of established procedures to ensure a safe environment for service users and staff. 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 Unannounced Inspection 26th January 2006 10:00 Wrottesley Park House Nursing Home DS0000036983.V280165.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.V280165.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.V280165.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.V280165.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th December 2005 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 DS0000036983.V280165.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 took place over two days. On the first day of inspection three inspectors were present and two returned on the second day. Once again, inspectors focused on individual areas but have cross referenced their conclusions where appropriate to build a picture of how the home is functioning. Inspectors talked to staff, service users and visitors, examined records and observed practice and the environment. The judgements reached within the body of this report reflect the collective view of the inspection team. The purpose of the inspection was to monitor progress relating to requirements made following previous inspections, but particularly those from an announced inspection in November 2005 and an unannounced inspection in December 2005. The frequency of visits to the home reflects the level of concern about the home’s current performance and concerns about the safety, welfare and quality of life of the people accommodated at the home. These concerns are shared by placing authorities and multi-agency adult protection procedures are being conducted alongside the regulatory work of CSCI. Following the December inspection, 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. Notices were served relating to the failure of the home to provide good assessment and care planning documentation; the unsafe use of bed rails and service user access to excessive hot water temperatures; and the lack of induction training for staff. These were all matters which had been raised in previous reports. At this inspection those bed rails which were examined were considered safe, but the provider has failed to comply with the Regulation 43 Notice in failing to provide CSCI with a protocol describing how safety is to be consistently maintained. Hot water temperatures were still a problem, so the provider is considered to have failed to comply with the notice in both having hot water supplies in excess of 43°C in the home and failing to provide CSCI with a procedure to monitor, maintain and rectify faults in the operation of the thermostatic valves. Assessment and care planning documentation was still found to be inadequate. No new staff had been appointed so full compliance with the notice relating to induction could not be assessed, but a procedure to show how the home intends to comply has not been provided to CSCI. Requirements relating to these issues are reintroduced and reinforced in this report so that the provider continues to be aware of what is required whilst CSCI considers further action. The home’s acting manager confirmed that she will now not to be pursuing registration and is in effect “stepping down” from the home’s manager post. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The findings of this inspection, consistent with those from inspections conducted in November and December 2005, are that significant improvements are needed across most aspects of the home’s operation and the national minimum standards. It is considered that the failure to assess need 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. The absence of a manager with the capacity to effect change and improvement is an additional concern. The home fails to focus on service users’ needs comprehensively and generally the individual wishes, choices and aspirations of service users are not respected or met. Service users have spoken of their 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. The home is considered to be placing people at risk through lack of adequate training and lack of established procedures to ensure a safe environment for service users and staff. 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. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 7 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.V280165.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.V280165.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, 2 and 3. Individuals have been admitted to the home without having their individual needs and aspirations assessed. This continues to put the safety and well being of people living at the home at risk. The home is unable to meet the diverse needs of the people accommodated. EVIDENCE: As there have not been any recent admissions to the home the focus of this inspection was to revisit records which were looked at in December to see whether improvements had been made. At this inspection, the record for a service user admitted in October 2005 was seen to contain a pre–admission assessment form. This part of the documentation was looked for by two staff members during the December inspection but was not be located at that time. The form was not dated or signed, the last page of the assessment designed for recording information such as the individuals social activities, hobbies and interests was observed to be blank and overall the contents of the form lacked essential information necessary to plan and review the person’s needs. A service user’s needs assessment, which had been changed for end of life care, was examined. This lacked the detail which would be needed to make sure the staff had the guidance to deliver the person’s care properly. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 10 The home continues to accommodate people with a huge range of needs, including learning disability, physical disability, mental health, sensory impairment and acquired brain injury. In addition a number of people have a range of quite complex medical needs. Of the four people case tracked by one inspector there was insufficient care documentation available to provide care staff with knowledge required to support individuals effectively. Staff spoken with had not been provided with training opportunities in relation to disabilities in order to deliver the necessary support and care required. Observations during the inspection, and outcomes of discussions with relatives and residents confirmed inspection findings reported at the December inspection regarding the effects of disruptive behaviour shown by some residents. Five individuals are currently described as displaying challenging behaviour to others and this appears to upset residents who are normally placid. One resident described how a glass was thrown in sheer frustration due to the noisy outbursts; entries in care plans match comments made by residents on Green unit as their rest is disturbed by the noisy behaviour of ‘neighbours’ in the early hours. A copy of a “draft” statement of purpose for the home was forwarded to CSCI via a consultancy organisation following the November 2005 inspection. The registered person has made no attempt to discuss this draft statement of purpose with CSCI or confirm that this is the document that will be used by the home. Wrottesley Park House Nursing Home DS0000036983.V280165.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 home has failed to improve its care planning systems and practices 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: The care for nine people was case tracked in detail by two inspectors. Although there was evidence that the care plans had been reviewed since the last inspection, significant shortfalls were found in care assessments. Some assessments found on file were not dated or signed by the assessor. Information for care delivery did not identify the type of support to be given, by whom or when and one care plan did not take into account a service user’s condition which has a significant impact on the level of care and support required during a relapse. Other documentation relating to another service user’s care needs just indicated ‘needs assistance’. Again the type of assistance, level required, when and by whom was not documented. Care Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 12 plans seen did not promote a person-centred approach. Continence product assessments seen on two files did not indicate the product required or size instead notices continue to be displayed on bedroom walls. One service user spoken with reported that the care provided to him on the morning of the inspection was “above expectations because it was provided by two staff that care” and “the good ones make up for the bad ones, however there is still room for improvement”. A pain assessment was seen on the individual’s file, dated 11.12.05. This assessment indicated a scoring of 5 which is the highest score to describe someone’s feelings relating to pain. The assessment stated “the worst I could feel”. A pain diary that accompanied the assessment was blank. The person’s care plan for maintaining safety stated that “he has his nurse call system to hand when in bed”, however when the person was observed the call bell was out of reach despite the person physically not being able to reach for assistance if required. Another service user was heard shouting for help for a long period of time before assistance eventually arrived. It is positive to report that following the last inspection the home has approached the RNIB to request information on ‘Talking Books’ for one person who is registered blind. However although the care plan identifies that this individual experiences disorientation due to his blindness there was no evidence available to suggest how to encourage his independence around the environment, for example, with the use of tactile symbols. It identified in his communication care plan that “he can be verbally abusive especially when waiting for someone”. The care plan seen in relation to mobility stated that he must be supported under one arm. His preferred guidance was not stated. The person spends the majority of his time in his bedroom however the nursing call bell was observed not to be within reach. Discussions with the person indicated that things at the home had improved and that staff are not moving tables around so much in the dining room which has helped him. Of the care files scrutinised there was no evidence available to suggest that service users are involved in decision-making processes or how individual choices have been promoted. Discussions held and observations made suggest that the home is unable to meet the communication needs of the people accommodated. No pictorial signs and symbols or other forms of communication to assist service users with profound needs were available. It was reported that relatives advocate on behalf of service users, as the home does not access an independent advocacy service. The management of service users’ finances was not reviewed on this occasion however there was no information relating to finances seen on the care files scrutinised. As part of the care documentation a number of risk assessments had been undertaken including a nutritional risk assessment. One person had lost 3 kg in a month and although daily records indicate that the person’s appetite had significantly decreased, a fluid chart was only implemented on the Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 13 recommendation of a General Practitioner who visited the home during the inspection. A further nutritional risk assessment clearly identified that another service user was classed as obese and at ‘high risk’ with a score of 28. The home had failed to implement food charts to monitor the individual’s dietary intake and a weight chart on file clearly indicated that the person had put on 12 kg since 28.11.05. Risk assessments were not available for supporting individuals to take risks as part of an independent lifestyle - for example no assessment had been undertaken for someone who accesses the community independently, or for making hot drinks without supervision or any other activities. A halogen heater was found located in the room of a service user who is registered blind. Many of the residents who live at the home are prescribed large quantities of complex medication. There was no evidence within care plans of how medication is effectively reviewed and managed, including the potential for side effects. Wrottesley Park House Nursing Home DS0000036983.V280165.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): EVIDENCE: These standards were not inspected on this occasion. It was noted, however, that the home is in the process of employing a second activities co-ordinator. Scrutiny of this individual’s recruitment file and discussion with the acting manager confirmed that the applicant has not had any previous experience of providing specialist activities. The acting manager demonstrated that she is seeking suitable training days for this individual to access. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 and 20 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. Continued shortfalls in medication practices are placing service users at considerable risk of deterioration in their health. EVIDENCE: Staff were seen to knock on service users bedroom doors prior to entry throughout the inspection, however inappropriate notices continue to be displayed around the home such as bath and shower “lists” and continence product information thus failing to promote the privacy and dignity of the people accommodated. There was no evidence available to suggest that service users’ preferences with regard to their care had been identified and respected. One person said that he could not recall being involved in the development of his care plan and his preferred preferences even though he had signed a contract to say that he Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 16 has read and understood this. A number of individuals were seen without footwear or socks/tights etc and one person freely walked around the home wearing pyjamas all day. The person commented that she had been to bed as she did not sleep the previous night, however records evidenced that she had not been administered her prescribed medication as it was out of stock. A requirement was made at the previous inspection in relation to people being provided with the technical aids they require. A physiotherapist assessment was seen on one file dated 19.12.05 for one individual who is confined to a wheelchair. The assessment stated that the current wheelchair is unsuitable due to the height of the person and that the person has fallen out of the chair due to balance. It stated that the person was measured for a new chair two months ago and that if he was in a more suitable chair he was “less likely to suffer the reoccurring injuries to his lower limbs which occur at present”. A care plan seen on file dated 25.01.06 documents that the person has recently had the new wheelchair but due to recent illness is now unable to “self-propel”. During the inspection a number of health and social care professionals visited the home including a general practitioner, chiropodist, social workers and lymphoedema nurse specialist. It is positive to report that one person case tracked has been provided with a new mattress appropriate to her needs, following a letter of concern from a social worker forwarded to the manager requesting an appropriate mattress be obtained. Examination of care records contained recent advice (since the December inspection) from specialists such as hospital consultants, which should have triggered changes to care plans and management. Records failed to show whether this professional advice had been carried out. Non-compliance with the advice of specialist medical personnel is not acceptable and the home needs to demonstrate that appropriate action is being taken. An example of this is that records pertaining to one service user stated that her G.P had visited and recommended that she should be on a strict diabetic diet due to a fluctuation in her blood sugar (BM) from overeating. A diabetes care plan was on file reviewed on 12.01.06. This stated that ‘her BM remains unstable at times due to poor compliance with diet’. An action plan was found on file from a recent outpatients appointment at the Dietetic Department together with a meal plan. However only four daily food charts had been completed by the home since July 2005. Only entries for supper had been documented since December, which stated biscuits and cereals. Daily records also evidenced that the persons BM was tested high after she admitted to taking food from the kitchen trolley and fridge. Records of 23.01.06 also state that her ‘current insulin pen is not giving the required amount of insulin- faulty?’ However there was no evidence to suggest that this had been followed up. Gaps on this person’s Medication Administration Record (MAR) were noted on the 24.01.06 and 25.01.06 and it could not be Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 17 established whether this person had received the prescribed doses of insulin on the 24.01.06 and 25.01.06. The daily notes of this person also evidence that the person has been experiencing psychotic symptoms and observation of MAR charts show that the person had not been given her ant-psychotic medication since 22.01.06; it was recorded as out of stock. The CSCI pharmacist inspector visited Wrottesley Park House Nursing Home three times in 2005 due to concerns regarding medication practices. In December 2005 the pharmacist inspector judged “that the medicine management within the home had not improved” and that “further systems still needed to be established to ensure that all the residents medication needs were fully met”. The pharmacist inspector identified that a resident had run out of her medication on the 18th December 2005 and an immediate requirement was issued asking the home to explain why they had allowed this resident’s medication to run out and to ensure that it was recommenced with immediate effect. During observation of this resident’s care records at this inspection it was noted that on the daily care records for the 21.12.05 (and thus the day after the pharmacist’s visit) it is documented “run out of medication”; it is not until the 26.12.05 that it is documented “medication arrived and given”; the home therefore did not comply with the immediate requirement issued. Other MAR charts examined at this inspection showed similar deficits such as: One person did not receive full doses of his antipsychotic medication on the 23.01.06, 24.01.06 and 25.01.06; the abbreviation used defined it as out of stock. • A person did not receive his diuretic tablet for two days - again the abbreviation used identified it as out of stock. • It was documented on another persons MAR chart that they had not received a drug for four weeks, the abbreviation used defined the drug as out of stock. A member of nursing staff informed the inspector that this drug had actually been discontinued; however as identified in the pharmacist inspector’s report there was no written evidence to support this. Further observation of this person’s MAR chart identified that another drug was recorded as out of stock on the 17.12.05; nothing was documented in the care records until the 23.12.05 when a relative complained. This person was subsequently admitted to hospital following an apparent deterioration of their condition. • A person that continually refuses medication including insulin was observed not to have a plan within her care records on how to manage this or to explore the reasons behind her refusing medication. Observations made at this inspection suggest that no improvements have been made to medication practices and confirm that the home is placing residents at • Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 18 significant risk by not having a robust system in place for medication practices and procedures. Over the two inspection days the management of an individual who was terminally ill was observed. Appropriate professionals from the local hospice visited and suitable pain management was organised. When the care records for this person were looked at, specifically regarding the provision of palliative care, the care plan lacked details about the care of the specialist equipment (syringe driver) being used, and how it was to be managed. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The complaints process within the home is not satisfactory and requires prompt action to ensure that residents and/or their significant others are listened to and their concerns acted upon robustly. 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: Two complaints received by CSCI in December 2005 were forwarded to the registered person for investigation with a request that the report of the outcome of the investigation be sent to the complainants and CSCI. The acting manager for the home completed both investigations. CSCI are concerned that some of the investigation findings regarding one of these complaints show inappropriate actions being carried out in the home. • The home used a specialist bed, which was the property of another service user without the owner’s consent. When this bed broke down the home could not authorise its repair. • Staff were using the resident’s toiletries to carry out domestic cleaning duties. • The home did not adhere to its own policy for labelling residents’ clothing, this was not identified as a main reason for clothing being lost. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 20 • The report did not account for the fact that lack of significant information in the person’s care plan did not give staff guidance to effectively meet his needs and preferences at all times. In addition to the complaints detailed above, residents and relatives raised various concerns during the inspection, elements of which are documented throughout this report. The November and December 2005 inspection reports describe two incidents where people admitted to Wrottesley Park sustained bruising and these events were investigated as part of the adult protection process following concerns raised by family on both occasions. As this inspection progressed inspectors became increasingly concerned that residents within the home appear to have sustained injuries that had not been professionally acted upon, staff had not followed correct procedures or established how injuries, such as bruising, had occurred. For example: • An entry in the daily records of a vulnerable resident on 12.01.06 stated: “…. (Residents name) has some finger marks on neck- ?cause” The acting manager stated that she was not aware of this injury and it appears that the nurse in charge of the unit at the time had not reported it to her. Furthermore, no accident /incident form to investigate the injury of unknown origin had been completed. This incident prompted inspectors to have a more detailed look at the person’s records which outlined 9 separate events of minor injuries observed on this individual. Most of the evidence about these injuries was recorded in the persons “care book” kept in their bedroom. This book was not made available at the last inspection despite the inspector going into the bedroom on three separate occasions. Body maps/records of bruising as seen in other care plans case tracked had not been completed for this person. In addition, care plans did not describe any guidance for staff to maximise the comfort of the person whilst recovering from these injuries. Although at least three of the entries recorded that the injuries were shown and reported to the nurse, analysis of the home Accident Book for the dates these injuries occurred confirmed that none of them were recorded in this document. A random selection of three other residents’ care records contained recent recorded entries of bruising being observed on each of these three individuals. Examples of these entries are recorded below: • “ bruising to left upper thigh and upper left arm, also red area on forehead” (22.12.05). The following night it is written “bruising remains extensive to left arm and leg”. • Another residents file documents “Carers have noted a purple bruise, approx 2.5-3 inches diameter” Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 21 • “Small black bruise noted on right forearm”. CSCI are 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. Some staff have now received training in “Recognising and Reporting Abuse”, which should heighten their awareness regarding situations that could be classed as abusive and evidence has been submitted to CSCI to confirm that further training dates are planned. During the inspection one resident became upset and requested to speak with an inspector. The resident alleged that another resident had assaulted her. The acting manager was informed who initiated an appropriate referral according to local adult protection procedures. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 22 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. A lack of investment and planning for refurbishment of the home that includes individual and communal bathrooms does not create a pleasing and pleasant environment to live in and is placing service users at risk Policies and procedures are not in place or being followed to ensure good hygiene practice. EVIDENCE: On both inspection days the majority of bedrooms seen and many parts of the communal areas had an overpowering unpleasant smell of stale urine. Many furnishings were seen to be shabby in appearance as well as malodorous. Many of the en-suite bathrooms smelled of damp; the vinyl flooring has lifted resulting in a lack of an effective water seal. External brickwork immediately outside a newly built bedroom was observed to have a significantly large area of damp and this was brought to the attention of the maintenance person. Relatives complained to inspectors how shabby the home had become. Some have been visiting the home for a considerable length of time. It was reported that one resident had never had their room decorated since moving in 10 years ago, and the condition of his carpet was described as ‘terrible’. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 23 The inspection in December 2005 had identified that staff are not aware of good practice regarding infection control. Infection control training had been provided the day before this inspection however this appears to have had little impact on staff in terms of putting this theory into practice. Although staff were aware of the inspectors being present in the home for two days this did not appear to impact on ‘sloppy practice’ reported by residents and relatives. 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. For example, in one bedroom belonging to a bedridden resident a used continence appliance had been left on the bathroom floor. A urine drainage bag was hanging over the toilet bowl, and the end of tubing for the drainage bag was contaminated as it was also lying on the bathroom floor. A used suction machine was observed in another bathroom. When an inspector was invited into the bedroom of a very ill resident by his relatives, it was seen that the bedrail padding was soiled with what appeared to be discharge from wound dressings. A person with a specific infection did not have information on his records to show that this matter has been fully explored. This is an area of concern, as the person recently suffered skin trauma and the wound had not been dressed appropriately. A dirty syringe designed for single use and generally used to flush feeding tubes was observed next to an individual receiving PEG feeds. The feeding pump was observed to be dirty. Stained bed linen observed at a previous inspection had been replaced and the acting manager had contacted the local infection control nurse specialist as requested following the December 2005 inspection. However an audit conducted by this professional confirmed that action is needed to reduce infection risk, including replacing damaged flooring in bathrooms, checking of mattresses, correct disposal of syringes/needles, and provision of adequate linen bags. Bathrooms continue to be used for storage and one locked bedroom, not in use by residents, was observed to contain equipment such as gloves and incontinence pads. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 24 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 Staffing levels and 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 staff member spoken with commented that the team would benefit from accessing a number of training opportunities such as palliative care, alzheimers disease, complementary therapy, learning disability, mental health, physical intervention, peg feeding, managing difficult behaviours, alcohol and drug abuse and report writing. A common theme observed, and reported to inspectors by relatives and residents, was the lack of interest and indifferent attitude of some members of the care team. Although some carers were spoken about with fondness, it was reported that many staff members are bossy, negative and inflexible. At the start of the inspection when it was apparent that staff were unaware that inspectors were in the building, several inappropriate responses were overheard being made by staff to residents. As identified at previous inspections call bells continuously ringing were heard as well as reported to be an area of concern for relatives. When an inspector investigated a call bell that had been heard ringing for nearly 20 minutes, it was seen that it did not display the correct location of the caller. The system showed help being requested in a bathroom but in fact the call was from a Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 25 service user requesting assistance in a bedroom. A relative stated that when they visited earlier in the week they called for help for their relative and waited 25 minutes for assistance. All individuals spoken to were complimentary on the welcoming helpful attitude of the hotel services team and the administrator The acting manager showed examples of an induction checklist which was agreed would be suitable for new staff on their first day of employment. Senior staff have completed induction checklists on a retrospective basis. A more in depth induction programme has not yet been devised and the inspector advised the acting manager of where she might locate examples of induction programmes. This discussion served to indicate that little guidance had been provided by the organisation’s senior management as to sources of training and support. Following the last inspection a statutory notice was served as a result of continued inadequate induction of new staff; CSCI has not received any communication from the registered person to show how the home will comply with the notice. The December 2005 inspection report detailed how the acting manager has audited staff personnel files and is taking action to remedy the shortfalls. Because some staff were previously appointed prior to a CRB disclosure/POVA first check being obtained, not all CRB disclosures have been returned to the home. A discussion with the acting manager identified that it is not clear who has responsibility for checking CRBs on their receipt and the procedure to follow should a CRB be returned that is not satisfactory. The registered person must ensure that staff are aware of company policy regarding CRB disclosures and the acting manager was advised to seek guidance from senior management for the interim period. The acting manager was also advised to seek guidance from within the organisations employment policies as to how to deal with discrepancies between an employee’s own disclosure at application and the result of the CRB. Observation of the audit conducted by the acting manager shows that not all staff working in the home have a contract of employment. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 26 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. This home does not promote the health, safety and welfare of residents and is currently placing residents at significant risk of harm. Poor record keeping systems potentially place service users at risk. EVIDENCE: Many individuals spoken to expressed concerns about not being told what was going on in the home. Residents and relatives said they were never informed about their care, they always had to ask. A visitor specifically approached an inspector to describe an incident that had occurred on the day of the inspection where a message from a healthcare professional had not been conveyed to them. This was particularly upsetting as the relatives were visiting a loved one who was gravely ill. The inspection on the 16th December 2005 identified 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. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 27 At this inspection observations of eleven beds with bed rails attached were found to be fitted correctly. All beds checked had a bed rail attached to both sides of the bed, these rails were secure and fitted correctly in accordance with Medical Devices Agency and Health and Safety Executive guidance. Where pressure-relieving mattresses were in use these were secured directly to the bed base, thus the height of the mattress did not compromise the effectiveness of the bed rail. Bed rails were checked on Blue, Green and Brown unit on the first day of this inspection. It was noted on return to the home on the second day that the handover sheet for Yellow unit requested that staff urgently check the bed rails on this unit and these too were found to be fitted correctly. Although bed rails that were observed were fitted correctly the Regulation 43 notice issued following the December 2005 inspection 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 not been received. During visits to the home in September, November and December 2005 inspectors measuring hot water temperatures at various outlets accessible to service users recorded temperatures in excess of 43°C. At the inspection in December 2005 ten out of twenty five hot water temperatures were recorded at more than 44°C and four of these outlets had temperatures of between 51.6°C and 67°C. At this inspection a total of twenty-six hot water temperatures were checked, from varying outlets such as baths, showers and wash hand basins. One temperature from a wash hand basin within a WC next to a communal lounge was recorded at 64°C, two showers were recorded at 49 and 50°C respectively (maximum setting) and the hot water outlet for one bath was recorded at 48°C. An immediate requirement was issued at the time of inspection for emergency signage to be put in place and for the hot water temperature to be turned off to the hot water supply to the communal toilet. Of the twenty-six temperatures checked twelve were recorded at between 38 and 40°C, suggesting that the home experiences difficulty maintaining the hot water supply as close to 43°C. Two showers were found to have a spanner in place where the temperature regulator should be, when the inspector asked a member of staff how the water supply is turned off/on the staff member showed that the spanner is used for this purpose. This means that staff have no way of identifying how to increase/decrease the hot water flow accurately. It was observed that the markings on the tops of some taps to indicate whether the tap is hot or cold were still missing (previously identified for action July 2005). Following the December 2005 inspection a Regulation 43 notice was issued requiring the registered person to provide the commission with a procedure Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 28 identifying how they will effectively monitor, maintain and remedy deficits with regard to hot water temperatures. The registered person has failed to provide such a procedure and this inspection once again demonstrated the failure of the home to demonstrate safe practice in this area. Although work has been started by the handyman to repair and replace the missing tiles noted in the December inspection report, the enormity and extent of the job means that seven of the en-suites and the communal bathrooms reported to need urgent remedial action at the December inspection had not had this work done. Furthermore in the two en-suites where ankle height tiles had been replaced the job was incomplete and the nails sticking out of the walls holding the tiles in place posed another hazard. There was no warning signage to raise people’s awareness about the nails. In two records looked at in depth it was recorded that both residents had been injured as a result of furnishings in their bedrooms toppling on them. CSCI were not aware of these incidents and the acting manager also appeared unaware. When the bedrooms for both individuals were looked at, it was seen that none of the furniture had been secured to reduce the risk of it happening again. It was noted in the November inspection report that the registered person should assess each bedroom to ensure that there is no risk of wardrobes falling over should a resident pull on them. Despite the residents care plan being reviewed on two occasions since then, there is no risk assessment to minimise the re-occurrence of such an incident or reference to this incident. Analysis of the home’s accident book for the last three months also identified that three staff members had sustained injuries whilst moving and handling residents. It could not be confirmed that any of these individuals had been retrained and assessed as fit to safely move and handle upon recovery from these injuries. Evidence provided confirmed that moving and handling training has recently been provided to staff. In the last inspection report it was identified that a person sleeps on a mattress on the floor and that the record lacked information to show how this could be managed safely. None of the issues identified appeared to have been addressed. This was discussed with the acting manager at the end of the inspection. In an effort to resolve this issue, equipment suggestions were made to enable the person to be handled more effectively. Similarly, all care records looked at lacked necessary detail of what equipment to use for specific day to day moving and handling manoeuvres and little information was contained within the care plan or moving and handling assessment for one resident whose weight is almost at the maximum limit for the safe use of a hoist. Inspectors observed residents ‘taxied’ around the home in what the care team refer to as ‘sunken armchairs.’ Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 29 During the inspection several residents were observed to access the room designated for cigarette smoking, the door to this room was observed wedged open by a waste paper bin and no nurse call buzzer is fitted in this room. The resident that spoke with one of the inspectors regarding an alleged assault described how she was unable to call for a member of staff due to the room not having a call buzzer fitted. An electric double socket located in Room 10 (Green Unit) was observed to be cracked and the plaster -work surrounding this socket had gaps of approximately 1cm. The individual that resides in this room is cared for on a mattress at floor level and the mattress is immediately below the electric socket. An immediate requirement notice was issued for immediate action to be taken to prevent access to this socket. The home has not consulted with the local fire officer regarding the fitting of suitable detector in the new sluice room. A recent notification received by CSCI from the home described an incident where a resident was able to wander out of the home unnoticed. Visiting health and social care professionals have also expressed concern regarding the lack of security systems in place to protect vulnerable people, such as maintaining a safe entrance to the home. This was identified for action at the July 2005 inspection. Feedback received from residents and relatives regarding the conduct of the acting manager has been positive. However several residents and their relatives gave quite negative feedback regarding the home’s owners during the inspection. This was also identified in the July 2005 inspection report and it was recommended that the registered person meet with the friends and families of residents; this has not taken place. Recorded visits (as per Regulation 26) by the registered provider or nominated individual have not been received by CSCI since October 2005; a significant omission considering the concerns being raised during this period. An application form for a registered manager has not been received by CSCI and discussion with the acting manager confirmed that she will not be pursuing registration. As stated throughout this report record keeping systems require significant improvement in order to safeguard the people living at this home. A number of documents in care files, such as risk assessments, were found blank or incomplete and in general recording is inconsistent. It also appears that when care plans were changed over to their current format, important information was not transferred onto the new records accurately. All care plan records for Blue and Green unit are stored in a locked cabinet on Green unit. Discussions with residents, staff and relatives confirmed that they were kept together as it was easier for the nurse to write in them, and not as a Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 30 measure to promote resident centred care. This system must be further developed to maximise resident, and staff, access. Staff spoken with commented on the need to improve the current systems in place however some individuals felt that they did not have sufficient time allocated for maintaining records. One senior member of care staff showed an inspector a new system he has designed to replace the current daily book, which is located in service users’ rooms. The new system would provide guidance for staff and include sections to record information on daily report, keyworker input, reposition chart, dietary chart, fluid balance and a bowel chart. The staff member appeared enthusiastic to implement the new system as soon as possible with the support of the manager. This enthusiasm is positive and confirms that some members of care staff are more motivated than others. Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 31 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 2 2 1 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 2 27 1 28 X 29 1 30 1 STAFFING Standard No Score 31 X 32 1 33 1 34 2 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 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 2 X 1 1 X Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 32 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 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 (Timescale of Timescale for action 24/03/06 13/01/06 from November 2005 report not met-previous timescale of 21/07/04 not met) 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) 24/03/06 3 YA2 14 Full assessments of each service user must be conducted prior to admission, which must take into account specific condition related needs, specialist needs and management of risk and revised at any time when necessary to do so 24/02/06 (previous timescale of 15/12/05 not met; home unable to demonstrate by 20/01/06 as no admissions) 4 YA2 14 The registered person must confirm in writing to the service user that the care DS0000036983.V280165.R01.S.doc 24/03/06 Wrottesley Park House Nursing Home Version 5.1 Page 33 home is suitable for the purpose of meeting their needs (timescale 13/01/06 from November 2005 report) 5 YA3 14 requirement with which the home must demonstrate compliance) The registered person must not admit people whose needs it cannot meet or with whom it cannot develop effective communication (ongoing 24/02/06 6 YA6 15(1) 17(1) (Statutory requirement notice issued following December 2005 inspection) 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. 24/02/06 7 YA6 15(1) 8 YA7 12(3) 9 YA8 12(5) 10 YA9 13(4)(b) Care plans must set out how current and anticipated specialist requirements will be met. Staff must provide service 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 The registered person must consult with service users regarding all aspects of life at the home 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. DS0000036983.V280165.R01.S.doc 24/02/06 24/02/06 24/03/06 24/03/06 Wrottesley Park House Nursing Home Version 5.1 Page 34 11 YA11 16(2)(m)(n) forward from previous inspection but not assessed on this occasion) The registered provider must provide opportunities for service users to learn and use practical life skills (carried 24/03/06 12 YA12 12(1) The registered provider must enable service users to take part in age, peer and culturally appropriate activities (carried 24/03/06 forward from previous inspection but not assessed on this occasion) 13 YA13 12(1) The registered provider must enable service users to be come part of, and participate in, the local community (carried forward from previous inspection but not assessed on this occasion) 24/03/06 14 YA14 16(2)(n) The registered person must ensure that service users have access to a range of appropriate leisure activities (carried forward from previous inspection but not assessed on this occasion) 24/03/06 15 YA15 16(2)(m) The registered person must support service users to maintain family links and friendships (carried forward 24/03/06 from previous inspection but not assessed on this occasion) 16 YA16 12(1)(b) The registered person must ensure that daily routines of the home promote choice and independence (carried forward 24/02/06 from previous inspection but not assessed on this occasion) 17 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) 24/02/06 18 YA18 12(1)(b) timescale of 27/01/06 not met) Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc The registered person must ensure that service users can choose their own clothes, hairstyle and makeup (previous 24/02/06 Version 5.1 Page 35 19 YA18 12(1)(b) Service users must be provided with the technical aids and assistance required 24/02/06 (previous timescale of 27/01/06 not met) 20 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 last inspection) 24/02/06 21 YA18 12(4)(a) 22 YA19 12 23 YA19 12 24 YA20 13(2) 25 YA22 22(2)(3) 26 YA23 12(1)(13(6) 27 YA24 23-(2),(d)5, 16-2,j The registered person must ensure that the home is conducted in such a manner, which respects the privacy and dignity of service users. The registered person must ensure the healthcare needs of service users are assessed and robust procedures are in place to address them. Service users’ health must be monitored and potential complications and problems are identified and actioned and kept under regular review. The registered person must ensure service users receive all drugs prescribed to them without fail and comply with all requirements identified by the CSCI pharmacist inspector The home must provide service users and/or their representatives with an effective complaints procedure The registered person must ensure that any injuries sustained by service users are fully investigated and appropriate action taken A programme of routine maintenance and renewal of the fabric and decoration of the building must be produced, implemented and records kept (timescale from November 2005 report 13/01/06 not met) 24/02/06 24/03/06 24/03/06 24/02/06 24/02/06 24/02/06 24/02/06 Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 36 28 YA24 13 (4) (c) The registered person must establish a safe and secure entrance to the home and establish a system of monitoring which residents are in the building (timescale of 13/01/06 from November 2005 report not met – previous timescale of 1/10/05 not met) 24/02/06 29 YA26 16(1)(c) 30 YA27 12(1)(a,b) 23(2)(d) The registered person must provide furniture for service users which is safe and meets their needs The floor covering in shower rooms, ensuite facilities, communal bathrooms and showers must be cleaned and/or replaced, and the wall tiles attended to where necessary The provision for storage of aids and equipment must be reviewed. Bathrooms must not be used for storage 24/03/06 28/02/06 (timescale from November 2005 report) 31 YA29 23 (1) 24/03/06 (timescale of 13/01/06 from November 2005 report not met) 32 YA30 13(3) 18(1)(c, i) 13(3) 33 YA30 34 YA30 13 (3), (4) (c) The registered person must ensure that staff are aware of and follow Health Protection Agency guidelines. The registered person must implement appropriate action to address the deficits identified in the recent infection control audit. Taps in service users’ bedrooms must indicate which is hot and cold 24/03/06 24/03/06 24/02/06 (previous timescales of 1/10/05 and 13/01/06 not met) 35 YA30 13 (3) The registered person must ensure that the bedpan macerators are either repaired or replaced (one sluice disinfector now fitted). DS0000036983.V280165.R01.S.doc 24/03/06 Wrottesley Park House Nursing Home Version 5.1 Page 37 Compliance with previous immediate requirement not fully met 36 YA30 13 (3) Waste disposal bins must be appropriate for their use and fitted with lids (timescale of 24/03/06 13/01/06 from November 2005 inspection not met) 37 YA32 18(1)(a) The registered person must ensure that service users are supported by staff competent to undertake the tasks they do (timescale from December 2005 inspection) 24/02/06 38 YA32 18(1)(a) from December 2005 inspection) The registered person must ensure that staff have the specialist qualifications, skills and experience to support the service user group (timescale 24/02/06 39 YA33 18 (1) (a) The registered person must review staffing levels regularly to reflect service users’ changing needs (timescale of 13/01/06 from December 2005 inspection not met) 24/02/06 40 YA33 18 (1) (a) 41 YA34 19 (4) The registered person must continue to deploy an additional nurse to ensure that the clinical and health needs of service users are fully met 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 not met – this is an ongoing requirement with which the home must demonstrate compliance) 24/02/06 24/02/06 42 YA34 19 (4) The registered person must not allow someone to work at the home without obtaining a POVAL/CRB disclosure. (this is an ongoing requirement with which the home must 24/02/06 Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 38 demonstrate compliance) 43 YA34 19 (4) The registered person must ensure that staff are aware of company policy regarding CRB disclosures. The registered person must ensure that all staff receive training appropriate to the work they are to perform, and create a training and development plan to demonstrate this, linked to service users’ needs (timescale of 13/01/06 from November 2005 report not met) 24/02/06 44 YA35 18 (1) (c) 24/02/06 45 YA35 18(1)(a) 18(1)(c) (i) (Statutory requirement notice issued following December 2005 inspection) The registered person must 24/02/06 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 46 YA37 8 47 YA39 26 48 YA41 17 49 YA42 23 (4) The registered person must identify/appoint a suitable person to manage the care home The registered person must monitor the quality of the service provided, at least on a monthly basis and provide a written report to CSCI. The registered person must ensure that all records required by regulation are well maintained, up to date and accurate. The registered person must consult with the local fire DS0000036983.V280165.R01.S.doc 31/03/06 24/03/06 24/03/06 24/02/06 Wrottesley Park House Nursing Home Version 5.1 Page 39 officer regarding the fitting of a suitable detector in the new sluice room and for the fitting of appropriate self-closing devices for bedroom doors. The practice of using door wedges or other implements must cease (timescale of 13/01/06 from November 2005 report not met) 50 YA42 13(4)(a) of 27/01/06 from December 2005 inspection not met) The risk of injury to service users posed by the broken and sharp tiles in en-suite bathrooms must be reduced as a matter of urgency (timescale 24/02/06 51 YA42 13 (5) Safe systems for moving and handling service users must be established and adhered to (timescale of 27/01/06 from December 2005 inspection not met) 24/02/06 52 YA42 13(4) Arrangements for service users to have access to kettles etc must be risk assessed and reviewed (timescale of 27/01/06 from December 2005 inspection not met) 24/02/06 53 YA42 13(4) 27/01/06 from December 2005 inspection not met) Heat sources must be fixed and guarded (timescale of 24/02/06 54 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. 24/02/06 55 YA42 13(3),13(4c) The registered person must 23(2j) provide to the commission, a procedure which identifies how the home will effectively DS0000036983.V280165.R01.S.doc 24/02/06 Wrottesley Park House Nursing Home Version 5.1 Page 40 monitor, maintain and remedy deficits with regard to hot water deficits (Statutory requirement notice issued following December 2005 inspection) 56 YA42 13(4)(a) 23 57 YA42 12(1)(a) 58 YA42 17 37 The registered person must 24/03/06 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. The registered person must 24/03/06 ensure that the current “nursecall” system is fully operational and ensure that a call buzzer is fitted without delay in the room allocated for service users that smoke. The registered person must 24/03/06 ensure that staff are aware of their responsibilities to report and record all accidents and incidents and provide written notification to CSCI. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 41 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. Extracts may not be used or reproduced without the express permission of CSCI Wrottesley Park House Nursing Home DS0000036983.V280165.R01.S.doc Version 5.1 Page 42 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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