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Inspection on 08/01/07 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 8th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 27 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

Service users that were spoken with during the inspection were generally satisfied with the service they receive. Service users who were unable to communicate their needs appeared comfortable, clean, appropriately dressed, and staff were observed attending to these individuals with a sensitive approach. The home is able to cater for individual dietary needs and service users spoken with commented on their satisfaction with the meals provided. The home provides spacious private and communal rooms and the wide corridors ensure that service users dependant on wheelchairs for mobilising have sufficient space for manoeuvring around the home.

What has improved since the last inspection?

This inspection identifies that the home has achieved 29 previously made requirements. Nineteen other requirements have been assessed as partly achieved, these are in relation to areas where the home has shown signs of improvement but further attention is still necessary to fully achieve the requirement. Improvements identified at this inspection include: The home now has a statement of purpose and service user guide which provide the information that someone would need when considering using the service. Improvements to the care planning and risk assessment process means that staff are provided with the information they require to meet service users long term care needs. The food in the home is of good quality and plenty of fresh produce is now available. Service users have been provided with increased opportunities to access the community, such as shopping trips and visits to the theatre. The sensory room is no longer used to store equipment and therefore offers an improved resource for service users. The home is more proactive in seeking specialist advice and maintains clear records of contact with and visits by GP`s and other healthcare professionals. Improvements to the environment now mean that people residing at the home are provided with a pleasant and safe place to live. Training opportunities within the home have increased, including the provision of training to promote staff understanding and skills in more specialist areas and new staff are provided with structured induction training. Safer working practices now exist in relation to activities such as moving and handling, fire safety, hot water temperatures and the use of bed rails. Improved quality assurance and monitoring processes have been implemented.

What the care home could do better:

One new requirement made following this inspection is regarding staff supervision in that the provision of formal supervision of staff has not been consistent. It was identified that the manager has created a plan which should assist in meeting this requirement. The home is demonstrating that it is attempting to provide different avenues to increase service user involvement in decision making processes within the home but needs to develop and show that there is ongoing consultation with service users and/or their representatives regarding the planning of care and all aspects of life at the home. Further development is also needed by the home to demonstrate that robust processes are in place to meet short- term care needs, and in identifying and avoiding `trigger factors` that may give rise to challenging behaviour. This inspection identified that staff have been exploring the provision of educational opportunities for service users who wish to access different courses-this needs continued effort on the part of the home to ensure that service users are provided with full opportunities for life skills, educational development and ongoing access to community activities. Observation of care records show that staff are reporting and recording injuries however the home needs to be more proactive in its internal processes to monitor and reduce minor injuries to service users.

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 8th January 2007 09:00 Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wrottesley Park House Nursing Home Address Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902 750040 01902 755510 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Abbey Healthcare Homes 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.V328132.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 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 Homes 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.V328132.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted by four inspectors for the duration of one day. The inspection focused on “key” standards – that is, those areas of service delivery regarded as essential to the running of a care home, and areas where shortfalls had been identified at previous visits to the home. 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. CSCI have closely monitored Wrottesley Park House for sometime because of ongoing concerns regarding how the home was operating and a failure on the part of the provider to take action to improve the service, comply with requirements and protect the health and safety of service users. This resulted in CSCI serving four statutory notices in line with Regulation 43 of the Care homes Regulations 2001 in December 2005, followed by a Notice of Proposal to cancel the registration of Abbey Healthcare Homes Ltd in 2006. This inspection finds that the home has made progress in achieving or partly achieving requirements made at previous inspections and this has resulted in the home improving the outcomes for service users. Although some shortfalls are still evident these are much reduced and observations suggest that work is in progress to continue to address shortfalls. The provider, manager and staff now need to demonstrate that improvements can be sustained with their own internal processes to ensure all service users receive a quality service. What the service does well: Service users that were spoken with during the inspection were generally satisfied with the service they receive. Service users who were unable to communicate their needs appeared comfortable, clean, appropriately dressed, and staff were observed attending to these individuals with a sensitive approach. The home is able to cater for individual dietary needs and service users spoken with commented on their satisfaction with the meals provided. The home provides spacious private and communal rooms and the wide corridors ensure that service users dependant on wheelchairs for mobilising have sufficient space for manoeuvring around the home. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? This inspection identifies that the home has achieved 29 previously made requirements. Nineteen other requirements have been assessed as partly achieved, these are in relation to areas where the home has shown signs of improvement but further attention is still necessary to fully achieve the requirement. Improvements identified at this inspection include: The home now has a statement of purpose and service user guide which provide the information that someone would need when considering using the service. Improvements to the care planning and risk assessment process means that staff are provided with the information they require to meet service users long term care needs. The food in the home is of good quality and plenty of fresh produce is now available. Service users have been provided with increased opportunities to access the community, such as shopping trips and visits to the theatre. The sensory room is no longer used to store equipment and therefore offers an improved resource for service users. The home is more proactive in seeking specialist advice and maintains clear records of contact with and visits by GP’s and other healthcare professionals. Improvements to the environment now mean that people residing at the home are provided with a pleasant and safe place to live. Training opportunities within the home have increased, including the provision of training to promote staff understanding and skills in more specialist areas and new staff are provided with structured induction training. Safer working practices now exist in relation to activities such as moving and handling, fire safety, hot water temperatures and the use of bed rails. Improved quality assurance and monitoring processes have been implemented. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 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.V328132.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, Standard 2 not assessed. Quality in this outcome area is adequate. It was not possible to assess the home’s approach to admissions at this inspection. The home’s statement of purpose and service user guide now comply with requirements and provide the information that someone would need when considering using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not admitted any new service users, so it was not possible to inspect the assessment and admissions processes. The home’s statement of purpose and service user guide now contain all the elements required by the regulations and standard, except for detailed staffing arrangements. The home will need to demonstrate how it supports people to access this information as and when new service users are admitted. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is adequate. Improvements to the care planning and risk assessment process means that staff are provided with the information they require to meet service users long term care needs. Further development is needed to show that the home has robust processes in place to meet short term care needs and to demonstrate that service users and/or their representatives are involved in care planning processes and decision making. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At this inspection six care files that were scrutinised in detail showed that the home has improved the way it records information regarding service user’s long - term care needs. Several of the care plans seen provided detailed guidance for staff on how to care for quite complex medical conditions experienced by some individuals and care plans had been reviewed on a Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 11 monthly basis. However observation of the daily recording of information within care files shows that the home is failing to adequately record short term care needs, which without adequate monitoring could potentially become long term problems. For example, the home had initiated prompt contact with a GP for a service user who had recently developed a swollen leg, but had failed to develop a care plan to alert staff to this problem or provide information on how to promote comfort. Similarly for a service user who had sore eyes as a result of conjunctivitis, a care plan had not been drawn up to describe how to care for this individuals eyes and to inform staff how to reduce the risk of crossinfection to other service users. Care plans are generally more detailed in respect of service users’ behavioural needs and provide guidance for staff on safe management, however more work still needs to be done on identifying and avoiding ‘trigger factors’ that may give rise to challenging behaviour and any follow up action taken when adverse behaviour has occurred. A new form has been introduced by the home for the purpose of recording episodes of challenging behaviour, however for one service user scrutiny of their daily records showed at least six episodes of verbal and physical aggression directed towards staff and other service users that had not been documented on the new form. It is important that staff are consistent in their recording so as to help establish frequency of behaviour, effectiveness of intervention and to enable accurate feedback to other healthcare professionals. A range of risk assessments were available on all of the care files seen, these included assessments to inform staff how to move people safely, bed rail risk assessments, pressure sore risk assessments and observation of the pressure relieving equipment for these individuals was found to be appropriate for their documented “risk” score. Regular assessments had been undertaken of service user’s nutritional state, which included at least a once monthly recording of the individual’s weight. Some contradictions were identified within the recording of these risk assessments; this included a moving and handling assessment which gave conflicting information regarding the number of staff needed to transfer the service user, and for two service users who had gained an excessive amount of weight, there was nothing documented to show that staff had acted on this information. There was no date recorded on a number of moving and handling risk assessments. The home is demonstrating that it is attempting to provide different avenues to increase service user involvement in decision-making processes within the home. One service user confirmed that his comments had been raised at the last service user meeting in October 2006, minutes of which were available on each care file seen. Documentation is now available within files, which recognises that for some individuals it may be difficult for them to communicate their views on a group basis and alternative arrangements have been considered by the home, such as inviting significant others to attend meetings on their behalf or via a one to one discussion with staff. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 12 The home needs to demonstrate that there is an ongoing consultation with service users and or their representatives regarding the planning of care, one service user spoken with stated he was not aware of the content of his care plans and other service users have raised this at previous inspections. The manager confirmed that the care planning and review process is due to be discussed at the home’s next ‘family meeting’. During this inspection one individual spoke of how she had not received her contracted hours of one to one care but during feedback the manager confirmed that the home had provided this, it might therefore be useful if the home considered ways to involve this service user in the planning and recording of this information. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. Service users are given the opportunity to take part in a variety of activities within the home and community, although further work is still needed to ensure that service users are provided with full opportunities for life skills, educational development and ongoing access to community activities. The food in the home is of good quality and meets the dietary needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It is positive to report that the home has provided a range of activities throughout December to which families/significant others were invited, this included a ‘Bring and Buy’ day, ‘fish and chip’ supper and Christmas parties. The activity co-ordinators maintain records of all activities provided within the home, and these showed that people have been provided with increased Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 14 opportunities to access the community such as shopping trips, visits to the theatre and it was discussed that nearly all service users went out from the home over Christmas. The home has two activity co-ordinators, one has been in post for sometime and has received training, and the other individual commenced this role in 2006 and has yet to receive training –although the manager confirms this is planned. A discussion with one of the activity co-ordinators confirmed her enthusiasm for developing her role and described how when both activity persons are on duty they will offer different activities to try and cater for the needs of all service users; one service user confirmed that assistance is currently being provided to modify an internet package on their computer. The sensory room is no longer used to store equipment and therefore offers an improved resource; the manager confirmed that staff are aware of the need to exercise caution in the use of the flashing lights in this room with individuals who have a history of epilepsy. At this inspection the manager confirmed that staff have been exploring the provision of educational opportunities for service users who wish to access different courses - this needs continued effort on the part of the home to ensure that service users are provided with full opportunities for the development of life skills and access to other educational opportunities. One individual commented that the home could provide more individualised activities and another commented that they would like to enable service users to ‘get out more’-an ongoing challenge given the diversity of needs of the individuals accommodated. All staff spoken with confirmed that activities within the home had improved. Observation of the agenda for the next service user meeting shows that activities, holidays, lounge areas and key workers are items for discussion. The meal served during the inspection was well presented and service users commented on the ‘nice meal’ and confirmed that choices are offered, including fresh fruit. Observation of the kitchen confirmed plenty of fresh produce was available, a significant improvement from the inspection in September 2006. The home offers a four weekly rotational menu, and the manager confirmed that service users had been involved in devising the new menus, which cater for different dietary and cultural needs of service users. Throughout the inspection staff were seen to be providing appropriate assistance to service users who required help with feeding. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19. Quality in this outcome area is adequate. The home now has processes in place, which show that service users personal and healthcare needs are generally met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As identified earlier in this report the home has made improvements in the way it plans care for individuals and observations of care records show that staff are now maintaining clear records of contact with and visits by GP’s and other healthcare professionals. Records show that the home is more proactive in seeking specialist advice and that advice has generally been sought promptly by staff; although it was seen that for two service users there was nothing recorded to indicate that any action had been taken or specialist advice sought regarding excessive weight gain. Observation of care records for a service user with a visual impairment showed that this service user had sustained injuries to her hands and arms whilst self propelling and the home was informed that it would be useful to seek advice Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 16 from relevant professionals for guidance to ensure that this individuals sensory needs are fully met. Since the inspection in May 2006 the home has introduced a new ‘skin integrity’ form to use in care records for staff to keep a record of any injuries a person may have. It has been an ongoing concern by CSCI that when observing care records during inspections it has been identified that individuals residing at the home have sustained high levels of bruising, although it is positive that staff are reporting and recording these injuries. Cross referencing the information contained within the daily care records at this inspection shows that almost all incidents of injury had been recorded on the skin integrity chart, however not all entries had been signed to indicate which member of staff had recorded the information. Observation of the skin integrity chart showed that the home had acted promptly in reviewing the type of pressure relieving mattress available when a service user’s skin became reddened. However of concern were several entries of bruising of an unknown origin in two service users records and although for some of the entries staff had suggested a possible cause, this was not consistent. It was also seen recorded that one service user had sustained cuts and grazes to different areas of her legs, two of these wounds had required a wound dressing to be applied, however a wound care plan did not describe these wounds and for the month of their occurrence the wound care plan reads ‘no new wounds reported this month’. It would be expected that a care plan would detail these wounds so as to enable accurate monitoring of the wound and to provide guidance to staff on frequency of dressing change. A pressure sore care plan for another service user detailed that a wound dressing needed changing every 3-4 days, an entry on the 18/10/06 detailed the dressing had been changed then nothing further was recorded until the 29/10/06 when it states that the wound had healed. The September 2006 inspection makes reference to a damaged chair with a considerable amount of foam padding exposed and the home had attempted to repair the protective covering with parcel tape. The service user continues to be cared for in this specialist chair and appears to have sustained injuries from this chair, however observation of this service users records show that following the September inspection the home has made frequent contact with different professionals to obtain a replacement chair, and it was confirmed by the deputy manager that it is expected that a replacement chair should be available within the next few weeks. A shower chair in one service users bathroom was seen to be in a state of disrepair and this was brought to the attention of the manager for action. It is pleasing to report that when the CSCI pharmacist inspector visited the home in October 2006 it was identified that the home had made improvements to its medication practices, achieving thirteen previously made requirements. Six additional requirements were made as a result of the October visit. During an unannounced visit to the home in December 2006 the inspectors identified that oxygen cylinders were not being stored safely and a bag of water Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 17 designed to be used for tube feeding was in place next to a service users bed and the date of opening far exceeded the recommended safe ‘use by’ date. Although remedial action was carried out promptly by staff, the home should have been aware of correct procedures to ensure safe practice. At this inspection it was found that one service user who requires medication to prevent constipation, had not had an accurate record kept of bowel movements, the last recorded entry by staff was the 29/12/06, ten days prior to the inspection. Observation of a selection of medication administration records shows that staff have made clear records of medication administered to service users. The medication treatment room was not observed on this occasion. A full assessment of National Minimum Standard 20 was not undertaken at this inspection. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. The home has a written complaints procedure which is made available to service users and is on display in the home. Awareness of local procedures to protect vulnerable adults is good, but the home needs to be more pro-active in its internal processes to monitor and reduce minor injuries to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A written complaints procedure is available via the home’s statement of purpose and service user guide, and is on display in the home’s entrance hall. A complaints log is maintained and a management audit has been introduced. One complaint had been dealt with since the last inspection and it was seen that appropriate action through the home’s disciplinary procedures had been taken following this. The adult protection procedures are well known to the home and the majority of staff have attended training. Further training is planned for those who haven’t, and the home’s manager and deputy are planning to attend a course aimed at managing adult protection in February. A recent allegation of theft made by a service user at the home was referred through procedures, the outcome is not yet known but protocols relating to assisting with service users’ money have been improved to offer more protection to both people living at the home and staff working there. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 19 The home’s manager now undertakes to monitor skin integrity charts, with the intention of identifying in what circumstances people are sustaining minor injuries such as bruising, and instigating remedial action. It was found that although such injuries are being logged and noted, their cause and therefore steps to avoid repetition are not always being explored, identified or documented. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 29 and 30. Quality in this outcome area is adequate. The improvements that have occurred with the environment now mean that people residing at the home are provided with a pleasant and safe place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Observations of a selection of bedrooms, bathing and showering facilities and communal lounges show that the home has continued with a programme of redecoration and refurbishment, including replacing carpets and other floor coverings and providing new armchairs in the main lounges. On the day of this inspection painting was in progress in parts of the home and the maintenance person confirmed that bedrooms are painted in the colours that service users request. All parts of the home and equipment used by service users were observed to be clean and staff were observed using protective clothing appropriately when necessary. Information was available to show that staff have received Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 21 infection control training. One bedpan macerator that is no longer used by the home remains in situ on Brown Unit and the manager confirmed that arrangements would be made to remove this item. The lounge areas within the home have each been given a specific focus, relaxation, sports and activities, however they remain quite sparsely furnished and impersonal –a view shared at the time of a recent audit of the home as part of a quality review. It is acknowledged however that it might prove difficult to personalise these areas without compromising the space required by service users who require the use of a wheelchair to mobilise. The home provides a room for people who smoke, although as noted at previous inspections the door to this room was repeatedly seen propped open, which resulted in a strong smell of cigarette smoke in one of the lounges. Although not discussed at this inspection the home will need to plan how it can make changes to the layout of the home to ensure that small group living areas are provided by April 2007. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is now adequate, with progress being made. Staffing levels are currently sufficient to meet the needs of the people living at the home. Recruitment processes are robust and protect service users. Much effort has been made to develop a training plan and to deliver training so that staff are knowledgeable and competent to meet service users’ needs. Supervision and appraisal systems are being started which will allow management to assess staff competence and identify further development and/or training needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At this inspection, staffing numbers were sufficient to meet the needs of the service users. The home currently aims to provide a mix of qualified nurses, senior care and care staff with the target of having thirteen people on duty in the mornings and seven in the afternoons, solely concerned with care tasks. The manager confirmed that staffing levels will need to be reviewed when the numbers of service users residing within the home increases. The care staff are supported by administrative, catering, housekeeping, laundry and maintenance Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 23 personnel plus activities co-ordinators. Staff meetings are now being held with the manager’s aim being that monthly meetings will take place. One personnel file relating to a new starter was examined. The information and checks required by the regulations and to keep service users safe was available. It was acknowledged by the home’s manager that the CRB provided had been made incomplete (through the organisation’s process to protect confidentiality) by having the date removed and undertook to address this. The file contained a completed “Skills for Care” induction checklist. The home has made significant efforts to implement a training and development programme, with the home’s deputy manager taking a lead in this area. Training provided in the last twelve months includes: manual handling, health and safety, working safely with hazardous substances, 1st Aid, food hygiene, using hoists safely, tissue viability, falls prevention, infection control, documentation and care planning. Training to promote staff understanding and skills in more specialist areas e.g. with regard to specific disabilities, dealing with learning disabilities and possible associated behaviour has also been provided or planned. Training is being accessed for senior staff who need to be able to lead teams, and for kitchen and housekeeping staff who are also being supported to gain national vocational qualifications in their particular areas of work. The training matrix for the home identifies where there are “gaps” and it was acknowledged that moving and handling training for a number of staff is now due for updating. A dozen of the care staff have already achieved NVQ2 accreditation and ten more are pursuing accreditation at either Level 2 or 3. The home does not currently meet the required level of 50 of staff with NVQ2 but is well on the way to achieving this if everyone is successful. Staff supervision and appraisal have been started and managers recognise the importance of establishing these processes in order to monitor and develop staff competence and practice. The manager has acquired competence assessments for working with PEG feeds and hopes to develop a similar process for tissue viability. Discussions with staff confirmed an increase in training opportunities and care staff spoke positively about how trained staff were available for guidance and of the support provided by the management team. Most of the staff spoken with felt that the staffing levels are generally sufficient to meet service user daily care needs. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41, 42. Quality in this outcome area is adequate. Improved quality assurance and monitoring processes have been implemented, so that the manager and provider can assess how well the home is meeting its statement of purpose and the regulations. Efforts are being made to improve communication with people who live at the home and their families and to respond to feedback. Training and systems relating to safe working practices are much improved, meaning that service users are less at risk. This judgement has been made using available evidence including a visit to this service EVIDENCE: Ms Steventon, acting manager of the home, has applied for registration with CSCI. Ms Steventon has undertaken monthly audits of key areas of the home’s operation, such as medication administration, accidents, maintenance Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 25 and complaints. Where necessary, action plans are created. The home has dealt with one complaint since the last inspection, which is now believed to have been satisfactorily resolved and appropriate action was taken. An allegation has been referred appropriately through local multi-agency adult protection procedures, the outcome of which is not yet known. Regulation 26 visits, formerly done by the home’s senior management, are now being conducted by an outside body and this appears to be paying dividends in that actions are being recommended and acted upon by the relevant staff group. This was particularly evident when looking at safety and maintenance records. Quality questionnaires have been issued to staff, service users and their families and these are being analysed externally. The home manager has also engaged in service user/family meetings and hopes to promote these further, along with being available for 1:1 discussions. Generally record keeping has improved and a small number of shortfalls were identified at this inspection relating to staff not completing records in full, or failing to sign records. As reported under the staffing section earlier in this report, there has been a lot of training activity and much of this has been focused on safe working practices and health and safety. This has included the use of hoists and the use of bed rails and it would appear that accidents related to problems in these areas have decreased. The requirements of the Fire Safety Officer have been complied with, and further training is planned for staff in this area. Staff supervision and appraisal to monitor staff competence, identify any weaknesses and further inform the training and development plan for the home will consolidate these improvements. Previously a requirement has been made that heat sources within the home must be fixed and guarded in order to protect service users fully from risks of contact burns or of fire. At an inspection to the home in December 2006, when free-standing heaters had again been observed, the inspectors were informed by the operations manager and senior nurse that the heating installed in the home is inadequate for some service users who then provide their own supplementary heating. It was discussed at this time that the heating within the home should be sufficient to meet the varying needs of service users, without the need for supplementary heating. On the day of this inspection it was identified that all but one of the unguarded and free- standing appliances within the areas of the home seen had been removed. At the beginning of 2006 statutory notices were served on the home requiring improvements to the systems for keeping people safe. It was established through discussion with staff during this inspection that systems for ensuring the safety of bed rails have been established, with further training being provided in the near future. No problems were identified with bed rail Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 26 provision or fitting at this inspection. Similarly, systems have been put in place to monitor water temperatures and keep people safe from scalding. Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 27 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 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 3 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 X X X X 3 X 2 2 X Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 14 Requirement 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 Timescale for action 19/03/07 8/01/07-Home has been unable to demonstrate compliance as no admissions (Previous timescale of 20/01/06) 2. 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 19/03/07 8/01/07-Home has been unable to demonstrate compliance as no admissions (Previous timescale of 1/09/05, 15/12/05 and 20/01/06) 3. YA2 14 The registered person must confirm in writing to the service user that the DS0000036983.V328132.R01.S.doc 19/03/07 Wrottesley Park House Nursing Home Version 5.2 Page 29 care home is suitable for the purpose of meeting their needs 8/01/07-Home has been unable to demonstrate compliance as no new admissions (Previous timescale of 1/09/05, 13/01/06) 4. YA3 14 The registered person must not admit people whose needs it cannot meet or with whom it cannot develop effective communication 19/03/07 (Home has been unable to demonstrate compliance as no admissions) 5. 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. 19/03/07 8/01/07-Compliance now partly achieved. (Statutory requirement notice issued following December 2005 inspection) 6. YA6 15(1) Care plans must set out how current and anticipated specialist requirements will be met. 19/03/07 8/01/07 Compliance now partly achieved. (Previous timescale of 24/02/06 and 1/07/06, 1/12/06) 7. YA7 12(3) Staff must provide service 19/03/07 users with the information, assistance and communication support DS0000036983.V328132.R01.S.doc Version 5.2 Page 30 Wrottesley Park House Nursing Home they need to make decisions about their own lives and demonstrate how individual choices have been made 8/01/07 Compliance now partly achieved. (Previous timescale of 24/02/06 and 1/08/06, 1/12/06) 8. YA8 12(5) The registered person must consult with service users regarding all aspects of life at the home 8/1/07-Compliance now partly achieved. (Previous timescale of 24/03/06, 1/08/06 and 1/12/06) 19/03/07 9. YA11 16(2)(m)(n) The registered provider must provide opportunities for service users to learn and use practical life skills 8/1/07-Compliance now partly achieved. (Previous timescale of 24/03/06, 1/08/06 and 1/12/06) 19/03/07 10. YA12 12(1) The registered provider must enable service users to take part in age, peer and culturally appropriate activities e.g educational opportunities. 8/1/07-Compliance now partly achieved. (Previous timescale of 1/10/05, 24/03/06, 1/08/06 and 1/12/06) 19/03/07 11. YA13 12(1) The registered provider must enable service users to be come part of, and participate in, the local community 19/03/07 8/1/07-Compliance now partly achieved. (Previous timescale of 24/03/06 1/08/06 and 1/12/06) Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 31 12. YA14 16(2)(n) The registered person must ensure that service users have access to a range of appropriate leisure activities 8/1/07-Compliance now partly achieved. (Previous timescale of 24/03/06, 1/08/06 and 1/12/06) 19/03/07 13. YA16 12(1)(b) The registered person must ensure that daily routines of the home promote choice and independence 19/03/07 8/1/07-Compliance now partly achieved. (Previous timescale of 24/02/06 1/08/06 and 1/12/06) 14 YA17 14 (2) Schedule 3 (3)(m) Schedule 4 (13) 12(1)(b) 8/01/07-Compliance partly achieved. (Previous timescale of 1/12/06) Service users nutritional needs must be assessed and regularly reviewed and updated. 19/03/07 15. YA18 19/03/07 Service users must be provided with the technical aids and assistance required 8/1/07-Compliance partly achieved. (Previous timescale of 27/01/06, 24/02/06, 1/08/06 and 1/12/06) 16. YA19 12 Service users’ health must 19/03/07 be monitored and potential complications and problems are identified and actioned and kept under regular review. 8/01/07-Compliance partly achieved. (Previous timescale of 24/03/06, 1/07/06 and 1/12/06) Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 32 17. YA20 13(2) 19/03/07 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 (Not assessed in full at this inspection-see pharmacy report) 18. YA23 12(1)(13(6) The registered person must ensure that any injuries sustained by service users are fully investigated and appropriate action taken 19/03/07 8/01/07-Compliance partly achieved. (Previous timescale of 24/02/06, 1/07/06 and 1/12/06) 19 YA30 13(3) 8/01/07-Compliance not assessed at this inspection. (Previous timescale of 1/11/06) Clinical waste containers must be kept secure. 19/03/07 20. YA32 18(1)(a) The registered person must ensure that service users are supported by staff competent to undertake the tasks they do, through training, monitoring and supervision. 19/03/07 8/01/07-Compliance partly achieved. (Previous timescale of 24/02/06, 1/08/06 and 1/12/06) 21. YA32 18(1)(a) The registered person must ensure that staff have the specialist qualifications, skills and DS0000036983.V328132.R01.S.doc 19/03/07 Wrottesley Park House Nursing Home Version 5.2 Page 33 experience to support the service user group 8/01/07-Compliance partly achieved. (Previous timescale of 21/07/04, 1/02/05, 24/02/06, 1/07/06 and 1/12/06) 22. YA33 18 (1) (a) The registered person must review staffing levels regularly to reflect service users’ changing needs and ensure that there are sufficient numbers of staff on duty to meet service user needs. 8/01/07-Ongoing requirement with which the home must demonstrate compliance) 19/03/07 23 YA36 18(2) The registered person must ensure that persons working at the care home are appropriately supervised, with recorded supervision sessions at least six times a year in addition to regular day to day contact The registered person must ensure that all records required by regulation are well maintained, up to date and accurate 19/03/07 24 YA41 17 19/03/07 8/01/07-Compliance partly achieved. (Previous timescale of 24/03/06, 1/07/06 and 1/12/06) 25. YA42 13(4) Heat sources must be fixed and guarded. 19/03/07 8/01/07-Compliance partly achieved. (Previous timescale of 27/01/06, 24/02/06, 1/07/06 and 1/11/06) Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 34 26. 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. 19/03/07 8/01/07-Compliance partly achieved. (Previous timescale of 1/08/06 and 1/12/06) 27 YA42 13 (4),(5) (6) 23 (4) (d) 8/01/07-Compliance partly achieved (Previous timescale of 1/12/06) All staff must receive mandatory training relating to safe working practices and these be updated at the required frequency. 19/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3 4 Refer to Standard YA6 YA24 YA34 YA35 Good Practice Recommendations It is recommended that staff attend training in person centred planning (PCP) and a PCP be developed with each individual service user (Recommendation remains from Sept 06). The home should plan how it will make changes to the layout of the home to ensure that small group living areas are provided within the home by April 2007. The home should develop processes by which service users are supported to be involved in staff selection. It is recommended that appropriate courses be sourced for activity organisers. (Recommendation remains from Sept 06). Wrottesley Park House Nursing Home DS0000036983.V328132.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V328132.R01.S.doc Version 5.2 Page 36 - 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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