Inspection on 19/09/06 for Wyatt House

This inspection was carried out on 19th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Wyatt House 29/11/05

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

CARE HOMES FOR OLDER PEOPLE Wyatt House Lower Farmhill Stroud Glos GL5 4EE Lead Inspector Mrs Eleanor Fox Key Unannounced Inspection 19th August 2006 09:30 X10015.doc Version 1.40 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 Wyatt House DS0000064585.V306929.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 Older People. 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. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wyatt House Address Lower Farmhill Stroud Glos GL5 4EE 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) 01453 764194 The Orders of St John Care Trust Mrs Tracy Nurding Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate two named service users under the age of 65 years. This condition will be removed when the named service users reach the age of 65 or no longer reside at the home. 29th November 2005 Date of last inspection Brief Description of the Service: Wyatt House is a purpose built Care Home, circular in design, providing personal and nursing care to thirty elderly service users who are suffering from dementia. The Home also offers day care facilities and is situated in a large housing estate close to local shops and other amenities. The accommodation, consisting of thirty single rooms, is on two floors and has been fitted with a shaft lift to provide access to both floors. Although none of the rooms have en suite facilities, there are several assisted bathrooms and separate toilet facilities throughout the Home. All the bedrooms are pleasantly decorated and many have the benefit of attractive views. There are three lounges within the Home plus two dining rooms and a number of smaller sitting areas for service users’ use. Although access is somewhat limited, the enclosed well-stocked gardens are maintained to a good standard and may be enjoyed by the service users when the weather permits. The provider has information about the home, including the most recent CSCI report readily available for anyone who has expressed an interest. Current fees range from £483 to £725. Hairdressing, chiropody and any personal items are charged extra. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the home and takes into account the views and experiences of people using the service. One inspector undertook this unannounced inspection of Wyatt House over one day in September. During the visit, she chose three of the residents for particular scrutiny. She spoke to each of these people and in two cases a relative, read their care records, visited their bedrooms and, where possible, observed their interaction with members of staff. The inspector read selected personnel and recruitment records, walked around the property and observed the service of a mid day meal during her visit. She also spoke with some of the staff who were on duty on this day. Finally, she talked with the Manager, and to her deputy, particularly in relation to general management issues. Both were open and most cooperative in providing information as requested. CSCI surveys were distributed to residents, relatives and members of staff working at the home. Twelve were returned from residents although in the majority of cases, a relative completed the form; five surveys were received from staff and seven comment cards were received from relatives and advocates. Many of their comments and opinions are reflected in the content of this report. What the service does well: Each prospective resident is fully assessed before admission to Wyatt House is arranged, ensuring that the home is able to meet all his or her care needs. Excellent care documentation is prepared for each person; the thorough content gives clear details to the carers of the particular needs of each resident. Medication administration is also managed well. Residents living at Wyatt House are treated with courtesy and friendly respect. Twelve of those people who responded to the questionnaires made positive comments about the staff with one person saying, Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 6 The staff have great patience; they are always so kind to (my relative) and to us.” A good range of appropriate activities are provided for the residents if they wish to take part. Any complaints or concerns are addressed promptly and, if required, full investigations are undertaken. Maintenance and decorative requirements are addressed in a timely fashion, giving the residents a comfortable home in which to live. Employees have the opportunity to attend training appropriate to their work. The home has the benefit of strong leadership and committed focussed management. There is also a good focus on improving the quality of care provided to residents at the Home. What has improved since the last inspection? 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. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A thorough assessment process plus an invitation to visit the property and the provision of literature about the home, although now requiring some revision, enables prospective residents and their families to make an informed decision regarding their admission and gives them assurance that their needs will be met. EVIDENCE: A comprehensive selection of information about the home is provided to each prospective resident and/or their relatives. However the content has still not been fully reviewed and updated following the change of ownership in early 2005. The manager did confirm that the new brochures would be finalised very shortly. A contract outlining the terms and conditions for admission to the home, had been provided to each of the residents who were selected as part of a case Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 9 tracking exercise during the inspection of the home. Signed copies of the completed documentation were seen in their personal files. Available records in the residents’ care files show that thorough assessments are undertaken of each person to ensure that the home is able to meet his or her care needs. These details are all documented for reference when the admission processes are carried out. The staff also have the benefit of the Social Services Assessment plus any information provided by previous care personnel. The daughter of one resident described the visit she had made to the home prior to her Mother’s admission; she had been most reassured by and grateful for the sensitive guidance and support she had received from the staff both before and after her Mother’s arrival at the home. The husband of another prospective resident visited the home during the inspection. Intermediate care is not provided at this home. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care planning systems in place fully provide the staff with the information they require to care for all the residents’ needs. Medication systems are also managed well, ensuring that residents should not be put at any risk of potential errors. Residents are also treated with courtesy and respect. EVIDENCE: Extremely thorough clearly written care plans are developed for each resident; those relating to the three people chosen as part of a case tracking exercise were read in detail on this visit. In each case a most comprehensive assessment had been undertaken followed by the preparation of specific care plans. These provided all the information required to guide the staff who were providing care. Each document had been reviewed appropriately and appeared to reflect the resident’s current condition. Two visitors who were questioned, strongly confirmed that they had input into decisions about their respective relative’s care; each was satisfied with the care provided. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 11 In addition, detailed risk assessments are documented as appropriate; these are reviewed as necessary, but at least once a month. Care plans are prepared in typewritten format to aid clarity. There were clear records to indicate that care from other healthcare professionals is sourced when required. One person had received treatment from a community psychiatric nurse, incontinence nurse, chiropodist and the General Practitioner in recent months. The medication administration systems relating to the three selected residents were inspected on this occasion. Storage, medication policies and the management of homely remedies were also observed. All the medications were stored securely. In the particularly hot weather it had been identified that the drug storage room could not be maintained at an equitable temperature; air conditioning is now going to be provided for this area. Medications were stored, administered and recorded correctly. Any handwritten entries were documented accurately. Photographs were provided for each person to aid identification. Medication policies were readily available and a recent copy of the British National Formulary was provided for reference purposes. Homely remedies are managed correctly. Throughout the visit, members of staff were observed and overheard addressing the residents in a respectful but friendly and sensitive fashion. All personal care appeared to be given in privacy. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Good opportunities are provided for varied and stimulating activities to occupy the residents and thus improve their quality of life. They are also facilitated to maintain any links they wish with family, friends and the local community, thus adding interest to their lives through social contact. The meals are nutritious and balanced, offering a good choice and variety to the residents. EVIDENCE: A good variety of activities to suit the residents in this home are arranged on a daily basis; these are advertised on the home’s notice boards but staff also remind residents verbally and if necessary guide them to the appropriate room if they wish to take part. Photographs of a variety of events and celebrations were also displayed; the residents present were clearly enjoying themselves. On this day a group of people were playing a balloon coordination game; others were relaxing in the dedicated diversional therapy area and some listened to light music or watched the television in their bedrooms. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 13 One to one stimulation is also provided as appropriate; one of the carers described some of the individual care she gives to the residents. Residents’ level of participation in activities is fully documented for further reference. Residents are free to see family and friends whenever they wish. Three relatives spoke to the inspector on this visit. All three spoke in a complimentary fashion about the home, confirming that the staff are friendly and supportive and that their relatives were receiving good care. Although all the residents are suffering from varying degrees of confusion, there are clear instructions in the care plans that they must be offered choice whenever possible. Members of staff were heard offering choice about meals, participation in activities and whether one resident would like to have a walk in the garden. The service of the mid day meal was observed on this visit. The majority of residents sat in the dining room although some preferred to remain in their bedrooms or in alternative areas of the home. Members of staff were observed trying to present the food in an appetising fashion. Most of the residents required some degree of support to eat their meals; assistance was provided in a sensitive and considerate manner. Most people appeared to enjoy their meal. There were recorded comments in the care files indicating when residents had not eaten an adequate meal; dietary supplements were provided as and when necessary. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A satisfactory complaints system enables residents and their families to feel assured that their views would be listened to and acted upon. Residents are offered a good level of protection against abuse. EVIDENCE: A comprehensive Complaints Procedure has been prepared for Wyatt House. A copy of the document is provided to each prospective resident and/or relatives with other information about the home. The details are also displayed within the home. There have been two formal complaints about Wyatt House since the last inspection. Both were addressed promptly, fully investigated and, where necessary, remedial action taken. The home provides a fully documented policy to address all forms of abuse. The policies are readily available for staff to read. Abuse issues are covered in the Induction Programme, which each newly appointed member of staff attends. There has also been further formal training on the subject. Members of staff who were questioned displayed a good understanding of the issues. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 15 Information on sourcing advocacy support is provided if the residents require this facility. POVA (Protection of Vulnerable Adults) legislation is correctly followed at Wyatt House. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The Home is designed, furnished and maintained to suit the special needs of the elderly service users living there. EVIDENCE: On this occasion, damaged woodwork on the exterior of the building was being repaired and decorated. Since the last inspection replacement armchairs have been provided in the lounge, a parker bath has been installed, replacement flooring has been fitted in the lounge and ten new wheelchairs have been purchased. The entire home was reasonably clean, pleasantly decorated and there was a calm relaxed atmosphere throughout the property. A visit was made to the bedroom of each of the residents who had been selected for case tracking. Each room had been personalised with photographs, treasured possessions and in some cases, some small items of furniture. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 17 Full laundry facilities are provided in the home; the room is kept secure when no one is working in this area. Residents’ personal clothing is discreetly marked and returned to their own bedrooms for storage. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents at Wyatt House receive care from a competent stable workforce. EVIDENCE: On this occasion there were thirty residents living in the home. The Manager and her deputy were on duty with another nurse and six carers to look after the residents. Two cleaners, the maintenance man, cook and kitchen assistant were also working that day. A nurse, five carers and a kitchen assistant were scheduled to be on duty in the evening with a nurse and three carers working overnight. The Manager has recently been given permission to increase the staffing cover to seven carers in the morning and six carers in the evening. This should help to meet the shortfalls identified in questionnaires returned from relatives and staff, many of whom commented that the home was sometimes short of staff, putting pressure on those people trying to provide care to the residents. Of the twenty-four carers employed at the home, ten have achieved a National Vocational Qualification, Level 2 in Care. Four carers are undertaking the training at the current time and a further two people have made a commitment to commence NVQ, Level 3 in Care. The home has been successful in recruiting an additional four members of staff since the last inspection; their personnel files were seen on this occasion. In Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 19 each instance, the prospective employee had completed an application form providing details of his or her employment history; records had been made of the interview processes, and correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. Two written references had been provided for each applicant. Each new employee is fully inducted to his or her role. The records show that mandatory training continues to be addressed in a timely manner. Members of staff working at Wyatt House have also attended additional specialist training appropriate to their roles. In recent weeks, this has included Customer Care, Dementia Care, and training in new catering procedures for the cooks. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Robust management systems ensure that the financial interests, and the health, safety and welfare of people using the service are safeguarded. There is also evident commitment in the Home to improve the services for the benefit of the residents living there. EVIDENCE: The Manager, a very experienced trained nurse who has also undertaken additional management training, is well supported in her role by her deputy, a trained mental nurse, and her administrator. The home now has the benefit of strong leadership and committed focussed management. With the exception of one person all the staff who responded to the questionnaires or who spoke to the inspector felt that they received good management support at Wyatt House. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 21 There are a number of quality improvement measures undertaken at this home. An in-house relatives satisfaction survey was completed in April 2006; an action plan was prepared to address the issues identified. A further satisfaction survey has now been conducted by the Orders of St John Care Trust. The results of this survey have not yet been collated. Medication administration and care planning are both closely monitored internally. Any complaints, accident and incidents are all audited on a monthly basis. Residents’ satisfaction with the provision of meals is also monitored. The Administrator continues to take responsibility for the personal monies for the majority of the residents in the home; the records relating to the three residents selected for case tracking were checked on this occasion. It was observed that meticulous records are maintained and that individual secure storage is provided. Residents’ status in relation to ‘Power of Attorney’ is also maintained on file. Records were provided to show that statutory maintenance/inspection of equipment and services is arranged in a timely fashion. Where faults are identified, they are rectified as necessary. Water temperatures are checked at outlets on a monthly basis; in recent months these have remained within safe levels. Fire prevention management and training of staff appears to be addressed correctly. Records showed that fire drills had been undertaken in June, July and August 2006. One member of staff showed that she had a clear understanding of her responsibilities if the fire bells were activated. An Environmental Health inspection took place in 2005; issues highlighted for improvement have now been corrected. The home has just been awarded the ‘Fit to eat’ award by Stroud Council. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x 3 x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 x 3 x x 3 Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 6 (a & b) Requirement The Statement of Purpose and Service User’s Guide must be fully reviewed and updated. Once completed, copies must be made available to current and prospective residents. A copy must also be provided to the Commission for Social Care Inspection. Timescale for action 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP28 Good Practice Recommendations It is recommended that at least 50 of care staff should be trained to NVQ, level 2 or equivalent. Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Wyatt House DS0000064585.V306929.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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