Inspection on 29/11/05 for Wyatt House

This inspection was carried out on 29th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wyatt House 19/09/06

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 Unannounced Inspection 29th November 2005 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.V266920.R01.S.doc Version 5.0 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.V266920.R01.S.doc Version 5.0 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 To be appointed Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 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. 17/05/05 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. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced inspection over a period of 5.5 hours. During the day she talked to five of the residents, read their care records, visited their bedrooms and observed the arrangements for some diversionary activities, which had been organised that day. The inspector also spoke with members of staff, and looked at a selection of recruitment and training records plus other documents, which were available in the home. Finally, the inspector was given the opportunity to speak with the Manager and the Administrator, both of whom were most cooperative in providing information as requested. The Manager informed the inspector that she is about to be seconded to another home managed by the Orders of St John Care Trust for a three-month period. The Deputy Manager will manage Wyatt House during this time. What the service does well: What has improved since the last inspection? The Home is now showing the benefits of strong effective management. On the whole, policies and procedures are implemented correctly and effectively. There appears to be a more positive attitude from the staff employed in the Home with three people commenting on how much they now enjoy working there. There continues to be improvements in the décor of the Home; the provision of new furniture and decorative changes has created a more homely welcoming atmosphere throughout the property. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 6 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.V266920.R01.S.doc Version 5.0 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.V266920.R01.S.doc Version 5.0 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): 2 and 3 A thorough assessment process plus the provision of detailed information about the Home enables prospective residents and their advocates to make an informed decision regarding admission to Wyatt House and gives them assurance that their needs will be met. EVIDENCE: Following the takeover of management responsibility by the Orders of St. John Care Trust, residents who are privately funded are now provided with a revised copy of the terms and conditions for admission to the Home. Social Services funded residents or their advocates are also provided with appropriate documentation for their information. Each person is given up to date details about any ‘RNCC’ funding to which they may be entitled. Signed copies of the contracts were seen in the records relating to those residents who had been selected as part of a case tracking exercise. Each prospective resident is fully assessed before moving into Wyatt House. Documented records of the processes are maintained in the residents’ care files. The Home has a long waiting list for admission. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 9 Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 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 and 9 The care planning and medication administration systems in place require some additional action to address the residents’ care needs appropriately and also to ensure that the people living at the Home are not put at any risk of potential error. EVIDENCE: Fully detailed care plans are prepared for each resident based on an assessment of his or her care needs. Any identified need is clearly linked to an explicit care plan. The Manager has been responsible for preparing these documents and they are all typed for increased clarity. Risk assessments are also prepared to address any vulnerability to pressure, manual handling needs plus any specific issues, such as aggressive behaviour and resistance to personal care. Handwritten reviews are undertaken on a monthly basis although documentation relating to one person was dated during the period the person was in hospital and did not reflect the actual condition at that time. Medications were stored securely. Handwritten records seen on this occasion were clearly written but in most cases were only signed by one person; none Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 11 contained a counter signature, as is required when not written by the prescribing Doctor. Some had not been signed at all. There were also examples where analgesia was prescribed ‘PRN’; this requires a more detailed explanation, such as, ‘when required to ease pain’. Controlled drug records accurately matched the stock in the dedicated cupboard. None of the residents were self-medicating drugs on this occasion. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 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): 13 and 14 Residents are facilitated to maintain any links they wish with family, friends and the local community, thus adding interest to their lives through social contact. EVIDENCE: Visitors are welcome in the home at any time although only one relative was spoken to on this occasion. This lady was most effusive in her praise of the staff and their attitude both to her relative and to herself. She commented that, “They always have a friendly word for me. I never feel a nuisance or in the way when I ask questions.” The written care plans do indicate that residents must be permitted to make choices, as far as they are able. Many are unable to exercise choice in their lives due to varying degrees of confusion. However, it was observed that one gentleman made it very clear to a carer that he did not wish to sit in one of the lounges; his decision was respected and he was immediately assisted back to his bedroom. Another lady refused to eat the meal that had been prepared for her but readily ate the alternative food, which was then brought to her. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 13 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): 18 The implementation of the Home’s robust policies and procedures gives residents and their families the assurances that they may expect to live in a safe and protected environment. EVIDENCE: The Orders of St John Care Trust have prepared detailed policies to address all forms of abuse. Copies of this documentation are readily available to staff at this home. Risk assessments to address issues relating to residents who display challenging behaviour have been documented and are filed in the care records. A study session on “Challenging Behaviour and Abuse” was arranged in the home on 25.10.05; twenty members of staff attended this training event. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 14 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, 24, 25 and 26 Continued environmental improvements ensure that the residents live in a homely and safe accommodation. EVIDENCE: The general appearance of this home continues to improve. Since the last inspection, five bedrooms have been redecorated, as has the small lounge. Plans are now in place to refurbish one of the bathrooms and to replace some deteriorating windows. The handyman was repainting one of the corridors on this day. All the exterior paths to the building were very icy and slippery on this occasion, creating a potential risk to staff and visitors approaching the building. The garden, although well maintained and fully enclosed, continues to be inaccessible to residents without assistance from the carers. Residents’ bedrooms were clean; many of the beds had been made with fresh bedding. Many had photographs of the resident in their younger days fixed to the door to assist the person to locate his or her room. There was considerable Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 15 evidence of personalisation, particularly with photographs of loved ones and other treasured possessions. Where required, light bulbs had been replaced with those of a stronger wattage to improve the lighting in the bedrooms. Despite the icy weather conditions, the whole home was pleasantly warm but well aired. The majority of the home was also clean with only minor offensive odours in some areas. The laundry was tidy and well organised. The laundry assistant displayed a good knowledge of infection control procedures and appeared to be making every effort to return clean well presented clothing to the correct owners. Clinical waste is addressed appropriately. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 16 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, 29 and 30 Residents receive care from a stable competent workforce but some minor improvements in recruitment practice would help to ensure that they are fully protected. EVIDENCE: There were thirty residents living in the home although one person was in hospital receiving treatment for an infection. Despite the extremely difficult driving conditions due to the weather, only one person had been unable to attend for duty on this day. As a result, in addition to the Manager, there was another qualified nurse with five care staff to care for the residents; a nurse and five care staff would be covering the evening shift and a nurse and three carers overnight. There appeared to be an adequate number of staff on duty to address the residents’ needs. Scrutiny of the personnel records relating to staff employed since the last inspection showed that careful recruitment processes continue to be observed in the home. All the required employment checks are undertaken before the member of staff joins the team and each person is fully inducted and supervised in their new roles. Full records are maintained of the recruitment processes. Application forms still do not request a full employment history, as is required. Updated documentation is now being introduced. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 17 Discussions with the member of staff responsible for organising training and observation of the records show that training requirements are addressed methodically and carefully, ensuring that any identified needs are addressed in a timely manner. Members of staff who were questioned had a clear idea of the action to take if the fire alarm sounded. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 18 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): 35, 36 and 37 Through the implementation of effective management policies and procedures, residents are protected and their rights are upheld. EVIDENCE: The Administrator continues to take responsibility for the personal monies for the majority of the residents; five were selected for inspection as part of the case tracking exercise. The money is maintained in individual secure storage and accurate records of every transaction documented. Each person’s position in relation to any ‘Power of Attorney’ arrangement is clearly recorded. Good progress has been achieved in ensuring that staff are all fully supervised in their roles. Documented records of these processes are maintained in the personnel files. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 19 Clear and appropriate records are maintained in the home, both electronically and in paper form. Data Protection requirements are observed correctly. All records are maintained securely. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 20 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 x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 3 3 3 x Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP9 Regulation 15(2 b, c, d) 13(2) Requirement Care plans must be reviewed to accurately reflect the resident’s current condition. The person making the record in the drug administration documentation must sign any handwritten amendments. These must also be countersigned by another witness The drug administration documentation must give clear direction when a medication may be administered Each employee must provide a full employment history plus a satisfactory explanation for any gaps in employment (Time scale 31/7/05 not met) Timescale for action 31/01/06 31/12/05 3 OP9 13(2) 31/12/05 4 OP29 Sch. 2.6 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Wyatt House Refer to Good Practice Recommendations DS0000064585.V266920.R01.S.doc Version 5.0 Page 22 1 Standard OP19 It is recommended that the exterior paths of the building should be salted in icy weather to minimise the risk of accidents to staff and visitors. Wyatt House DS0000064585.V266920.R01.S.doc Version 5.0 Page 23 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.V266920.R01.S.doc Version 5.0 Page 24 - 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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