Inspection on 13/07/06 for Wychdene

This inspection was carried out on 13th July 2006.

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 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

Wychdene 20/07/09

Wychdene 16/12/08

Wychdene 19/02/08

Wychdene 26/02/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Wychdene 19 Callis Court Road Broadstairs Kent CT10 3AF Lead Inspector Tina Thomas Key Unannounced Inspection 13th July 2006 10:00 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 Wychdene DS0000065494.V303780.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. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wychdene Address 19 Callis Court Road Broadstairs Kent CT10 3AF 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) 01843 865282 Mylan Ltd Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of four (4) Service Users to be accommodated at any one time over a maximum period of 28 days. To admit one (1) Service User, whose date of birth is 22/06/1944. Date of last inspection 13/10/05 Brief Description of the Service: Wychdene residential home. It is owned by a private company. It is a large detached property situated in the village of Broadstairs. The home is located in close proximity to local amenities. Wychdene is registered to provide personal care and support for up to 28 older people, who require varying degrees of assistance. The home currently has no registered manager. Fees range from£303-358.75 Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first inspection conducted at the home since it is has been under the new ownership of Mylan Ltd. The registered manager of the home left in July 06. The site visit was conducted over a day and a half with the assistance of the acting manager Sonia White. The inspection included gaining the views of the service users, their relatives, and staff, reviewing documentation including service users care plans and policies and procedures and a tour of the building. Two immediate requirements were made during the site vist regarding raised water temperatures and medication issues. What the service does well: What has improved since the last inspection? What they could do better: The provider must update its statement of purpose and service user guide so that prospective service users are aware of exactly what is on offer at the home. The provider must ensure that it does not admit service users that are out of category of the homes registration. Medication practices must be improved to ensure service user safety. Care plans must be developed to better instruct staff as to how to look after service users and to meet their needs. Staffing numbers need to be reassessed to ensure that they are meeting service users needs. Some staff have not completed some mandatory training. The provider must produce an annual development plan. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 6 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. Wychdene DS0000065494.V303780.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 Wychdene DS0000065494.V303780.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 Quality in this outcome area is poor. The judgement has been made using available evidence including a service visit. People do not have the information they need to make an informed choice. Some people have been admitted to the home without suitable consideration as to whether their needs can be met. EVIDENCE: The statement of purpose and service user guide has not been updated to reflect the new changes in management. It does not reflect that there are service users that live in the home that have cognitive impairment. It states that the home offers day services. The registered provider must inform the Commission as to how this can occur without impacting on current service users. Each Service user has a contract with the home. It was noted that sometimes people change room and this is not reflected in their contract. There are contradictory comments in the contract regarding telephone charges. The contract makes an incorrect statement regarding the role of the Commission. This must be removed. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 9 Pre admission assessments were viewed and found to be well-documented and holistic in approach. However, it is apparent that there are some people who live in the home that may have cognitive impairment. The care manager’s assessment for one service user stated that the service user had dementia. The home is not registered to care for people with dementia. The home must ensure that people in the home who are demonstrating lack of cognitive ability are suitably assessed by an appropriate health care professional and a firm diagnosis made. Variations to the registration must be applied for. Wychdene DS0000065494.V303780.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): 7,8,9,10, Quality in this outcome area is adequate. The judgement has been made using available evidence including a service visit. All service users have a plan of care. People’s health care needs are generally met. Medication practices are unsafe. People feel they are treated with dignity and respect. EVIDENCE: Each service user has a care plan. The service user’s plan does not set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met. However, they do clearly indicate the service to be provided and the objective of the care. The inspector and manager discussed how these could be developed to more clearly describe the action staff must take to deliver service users care and ensure continuity of care. Conversation with staff indicated that they had a good knowledge of individual service users and were aware of service users preferences. Daily records were well written by care staff. The care plan is reviewed monthly. Service users should sign their agreement of their care plan. Service users did not always have necessary risk assessments in place. Care must be taken that information from the care manager’s assessment are transferred to the homes care plan accurately. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 11 Service users personal and oral hygiene was met. However service users do not have a risk assessment completed to measure whether they are at risk of developing pressure sores. Service users psychological health is not suitably monitored and as previously mentioned there are service users that are out of the category that the home is registered to care for. Nutritional screening is not undertaken on admission or subsequently on a periodic basis, however there was evidence that people are weighed regularly and food intake recorded and appropriate action taken when necessary. The medication procedures were discussed. It was agreed that there are issues regarding the storage and dispensing of medication. An immediate requirement was made regarding the dispensing of medication. Medication must be suitably stored. Medication administration records were generally well maintained. However, they contained some handwritten entries that were not signed or dated. This was discussed with the manager. Some service users self –medicate and are supported and encouraged by the home to do so. However, the home should ensure that there are sound procedures and risk assessments in place to support this practice. People that live in the home expressed that their privacy and dignity was maintained. Staff were observed to knock on bedroom doors before entering. Staff spoke in a friendly and respectful manner to service users. Service users have access to a cordless phone for incoming phone calls. There is a pay phone but this line is now used for the fax machine, so unless service users have a private line in their bedrooms they have no means of making a private call out of the home. Wychdene DS0000065494.V303780.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 Quality in this outcome area is adequate. The judgement has been made using available evidence including a service visit. Day to day activities are rigid and practices are historic. Leisure activities need developing. Visitors are welcome at the home. EVIDENCE: Some routines within the home are rigid and inflexible. Practices tend to be historic. Events are often determined by staff numbers and availability, for example, due to staffing it is necessary for night staff to get a certain about of people up early in the morning. The times that people get up and go to bed should be determined by the service users themselves and their preferences recorded in their care plan. Some service users were already in their nightwear at 7.00pm. There were no evening activities for service users. Staff talked enthusiastically about social activities. They expressed that this is an area that could be strengthen. They expressed that they would like to see opportunities available for service users, for example coach trips or taking service users out shopping. Staffing would need to be increased for service users to have these opportunities. The manager spoke about entertainment that had been booked for later on in the year. There was evidence that service users had planned their Christmas activities and chosen the food over that period. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 13 The home has a visitor’s book, which clearly shows that visitors come and go at selection of times. Service users said that they could see their visitors in the privacy of their own room if they choose and staff are happy to facilitate this. Service users have regular recorded meetings where that have the opportunity to make choices that affect the running of the home. Service users choices and preferences must be more fully documented. Wychdene DS0000065494.V303780.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, 18 Quality in this outcome area is good. The judgement has been made using available evidence including a service visit. The home has suitable complaints procedures. Procedures are adequate to potentially protect service users form abuse. EVIDENCE: An adult protection alert was raised following a complaint by the family of a deceased service user. The home investigated the complaint fully in line with their own complaints procedure, acknowledged that there were areas of practice that needed to be approved, and changed policy and documentation to ensure better practice. The manager and provider appreciated the feedback and it was used to improve quality assurance. Staff are trained in adult protection. When questioned they also demonstrated a knowledge and understanding of adult protection. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 15 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): 19,21,23,24,26 Quality in this outcome area is adequate. The judgement has been made using available evidence including a service visit. Service users live in a safe well-maintained environment. Toilet, washing and bathing facilities are provided to meet the needs of service users. Some shared rooms are inadequate. The home is generally free and clean from offensive odours. EVIDENCE: The home is maintained to an adequate standard, although there are areas that would benefit from decoration. The home has a passenger lift and a stair lift to enable service users to move around independently. Service users have access to comfortable indoor and outdoor space. Bathrooms were clean, one toilet did not have a sink and the manager must find a solution to promote good hand washing practice. One shared bedroom is very small and is obviously smaller than the 16sqm indicated in Standard 23.8. The home must find a suitable solution regarding Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 16 the service users in this shared room and inform the commission of how they intend to correct this situation. Shared rooms do not have suitable fixed screening to ensure privacy and dignity of service users. Some rooms have only one double plug socket. Some of the homes commodes are aged and unattractive. Generally, the home is clean and free from offensive odours. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30 Quality in this outcome area is adequate. The judgement has been made using available evidence including a service visit. The home is understaffed. Staff has suitable induction training and NVQ training. Service users are supported and protected by the homes recruitment policies and practices. Some staff do not have adequate mandatory training. EVIDENCE: The home has a recorded rota indicating which staff are on duty at what times. The home does not use a recognised staffing tool to determine staff numbers. It appears that the providers of the service determine staff numbers. They must provide evidence to the commission how they ensure suitable staff numbers to meet the needs of service users. Staff indicated that there were times when they were short of staff and did not have time to participate in the social activities that they know service users would enjoy. The acting manager used to be the deputy manager but is now covering both roles. This effectively leaves an absence of one staff member working ‘hands on.’ More than 50 of care staff are trained to NVQ level 2 in care. The homes induction is in line with skills for care. Recruitment practices were good. All staff had references in place and CRB checks before commencing work at the home. Staff files are held together in a ring binder file. They should be held individually and in a secure, locked cabinet as they hold personal data. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 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): 31,32,33,35,38 Quality in this outcome area is adequate. The judgement has been made using available evidence including a service visit. The acting manager is able, but needs supporting in her new role. The home has an ‘open’ culture. The home does not have an effective quality assurance system in place. Service users financial interests are safeguarded. EVIDENCE: The Manager is new to her role. She was previously the deputy manager of this home. She is in the process of undertaking NVQ 4 and intends to undertake the Registered Manager Award. She is awaiting a fit person interview with the Commission, so that she can become the registered manager. Unfortunately there has not been a replacement for the deputy manager post and the manager is covering the duties of both her old deputy role and the manager’s role. This is proving to be unsustainable. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 19 The Managers role is specific and the acting manager has recognised that there are areas that she must understand more fully as once she becomes registered with the Commission she will have greater responsibility and accountability, than when she was the deputy. Examples are employment law and health and safety. She must be supported, and given time, by the registered individual to achieve the homes goals in accordance with regulations and the homes own development plan. The acting manager does not currently have a contract reflecting her new role, or job description. She has not had an induction into her new role. The provider must ensure that she has regular formal supervision. She currently has no autonomy over policy, staffing, or budgets. The providers deal this with. The ethos of the home is very open. The home has staff and service user meetings on a regular basis. The acting manager and staff were very open and willing to discuss practice during the site visit. There were examples of where practices were improved due to open dialogue. Whilst there is evidence of some quality assurance practices in place, there is not an annual development plan for the home, based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users. The homes systems regarding service users finances were viewed and found to be satisfactory. The health, safety and welfare of service users and staff are not always maintained. An immediate requirement was made regarding raised water temperatures. Safe working practices are not always maintained. Some staff have not completed, or suitably updated, mandatory training. The registered person must provide the Commission with a plan of action regarding this and submit evidence that future training has been booked. All accidents, injuries and incidents of illness or communicable disease are recorded and reported. Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 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 2 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 3 x 1 2 x 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 x x 2 Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 21 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 OP1 Regulation 4 Requirement The home must update its service user guide and statement of purpose. It must reflect what may reasonably be expected at the home for prospective service users. The Registered Provider must demonstrate to the Commission how the home can offer day care services as described in the Service User Guide without it impacting on current service users. The contract must be reviewed and corrected where errors have occurred The home must ensure that people in the home who are demonstrating lack of cognitive ability are suitably assessed by an appropriate health care professional and a firm diagnosis made. Variations to the registration must be sought if necessary Timescale for action 31/08/06 2 OP1 4 31/08/06 3 OP2 5 31/08/06 4 OP3 14 31/08/06 Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 22 5 6 OP7 OP9 13 12 13 16 17 23 sch 3 16 Care plans must contain relevant risk assessments Appropriate medication practices must be actioned and adopted by the home in line with robust policies The care home must supply the service users with appropriate telephone facilities Rooms that are currently shared must have at least 16sq m of usable floor space The home must supply the commission a plan of its intentions towards the service users that are occupying a room which is obviously less than suitable floor space. The Registered Provider shall having regard to the size of the care home, the statement of purpose, and the number and needs of the service users, ensure that at all times suitably qualified, competent and experience persons are working in the home in such numbers as are appropriate for the health and welfare of service users. This requirement was made previously with a compliance date of 15/11/05. This has not been met. The evidence of how the provider determines staff numbers to meet service users needs must be sent to the Commission. 31/08/06 31/08/06 7 OP10 31/08/06 8 OP23 23 31/08/06 9 OP27 18 31/08/06 10 OP30 18 The Provider must ensure that all 31/08/06 staff have mandatory training and must provide the Commission with a plan of action regarding this matter, together with evidence that this training has been booked. DS0000065494.V303780.R01.S.doc Version 5.2 Page 23 Wychdene 11 OP33 24 The home must have an annual development plan for the home, based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users. Evidence of this must be sent to the Commission 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations Service users should sign their care plans as evidence of their agreement of it. There should be suitable risk assessments in place to ensure the safety and monitoring of service users who self medicate One toilet does not have a sink. A solution must be found to promote good hand washing practice. The home should put in place a programme to replace aged and unsightly commodes. Staff files should be held individually and in a locked, secure cabinet. 3 4 5 OP21 OP24 OP29 Wychdene DS0000065494.V303780.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Kent and Medway Area Office The Oast Hermitae Court Hermitage Lane Maidstone Kent ME16 9NT 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 Wychdene DS0000065494.V303780.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. 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