CARE HOMES FOR OLDER PEOPLE
Wymeswold Court London Road Wymeswold Nr Loughborough, Leicestershire LE12 6UB Lead Inspector
Mrs Janet Browning Unannounced 18 May 2005 09:00
th 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 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. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Wymeswold Court Address London Road Wymeswold Nr Loughborough Leicestershire LE12 6UB 01509 881615 01509 881635 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Highfield Care Homes No 2 Ltd Mrs Sharon Elizabeth Edens CRH 40 Category(ies) of Physical Disability over 65 years of age (PD(E)) registration, with number 34 both, Old age, not falling within any other of places category (OP) 34 both, Dementia - over 65 years of age (DE(E)) 6 both, Dementia (DE) 6 both. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No one under 60 years of age who falls within the category DE to be admitted into the home. 2. Service User Numbers - DE or DE(E). No person to be admitted to the home in categories DE or DE(E) when 6 persons in total of these categories/combined categories are already accommodated. 3. No persons falling within category PD(E) may be admitted to the home when 34 persons who fall within category PD(E) are already accommodated. Date of last inspection 24 November 2004 Brief Description of the Service: Wymeswold Court is a care home providing personal care and accommodation for thirty-nine older persons. The home is owned by Southern Cross Limited. The premises are located about five miles from the town centre of Loughborough close to shops, pubs, the post office and other amenities. The home is easily accessible by private transport. The premise was built as a sheltered housing for older persons but prior to completion was converted and registered as a nursing home. The premise was later registered to provide residential care only. The premises consist of two floors and access to both floors is accessible by use of the passenger lift or stairs. A number of facilities for example a choice of lounge and dining areas can be found on both floors. The premise has thirty-eight single bedrooms, six with ensuite facilities and one double room with ensuite facility. The premise has a courtyard with large pond to the rear of the building which is well maintained and which is accessible to all service users residing in the home. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection over eight hours. Four residents were case tracked looking at their care notes. There was an opportunity to talk with four residents, four members of staff and one relative during the inspection. Two of the residents case tracked were unable to communicate their perspective of care within the home. Comment cards were received; six from residents, six from relatives and two from health care professionals. Some of the home’s records and documentation was also inspected. What the service does well: What has improved since the last inspection?
The acting manager has now been registered and has instigated many new systems to improve care within the home. Two examples are that many risk assessments are performed throughout the home to ensure resident safety and training programmes have been introduced for the staff. The manager indicated that she has many plans for the home and it will be interested to see them put into place. Staff feel that the manager listens to any concerns they have and that “things get done” which was also evident during the inspection. The manager also obtains opinions from relatives with regular relatives meetings and has an open and transparent complaints procedure. The home is working hard to learn new ways of caring for people with dementia obtaining advice from a community health professional. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 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. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 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 standard(s) 1, 3, 4, 5 and 6. The home’s statement of purpose and assessment process have sufficient detail to ensure that residents and prospective residents have the information they require to make an informed decision about admission to the home. EVIDENCE: The home has recently been taken over with new providers, Southern Cross, which as yet to be reflected in the Statement of Purpose. The Statement of Purpose gives clear information to enable prospective residents, relatives and other agencies to make a decision as to whether the home is able to meet their needs. The plan is for it to be available on audiocassette for those people who have difficulty reading printed documents. The assessment process is detailed with the home performing their own assessment once the resident is admitted and as their needs change. More information could be obtained regarding residents’ life histories, which is especially pertinent for residents who have dementia. The home offers trial periods for 4 – 6 weeks but it also offers day visits. Intermediate care is not provided. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 9 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 standard(s) 7, 8 and 9. The care plans are of a generally good standard, if sometimes variable, to enable staff to have the information they require to meet residents’ needs and together with the medication procedure requires improving to ensure that residents’ safety is maintained. EVIDENCE: Four residents’ records were examined and the records were of a generally high standard, being updated monthly, and the involvement of relatives and residents evident in reviews. However, the evaluations were inconsistent in detail and this sometimes did not inform the reader if any changes occurred or if the care delivered in the plan was effective. For example, phrases such as “care plan continued” are used often, which does not give the reader any information as to the outcome of the care given. Physical aspects of care in care plans were well detailed but for confused residents or residents with dementia, social needs, behaviours and usual daily routines were scant in detail. For residents who are unable to voice their concerns or choices, it is important to have documented details of their usual routine and how to approach any challenging behaviour. For example, one resident was prescribed medication for his agitation and distress. Details of how and when this was to be administered or how to approach the resident when he became distressed, was not reflected in any care plan. Comments
Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 10 from a member of the community mental health team indicated that staff are willing to take advise from the multi-disciplinary team regarding dementia care. Observations of staff demonstrated an understanding of promoting safe mobility with residents with one member of staff teaching more junior members the correct procedure to assist someone when walking and conversations were taking place with residents and staff which indicated that staff had formed relationships with residents. The indications were that not all staff were aware of safe administration of medication. For example, in the morning one carer in the medication room dispensed medication for another carer to give to the residents. The carer was observed taking two pots of medication into the lounge, she was observed putting one pot inside the other and proceeded to give medication to one resident in the lounge and then went to find the other resident in the home. This method of administration is poor practice as errors could easily occur. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 11 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 standard(s) 15 Dietary needs of residents are well catered for with a varied selection of foods available that meets residents’ tastes and choices. EVIDENCE: Discussions with some residents and comment cards received from relatives gave mainly positive comments regarding the quality of food served in the home. Choices are available for meal times, with extra servings available for residents who have changed their mind. A comment card received indicated that there was not a choice at teatime, but talking with residents, a relative and staff and observing the meals at teatime indicated that this was not evident with a hot snack available and sandwiches. One resident stated • “They always accommodate you for meals if you change your mind.” One comment card received from a relative stated, • “The food is really good and freshly cooked.” Discussions with the assistant cook also confirmed that a choice of meals is accommodated even with a last minute change of mind. The manager stated that she plans to have a photographic style menu to make choosing easier for those with communication difficulties. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 12 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 standard(s) 16 and 18. Complaints are handled objectively and relatives are confident that their concerns are listened to. The staff are not fully aware of the procedures of reporting any suspicion or allegation of abuse to ensure that residents are protected from risk of harm. EVIDENCE: Discussions with residents and relatives throughout the day demonstrated that they felt happy that their concerns would be listened to. Opinions were received from relatives both on the day and in comment cards received prior to the inspection; • “I know how to complain; there is a comments book in my mother’s room which I can use.” • “Any concerns I have had, have always been listened to and action taken.” When asked if she knew how to complain, one resident stated, • “I would complain to the carers, but I have never had to complain.” The complaints book was inspected and gave full details of complaints received, findings of investigations, action taken and considerations for future preventative action. When talking with staff, they had some awareness of when to report any suspicions of adult abuse but were not fully aware of the correct procedure to follow or of the Department of Health’s “No secrets” document. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 13 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 standard(s) 20, 21, 22, 23, 24 and 25. The communal areas and individual rooms are such that generally residents have access to a safe and comfortable environment. EVIDENCE: The rooms of the residents case tracked were clean and comfortable with personal possessions on display. The home had recently had problems with residents with dementia going into other residents’ rooms. This has been resolved, after consultation with residents and relatives, that individual rooms will be locked when not in use by residents. One relative spoken with stated; • “I am happy that the my mum’s door is locked as they unlock it when we come so we can sit in her room to talk.” Individual room keys have been obtained and the registered manager is in the process of risk assessing each resident as to their capability of using a key and the manager has obtained a special door stop, which complies with fire regulations, for one resident who likes her door open at all times. After incidents of a confused resident wandering outside of the communal courtyard into the car park, the area was risk assessed and the gate is now
Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 14 secure. The indications were that the home had specialist equipment for moving and handling residents and mobility aids and there was a large shower room with access for wheelchairs. One bathroom was being used as a store for unused wheelchairs and a bed rail, which was inappropriate. The monitoring of hot water is also maintained regularly, but on the day of inspection, random testing of hot water revealed that the temperature of the hot water in a bathroom was reading as 49.2 C, which is above the recommended temperature to prevent scalding. The manager was dealing with this at the time of inspection. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. Overall staffing levels throughout the week were in sufficient numbers at the time of inspection, with indications being that residents’ needs were being met. The home’s recruitment procedure was generally good to ensure that residents are not put at risk of harm. EVIDENCE: During the inspection the indications were that needs were being met. Examination of staff rosters indicated that staffing numbers varied with some days being above the recommended numbers to meet residents’ needs and some days below. Comment cards received and talking to a relative resulted in mixed responses to staffing levels such as; • “I feel that there is enough staff” • “They could always do with more staff.” There is a risk that any sudden increase in dependency levels would cause an increase in workload and thus create a potential of residents’ needs not being met. Some comments from residents regarding the staff attitudes were; • “The staff are very friendly.” • “I feel safe here.” The home’s recruitment procedure was generally good, but with the recruitment of staff from overseas, there are indications that checks on the authenticity of documentation are not being made nor checks if these perspective employees are on the Protection of Vulnerable Adults register. None of the staff have NVQ level 2, but the two members of staff spoken to have received in-depth training in dementia care with one started NVQ course.
Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38. The manager has a good understanding on how to improve the home so that it is run in the best interests of the residents. Health and safety promotion is generally good, ensuring that both residents and staff are protected from risk of harm. EVIDENCE: Comments from relatives about the management of the home were: • “The home has improved a great deal over the past few years.” • “I can’t fault the new manager, we are kept fully informed.” The service providers carry out monthly audits within the home and the registered manager regularly audits the care notes. Residents and relatives views are obtained via comment books in the rooms and from relatives meetings which are held every 8 – 12 weeks. Staff comments were; • “It’s a lot better here, things seem to get done.” • “I think the care here is good, but there is always room for improvement.”
Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 17 Accident records were not always completed, and it is noted that on at least one occasion the CSCI were not informed of an incident involving a drug error. Records regarding health and safety such as fire drills, maintenance, etc indicated that they are being performed regularly. Individual risk assessments are completed for areas within the home considered at risk. A small kitchen upstairs to which all staff and residents had access had not been risk assessed as to the possible dangers it presented to the residents, especially those with a degree of confusion. The manager addressed this immediately and performed a risk assessment, removing all hazards. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x 3 3 2 3 3 2 x STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 3 x x x x 2 Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 19 No 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 7 Regulation 15 Requirement Care plans, especially for residents with dementia, must include a detailed plan of social and behavoural needs. Care plan evaluations must show the effectiveness of the care delivered. The medication procedure must be safe and staff aware of the procedure for safe administration of medication. Full prescibing information must be obtained and documented for as required medication. Residents must be protected from risk of harm or abuse by training all staff on all aspects of adult protection including reporting. Suitable provision must be made to ensure that all equipment is stored suitably. All hot water temperatures must be below the recommended temperature to prevent risks of scalding. The robust recruitment process must be replicated for overseas workers in that; a) all new staff are confirmed in post only following completion of
C51 S39563 Wymeswold Court V225402 180505.doc Timescale for action 20/07/05 2. 9 13 Immediate 3. 4. 9 18 13 13 20/07/05 20/07/05 5. 6. 22 25 23 13 20/07/05 20/07/05 7. 29 19 20/07/05 Wymeswold Court Version 1.30 Page 20 8. 38 37 a satisfactory check of the Protection of Vulnerable Adults registers and satisfactory police checks in line with POVA guidance. b)The home must be satisfied as to the authenticity of all documentation received from prospective employees. All incidents as listed in regulation 37 must be reported to CSCI without delay. The registered manager must ensure that this is followed by all staff. 20/0705 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 4 27 Good Practice Recommendations It is recommended that life histories are obtained for confused residents and residents with dementia as per current good practice. It is recommended that staffing levels are based on residents dependency levels as per the Department of Health Residential Forum. Wymeswold Court C51 S39563 Wymeswold Court V225402 180505.doc Version 1.30 Page 21 Commission for Social Care Inspection The Pavillions 5 Smith Way, Grove Park Enderby, Leics LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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