Inspection on 21/11/08 for Wyndham House

This inspection was carried out on 21st November 2008.

CSCI found this care home to be providing an Poor service.

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

Wyndham House 15/01/09

Wyndham House 30/09/08

Wyndham House 03/04/08

Wyndham House 28/11/07

Wyndham House 24/07/07

Wyndham House 07/06/07

Wyndham House 14/12/06

Wyndham House 04/05/06

Wyndham House 02/02/06

Wyndham House 30/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Wyndham House Manor Road North Wootton Kings Lynn Norfolk PE30 3PZ The quality rating for this care home is: The rating was made on: zero star poor service 30/09/2008 A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Kim Patience Date: 2 1 1 1 2 0 0 8 Information about the care home Name of care home: Address: Wyndham House Manor Road North Wootton Kings Lynn Norfolk PE30 3PZ 01553631386 01553631105 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Eaglecrest Care Management Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia 0 Over 65 44 Conditions of registration: Admission to additional places can only begin following an improvement in the service level rating for the home Date of last inspection Brief description of the care home Wyndham House is a large detached building in North Wootton, close to the town of Kings Lynn. The Home was originally a Victorian house, which has been extensively extended. The Home provides care for up to thirty six older people who have dementia. There are twenty six single rooms and five shared rooms on the ground and first floors. The majority of the bedrooms are en suite. The fees for this home range from #380.00 to #597.74 3 0 0 9 2 0 0 8 Care Homes for Older People Page 2 of 15 What we found: Care plans and health assessment are more detailed and records are more organised. The quality of the information still needs to be improved and there are shortfalls in maintaining up to date, accurate records. For instance, one resident had developed a pressure sore but there was no mention of this in the records apart from one entry in the daily care notes indicating that a district nurse had been called to attend to it. For the same person there was an entry in the daily notes saying that they had a sore groin and should be kept treated but no further guidance about how or with what. In another case, a resident was experiencing some behavioural disturbances but there was no care plan guidance as to how the person should be supported at these times. For this same resident there was a nutritional needs assessment stating that they were at low risk but records of weight showed that there had been some weight loss. We also found that the home are not responding promptly to peoples health needs. The daily records for one resident showed an entry made by a care assistant on the 13/11/08 stating that they had a sore sticky eye. Then on the 21/11/08 another entry was made stating the same. When we looked at the persons medical records the home had not contacted a GP. We spoke to the resident and could see that the eye was still visibly red, sore and sticky. We asked if it felt sore and the person said yes. In the records relating to another person a GP had been called as the they were not passing urine. The GP advised to push fluids and later entries indicated that the person was passing urine without a problem. This suggests that staff did not identify the need to increase fluid intake. We also found that a person due to have a blood test in October to check that their warfarin levels were correct had not had the test. The warfarin continued to be given at the same dose and the home had not contacted the surgery to ensure the test took place. We raised this matter during feedback and asked the manager and Mr Fanibi to attend to it without delay. However, a week after the inspection we were informed by another visiting professional that it still had not been done. This resident had been placed at risk. We also found there to be numerical discrepancies with this persons warfarin 3mg tablets where there were 4 tablets more than could be expected from the records. When we looked at medication records we also found that for a person prescribed ear drops for an infection to be administered three times daily recent records indicated they were only being administered twice daily. The ear drops were started 14th November 2008. Care note records showed that the most recent entry relating to contact with healthcare professionals on 11th November did not relate to an ear condition. Three records before this were not dated but related to the clearance of excess ear wax. Another person was prescribed an antifungal cream to treat soreness beneath her breast. The cream was prescribed for twice daily application but medication records indicated it was started 13th November 2008 but was being administered only once daily in the mornings. Care note records showed that there was an entry relating to contact with the GP on 23rd October 2008 about this but we found no further records of any subsequent follow up to this. We found there to have been a number of situations where medicines scheduled for administration were not given to people because they had not been obtained. This included painkillers where there was evidence that these were previously administered Care Homes for Older People Page 3 of 15 frequently because they were needed by people prescribed them. For example one person prescribed a painkiller for moderate pain and previously administered it four times daily the painkiller was not available to give the person from 21st October to 3rd November 2008. We noted that the persons care plan stated the need for painkillers but recorded differing painkillers than that currently prescribed. For another person whose care notes indicated a need for laxative medicines their lactulose liquid was not available to administer on 5th September 2008. This person was also prescribed laxative Movicol sachets (macrogol) but there was no record of these on the current or previous medication charts starting 13th October 2008. Daily care notes for this person indicated on 13th October 2008 they were presenting with psychological agitation and shouting alot. The GP authorised an increase in psychotropic medicine haloperidol. On 29th October 2008 daily care notes indicate this person had not been to the toilet for a week. GP came and said continue with lactulose liquid and Movicol sachets. During the inspection we found there to be significant numerical discrepancies when comparing samples of medicines available with records of their receipt, administration and disposal. We found that where medicines were prescribed with variable doses such as paracetamol tablets 1-2, there were no records of the exact doses given. We could not determine that all prescribed medicines were being administered in line with prescribers instructions. We found that where there were changes to doses authorised by prescribers these were not being accurately recorded. When we informed the manager and Mr Fanibi about the discrepancies the manager was unclear about the action needed to resolve these issues. We found a number of people had missing dentures. There was no care planning or review of nutritional needs to ensure that a good diet was maintained until the teeth had been found or replaced. When we spoke with one relative, she stated that her fathers teeth had been missing for 3 weeks. She said the home did not offer softened food that he could manage and on the Sunday when she visited he was given Beef Stew that he could not eat. One person was said to have lost their dentures the year before and despite being asked by a friend on her behalf several times the home had not taken any action until the last week. We checked accident records and crosschecked these with care records. We found that in some cases entries made in the daily care notes relating to accidents had not been followed by completion of an accident report form. There was an accident report for one person stating that on the 12/10/08 they had a fight with another resident and fell and hit their head but this did not appear in the daily care notes. On the 14/11/08 there was an entry in the staff communication book for the same resident saying that they had been physically fighting with another resident but there was nothing in the daily notes or accident reports. We found that the home had done nothing in response to accidents and incident such as these in order to protect people from harm. We also found that there was a greater number of accidents occurring during the night shift when the staffing levels are low. (See staffing 27-30) Improvements have been made to the environment. New dining room furniture has been purchased and is now in place. The dining room has also been redecorated. The arm chairs that once occupied the sun-room area overlooking the garden in the dining room have been removed and people who enjoyed sitting there now have to sit in the lounge areas. One relative said that some ladies were not happy about losing this area to sit in. The lounge areas have now been separated and the connecting doors have Care Homes for Older People Page 4 of 15 been sealed off to create a quiet lounge. On the day of the visit most people were sitting in the lounges, some watching television and some in the quiet area. We could detect unpleasant odours in the lounges and in some bedrooms. On the day of the site visit we were told that there were 26 people living in the home. All have a diagnosis of dementia apart from one person. The manager said that the homes target staffing levels based on the level of peoples needs is 5 care assistants on each shift during the waking day and 2 care assistants on duty during the night. However he said that ideally they needed 3 members of staff on duty at night as there are 12 residents that need support during the night and staff also have laundry duties. The laundry facilities are located outside of the home and this means for periods of time there is only one member of staff in the home. On the day of the visit the manager said there were 4 care assistants on duty in the morning. He said they had booked an agency worker but they canceled. At approximately 9:45 one care assistant left the home to accompany a resident to the hospital for a planned appointment leaving only 3 care assistants. We spoke with a senior member of staff and asked about the morning routine. They told us that at the start of the day shift there are usually 6-7 residents up and in the dining room and all residents were up by 9:00. 3 residents need hoisting and therefore need support from two members of staff. One member of staff is needed to serve breakfast and supervise people who are already up. At 7:15 one member of staff starts the medicines round and that takes approximately 1 hour 40 minutes. That morning the relative volunteer had served breakfast and supervised residents already downstairs leaving 3 members of staff to assist the remaining 20 people. We spoke with the relative who said she is helping out with breakfast as there is not enough staff. This is not appropriate and volunteers should not be considered as part of the care hours. In the afternoon there were 3 care assistants on duty up until 17:00 when the number increased to 4 during the teatime period. We observed that at teatime one member of staff was in the kitchen assisting the kitchen assistant to prepare the teatime meal, leaving 3 members of staff to support the 26 people with the meal. In addition, we also expect that during this time one member of staff will need to administer medicines. The night shift starts at 21:00 when there are 2 staff on duty. One member of staff interviewed said that nearly all residents are in bed before the night shift starts. This raises questions about how much choice people have about the time they go to bed. As written earlier, there are 12 residents that need support during the night for various reasons and some need 2 carers. Night staff have laundry duties and in order to complete these they have to go outside to the separate laundry building. At these times one member of staff is left in the home. It is also expected that staff working a long shift would be given a break. The accident records showed that the majority of accidents occurred during the night indicating that staff are unable to provide adequate support to people who need it. We examined the staff rotas for the month preceding the visit and found that on numerous occasions the staffing levels fell below the homes target levels. In the afternoons the number fell consistently below the target level of 5 and on one occasion there were only 2 people on duty between 14:00 and 17:00. In the mornings the number frequently fell to 4 on duty and on one occasion only 3. The night shifts were covered by 2 staff, however, on some occasions one of those staff was supplied by an Care Homes for Older People Page 5 of 15 agency. We also noted that on at least 2 nights of each week there was no senior member of staff trained to administer medication. The home is frequently using agency staff and the same staff are supplied each time. Relatives spoken with during the inspection and some members of staff expressed concerns about the low staffing levels and the lack of time available to fully meet peoples needs. The core of staff working in the home are committed to providing the best care they can with the time and resources available. Relatives spoke highly of staff and felt that they were doing the best they could. They were concerned about the high turnover of staff and the many different faces they see in the home. Low staffing levels have been an ongoing issue. We looked at the quality of recruitment practice in the home. We looked at the files relating to 3 members of staff appointed since the last visit. One of those files contained all the necessary pre employment checks and the other 2 did not. The recently appointed deputy manager had started work without 2 references and a criminal records check. However, the home had received a POVA check that was clear. The other person was previously working at the home as an agency worker. At the last inspection, we identified that this person did not have a criminal records check and should not be working in the home. Since then the person has been appointed as a permanent member of staff but still did not have a POVA check or CRB. We told the manager and proprietor that this person should not be working until these checks are completed. Soon after the last inspection the crisis manager left the home leaving the newly appointed manager to manage the home. A deputy manager was appointed and started on the 3/11/08. The rotas show that the deputy has only worked on 6 days between the 3/11/08 and the 21/11/08 and was absent on the other days due to leave and sickness. We spoke with the new manager during the inspection who said he had been working hard to make improvements but realised there was still work to be done. An improvement plan has been submitted. We discussed the issues around staffing shortages and he said it was a balance between having the right number of staff on duty and the financial resources available. He said this had been discussed with the Mr Fanibi the home owner and he had informed him that staffing levels needed to be increased, particularly at night. Mr Fanibi was present during feedback when we discussed the concerns about staffing levels. Mr Fanibi did not agree that the staffing levels were insufficient even when we supported our judgement with evidence that peoples needs were not always being met. Mr Fanibi said that he had to consider the financial viability of the home. What the care home does well: What they could do better: Care Homes for Older People Page 6 of 15 The service must improve record keeping in order to ensure that there is accurate up to date information about peoples health and care needs. They must also identify peoples health needs and respond promptly so that people get the correct medical treatment they need. Medication management practice is still poor and action must be taken to ensure that people are safeguarded from harm. Staffing levels must be increased so that there are sufficient staff on duty each shift. In addition, the home must have staff that have the necessary pre employment checks in place and that are trained and competent in their role. This service has continued to provide poor quality outcomes for people living in the home despite repeated requirements made by the Commission highlighting the areas that must be improved. The Commission is now taking enforcement action against the home to seek better outcomes for people who live there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 15 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 3 17 The service must retain 30/10/2008 records, in accordance with schedule 3 and 4, relating to people living in the home for any period of time. This is so that the service can show information relating to individuals health and care needs and how they have been met. 2 3 14.1(2) People who use the service 17/07/2008 must have their needs assessed prior to admission so that the home can assure people they have the capacity to meet their needs. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 3 7 15.1 People who use the service 17/07/2008 must be assured that their needs are properly assessed and written into care plans so that their holistic needs can be met. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. Care Homes for Older People Page 8 of 15 4 7 17.1(a) People who use the service 17/07/2008 must have the name of the registered GP written in their records so that staff know who to contact if medical advice is needed. People who use the service 17/07/2008 must be assured their nutritional needs are accurately assessed and met so that their health is safeguarded. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 5 8 12.1(a) 6 8 13.4 People who use the service must be assured that risks associated with daily living are assessed and action taken to minimise or eliminate risk so that they are safeguarded from harm. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 17/07/2008 7 9 13 Medicines must be given to 29/10/2008 people at the home in line with prescribed instructions at all times. This must be demonstrated by the homes record -keeping practices . Repeat requirement 08/08/08 This is so that peoples health and welfare is safeguarded. Care Homes for Older People Page 9 of 15 8 9 13 Medicines no longer in use for people prescribed them must not be retained at the home. timescale 14 days This is so that peoples health and welfare is safeguarded. 29/10/2008 9 9 12 The non-availability of 29/10/2008 medicines must be avoided at all times. Medicines must be promptly obtained so they can be given to people at the home as prescribed. Repeat requirement 08/08/08 This is so peoples health and welfare is safeguarded. 10 9 13 Medicines prescribed for 29/10/2008 external application must be safely and securely stored so that people at the home are not at risk of accidental harm . Repeat requirement 08/08/08 This is so peoples health and welfare is safeguarded. 11 9 13 Medicines must be 29/10/2008 administered to people living at the home by staff who follow safe procedures for their administration at all times. Repeat requirement 08/08/08 This is so that peoples health and welfare is safeguarded. 12 9 13 Full and accurate records for 29/10/2008 the administration of medicines (including external medicines and those prescribed with variable doses) must be completed by staff at all times. Repeat requirement 08/08/08 Care Homes for Older People Page 10 of 15 This is so that peoples health and welfare is safeguarded. 13 10 12 The service must ensure that 29/10/2008 peoples privacy and dignity is promoted at all times. This is so that peoples health and well being is promoted. 14 12 16 The service must ensure that 30/10/2008 people living in the home have the opportunity to exercise choice in relation to all aspects of daily life. This is so that peoples health and well being is promoted. 15 15 16 The service must ensure that 30/10/2008 people are provided with a nutritious diet that is presented in a way that meets their physical and cognitive abilities. This is so that peoples health and well being is promoted. 16 22 23 The premises must be 30/10/2008 designed in a way that meets the needs of people with demenia. This is so people are supported to orientate independently around the building and to enhance well being. 17 26 23.2(d) People who use the service 17/07/2008 must be assured that the home will be kept hygienic, odour free and in a good state of repair and redecoration. This requirement made at the last Care Homes for Older People Page 11 of 15 inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 18 27 18.1(a) People who use the service 17/07/2008 must be assured that suitably qualified competent and experienced staff will be available in sufficient numbers at all times. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 19 30 18.1(c) People must be assured the 17/07/2008 home will provide staff who have been trained to carryout the duties they are expected to perform. This requirement made at the last inspection on the 17/07/08 has not been met. Enforcement action is now being considered. 20 33 24 The service must have systems in place to monitor the quality of the service. This is so that the service can identify any shortfalls and make improvements where necessary to promote the health and welfare of people living in the home. 30/10/2008 21 37 17 The service must retain records relating to people who live in the home. This is to safeguard the health and welfare of people 30/10/2008 Care Homes for Older People Page 12 of 15 living in the home. 22 37 17.2 The home must keep an 17/07/2008 accurate up to date record of staff on duty each shift to ensure they know who is on duty and that staffing levels can be accurately monitored. The service must have a robust risk management system in place. This is so that people living in the home are safeguarded. 24 38 37 The service must report all 30/10/2008 serious incidents occuring in the home in accordance with regulation 37. This is so that the handling of serious incidents can be monitored to ensure the protection of people living in the home. 30/10/2008 23 38 13 Care Homes for Older People Page 13 of 15 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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