Inspection on 03/04/08 for Wyndham House

This inspection was carried out on 3rd April 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 21/11/08

Wyndham House 30/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wyndham House Manor Road North Wootton Kings Lynn Norfolk PE30 3PZ Lead Inspector Kim Patience Unannounced Inspection 3rd April 2008 10:30 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 Wyndham House DS0000064103.V361912.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. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wyndham House Address Manor Road North Wootton Kings Lynn Norfolk PE30 3PZ 01553 631386 01553 631105 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) Eaglecrest Care Management Ltd vacant post Care Home 44 Category(ies) of Dementia - over 65 years of age (44) registration, with number of places Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Admission to additional places can only begin following an improvement in the service level rating for the home 28th November 2007 Date of last inspection Brief Description of the Service: 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 Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection report includes information gathered since the last inspection and a site visit to the home. The site visit took approximately 8hrs to complete and involved a tour of the premises, inspection of records relating to residents and staff, interviews with residents, visitors to the home and staff. What the service does well: What has improved since the last inspection? Since the last inspection the home has introduced new care plans and associated assessments. Some have been completed and the quality of the information is better than seen previously. Care plans include some person centred information and the home has gathered some life history information. Observations of the mealtime experience showed some improved outcomes such as lunch was more organised and residents appeared happier and calmer. This would indicate that people felt they were having their needs met as they expected. Staffing levels have been increased by one throughout the day and the home now has a kitchen assistant to cover teatime meals, which enables other staff to concentrate on care tasks. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Wyndham House DS0000064103.V361912.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 Wyndham House DS0000064103.V361912.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is poor as the home still cannot fully demonstrate that they complete the pre admission process in accordance with the policies and procedures. Therefore people cannot be confident that the home has the capacity to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has policies and procedures in place for the admission of new residents. The records relating to two new admissions were inspected. Both were found to contain pre admission assessments that were completed adequately and showed sufficient detail about the person’s needs. However, one pre admission assessment was dated the day after the person was admitted and the other was again completed after the person was admitted to the home. This means that the assessments did not take place before people were admitted to the Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 9 home and therefore the home had insufficient information to determine whether they could meet people’s needs before they came to stay. The findings in this outcome area are similar to those found at the inspection in November 2007. Wyndham House DS0000064103.V361912.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor as people still cannot be assured that their health and personal care needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans relating to three people were inspected, observations of those residents engaged in their daily routines were made and staff and relatives were spoken with. At the last site visit it was reported that the home had introduced new care plans and were in the process of transferring information from old records into the new format. During this visit the acting manager and the homes consultant were present. They reported that the home had not achieved what they expected since the last inspection and they were aware of shortfalls in care planning and associated record keeping. They had been working hard to improve the care plans and had introduced another care plan format. The task of care planning had been delegated to senior care assistants. But when interviewing senior Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 11 staff it was clear they had been given some support with the task but had not received any formal training. They were unclear about how care plans should be written and did not find the current format helpful. Staff stated that due to the deficits in care planning they did not feel that people’s needs were always identified and fully met. Although, they also stated this could be due to poor staffing levels and long shift patterns. (See standard 27) On inspection of the care records it was found that in some cases the process of care planning had not started following admission to the home and in one case there was a delay of 13 days before care plans were written. This means that care assistants did not have information about the individual’s needs and how they should be met. The care plans examined did not show any evidence of relative involvement in the care planning process. However, relatives spoken with were aware that care plans were written but did not necessarily know what they entailed. Some of the recently written care plans included some detailed person-centred information whilst others did not. For instance, care plans stated that individuals liked to have a bath, yet did not state their preference in terms of frequency. One visiting professional stated that people did not always get regular baths, but felt this was due to the lack of staff at times. Social care plans were either not written or contained information that did not reflect people’s individual interests or hobbies. There was also little evidence that people’s psychological needs were being assessed and met. Therefore, the home cannot fully demonstrate they are providing care that meets people expectations and is consistent with their previous experience. Additionally, care plans had not been written to cover all needs and some did not necessarily reflect changes in needs. For instance, one resident’s health had deteriorated and as a result was now being nursed in bed. Staff confirmed this was the case, however, on examination of the care plans they had not been updated to reflect the changes in need and did not state the resident’s current health and care status. Therefore, care staff had no instructions as to how the individual should be cared for. Another resident had experienced weight loss prior to moving into the home and this had continued to be of concern, yet there was no care plan or dietary planning in place to address this need. Nutritional needs assessments have been introduced along with dietary intake records. However, these were either not completed correctly or did not show any information. In addition, weights were not being monitored consistently. This means the home cannot demonstrate they are assessing people’s nutritional needs fully and taking action where risks are identified. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 12 In one case a risk assessment had been completed for needs such as behavioural disturbances and contained good information about ways in which staff should support the person at these times. However, where assessments had been completed for the risk of pressure sores they were not followed up with a care plan setting out how the risk should be minimised and what equipment is required. This means risks are being identified but the home cannot demonstrate that action is being taken to protect people from the risk. There was evidence that some assessments and care plans had been reviewed but this was inconsistent. There was clear evidence that care plans had not always been updated to reflect people’s current needs. Whilst completing a tour of the premises prescribed creams were seen in residents rooms. This was identified as a risk at the last pharmacy inspection on the 6th March 2008 and a requirement was made. Also, when talking to the relatives of one resident a concern was expressed about two tablets that were found alongside a small pot in the tray of the residents walking frame. At the time it was raised with the manager who said he did not know how they came to be there. This indicates that the tablets were left with the resident and not observed to be taken at the time they were administered. This is considered unsafe practice. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate as the home is making efforts to provide a lifestyle that matches people’s needs and expectations. However, improvements are needed in social care planning and the provision of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has started to gather life histories relating to individual residents, however this is work in progress and there is still a lot of information that needs to be gathered and translated into care plans that address people’s social and psychological needs. Staff reported that since the last inspection the activities person has left and not yet been replaced. Staff said they were trying to do what they can to provide activities but were restricted by the number of staff on duty each shift. Staff also lacked knowledge of individual residents’ life histories, interests and hobbies, which means they would be unable to provide day-to-day activities that were consistent with people’s previous lives and experiences. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 14 During the visit there was very little activity or stimulation for people and at times during the morning and afternoon the majority of residents were seen sitting in the lounge asleep or sitting quietly. However, one care assistant was seen playing ball games in one lounge for a brief period of time. In addition, there were a few residents who were seen going out to the garden for a walk. In the afternoon, several visitors were seen in the dining room and the inspector had an opportunity to sit with the group and hear their views about the service. The visitors attend the home on a regular basis and have formed their own social group, which is good as it provides stimulation for a wider group of residents. The visitors said they always felt welcome in the home and clearly had a good relationship with staff. They thought that the standard of care had improved over the last 12 months and care of their relatives was adequate. One relative said her mother was always clean and tidy. Whilst she had concerns about the care previously she was now satisfied. The acting manager has been proactive in arranging seasonal events such as a party at Easter and has involved relatives in the planning of future events and summer activities, such as gardening. The meals and mealtime experience was assessed and observed. The home employs a fulltime chef and kitchen assistants at lunchtime and at teatime. The staffing levels during the lunchtime period appeared to be better, resulting in an improved experience for residents. The dining room seemed much calmer during lunch and some residents showed positive signs of wellbeing. Menu planning is completed by the manager in collaboration with the chef, residents and relatives. New menus are about to be introduced that will take into account people’s likes dislikes and personal preferences. Annual dietary assessments have been introduced to ensure that people’s needs and preferences in relation to food are incorporated into the menus. Finger foods have been introduced in the afternoon and staff say these have been successful and residents appear to enjoy them. At lunchtime, residents were seated at the dining tables 15 minutes prior to the meal being served. Tables were already laid with placemats, cutlery and condiments. Flowers were seen on the tables and were a nice touch, they also stimulated conversation between residents, which is good. The menus that were once displayed on the tables were not seen and it was not clear what was being offered for lunch. It would be beneficial to residents to have a reminder of what is being served for lunch. Menus showing pictures and text will aid memory and recall and stimulate appetite. There appeared to be two different meal choices and the meal size was varied which shows that people’s individual needs have been taken into consideration. Some people were offered alternatives when they did not appear to eat their meals and this is good. One lady was being offered support with her meal and Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 15 the care assistant offered this in a kind and sensitive manner. She was observed to talk to the resident and describe the food that was being given. One resident was observed to have some difficulty with using her cutlery and was eating her meal with her fingers. Foods that are more easily handled would have been more appropriate here and this may be an indication that her nutritional needs have not been assessed in a meaningful way. Another resident needed to be prompted regularly as a reminder to eat. His nutritional needs assessment and care plan did not state that he needs some prompting. Drinks were offered to residents, but although there were two different drinks available a choice was not given. In addition, one resident was calling ‘‘can I have a drink please’’ but staff appeared to ignore him for some time. Training must be provided to ensure that staff understand the psychological effects on the resident of not responding to their needs in this way. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good as the home has a complaints procedure in place and people feel confident that complaints will be listened to and dealt with appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure, which is contained within the service users guide and publicised at key sites in the home. The acting manager said no complaints have been received by the home recently and felt that the service had improved. Relatives spoken with said they felt confident in raising concerns and that any matters would be resolved. Relatives meetings are to be held on a regular basis to provide a discussion forum and an opportunity to contribute to the improvement of the service. There have been no adult protection concerns since the last inspection in November. See standard 30 for details in relation to training. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 26 Quality in this outcome area is adequate as the home provides a reasonable standard of accommodation. However, improvements are needed to ensure the home is clean, in good condition throughout and odour free. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was completed and some residents’ rooms were viewed. The home has two main lounge areas that are separated by a large sliding door. On the day of inspection the TV was on in one area and music playing in the other. The noises were conflicting and could be heard in both lounges. This has been raised as an issue at previous visits as conflicting noises can add to confusion and disorientation people with dementia may already experience. The home should make efforts to keep the interconnecting door closed to minimise the noise in each area. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 18 It was also noted that the carpet in the lounge was stained and looked dirty and must be kept clean in order to promote hygiene and dignity. In addition to the lounge there are a number of other seating areas around the home. There is a seating area adjoining the dining room with views over the garden and some chairs in the entrance hall. These areas provide a choice of places to sit. The dining room is arranged in a way that provides people with choice and privacy. Some of the dining room chairs were stained and an offensive smell could be detected when sitting on some of the chairs. The home must ensure that the chairs are kept clean and free from odour in order to promote hygiene and dignity. This could also indicate that people’s continence needs are not managed well. There are some areas of the home that are in need of redecoration, such as some bedrooms and corridors in the original part of the home. The provider must ensure there is a plan of maintenance and redecoration to address these issues. When entering some residents’ bedrooms offensive odours could be detected. However, most of the rooms were personalised, homely and odour free. Some of the rooms contained items that could be considered as hazardous to people’s safety if used incorrectly or accidentally ingested, such as denture cleaning tablets, shampoo and creams. The home must ensure that risk assessments are completed to assess the risk to the individual and to others that may have access to the products. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor as the home cannot demonstrate they have adequate numbers of trained staff on duty at all times to ensure the well being of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection the home was accommodating 30 residents. Staff said that 23 of those residents need full assistance with their personal care needs. The home’s target staffing levels are 6 care assistants in the morning, 5 in the afternoon and 2 at night. Since the last inspection the home has increased the staffing levels by one during the waking day and now has a teatime kitchen assistant. However, at night the staffing remains the same. Copies of the staffing rotas 17/03/08 – 13/04/08 were taken for analysis and showed that the home has experienced some problems with maintaining the target staffing levels due to a high level of sickness and high staff turnover. Analysis of the 56 shifts (waking day) during the 4-week period showed that 50 of shifts fell below the home’s own targets. The last inspection showed that 44 of the shifts fell below the homes targets. Therefore, this means the home is still unable to maintain adequate staffing to meet people’s assessed needs. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 20 Staff interviewed said the residents would benefit from increased staffing levels in the morning as 6 care assistants were not always sufficient considering the other duties they have to undertake. For instance, one member of staff is required to remain in the dining room to supervise breakfast as people are getting up. Two members of staff are needed to administer medicines between 7.45am and 9.30am, so there are only 3 care assistants to support residents getting up from 7.45am. One member of staff interviewed said that only people’s basic needs are met due to the time pressure. In addition, staff raised concerns about the 14 hr shifts they were being asked to work as they considered the quality of people’s work to be reduced by working long hours. It was also said that there are also a number of new staff who require increased supervision and support from more experienced care staff. The home has employed an extra person to cover 8am – 2pm, but at the time of the site visit the person had not commenced. Staff training is being provided and the home is currently sourcing training for 2008. The administrator was in the process of creating a training matrix to establish the training needs of each care assistant but it had not been completed at the time of this visit. Staff interviewed have been provided with some training but some had not received training in moving and handling and dementia care. These are two key training needs and the home must ensure that staff are sufficiently trained to meet the needs of the people they are accommodating. The home does have an induction-training programme that meets the skills for care common induction standards. However, at least one new employee had not completed a full induction-training programme. Therefore, the home cannot demonstrate that all new staff are provided with adequate basic training when they commence employment. The home’s Annual Quality Assurance Assessment says that 59 of staff have or are working towards an NVQ2. The home employs 22 staff and 9 have left in the 5 months preceding the inspection. This indicates the home is currently experiencing difficulties retaining staff. Relatives spoken with said that some very experienced care assistants have left. Continuity of staff and familiar faces are important to people with dementia, as staff need to build a good knowledge of people and their needs to be able to provide good care. As stated in standards 7-11, care plans do not necessarily provide staff with adequate information about people’s changing needs and guidance as to how they should be met. The files relating to 4 newly employed staff were inspected and found to be in good order. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 Quality in this outcome area is poor as there is a lack of continuity of management resulting in shortfalls in maintaining adequate management systems for the welfare of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the registered manager has left and the deputy manager is currently acting as manager until a new manager is appointed. This is the fifth change of manager since the current proprietor took over in 2005. The home has had difficulties retaining a manager for any reasonable amount of time and must endeavour to resolve this, as it results in a lack of continuity of management and management systems that underpin good care services. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 22 The home has quality assurance systems in place and is conducting annual stakeholder surveys. Relative meetings have been introduced in order that people have the opportunity to discuss any areas for improvement and contribute to the home’s improvement plan. The home does not handle residents’ finances. Some staff supervision has taken place during the time the previous manager was employed. However, it is not clear whether the home has an ongoing plan of supervision and this will be assessed further at the next inspection. Health and safety was not fully assessed on this occasion however this inspection shows that there are a number of concerns associated with health and safety, such as staff working long shifts, lack of training in moving and handling and a lack of risk assessments for products that may be hazardous if used incorrectly. The home is monitoring the rate of accidents and has introduced flow charts to assist staff in reporting and responding to accidents correctly. Accident audits have been introduced with a view to identifying the frequency and type of accident so that action can be taken to reduce them. Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 23 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 X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 1 Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 24 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. Standard OP3 Regulation 14(1)(2) Requirement People who use the service must have their needs assessed prior to admission so that the home can assure they have the capacity to meet needs. This is a repeat requirement. People who use the service must be assured that their needs are properly assessed and written into care plans so that their holistic needs can be met. This is a repeat requirement. People who use the service must be assured their nutritional needs are accurately assessed and met so that their health is safeguarded. This is a repeat requirement. 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 is a repeat requirement. People who use the service must be assured that the home will be kept hygienic, odour free and in a good state of repair and DS0000064103.V361912.R01.S.doc Timescale for action 31/05/08 2. OP7 15(1) 31/05/08 3. OP8 12(1a) 31/05/08 4. OP8 13(4) 31/05/08 5. OP26 23(2d) 31/05/08 Wyndham House Version 5.2 Page 25 6. OP27 7. OP30 8. OP9 redecoration. People who use the service must be assured that suitably qualified competent and experienced staff will be available in sufficient numbers at all times. 18.1(c) People must be assured the home will provide staff who have been trained to carryout the duties they are expected to perform. 13.2, 13.4 Medicines prescribed for external application must be safely and securely stored so that residents are not at risk of accidental ingestion 18.1(a) 13.2, 13.4 Written guidance available for staff when considering the administration of psychotropic medicines prescribed on a PRN basis must accurately reflect most recent prescribed instructions 31/05/08 31/05/08 11/04/08 9. OP9 11/04/08 10. OP9 13.2, 13.4 An investigation must be 18/04/08 conducted in relation to an erroneous incident when a resident was administered a higher dose of lisinopril 09/02/08 to 12/02/08 -see report RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that arrangements are made to meet DS0000064103.V361912.R01.S.doc Version 5.2 Page 26 Wyndham House the needs and preferences of all residents administered medicines. This relates to a resident who is not being administered medicines scheduled for the evening medicine round because already asleep. 2. OP9 It is recommended that an up to date specimen signature list of care staff authorised to handle and administer medicines is made available It is recommended that the home find a way of displaying the menu of the day in format suitable for the needs of the people it accommodates. It is recommended that the home find a way to reduce the conflicting noises in the lounge areas. 3 4 OP15 OP19 Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Aylesbury Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR National Enquiry Line: 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 © 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 Wyndham House DS0000064103.V361912.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!