Inspection on 04/05/06 for Wyndham House

This inspection was carried out on 4th May 2006.

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

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

Other inspections for this house

Wyndham House 15/01/09

Wyndham House 21/11/08

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 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 4th May 2006 10:50 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.V293860.R01.S.doc Version 5.1 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.V293860.R01.S.doc Version 5.1 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 Miss Georgina Cooper Care Home 36 Category(ies) of Dementia - over 65 years of age (36) registration, with number of places Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2006 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 ensuite. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and completed by two inspectors over a period of 7.5 hours. A tour of the premises was carried out, records relating to residents and staff were inspected. Several residents were spoken with along with two visiting relatives, several care staff, the manager and deputy manager. Observations of staff and residents were made throughout the day. Feedback was not provided on the day of the inspection but at a later time when Mr Fanibi, the operations manager and regulation manager, Frances Chatten could be present. The manager does not demonstrate a commitment to improving the service. It is disappointing to find that only fourteen of the twenty-nine requirements made at the last inspection have been met. Additionally, the organisation has a responsibility to monitor the quality of care provided and the management of the service. Visits conducted under regulation 26 should identify areas for improvement, some of which are clearly apparent. The management must meet the requirements made within the timescales set. What the service does well: What has improved since the last inspection? • • • Inspectors found some improvements have been made to the environment. The laundry facilities are much improved following requirements made at the last inspection. The care plans for residents admitted recently were an improvement on those previously completed. However, were still not satisfactory. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 6 • • Staff have received training in adult protection and a training programme has been produced. A key worker system has been introduced. What they could do better: The manager and operational manager of the home need to demonstrate more commitment to improving the service so that it is compliant with Regulations and National Minimum Standards. At the feedback session both were asked if they thought the requirments made as a result of the last inspection in February 2006 had been met. The manager thought that they had largely been met and the operational manager thought that they had been wholly met. This is disappointing as it indicates that the Company have not got robust systems for monitoring outcomes in the home and that the manager is not being proactive in terms of her on site supervision of staff and systems. The management of the home now needs to take urgent and robust action to address the following as the Commission will need to consider enforcement action should a similar situation be found at the next inspection. • third time) Care plans must be improved to provide clearer information about people’s health, social and emotional needs. (Requirement is made for the General record keeping must be improved to fully demonstrate that people’s needs are being met. Risk assessments are inadequate and most relate to risks posed by the environment and are misplaced in resident’s files. (Requirement is made Nutritional needs assessments must be written and implemented. (Requirement is made for the third time) • • for the third time) • • The number of accidents must be monitored and a three monthly audit completed. (Requirement is made for the second time) Where the need for equipment has been identified the home must respond promptly by obtaining the equipment so that there is no delay in meeting people’s health and care needs. Medication arrangements are of concern. The pharmacy Inspection showed several areas of risk and during this inspection further concerns were highlighted. (Requirement is made for the second time) Mealtime arrangements must be reviewed to ensure they are appropriate to peoples needs. DS0000064103.V293860.R01.S.doc Version 5.1 Page 7 • • • Wyndham House • The home provides little in the way of activity and stimulation. (Requirement is made for the second time) • is made for the second time) • Staff must be alert to the issues of privacy and dignity, training and supervision must be provided in order to raise awareness. (Requirement The home did not demonstrate that choice and autonomy was promoted. (Requirement is made for the second time) • • • • • • • • The home does not maintain a record of complaints in accordance with the policy and procedure. Whilst there have been some improvements in the environment, further work is required. Signage cues and prompts to aid memory and orientation must be introduced. There was no evidence of assistive technology such as door sensors or pressure mats. The call bell system needs to be reviewed to ensure that there are accessible call bell facilities in all rooms. The standard of cleanliness in some areas could be improved. Odours must be identified and eliminated. Infection control procedures need to be improved and staff may need reminding of good practice in this respect. Premises risk assessments must be thorough and identify all hazards to people’s safety and welfare. Staffing levels appear inadequate and there is evidence to support the Commissions view that residents are not adequately supervised. (Requirement is made for the third time) • • • The home must assist staff to transfer learning to practice and a mentoring system is recommended here. The home does not have a policy and procedure in respect of monitoring quality and the quality assurance system needs to be developed. 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. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 8 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.V293860.R01.S.doc Version 5.1 Page 9 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): 3,6 This home carries out adequate pre-admission assessments and are able to confirm that they can meet peoples needs prior to them being admitted. The home does not provide intermediate care services. EVIDENCE: Service user records were inspected and each contained adequate information to make a decision as to whether the home can meet people’s needs before they are admitted. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 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 It cannot be said that service users needs are set out in an individual plan of care due to the lack of information contained in the care plans. Nor can the home demonstrate that resident’s health needs are fully met due to inadequate care planning, inappropriate action in response to health needs and poor record keeping. Also, the medication arrangements at the home do not protect service users from the risk of harm. Equally, the home cannot demonstrate that residents are treated with dignity and respect due to poor record keeping and care practice. EVIDENCE: The home has a good care plan format that is computer generated and easy to read, but these do not promote person-centred planning. On inspection of residents care plans it was found that they were not completed in full and did not adequately cover peoples’ individual needs. For instance, some care plans contained little or no information and others were not consistent with the observed care needs of individuals. Care plans were not Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 11 personalised and did not contain life history information that is essential in the care of people with dementia. Care plans had also not been reviewed in accordance with the required standard. Daily records contained basic information and notes from daily records relating to changes in care needs had not been transferred to care plans to provide an up to date record. Care plans had not been prepared for specific health needs such as the management of pressure sores and behaviours and there were no risk assessments in this respect. However, waterlow assessments had been completed and identified the high risk of pressure sores in some cases. Information relating to health care needs was also limited and there was insufficient up to date information to enable care assistant to provide effective care. Bathing records indicated that residents were being bathed once a week in some cases and once every two months in others. There were no other records to show the reason for the variation and no associated risk assessments. This could be attributed to poor record keeping. Nutritional needs assessments were inadequate and information about peoples likes, dislikes and dietary needs were not completed. Files contained lots of risk assessments, however, the majority related to environment risk assessments and were misplaced in residents files. Risk assessments were not personalised and did not identify risks that are specific to the individual. There were no risk assessments in relation to behaviours i.e. wandering, agitation or aggression. Other examples have already been provided in the above text. Many of the issues raised at the last inspection are still outstanding and little progress has been made in this respect. A requirement concerning care planning is made for the third time and the manager must be proactive in making the necessary improvements to ensure that care staff have sufficient information to ensure that residents needs are met and effective care is provided. See requirements The medication arrangements were inspected by the Pharmacist inspector on the 3/05/06 and the findings are produced in a separate report, available on request. However, the medication arrangements were found to be unsatisfactory and as a result immediate requirements were made in order to protect residents from risk of harm. Further statutory requirements are made in the pharmacy inspection report. It was disappointing to see that following that inspection, poor practice in respect of administration of medicines was still observed and issues around the safe storage of prescribed external applications remain. See requirements. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 12 In respect of privacy and dignity it was difficult for inspectors to ascertain from discussions with residents, whether needs are met in this respect. However, observations made during the inspection indicate that they are not. For instance, one resident was partly dressed and his catheter bag was clearly on display. Others were seen to have soiled clothing and emitting strong stale odours. Blue plastic aprons were placed around some residents during mealtime as opposed to a napkin, which would be more usual when dining. The communication between staff and residents was, at times, poor, staff did not approach residents in a respectful manner and did not always explain what they were doing or offer choice. The language used by some staff could be described as patronising, though probably well meaning and indicates a lack of understanding of these issues. A requirement in respect of privacy and dignity was made at the previous inspection and therefore this is made for the second time. The manager must educate staff about these issues and provide proper practice supervision so that issues can be identified and addressed. See requirements. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The home cannot demonstrate that they are meeting residents expectations, preferences and needs in respect of activity and stimulation due to the lack of person-centred care and information. People are assisted to maintain contact with their families and relatives can visit when they wish. The home cannot demonstrate that people have choice and control over their lives due to poor record keeping and institutional practice. The home cannot fully demonstrate that peoples nutritional needs are met due to poor care planning, lack of supervision and support with dining and lack of choice. The dining area was pleasantly decorated, bright and airy. EVIDENCE: The care plans inspected did not show details of people’s life history nor did they show much information about people’s interests and hobbies. Therefore it is not possible for staff to be confident that they are meeting resident’s needs in this respect. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 14 The home has made efforts to recruit a training coordinator but so far have not been able to. So there are no planned activities and residents are provided with little stimulation and activity. On the day of inspection, most residents were seated in the lounge with little to entertain them and were taken back if they strayed too far. Meaningful activity and occupation should be built into everyday life and information gathered about residents previous life would assist with this process. For instance, some residents may have been keen gardeners and would enjoy working to maintain the garden, with support. Alternatively, some may enjoy being involved with the daily routines such as setting tables for lunch, clearing up afterwards, or being involved with light domestic duties. (All within a risk assessed framework) Meaningful activity does not have to be a formalised plan and given the right guidance and opportunity care staff can promote activity with residents in the work they do. During the inspection, staff were seen to take residents outside in the garden, however, it was very quick and appeared to be a meaningless routine. A visiting relative also stated that the home provides little in the way of activity and her mother needs to have lots of stimulation. Therefore, the family visit regularly to take her out and provide the activity she does not receive in the home. Current staffing levels do not allow staff to spend time with residents and this is explained in more detail in standard 27. The manager must address the area of activity and stimulation. Staff need to be provided with adequate information, guidance and time to meet peoples needs in this respect. A requirement was made at the last inspection and is made for the second time. See requirements During the inspection relatives were seen entering the home, two were spoken with. Both said they were welcome at the home at any time. Mealtime was hurried and people were not provided with meaningful choice. However, staff had consulted with residents about their choice of meal in the morning, but many could not remember what they had chosen. Staff did not have time to assist or prompt people to eat and some residents left their meal untouched. Food was served and plates cleared within 15 mins. No finger foods were available for those that did not settle for long enough to eat a meal. Drinks were served from a dirty jug that looked as though it had previously been used to mix gravy. Two care assistants were serving food to residents and one was assisting in the kitchen. Most of the 34 residents were seated in the dining room. Care plans did not include assessments about people’s nutritional needs and how they are met. One resident who is a vegetarian was served meat on more Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 15 than one occasion. The home must review the mealtime arrangements to ensure that people’s holistic needs are met. See requirements. The dining room was spacious and pleasantly arranged and the tables were nicely prepared with tablecloths and place mats. There was a white board on the wall displaying the meal options and staff on duty, this acts as a good reminder to those with poor recall. This is good practice. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home cannot demonstrate that complaints are dealt with in an appropriate manner due to a lack of a complaints log and any monitoring systems. The home has made efforts to ensure that residents are protected from abuse by providing staff with training and knowledge of correct procedures for dealing with allegations of abuse. EVIDENCE: The home has a complaints policy and procedure that clearly states how complaints will be dealt with. However, the home does not maintain a log of complaints in accordance with the complaints policy and therefore are not able to monitor the number of complaints effectively. It is required that a record of complaints is maintained and available for inspection. See requirements. The commission has been made aware of six complaints, mostly anonymous in the last two months. Two of the complaints were sent to the home for investigation in accordance with the complaints procedure. The home responded within the requested timescales. However, the investigation into elements of the complaint was less than satisfactory and a requirement is made for a full investigation to be conducted and forwarded to the commission. See requirements. In respect of the other complaints, an investigation into the matters raised was incorporated in this inspection and elements of the complaint are substantiated. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 17 Adult abuse training has now been provided to staff following a requirement at the last inspection. The whistle blowing procedure has been updated and made available to staff. The adult protection policy has been improved to include the name of the commission however the requirement made at the last inspection stated the contact details of all agencies that need to be informed of adult protection issues should be included and the policy still excludes social services department. This requirement is carried forward for the second time. See requirements Staff spoken with, were aware of the policies and procedures in respect of adult protection and would report matters of concern. The concerns raised in standards 7-11 with regard to care plans do not demonstrate a commitment to protect people from harm. If peoples needs are not fully assessed and risk assessments are not written then it is impossible for staff to fully protect people from harm. The home has had 52 accidents, in the last two months, 46 involving residents falling. This could be attributed to poor care planning and low staffing levels at these times. See standards 7-11 and 27-30 for further details. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 18 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): 19,20,22,23,24,25,26 Improvements have been made to the environment over the last 11 months and the proprietor has plans in place to continue with this work. However, further work is required and some health and safety issues need to be addressed. The home employs domestic staff to ensure that a good standard of cleanliness is maintained. EVIDENCE: Improvement to the premises has continued and the home has a plan of maintenance and renewal to address the outstanding issues in respect of redecoration and repair. The proprietor has invested a significant amount of money in the refurbishment of the home and demonstrates a firm commitment to continuing. A tour of the premises was carried out and some service users rooms were entered. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 19 The communal areas appeared to be clean, tidy and fairly well maintained. The last inspection report highlighted a concern about the main lounge used by residents. This lounge is separated into two areas and doors have been fitted between the two to allow service users choice in terms of visual and audio entertainment. However, during the inspection the doors between the two rooms were open for the majority of the time and the sound of the radio in one room and TV in the other was creating conflicting noises that could lead to confusion and agitation. The requirement to address the situation is made for the third time. See requirements. The second lounge on the first floor is a quieter room for residents to sit in, however, it is not well used and resident’s do not have independent access to it because of its location in the home. Staff said that on occasions residents and their relatives sit in the room when they wish for some privacy. The home could consider making the room more accessible and perhaps use it for activity, such as art and craft sessions and reminiscence work. See recommendations. The home has a large dining room with views out to the rear garden. The tables were nicely laid out with tablecloths and the room looked clean and tidy. Some resident’s rooms were entered during the tour and some are in need of redecoration and repair. The home has a plan of maintenance and renewal noting the improvements needed in each room. All the issues identified are being addressed in the plan. Some rooms have already been redecorated and new furniture purchased raising them to a good standard. Residents have personalised their rooms with photos and other memorabilia, some have brought in items of their own furniture. Some beds were inspected and it was found that some sheets and pillowcases were soiled; even-though the bed had been made. See requirements The temperature in the building was variable. On the day of inspection it was warm outside. In the original building the heating was on and it was very hot. In other parts of the building it was cool. It was not clear whether the heating could be turned off. Staff stated it was on most of the time making it unbearable to work in. The home should assess the efficiency of the heating system and update it if necessary. See recommendations The home has a call bell system, which is located in every room. However, the call bell was not easily accessible in all rooms. For example, call bells were not accessible at bedsides and chairs. It is required that the home provides accessible call bells in all rooms. See requirements Additionally, the home does not have assistive technology, such as sensor mats and door sensors. This equipment is very useful in homes caring for people with dementia as it maximises independence while minimising risk. With assistive technology staff can be aware of residents movements and assist where necessary. The home has a number of people who like to walk at Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 20 night and staff have no way of knowing who is up and where they are until they see them or are alerted by another resident. The home has had 46 accidents relating to falls in the last 2 months, the majority of these occurred in the evening and during the night. If risk assessments were completed correctly, the need for equipment would be identified and the environment would be much safer. It is essential that the home address this issue to protect people from unnecessary harm. See requirements. See staffing standards 27-30 also. The home has very little in the way of signage that would aid orientation and recall. Some resident’s rooms had photos and names and others did not. The home must make improvements here and progress to an environment that is enabling and one in which people can find their way around independently. See requirements. The home has made efforts to reduce the chance of cross infection in the home by providing staff with antibacterial alcohol gel to clean their hands with. This is good practice. Following a requirement at the last inspection, all bathrooms have been provided with hand towels. Again, this is good practice. The inspectors did not observe any clinical waste bags for the disposal of items such as soiled incontinence pads. In one room it was found that a used catheter bag had been left to drain in the toilet and it was not possible to tell how long it had been there, in the same room a used catheter bag had been placed back in the box with the clean ones. The home still needs to improve practice in respect of infection control and provide the proper facilities for the disposal of contaminated waste. See requirements. Odours were also detected in some rooms, though some of these issues have been addressed by replacing carpets where needed since the last inspection, the home still needs to continue to make improvements in this respect. See requirements. At the last inspection a requirement was made in respect of toiletries and creams found in communal toilets and bathrooms, which were not labelled with individual residents names. This could indicate that these products were for communal use and that is not good practice. Similar issues were identified during this inspection. Products should be labelled with the residents name and stored safely to reduce the risk of accidental consumption. In addition, toiletries were seen in resident’s rooms and no risk assessments had been carried out in this respect. Again, items such as these should be stored safely and risk assessments must be completed. The requirement is made for the second time. See requirements. A number of other health and safety risks were identified. Tthe home has risk assessments in respect of the environment. However, these are placed in resident’s files. (See standards 7-11 for further details). During the tour of the building inspectors found unguarded stairways and unlocked doors to storage Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 21 cupboards/ electrical cupboards. There were no risk assessments available for these hazards. The home must complete a thorough risk assessment in respect of the premises, identify hazards to people’s safety and welfare, assess the risk and take action to minimise risk. See requirements. Following a requirement at the last inspection to improve the laundry arrangements and facilities in the home, great improvements have been made and risk assessments have been written. This is good practice. The standard of cleanliness in the home was found to be reasonable. A team of domestic staff are employed to maintain good standards. There are some improvements still to be made and these have already been identified in the report. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 22 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 It cannot be said that the home has sufficient numbers of staff to meet people’s needs safely and effectively. The management have responded well to the requirement to progress towards a demonstrably competent workforce. Recruitment practices have improved following requirements made at the last inspection. Whilst the home has a training programme, it cannot be said that staff are fully competent to do their job due to a lack of support and supervision in transferring learning to practice. EVIDENCE: Six weeks of staffing rosters were provided on request. The information contained in the rosters was analysed and showed that the home was not consistently meeting the minimum staffing levels and this is of concern. The current staffing levels are 5 CA’s 7-11am, 4 CA’s 11-2pm, 3 CA’s 2-5pm, 4 CA’s 5-9pm, 2 CA’s 9-7am. Providing a total of 602 hours per week. However, as stated above the home is failing to consistently meet their target hours. Given the category and number of people the home is accommodating the staffing levels should be much higher than they are set currently. People with dementia have additional needs and require a greater level of supervision and support. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 23 The previous inspection required the manager to conduct a staffing review to address the problems of inadequate staffing at specific times of the day. The home did not provide a staffing review as required and have failed to demonstrate that staffing levels meet people’s needs. During the inspection, observations and records indicated that people’s health, care and social needs were not being met and as a result, at times people were exposed to risk. As mentioned previously, the incidence of falls is high and the occurrence of these accidents can be linked to times when staffing is lower, such as evenings and during the night. There was a lack of activity during the day for residents. This can be attributed to the lack of time and availability of staff. Routines such as lunchtime and administration of medicines were hurried, as discussed in standards 12 and the pharmacy inspection report. There was also evidence to suggest that residents were not given meaningful choice in respect of daily routines, for instance times for getting up and going to bed. These choices were not reflected in care plans. (See standard 7). The home employs a cook at lunchtime and teatime, which is good. However, on the day of inspection there were two care assistants assisting in the kitchen, therefore taking them away from the residents and increasing the risk of cross contamination. The home needs to employ kitchen assistants to undertake this task. See requirements It is required that the management assess the dependency levels of residents and review the staffing levels. The management must provide the Commission with a thorough staffing review and increase the staffing levels to ensure that people’s needs are being adequately met. See requirements. Domestic and laundry staff are employed, this is good, as care staff do not get involved with these tasks and can concentrate on care. At the last inspection, a requirement was made in respect of ensuring that all new staff recruited have the necessary pre-employment checks prior to starting work. This requirement has been met. The files of 5 new members of staff were checked and found to be satisfactory. Each had completed a basic induction, although the home has a full induction programme, there was no evidence of this being completed by these members of staff. The home has produced a training programme that includes mandatory training. The programme this year demonstrates a good commitment to improving the skills and knowledge of the workforce. All staff will be trained in dementia care awareness and adult protection. There are 6 care assistants currently undertaking NVQ’s and staff spoken with felt positive about the training that had been provided. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 24 Moving and handling training has been provided to all staff; however, during the inspection poor practice in respect of moving and handling was observed. It is required that the competence of staff is assessed and further training is offered to those who need it. See requirements. It is important to note that staff require supervision and support to transfer new learning into practice. This is the role of a mentor and perhaps the home should consider assigning a mentor to small groups of staff so their performance can be assessed, monitored and further training needs identified. See recommendations. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 25 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): 31,33,35,36,38 The home has a registered manager who has yet to demonstrate that the home is managed in a way that promotes the best interests of its staff and residents. Quality monitoring processes are being implemented, however, the management need make significant progress in this area before it can be said that they have an efficient quality assurance system. The home does not assist any residents with their finances. It cannot be said that the home protects the health safety and welfare of staff and residents due to the lack of an adequate risk management system. EVIDENCE: The manager, Georgina Cooper was employed in November 2005 and has been recently registered as manager by the Commission. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 26 She is currently undertaking an NVQ4, which will help to further develop and update her management skills. It is of concern that the home has a number of repeat requirements in key areas that have not been addressed. This raises questions in respect of the management of the home and the ability of the manager to run the home in a way that promotes residents best interests. The manager must demonstrate to the Commission that she is competent and has the ability to address the outstanding issues within the agreed timescales, some of which have been negotiated by the manager. See requirements. Staff spoken with talked of the manager being supportive and approachable, this is positive and promotes good relationships with staff. The home has started to implement some quality monitoring processes. Regulation 26 visits are carried out, however, these have failed to identify and address some of the deficits identified in this report. Therefore the quality of those visits is questionable. Resident’s surveys have been sent to relatives, either for them to complete or to assist the residents to complete. The home does not have a policy and procedure for quality assurance and this must be developed. The quality monitoring systems need to be further developed so the home can report on the quality of all aspects of the service. Consultation processes need to be developed so that all stakeholders have the opportunity to comment on the quality of the service and any concerns can be addressed. The home must conduct a quality review at least once a year and provide a report to all stakeholders and the Commission. See requirements Staff supervision has commenced and staff spoken with confirmed they have had at least one session. There is no formal plan for supervision and the commission will continue to monitor the frequency of supervision to ensure that it meets the standards. Records relating to health and safety were inspected. Wheelchairs, hoists and other equipment have been serviced to ensure they are in good working order. Fire safety records are being maintained in accordance with the standards. The home is about to Commission a further fire safety inspection to confirm that they are now complying with the regulations in this respect. Environment risk assessments are in place, however, a number of risks were identified during the inspection and must be addressed. See requirements and standard 19 for details. Risk assessments must be improved as discussed in standards 7 – 11. Accident records were inspected and found that the home has had a total of 75 accidents in the last 3-month period. The last two months records were taken and analysed. The results showed that 52 accidents had occurred, 46 of those Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 27 were as a result of falls involving 21 different residents. Most of the accidents occurred at times when staffing levels are at their lowest. In this report a number of requirements are made that relate to improving the risk management systems and subsequent care of residents. The management is required to monitor the incidence of accidents and identify the reasons why they occur. Appropriate action must be taken to protect people from harm. The Commission must be provided with an accident monitoring report showing any action taken. See requirements Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 28 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 2 X 1 2 2 2 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 2 X 1 X 3 2 X 1 Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 29 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 OP7 Regulation 15 Requirement It is required that the care plans contain detailed guidance for the staff about how to meet the resident’s needs. This includes nutritional needs assessments. Carried forward for the third time It is required that effective risk assessments are undertaken and that these are recorded within the care plans. Carried forward for the third time It is required that prescribed medicines for external use are stored safely. It is required that clear written guidance is provided for PRN medication. Carried forward for the second time. It is required that staff are provided with update training in respect of privacy and dignity and their practice is assessed in this respect. This is the second DS0000064103.V293860.R01.S.doc Timescale for action 04/08/06 2. OP7 13 (4c) 04/08/06 3. OP9 13 (2) 04/06/06 4. OP9 13 (2) 28/06/06 5. OP10 12 (4a) 04/06/06 Wyndham House Version 5.1 Page 30 requirement in respect of privacy and dignity. 6. OP10 12 (4a) It is required that individual risk assessments are undertaken with regard to the provision of locks on the bedroom doors. This is repeated for the second time It is required that the interests, hobbies and social needs of the residents are assessed, recorded and that appropriate activities are provided. This is repeated for the second time It is required that mealtimes are reviewed and arrangements are made to make them more appropriate to peoples needs. It is required that the home maintains a record of complaints It is required that the home conducts a full investigation of the complaints sent by the Commission and supplies the Commission with the report of the investigation. It is required that the Adult Protection procedure clarifies the notifications that need to be made and includes the contact numbers for these agencies. This is repeated for the second time It is required that the home completes a thorough risk assessment of the premises to identify and eliminate hazards to peoples safety It is required that arrangements are in place to prevent the television and radio (or two televisions on different stations) being on in the same room. This is repeated for the second DS0000064103.V293860.R01.S.doc 04/06/06 7. OP12 16 (2m) 04/08/06 8. OP15 16(2i) 31/07/06 9. 10. OP16 OP16 17(sch 4, 11) 22(3) 31/05/06 31/05/06 11. OP18 13 (6) 31/05/06 12. OP19 13(4ac) 04/06/06 13. OP20 12 (4a) 31/07/06 Wyndham House Version 5.1 Page 31 time 14. OP21 13 (4a)12 (4a) It is required that toiletries and razors are not left in the bathrooms and that residents have their own toiletries This is repeated for the third time It is required that the home reviews the call system to ensure all rooms have accessible call bells. It is required that the home has suitable equipment to meet residents needs. This relates to the need for assistive technology It is required that the home has appropriate signage to assist with orientation and recall. It is required that clean bed linen is provided at all times. It is required that the home makes suitable provision for the disposal of clinical waste. i.e soiled pads and used catheter bags. It is required that offensive odours are identified and eliminated It is required that the residents are able to get up and go to bed at a time of their choosing. This is repeated for the second time. 04/06/06 15. OP22 23(2n) 31/07/06 16. OP22 23(2n) 04/08/06 17. 18. 19. OP22 OP26 OP26 23(2n) 16 (2je) 13(4a) 31/07/06 31/05/06 04/06/06 20. 21. OP26 OP27 16(2k) 12 (4a) 04/06/06 04/06/06 22. OP27 18 (1a) It is required that a review of the 04/06/06 staffing is undertaken and that staff are available to meet the residents needs. This is repeated for the second time. It is required that the staffing levels are increased in the afternoon to provide dedicated kitchen staff to cover for the preparation and clearing up of the lunch and tea time meal. This is repeated for the DS0000064103.V293860.R01.S.doc 23. OP27 18 (1a) 04/06/06 Wyndham House Version 5.1 Page 32 second time 24. OP38 13 (4) It is required that a regular thorough audit, at least three monthly, is undertaken of accidents to identify and reduce risk. Particular attention should be paid to the incidence of falls. This is repeated for the second time 04/07/06 25. OP30 13(5) 26. OP33 24(1)(2) It is required that the home 04/07/06 trains and assesses staff in moving and handling techniques to ensure safe practice at all times. It is required that the home 31/10/06 establish and maintain a system for monitoring quality. The system must include consultation with all stakeholders and an annual report on the quality review must be produced and supplied to stakeholders and the Commission. 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. 3. Refer to Standard OP19 OP30 OP25 Good Practice Recommendations It is recommended that the home consider making the first floor lounge more accessible and useable for residents. i.e. for activity and reminiscence work It is recommended that the home introduce a mentoring system to ensure good practice is maintained. It is recommended that the home review the heating system to ensure it remains efficient. Wyndham House DS0000064103.V293860.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. 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