Inspection on 07/06/07 for Wyndham House

This inspection was carried out on 7th June 2007.

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

The inspector 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 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 7th June 2007 10:55 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.V342787.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.V342787.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 Mrs Susan Addison Care Home 36 Category(ies) of Dementia - over 65 years of age (36) registration, with number of places Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 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. The fees for this home range from £380.00 to £597.74 per week. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection includes information submitted by the home, information arising in relation to the home since the last inspection and a site visit that took approximately 7 hours to complete. During the site visit, residents and staff were spoken with, a tour of the premises was completed and records relating to residents and staff were examined. The manager was available for consultation throughout and helpful in facilitating the process. What the service does well: What has improved since the last inspection? • Residents records contain more person centred information that enable care assistants to provide care that meets their expectations and preferences. The home has now reduced the number of falls related accidents and introduced falls diaries. 2 members of staff are now trained as moving and handling instructors. The manager now has allocated budgets, which allow her to have more day to day control over the management of the home. Some improvements have been made to the fabric of the building. • • • • What they could do better: • The home could start to develop residents care plans to make them more individual and person centred. While there is a lot of information relating to each individual it is not effectively translated into the plans of care. This would enable care assistants to access the information they need to deliver person centred care more easily. DS0000064103.V342787.R01.S.doc Version 5.2 Page 6 Wyndham House • • The home must ensure that people are protected from harm and that risks identified through assessments must be minimised or eliminated. Staff require further training so that they can ensure privacy and dignity is promoted at all times. 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.V342787.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.V342787.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 and 6 Quality in this outcome area is good. People who use the service can be assured the home can meet their needs before making a decision to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the pre-admission process has not changed. However, the information provided to prospective users of the service had been improved and the home now has a brochure that provides basic information about the facilities and services. All people expressing an interest in the home have an initial basic assessment in order to ascertain if the home can consider the person for admission, based on suitability. Following the initial assessment, people are invited to view the home at any time they wish to. A full pre-admission assessment is completed Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 9 and the home confirms in writing that they are able to meet the assessed needs prior to admission. Prospective residents are supplied with a copy of the service users guide, statement of purpose, terms and conditions of residence and a copy of the complaints procedure. Full care plans are completed within one week of admission. Wyndham House DS0000064103.V342787.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 and 10 Quality in this outcome area is adequate. People who use the service can be assured that their health and care needs will be adequately assessed and met. However, improvements need to be made to care plans before this outcome area can be rated as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records relating to three people who use the service were inspected. The records were found to contain assessments of the activities of daily living (ADLs) that provide good person centred information. The ADL showed the persons preferences and choices in respect of usual routines and this is good. In addition, it contained information about strengths and abilities. There was a night care assessment which again provided some good person centred information such as the time the individual likes to go to bed, if they like the light on at night and whether they like a cup of tea in the morning with or without sugar. Files also contained a summary of the individual that contained good information about life history, interests and hobbies. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 11 Staff spoken with said that the files provided good information about individuals and their life experiences which helped them to deliver care that is consistent with how they wished to live their lives. Of the five relatives surveys returned, 3 said that the home supports people to live the life they choose and two felt that was not always possible. Of the ten resident surveys, all ten indicated that they always got the care and support they need. The last inspection highlighted issues with the use of generic care plans and a strong recommendation was made that the home should consider care plans that allow the assessor the flexibility needed to make care plans individual and person centred. The home has not responded to the recommendation and the findings are the same. Care plans still appear as a generic tick list and are not individualised so the recommendation is made again. See recommendations. Risk assessments were written but again there is a trend towards the use of generic risk assessments that lack a person centred approach. Risk assessment have now been written for the availability of products, such as toiletries that may be hazardous if misused. However, observations of people’s rooms showed the risk assessments were not always being adhered to. See requirements. The home maintains good records in respect of people’s health and medical contacts. Resident’s files showed that where a medical need had arisen, the appropriate health professional had been contacted. The home is assessing nutritional needs and at the time of inspection the manager was in the process of implementing the ‘Malnutrition Universal Screening Tool’ (MUST). Observations of mealtime showed that peoples nutritional needs were being met in an individual way, taking into account their preferences, choices, and their physical abilities. The homes medication arrangements were inspected and found to be in reasonable order. The home uses a monitored dosage system (MDS) and most medicines are supplied in this system. The medication charts for each resident were checked and found to be in good order. Each residents chart is preceded by a covering page that includes the name, date of birth, any special requirements and photographic identification of the resident. The charts clearly showed the medicine to be administered and the dose and frequency was highlighted, this is good practice. On examination of the charts there were one or two gaps where it could not be determined whether medicines were administered or not. However, the home has medication audits in place and any issues are promptly dealt with. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 12 The senior carer administering medicines at lunchtime was observed. The practice was seen to be good and medicines appeared to be administered correctly. Medicines are stored in a very small room with little storage space to store excess medicines. On the day of inspection the room was hot, however, when questioned, the manager said the temperature is monitored and maintained at approximately 22 degrees. There is a plan to relocate medicines to a new storage area, which will be an improvement. On the day of inspection a number of issues arose in relation to peoples privacy and dignity, such as the blanket use of plastic aprons at lunchtime and the visibility of incontinence products in peoples rooms. While there was an improvement in the way that people’s dignity is promoted the home needs to continue to educate staff about the importance of respect and dignity. Wyndham House DS0000064103.V342787.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 and 15 Quality in this outcome area is adequate. People who use the service can be assured that the home will provide activities, but activity provided is not always based on people’s life experiences and interests. People who use the service can be assured that they will be provided with wholesome food of their choice, but not always based on their personal preferences and experience of dining. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As mentioned in standards 7-11, the home has lots of person-centred information relating to the people who use the service. This information includes people’s life history, hobbies and interests. However, the information is not necessarily used to create an individual plan of meaningful activity. For instance, during discussions with one of the activities coordinators it was clear that there was little knowledge of what the individual’s preferences were in terms of activity and little understanding of how to use information held to provide experiences that the individual can relate to. Group activities are Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 14 provided and on the day of inspection activities such as a quiz game and colouring were taking place. People seemed to enjoy the activities and many were taking part. The activities coordinators maintain records of all activities people engage in and most residents were regularly involved in some. The records also showed that one to one sessions were provided for reminiscence and various games. Some outings have also been arranged and in June some residents are going to Heacham and in July some are going to Sandringham. In general, the provision of activities is much better now the home has a full time activities coordinator and ensuring the information relating to peoples previous experience is used could make further improvement. The mealtime experience was observed. People were seated at the tables at 12 noon ready for lunch, but lunch was not served until 12.25, a delay of 25 minutes, during which time people were either falling asleep or very restless not knowing what was happening. The room was adequately staffed, however, staff did not engage with residents unless they had to and stood together waiting for dinner to be served. The time could have been spent talking to residents and reassuring them about why they were there. Instead the experience was very task focussed. Tables were nicely laid and menus are now provided as a reminder of what is for lunch and this is an improvement. Each resident was supplied with a plastic cup and orange juice, there did not appear to be a choice of drinks and the home must provide people with choice at all times. In addition, each resident was wearing a white plastic apron and this did not indicate that people had a choice of what to wear in order to protect their clothing. See requirements. When lunch was served, meals were ready plated and taken to the tables. Care assistants were taking named meals indicating that people’s preferences had been considered here and that is good practice. One lady asked for a small portion of food and this was provided. People who needed assistance to dine were supported in a discrete and sensitive manner. There was appropriate conversation and people appeared to enjoy the experience. However, one person was given some assistance and it appeared she was able to manage independently, but needed some encouragement. The care plan also stated that she could eat without support. The home must promote peoples independence as these daily living skills will be lost otherwise. Nine of the ten service users surveys indicated that people always like the meals and one stated usually. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 15 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 adequate. People who use the service can be assured that there complaints are taken seriously and they are safeguarded from harm. However, improvements are required in the investigation of complaints before the outcomes can be considered as good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure that is publicised in the service users guide and on the notice board of the home. Nine of the service users surveys indicated that people know how to make a complaint and one indicated they did not. Of the five relatives surveys returned, three indicated they knew how to make a complaint and two did not. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 16 In May 2007, the Commission received a complaint and it was referred to the home for investigation. The home provided a report on the investigation in accordance with the complaints procedure, however, the Commission considered the investigation to be biased in favour of the home. The inspection showed that some elements of the complaint may be substantiated, but the home’s investigation considered the complaint to be unsubstantiated and it lacked rigour as no visit was made to the home to assess the situation face to face. The home has been asked to re-investigate the complaint and submit a revised report on the outcome. There were no adult protection concerns to report and staff are aware of the procedures for safeguarding vulnerable adults. Wyndham House DS0000064103.V342787.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 and 26 Quality in this outcome area is adequate. People who use the service can be assured that the standard of accommodation will be fair and constantly improving. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall on the day of the site visit the home was found to be clean and tidy. The accommodation and facilities are of a reasonable standard and appear comfortable and homely. Some improvements have been made such as the replacement of carpets in the first floor corridors and non-slip flooring has been fitted to the en suite facilities on the first floor. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 18 The home needs to make further improvements such as improving the bathrooms to make them more pleasant, one bathroom has a broken bath panel and in general the bathrooms lack a comfortable homely feel. Some areas are also in need of redecoration, such as some resident’s rooms. At the last inspection a requirement was made that risk assessments are completed on products such as toiletries kept in peoples rooms. The home has written some risk assessments, however, some products remained and could be hazardous if consumed. The home must take steps to protect people from harm and ensure that they act on the outcome of the risk assessments. See requirements. In addition, when looking at resident’s accommodation items such as incontinence pads were visible and this does not promote peoples dignity. See requirements. Wyndham House DS0000064103.V342787.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 and 30 Quality in this outcome area is adequate. People who use the service can be assured that they will have their needs met by a sufficient number of staff who are trained and improving their skills and competence continuously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of inspection the home was accommodating 35 residents. The homes target staffing levels are 5 care assistants in the morning, 4 in the afternoon and 2 during the night and the levels are unchanged since the last inspection. However, examination of the staff rotas shows on this occasion that the home has managed to maintain its target staffing levels for the four weeks preceding the visit and this is an improvement. In addition, the number of agency staff has been reduced to a minimum by recruiting a bank of staff. The staffing levels are still lower than what is expected for a home of this size and the needs of people living there. However, there was no evidence that people’s needs were not being met. Although, the same questions arise about how much choice people are given in terms of daily routines and some evidence of this is detailed in the report (see standards 7-11). Requirements are made in this respect and the home must demonstrate that people are Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 20 provided with choice and enabled to live in a way that is consistent with their previous life experience. The home continues to provide training for staff and the staff interviewed confirmed that the training was good, although most of the training is delivered in house using videos. The manager was able to produce a training plan showing training that has taken place this year so far and training planned during the remainder of 2007. Staff have been trained in subjects such as safeguarding vulnerable adults, Moving and handling, falls training, food awareness and health and safety. Two staff have completed the training for trainers course in moving and handling, twelve staff are in the process of completing an NVQ 2 and three are in the process of completing an NVQ 3. The files relating to new staff were inspected and were found to be in order. The home has maintained the improvements made at the last inspection. Wyndham House DS0000064103.V342787.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, 33, 35 and 38 Quality in this outcome area is good. People who use the service can be assured that management systems are in place to ensure the smooth running of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home now has a registered manager who continues to manage the home well. Improvements made at the last inspection have been maintained and further improvements can be seen. The manager now has a budget and this provides much more day to day control over the management of the home. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 22 Quality assurance monitoring tools have been introduced and stakeholder surveys have been circulated. The home is in the process of finding a way to publish the results of the surveys and it was suggested that they use the recently developed newsletter. The home does not hold any money for residents and therefore does not get involved in the area of personal finances. Staff supervision has continued, however two staff interviewed could not recall having supervision for the last 6 months. Wyndham House DS0000064103.V342787.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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Wyndham House DS0000064103.V342787.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 OP8 Regulation 13(4)(a) Requirement People who use the service must be assured that all accessible areas of the home are safe so that they are protected from harm. People who use the service must be assured that they will be treated with respect and their privacy and dignity will be promoted so that their wellbeing is enhanced. Timescale for action 30/07/07 2 OP10 12(4)(a) 30/07/07 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 OP7 Good Practice Recommendations People who use the service should be assured that their needs are assessed and written into an individual plan of care so that their needs can be met considering their preferences and choices. Wyndham House DS0000064103.V342787.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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.V342787.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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