CARE HOME ADULTS 18-65
Wynfield House 115 Newton Drive Blackpool Lancashire FY3 8LZ Lead Inspector
Mrs Jennifer Dunkeld Unannounced Inspection 16th July 2007 9:30 Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 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 Wynfield House DS0000009729.V338632.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 Adults 18-65. 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. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wynfield House Address 115 Newton Drive Blackpool Lancashire FY3 8LZ 01253 392183 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) Blackpool & Fylde Society For The Deaf Mr Mark Greenhalgh Care Home 19 Category(ies) of Sensory impairment (19) registration, with number of places Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 19 residents to include: *up to 19 residents in the category of SI (Sensory Impairment) 25th September 2006 Date of last inspection Brief Description of the Service: Wynfield House is registered under the Care Standards Act 2000, to offer accommodation and personal care to up to 19 adults with a sensory impairment. The accommodation consists of 7 twin bedrooms and 5 rooms for single occupancy. There are 2 lounges on the ground floor and a dining room. A passenger lift operates between the ground and first floor. The home is relatively close to local amenities and facilities with good transport links. In appearance the premises blend in with the neighbourhood. There are spacious gardens to the rear of the property that are well maintained, some of the residents like to help in the gardening activities. The current fees per week are £357.12. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit was carried out over a day. The inspectors were Mrs Jenny Dunkeld and Mrs Joy Howson-Booth. The visit was unannounced on 16/07/07 and was over a 6hr period. The inspection was carried out to assess the home against the National Minimum Standards for Adults. Prior to the inspection we sent surveys to relatives of the residents and to the residents themselves to ascertain their views about the home. These reflected that people were generally content in the care they receive with comments such as, ‘I am always kept informed of important issues affecting my mother.’ ‘The staff treat me well’ and ‘I am alright here, everything is ok, I like this home’ We talked to 15 people using the service, and asked staff about those people’s needs. We also looked at the care plans, medical records and daily notes for these 3 people. This is called case tracking. We looked at all written information about the 3 people, to ensure their needs were being met. A number of areas of good practice were noted including the promotion of equality and diversity. An interpreter, with the skills of the British Sign Language, enabled the inspector to communicate with the residents. Some of the residents knew the interpreter and this made the visit pleasant for the people who live at Wynfield House, and gave them confidence to speak freely and openly. In general people were satisfied with the care they receive at Wynfield House with comments such as ‘The staff are good.’ People said they could come and go as they choose but many of them require staff support to go out and transport. An Immediate Requirement notice was served during the inspection in relation to a window in need of repair and a separate letter has been sent to the Deaf Society in relation to this. What the service does well:
The service has the best interest of the service users at heart, which is apparent from the service users stating that they are well looked after. The manager is keen to make improvements to ensure people are well cared for and their needs met. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 6 The manager and staff are endeavouring to ensure that people have a life style according to their needs and wishes with some in-house activities being offered to stimulate people. Weekly trips out are also on offer. The service ensures that the staff are able to communicate with the people who live in the home by encouraging them to learn BSL (British Sign Language.) Some staff are competent in BSL and have achieved a qualification BSL level 1. Others have yet to commence the training. Other training is also available for staff for example Food Hygiene. What has improved since the last inspection? What they could do better:
During the last inspection it was noted that: ‘The chef has developed a four weekly menu and consulted people as to their preferences. A choice is offered at meal times and the service users are asked as to which choice they would like.
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 7 The vegetables were served in tureens, which enhanced the appearance of meal presentation’ Since then a new Chef/cook has commenced employment and some of the residents were saying they don’t get a choice any more. During this inspection we dined with the residents and asked what today’s lunch meal was and were told ‘it is fish or Spanish omelette’. We decided that one would have fish and the other Spanish omelette. The response was ‘you will be the only one having the omelette as the residents don’t like it. The chef/cook had explained that she was endeavouring to ensure a healthy balanced diet, with variety. Advice was given to the manager that the menus should reflect a healthy balanced diet but also the preferences of the people who live in the home. If no-one likes Spanish omelette there is no point it being on the menu, as this results in people having no choice but to have fish for lunch. It was agreed to send some information supplied by a Community Dietician to the chef/cook that gives good advice in relation to the dietary needs of people. Vegetables were ready plated. Portions were adequate for some but not enough for others. Advice was given that if tureens are not used then people should be offered a little extra if they have finished their meal to ensure they have had an adequate amount to eat. The dining tables did not appear inviting when laid for lunch. The tablecloths were dirty from breakfast and the place mats had not been wiped. The cruet sets had dried food on them and some were empty. Mealtimes are social occasion and should be an opportunity to enjoy a meal in a conducive environment. Perhaps the chef/cook would want to ensure the meal is served in a room that sets the scene for an appetising meal. The service provider has enabled some staff to learn British Sign Language, which is vital in caring for the people who live at Wynfield House, as this is their main form of communication. It is important that all staff that do not have this training are enabled to do so at the earliest opportunity. Some staff do not have English as their first language, which according to some of the residents makes lip reading difficult. It was noted that one bedroom window had a sign attached to it saying not to open the window. The manager explained that it is lose and would drop down if opened. A quote had been obtained for replacing the window but the quote was very high. An Immediate Requirement notice was issued in respect of this window. Giving the provider a time scale in which to get the window repaired/replaced. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 8 Some of the people spoken with during this visit said they had to go to bed at a certain time. They also said they have to get up in time for breakfast at 8.20am. However the manager stated that they can go to bed and get up when they choose. Advice was given to ensure all the residents are aware of their right to choose when to get up in a morning and when to go to bed. One relative of a resident gave examples of what she feels the home does well. This included: ‘They have an appointed named carer for each resident.’ ‘The management and staff work hard to develop good relations with the residents.’ 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. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. No- one moves into the home on a permanent basis, before having their needs assessed and being assured that these will be met. EVIDENCE: Information provided to residents includes a Statement of Purpose. This document outlines the service provided and details information on resident’s rights, privacy, dignity, independence, security, choice and how the home enables people to achieve a fulfilled lifestyle. It was of concern that the complaints information contained in the Statement of Purpose did not provide contact details (phone or fax numbers) but stated that the resident should contact the manager for this information. Residents wishing to make contact with outside agencies shouldn’t need to ask for the information; it should be in the Statement of Purpose. It was also advised that the Statement of Purpose would be more user friendly if it was produced in a larger print format.
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 11 The manager stated that if the prospective resident lives within 50 mile of the home he would visit to carry out an initial assessment to ensure the home can meet the needs of the person. If the person lives further away from the home they are invited to have a 2-week trial stay at the home during which time the assessment would take place. One care file examined reflected that an introductory period had been offered. The resident signed to say she had enjoyed her trial period and has made friends in the home. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a home where their needs are generally identified and met. EVIDENCE: Three care files were examined as part of the case tracking process and were seen to have improved since the last inspection. The files are now organised into their own separate box file and sectioned into different areas – care plan, personal information (including past history, social and personal assessments), and medical information that reflects peoples diverse needs are being identified and met. The three care plans examined reflected needs were identified and there was clear instruction as to how staff are to meet these.
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 13 The manager was advised that some information had not been transferred onto the care plan, for example one resident had limitations in sight and needed to wear spectacles. In addition, some care information should be more specific for example the relief of pressure for one person who is sat or lying down for long periods of time. Daily notes on one care file indicated “staff to monitor food and drink” although no separate record of this monitoring had been completed. Where a specific need is highlighted it was advised a separate care plan sheet could be produced so that staff can record the input given. Some risk assessments were in place but the manager was advised that these need to be updated or a regular basis. One care file needed an additional risk assessment to be produced for the use of bed rails. Care files also reflected the following rights of the individual resident: - to rise and retire to bed at a time of their choice -who they wish to have involved in their care reviews Care files also showed that regular reviews are taking place – for example – one care plan was reviewed 21.1.07/30.3.07/8.5.07/22.6.07. Weight monitoring records were not available for the three residents who were part of the ‘case tracking process’. There was information on the daily notes that people are routinely checked upon during the night. Advice was offered that residents should be asked if they wish to have the night carer enter their bedroom. If they choose not to be disturbed, they should be asked to sign a disclaimer. Care notes for one person stated that they were to have two hourly checks at night and night records evidenced that care staff were doing this and providing personal care as needed. The current system for recording daily input was discussed with the manager and advice was given that some records reflect areas of concern but it is difficult to ascertain what action has been taken in relation to the concern. For example, on 15.4.07 one person complained her bottom dentures were sore; and on 10.6.07 another person had ‘big rash on L side of buttocks – cream applied” then “16.6.07 – red rashes still present on bottom”. No entry could be found to confirm what action had been taken to resolve/treat these conditions. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 14 The manager confirmed that staff record information on the following documents: daily records, the care plans, some on the district nurses own records and some information in the staff communication book. It was advised that each resident could have their own daily diary record kept in a dedicated folder that would then enable staff to keep one contemporaneous record rather than the current system, which appears confusing and does not reflect actions taken. Some of the people spoken with during this visit said they had to go to bed at a certain time. They also said they have to get up in time for breakfast at 8.20am. However the manager stated that they can go to bed and get up when they choose. Advice was given to ensure all the residents are aware of their right to choose when to get up in a morning and when to go to bed. The residents stated that the staff are good with comments such as: ‘They work hard’ ‘The staff are willing to help’ ‘ Most staff are able to sign but some are better than others’ One relative of a resident commented ‘Given my Mothers age and her frailty, she is able to make her own decisions, with support, as to what she wants’ Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 15 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from having an increased fulfilling lifestyle. People would benefit from having a diet that offered greater choice. EVIDENCE: One residents care plan reflected that she wanted to use the Internet more to keeping in touch with her family. The homes manager said that this had not been too successful but the manager will try again to support the resident to do this. There was recognition of the importance of being able to maintain family contact. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 16 The residents spoke of the outings that are now available. Some are enjoying the outings, while others find it difficult to participate due to their disabilities. Three files examined which indicated that the activities provided to residents have improved since the last inspection. For one resident it was noted that a range of activities have been enjoyed, including – attending church, going to work, community involvement (local pub, restaurants), walking trips, visiting the bookies. The residents are offered activities on a weekly basis – Monday p.m. Bingo; Wednesday – Deaf Club; Friday – No 4 pub; Special movie nights each Saturday. Other planned activities and outings have included – Ice Show, Lowther Paviaion, Tranpsort Exhibition, “Bollywood night”, Sea Life Centre, Blackpool Tower, Zoo, Football museum, Model Village and a “Steam and Sail” trip to the Lake District. The home is also developing in-house activities, which include – exercises, garden darts, quizzes and a recent “themed French Night” proved successful. A photographic record book is kept of the outings and were clearly enjoyed by those who have attended. The manager also confirmed that activities are also being developed for those people who are perhaps unable to go out – one resident is to be offered hand massages. Another resident has taken part in a range of activities in-house and it is hoped these activities can be further developed in the forthcoming months. Residents are also enabled to take part in voting – one resident file noted that they had “declined to vote”. A new Chef/cook has commenced employment and some of the residents were saying they don’t get a choice any more. During this inspection we dined with the residents and asked what today’s lunch meal was and were told ‘it is fish or Spanish omelette’. We decided that one would have fish and the other Spanish omelette. The response was ‘you will be the only one having the omelette as the residents don’t like it. The chef/cook had explained that she was endeavouring to ensure a healthy balanced diet, with variety. Advice was given to the manager that the menus should reflect a healthy balanced diet but also the preferences of the people who live in the home. If no-one likes Spanish omelette there is no point it being on the menu, as this results in people having no choice but to have fish for lunch. It was agreed to send some information supplied by a Community Dietician to the chef/cook that gives good advice in relation to the dietary needs of people. Vegetables were ready plated. Portions were adequate for some but not enough for others. Advice was given that if tureens are not used then people Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 17 should be offered a little extra if they have finished their meal to ensure they have had an adequate amount to eat. The cook/chef said she is going to consult the residents about what they like to eat. The dining tables did not appear inviting when laid for lunch. The tablecloths were dirty from breakfast and the place mats had not been wiped. The cruet sets had dried food on them and some were empty. Mealtimes are a social occasion and should be an opportunity to enjoy a meal in a congenial setting. Perhaps the chef/cook would want to ensure the meal is served in a room that sets the scene for an appetising meal. It was noticed that one resident dined at the dining table in her wheel chair but had to have a tray between her and the table as she was unable to get closer to the table as it was not high enough to take a wheel chair. Advice was given that leg raisers are available that would raise the table to be able to facilitate the wheel chairs of the two people who dine at that table. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents would benefit from living in a home that effectively manages their medication EVIDENCE: Care files examined as part of the case tracking process proved that residents are enabled to access a range of healthcare professionals, as needed. Medication records were examined and the following noted : The manager confirmed that the home now uses the Boots monitored dosage system and training has been provided by the pharmacist to staff at the home. Some staff have also applied to do further training in the administration of medication and the manager is currently looking at appropriate courses. Prescriptions are now being obtained and signed for by the home prior to medications being dispensed. The homes manager is currently working with
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 19 Boots to streamline and improve the current system. Individual records were examined and the following anomalies noted : Atenol tablet signed for on 8.7.07 but tablet still in the packet. The GP prescribed Lansoprazole for one resident 3.7.07 but only two entries were seen on the MAR (Medication Administration Record) – when the manager was asked about this he confirmed that the medication had been stopped by the GP. It was strongly advised that any changes in medication need to be made clear on the MARs sheet so that staff are clear about medications currently to be given. A record of changes (including a record of instructions from the GP) should also be included on the care plan records. There were occasions when medication had been given but not signed for and when medication had not been given but had been signed for. Entries are not being made when creams, etc., are used – the manager was advised that a simple signing sheet could be kept in the residents own rooms which staff can then sign at the time of applying the cream Looking overall at the medication records there still appears to be some poor recording and attention to detail. The manager was advised that staff may be administering medications without referring to the actual MAR sheets or making records at the actual time of administration. The manager was made aware that the inspector observed two different medications in unnamed pots being taken from the medication trolley during the inspection and this raised concern that the home may be secondary dispensing – a practice which should stop. No record of when Ensure or other supplement drinks are being given – the manager was advised these should be recorded when given as they are a prescription item. No controlled drugs are currently being used. The home has a controlled drugs record book for when/if any are prescribed. However concern was expressed that the current medication arrangements do not provide the required safe storage should a controlled drug be prescribed in the home. As well as this, stocks of medication are in a cupboard which is not secure and further thought needs to be given over the area of storage of medications. A record of medications received and returned was also seen. Currently unused or discarded tablets are kept in one bottle and returned when full. The manager was advised that the chemist may supply the home with a safe disposal system (DOOP) to add greater security in this area. The manager confirmed that self administration consent forms have been signed, as needed and advice was given that a risk assessment to self administer should also take place so that any risks or concerns can be
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 20 highlighted and addressed before any decision is taken for a resident to self administer. The residents stated that they are taken to the Doctor when necessary or the Doctor comes to see them. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a home were they are protected and safeguarded EVIDENCE: The AQAA (Annual Quality Assurance assessment) received from the manager states they: ‘Listen to and record all concerns and complaints and are alert to the possibility of abuse towards residents ‘ and have ‘Increased staff awareness through training’ The management have reviewed Adult Protection Policy and the Complaints Procedure ‘ The completed surveys received from the residents reflect that they know how to complain but have no complaints. The survey received from a relative indicates that when she has had minor concerns she has raised these with the manager and these have been quickly rectified.’ Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 22 The residents spoken with said they would tell the manager or Julie (senior carer) if they were unhappy about something. They said they were quite happy and had nothing they want to complain about. The staff have received Training in ‘Ensuring Protection’. The staff spoken with had a good understanding of what to do if they suspected abuse had occurred. In December 2006 an allegation of suspected abuse was reported to the homes manager, who took the appropriate action in reporting the allegation to the Commission for Social Care Inspection and Social Services. Investigations took place and the outcome was that the allegation was not upheld. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 23 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a home where improvements are being made to ensure they live in a safe, comfortable environment. EVIDENCE: The management of the home are endeavouring to improve the standard of the environment. This was evident from the stairs window having been replaced, the back stairway has been decorated and self-closing devices installed to some of the doors including the kitchen. In general the home is hygienic and free from offensive odours. However there was no hand wash solution in the staff toilet, which meant staff going to wash their hands in the residents toilet area. More was being ordered. It is important that the solution is always available to stop the spread of infection.
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 24 As advised during previous inspections the installation of push buttons to the outside of bedroom doors that trigger a flashing light in the bedroom would let the occupant know that someone is about to enter their room. The manager said that these are being looked into and will be provided in the not too distant future. Ceiling tracking for curtains between beds is needed in shared rooms to offer greater privacy to the occupants, the manager has identified this and he is seeking to get these installed. The Commission for Social Care Inspection would agree that these are essential. The hallway carpet is to be replaced which will greatly enhance the appearance of the home. The new carpet is to go from the hallway to the back of the home and replace the heavily soiled carpet. Bedroom I urgently needs the window repairing/replacing and an Immediate Requirement notice has been given to the manager in respect of this. The manager said that some of the lounge chairs are to be replaced and the lounges are being decorated. The residents have helped to choose the new decor for the lounges. This is a good practice, which reflects recognition of whose home it is. The TV in one lounge is in the window, which makes it difficult for the residents to see the screen due to looking into bright lounge. There is a need to look at resolving this situation when the room is redecorated. The residents also commented that the TV is too small. The manager said that it is going to be replaced. The residents in the other lounge also commented that the TV is too small. They said reading subtitles and lip reading would be easier on a larger screen. It was noticed that one resident dined at the dining table in her wheel chair but had to have a tray between her and the table as she was unable to get closer to the table as it was not high enough to take a wheel chair. Advice was given that leg raisers are available that would raise the table to be able to facilitate the wheel chairs of the two people who dine at that table. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 25 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes recruitment procedures ensure that the staff employed are of good character therefore safeguard the residents. EVIDENCE: All records that were examined in the staff recruitment files were satisfactory and staff said that they had undergone all of the employment checks before starting work at the home. The staff spoken with had a professional attittude to their work and in general good understanding of the needs of the residents. The residents spoke positively about the staff, comments included; ‘the staff are great’ and ‘nothing is too much trouble’ Their only concern was that some staff do not sign (BSL) very well, which means communication with them is difficult. This is further hampered if the staff members first language is not
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 26 English as it makes lip reading hard for the residents. It is important that the staff concerned have the opportunity to learn BSL as soon as possible. All staff receive formal supervision which enables their training needs to be identified. However the form currently used needs some adapting to ensure a comprehensive supervision is offered. Advice was given to the manager in respect of this. Since the last inspection to the home there has been a fairly consistant staff team which ensures consistancy of care. In addition to the manager 5 staff have achieved a National Vocational Qualification in care. This is above the National requirement of 50 of staff by 2008. The National Vocational Qualification training had a unit covering equality and diversity issues. Staff are going to be given the opportunity to watch a video in Dementia Awareness. It is hoped that this will encourage them to do further training and be able to offer a good service to one or two people who live in the home with a degree of dementia. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The residents are beginning to benefit from living in a home where the management is striving to make improvements. EVIDENCE: The accident book was examined and proved that records are being made appropriately. One resident had had four accidents as follows 16.6.07, 20.6.07, 26.6.07 and 10.7.07. These were discussed with the manager who confirmed that the initial record was felt to be an accident but the latter entries were to do with the lady concerned “wrapping herself up in her duvet and sitting on the floor”. Staff assumed she had fallen from the bed. However the resident has now ceased doing this.
Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 28 The manager is aware to audit the accident book and follow up on any patterns or concerns such an audit may highlight. The management now recognise that some people do need help to manage their money, but this support should not override their right to access their money and decide how to spend it. A record is maintained in the home of all monies held on behalf of residents and of all transactions. These records are checked at all senior staff hand over to ensure accuracy. This reflects an understanding of protecting people’s finances. There is a need to ensure that when parts of the home are in need of urgent repair that this is carried out quickly. There have been a number of improvements within the home since the last inspection. However, a window that is potentially dangerous had not been promptly repaired. An Immediate Requirement notice was given to the manager in respect of this. Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 x 12 2 13 3 14 3 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 2 X Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 30 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA24 YA20 Regulation 23(2)(b) 13(2) Requirement The service provider must ensure the home is maintained in a safe manner. The service provider must ensure that medication is accurately administered and recorded The service provider must ensure residents are provided with a choice of food in adequate quantities The Service Provider must ensure that the homes complaints procedure contained in the homes Statement of Purpose includes the telephone numbers of the Commission and of the local Social Services. The service provider must ensure the dining tables have adaptations as necessary to facilitate people who are in wheelchairs. The service provider must ensure that new staff receive training in British Sign language as soon as possible. Timescale for action 30/08/07 30/08/07 3. YA17 16(2)(i) 30/08/07 4 YA1 22(7) 30/08/07 5 YA29 23(2)(i) 30/08/07 6 YA32 18(1)©(i) 30/11/07 Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 31 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 4 5 Refer to Standard YA1 YA6 YA9 YA1 YA1 Good Practice Recommendations The service provider should ensure the homes Statement of Purpose is written in large print to make it easier to read. The service provider should ensure the care plans are specific in detailing how the need is to be met. The service provider should ensure risk assessments are up dated as necessary. The service provider should ensure peoples weight is frequently monitored as part of the care plan so that any changes can be noted and acted upon. The service provider should ensure as part of the care plan that people are consulted as to whether they wish to be routinely checked during the night. People should be asked to sign a disclaimer if they choose not to be disturbed. The service provider should ensure that the daily records give detailed information about the persons condition and what action is taken to rectify the condition. The service provider should ensure people are aware of their right to choose what time they rise in a morning and what time they go to bed at night. The service provider should ensure that meals are served in a congenial setting with clean table linen. The service provider should ensure the residents are supplied with a push button to their bedroom door that would trigger a flashing light inside the room to let the occupant know that someone wishes to enter their bedroom. The service provider should ensure the TVs are not sighted in the windows as this makes it difficult for the residents to lip read or read subtitles. 6 7 8 9 YA1 YA7 YA17 YA29 10 YA29 Wynfield House DS0000009729.V338632.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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