Inspection on 11/06/07 for Wyton Abbey

This inspection was carried out on 11th 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

Wyton Abbey 27/11/08

Wyton Abbey 20/11/07

Wyton Abbey 06/05/06

Wyton Abbey 17/10/05

Wyton Abbey 11/04/05

Wyton Abbey 18/11/04

Wyton Abbey 10/06/04

Wyton Abbey 08/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wyton Abbey Wyton Bilton Hull East Yorkshire HU11 4DJ Lead Inspector Eileen Engelmann Key Unannounced Inspection 11th June 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wyton Abbey DS0000019777.V342733.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. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wyton Abbey Address Wyton Bilton Hull East Yorkshire HU11 4DJ 01482 817610 01482 815604 lynnegeorge@primelife.karoo.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Limited 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) Position Vacant Care Home 33 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (33), Old age, not falling within any other of places category (33) Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The category Dementia (DE) relates to 5 service users aged between 50-65 years, and one named individual aged 40-50 years (application V30433 refers) The Garden Cottage, which is an un-staffed facility, accommodates up to 3 independent service users, who may access the facilities of the staffed home daily and in an emergency at any time. 6th January 2007 Date of last inspection Brief Description of the Service: Wyton Abbey is a large house set back from the main road, in its own grounds, adjacent to the village of Wyton, in the East Riding of Yorkshire. The house is a listed building, has extensive grounds with a small walled garden area for service users to sit in and a large car park for approximately 10 cars. Access to public transport is from the adjacent main road, which is a short walk along the homes driveway. Prime Life Ltd owns the home, which is registered for 33 residents of either sex, the majority of whom are over 65 years of age; Six residents may be under the age of 65 years and some residents may have dementia. The majority of the bedrooms are single with five bedrooms being shared. The adjacent Garden Cottage has three service users’ rooms for service users who are more independent. Services provided include personal care, meals, laundry and health care, with additional health services being accessed as necessary, for example, the district nursing services. Information about the home and its service can be found in the statement of purpose, this document is available from the manager of the home. A copy of the latest inspection report for the home is also available from the manager. Information given by the manager on 11/06/07 during the inspection indicates the home charges fees of £354.00 to £450.00 per week depending on the type of room required and the dependency level of the resident. There is no top-up fee and no additional charges other that those for hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last visit in January 2007 the registered manager for the home has left and an acting manager has been appointed. The acting manager is not yet registered with the Commission for Social Care Inspection, but for the purposes of this report they will be referred to as the manager. This unannounced visit was carried out with the manager, staff and residents of Wyton Abbey. The visit took place over 1 day and included a tour of the premises, examination of staff and resident files and records relating to the service. Staff on duty and several of the residents were spoken to; their comments have been included in this report. Information was gathered from a number of different sources before the inspector visited the home. Questionnaires were sent out to relatives, residents and staff and their written response to these was adequate. The inspector received 6 back from relatives (50 ), 2 from staff (17 ) and 4 from residents (33 ). The provider completed a pre-inspection questionnaire and returned this to the Commission within the given timescale. Since the last key inspection in June 2006 a further random visit was made in January 2007 to look at the progress the home was making regarding meeting requirements and recommendations from the key inspection. At this visit a number of concerns were raised by the inspector around the knowledge and skill base of the manager and staff with regards to management of the service and care of dementia clients. These have been passed onto the company and a request for urgent action around training and development of their personnel has been made. What the service does well: The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People living in the home said they are offered a good choice of meals and they enjoyed the quality of food. Specific wishes are catered for and they have plenty to eat and drink throughout the day. Relatives of the people living in the home said that they are made to feel welcome by the people working in the home and that they can visit when they please. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The person who owns the home must make the service user guide better by putting more information into it. People living in the home said that the staff are very good at talking to them and they felt comfortable talking about the service and their needs. The person in charge of the home must make sure she gets training about how to recognise what care and support people who would like to come into the home need, before she writes out the documentation to support the decision that the home can look after them. The people who are looking to come into the home will then know that they have chosen the right place to live in. The person who owns the home must make sure that the contract given to people who pay for their own care has enough information in it to tell the people living in the home how much they have to pay to live there and how much extra services cost. The staff do not always write down what care each person living in the home needs to make their life and health better. They should be talking to the residents more to find out what they like and how they want to be looked after. This helps the residents to have choice in how they are cared for and helps them stay as independent as possible. The person running the home and the people who are working in the home have to be given training around keeping people safe from harm, this helps them understand how to look after individuals and speak up if they think anything is wrong. The person running the home and the people working in the home need to go to training around dementia care, management of challenging behaviour, medication, infection control and health and safety to make sure they are able to look after the people living in the home and give them the right kind of care. The person who is in charge of the home must have urgent training and support around how to run the home, to make sure the residents and staff are kept safe from harm, and their health, safety and wellbeing are protected. The person running the home and the people working in the home need to have regular supervision. It is important that this takes place every two Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 7 months, as it will make the care being given better and look after the health and safety of the people living in the home. The person running the home must make sure she tells people from the Commission for Social Care Inspection and the Social Services about any incidents that may concern the health, safety and wellbeing of the people living in the home. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to her during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 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 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with information to enable them in making a decision about the home and if it is right for them. However, some of the information is misleading and some requires updating to provide more clarity. EVIDENCE: Discussion with the manager indicates that a pack of information including a brochure, statement of purpose and terms and conditions is given out to all people who enquire about placement at the home. The responsible person must make sure that the service user guide is developed to meet the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 10 It should be amended to include a break down of fees and have a list of the additional charges that a resident may have to pay on top of their fees for extra services such as hairdressing, chiropody, newspapers and toiletries. Comments from the surveys shows that 2 out of the 4 residents who responded received information about the home before they came in, and one individual said ‘ I was an emergency admission and didn’t have time to get any information, but I am happy with the choice of home made by Social Services’. Checks of four files showed that each individual has either a local authority contract in place or the homes terms and conditions for privately funded individuals. The terms and conditions should include information around the terms of notice required by the home from the resident. Discussion with the manager indicated that she requires support and training from the company to be able to undertake assessments in the community for residents wishing to be placed at Wyton Abbey. The manager said she has not had to assess anyone since she moved from her senior care position to that of manager in April 2007: she has not undertaken the process herself, but has gone out and watched the process being done by the previous manager. The responsible person must make sure the manager receives the necessary training to be able to complete the needs assessment process in an efficient and effective way, and that the needs of the resident and those of the people living in the home are taken into consideration before a placement is offered. Each resident has their own individual file and four of those looked at have a full needs assessment from Social Services completed within them. Concerns were raised by the inspector about two residents placed at the home and the manager’s and staff’s understanding of their needs around dementia care, medication, aggression and behaviour problems and dependency on alcohol. These concerns were discussed with the manager during the visit and with the Line Manager for the home the day after the visit. Comments from the surveys indicate that those relatives and residents who responded are satisfied with the care they receive, one individual said ‘the staff are very willing and caring’. Individuals feel that staff listen to them and act on what they say although ‘there are some delays as staff need to see to other residents’ and ‘sometimes I have to ask for more attention as staff are very busy’. Staff on duty are very good with the residents and give care in a supportive and caring way, however it was clear from watching them work that they lack understanding and skills in dealing with dementia clients. Discussion with the staff indicated that they know that they need training and development and felt frustrated that this had not been implemented. Discussion with the manager indicates that she also needs training and development around the care of people with dementia and those with alcohol related dementia. There are a number of ‘noisy’ residents whose actions upset other clients and staff Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 11 try their best to separate these individuals in different parts of the home, but lack the skills to be proactive about dealing with the dementia behaviours of the residents. One relative said that ‘ there is a need to separate the disruptive people from time to time, from those who are intimidated by their company. This would allow visitors and residents some quiet time to talk together’. The responsible person must make sure that the manager and staff have the skills and knowledge to meet the needs of the people living in the home, and that appropriate training is implemented as a priority action. The inspector’s concerns around the staff’s lack of skills and knowledge of dementia clients putting residents at risk of harm, was passed onto the Line manager for the home on the day following this visit and a request for urgent action was made to the line manager. Information from the Pre-Inspection Questionnaire completed by the manager and discussion with the residents, indicates that all of the residents are of a white/British nationality. The home does accept individuals with specific cultural or diverse needs following a needs assessment being completed. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. The home employs four staff member from overseas. Discussion with the staff indicates they work well together as a team and they consider their support to each other as a main strength in the progress being made to improve resident care. Residents are able to make a limited choice of staff gender when deciding who they would like to deliver their care, as the home only employs one male staff member at the moment. The home has recruited male staff in the past, but a lack of suitable applicants makes it difficult at this time. The manager said that she would discuss the lack of staff choice with potential residents during the needs assessment process. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 12 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Resident’s health and personal care needs are not appropriately supported by detailed care plans and risk assessments. This has the potential of residents not always getting the care they need. EVIDENCE: Information from the relative and resident surveys indicates that the majority of people who responded are satisfied that the staff give appropriate support and care to those living in the home. Individuals said ‘the staff allow residents the freedom to do what they want within their capabilities’, ‘residents are always clean and well dressed’ and ‘staff let me know about any changes to my relatives mental state, so I can come in and talk to them about this’. Observation of the staff at work indicate that they have a good rapport with the residents, but lack skills to deal with behaviour linked to the dementia needs of some of the residents. The home was noisy during this visit and the actions of some residents were upsetting to others. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 13 Care plans are in place for the four people whose care was tracked throughout this visit. Discussion with the manager indicates that she has audited some of the plans and is aware that they need to be up dated and developed further. Areas where they could be improved include • Staff must make sure that changes in care are clearly documented, and care plans are amended, or sheets removed and filed, as the person’s needs change. • Risk assessments are in place but have not been reviewed for some time: those seen for tissue viability must include the overall score and any action being taken as a result of the assessment. One falls assessment had been completed in 2004 and not reviewed since. These must be done on a regular basis. • Key worker notes must be up to date and used, or removed, from the care plans. • Information on religious beliefs/needs and the death and dying wishes and choices of the resident must be completed in the care plan documentation. • Information about a resident’s medication needs (where applicable) must be documented in the care plan. One person is on pain relief patches and this was not evidenced in their plan. • Evaluations of the care being given are being done but not on a regular basis. Staff should try to do this at least monthly or more often if necessary. • Resident’s names should be put in full onto the care plans pages and staff signing their daily diary entries should sign in full and not just initial or write their first name. • Daily notes of the care being given are very brief and do not document all the actions being taken by the staff to meet the individual’s needs. Telephone conversations with the manager since the visit indicate that she is putting more risk management plans into place where concerns were raised about certain residents health and welfare, and is acting on the issues raised during this visit. Survey responses show that residents and relatives are satisfied with the medical input they receive and information in the care plans shows that individuals have access to their GP’s, chiropody, dentist and optician services, with records of their visits being documented. Concerns over the health of two residents prompted the inspector to ask the manager to arrange a GP visit for these people, subsequent telephone conversations with the manager indicate that these have been done. The manager has also arranged for an urgent review for one resident with their care co-ordinator. Information from the manager indicates that two residents in the home are being treated by the District Nurses for pressure sores and discussion with the Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 14 staff shows that they are following the Nurses’ directions regarding pressure care. As discussed above some improvements to the tissue viability risk assessment is needed to make sure staff are proactive in preventing the residents from developing sores. Care plan notes for one resident show that staff have carried out blood sugar monitoring for this person. It was discussed with the manager that staff should only undertake this procedure if they have received training from the District Nurse, and this training should be documented in each staff member’s file. The District Nurse retains ultimate responsibility for this procedure. Checks of the staff files showed no evidence of the training being done and this should be in place before staff continue with this procedure. The home use Moss Chemist as their medication supplier and has a ‘blister pack’ system of medication, plus some boxes and bottles where medication is not suitable for putting into the heat-sealed system. At the time of this visit there were no controlled drugs in the home. Checks of the medication records showed that overall these are well maintained and kept up to date, however, there were a few areas in which they could be improved. These included: • Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. The manager was unsure why one resident was prescribed thiamine and the inspector explained the reasons why and showed her how to look up its use in the Formulary kept in the treatment room. It was recommended that the manager and staff ask the pharmacy and GP about medication if they are unsure of why tablets are prescribed or how they work. A more up to date formulary would be helpful to the staff as the one in use is 2004. • Information from the pre-inspection questionnaire indicates that 3 staff have undergone medication training and it is important that the manager completes this training and any other staff who handle medication in the home. Comments from the resident and relative surveys indicates that individuals are satisfied with the way that staff deliver care and they feel that peoples rights to privacy and dignity are respected. One relative said that ‘ my father has dementia, but staff have always respected my choices and decisions regarding his care’. Observation of the staff showed they are patient and kind with the residents and there is obvious trust between individuals. Verbal communication is not always possible for some residents, but staff work hard Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 15 to determine what individuals want and try hard to use gestures and facial expressions to make themselves understood. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 16 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with opportunities to participate in mainly group social activities. However, age appropriate, individual and diverse needs are not catered for. EVIDENCE: Information from the resident surveys showed that most people are satisfied with the social activities on offer and individuals felt there was always something they could participate in. Discussion with the manager indicated that the home has 8 male residents to 19 female, and activities are designed to suit both sexes. The men like to play cards and dominoes, whilst the women enjoy music and films. The male member of staff also inputs his time to 1-1 work with the male residents, talking about motorbikes, sport and leisure activities. The manager said that the home is making changes to its activity programme, to produce a monthly set of events. There are trips out every fortnight using the company minibus and the staff work together to carry out activities and social interactions with those living in the home. A record of activities is in place, but the detail in this could be better. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 17 The activities in the home are mainly group events and sedentary. The manager should consider how more individualised activities could be introduced, which take into respect the resident’s age, mobility, disabilities and individual needs. The home does have younger adults in the home and little is documented about how the home meets their social or emotional needs. There is a three-bed unit at the side of the home, which offers some residents a more independent lifestyle, currently there are two people living in this part of the home. Relatives made positive comments about the home in the survey responses, one person said ‘mum has memory loss and the staff keep us in touch through phone calls and chats during our daily visits’ and ‘staff go beyond their duties to ensure the residents feel safe and happy: visitors are encouraged to join in with daily life and I am satisfied with my relatives quality of life’. Other relatives said ‘there are lots of outings and entertainment, but our relative does not wish to join in and their decision is respected by the staff’. One person commented that ‘I find visiting my father very difficult, but the staff make it as pleasant as possible, they always make time for me’. Individuals said ‘the staff always make us feel welcome when we visit and they work hard to make the home feel like a home for the residents and have achieved a very good balance’. Information from the residents’ files indicates that there are a number of individuals who follow different spiritual faiths, including Methodist, Catholic and Church of England. The Catholic priest visits monthly and there are church visitors who come in and help the residents celebrate the major Christian festivals such as Easter and Christmas. Information in the pre-inspection questionnaire indicates that no-one in the home is using an advocate and information about advocacy services could not be produced by the manager during this visit. It was recommended that the manager should find out about local advocacy services and put their names and addresses into the Service User Guide. Information from the Pre-inspection Questionnaire indicates that only one of the residents handles their own financial affairs, the others have family or a representative who deals with this. The inspector is satisfied that they can access their personal allowances when needed. The home encourages residents to bring in small items of furniture and personal possessions to decorate their bedrooms. Discussion with the staff showed that residents with dementia are not aware of their care plans, but families and residents can talk to the staff about their care whenever needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 18 Observation of the lunchtime meal and discussion with the manager and staff indicated that some residents have their meals in their own bedrooms or the lounges, as they are too ‘noisy’ for others to enjoy their meals if they stay in the same room. Comments from the residents indicated that the food is good, and they are offered choices of meals on a daily basis. Staff are aware of each persons likes and dislikes and were seen to offer assistance to residents who need help eating and drinking. Two people received pureed meals and these were nicely presented. Specialist plates and eating equipment is available to those who need it, one resident was seen to eat with their fingers and refused to use cutlery. Staff were very patient with them and ensured that they got enough to eat and had the time to enjoy their meal. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 19 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 and 18. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The understanding of the arrangements for protecting residents is not satisfactory, placing residents at possible risk of harm or abuse. EVIDENCE: The home’s complaints policy and procedure was not on display in the home and is not in the statement of purpose for the home. Residents would have to ask the manager for a copy and it is questionable that they could understand it if they did so due to their mental health conditions. The responsible person must consider how the home can provide individuals with a simple and clear complaints policy that is visible within the home and which is available in formats that they can understand. There is a complaints book, which is kept locked away in the managers office and information within it shows that two complaints have been reported and investigated since the last inspection. It is recommended that the responsible person consider using a complaints form that is readily available to staff and people using the service at times when the manager is not in the office. During this visit the inspector found recorded information in a care plan around a serious incident linked to the challenging behaviour of a resident. Discussion with the manager indicated that she had not investigated this, no regulation 37 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 20 had been completed nor had a safeguarding adult referral been made to the appropriate authority. Further discussion showed that she did not understand fully her role and responsibility around reporting these incidents and she did not know how to make a safeguarding referral. Time was spent explaining the procedure to her and the inspector asked that she make the referral to the Social Services Team and arrange a review of the residents care needs with his care co-ordinator and ask his GP to visit. The inspector also asked the manager to start documenting instances of challenging behaviour regarding the resident. A follow-up telephone call to the manager the day after this visit found that the manager had not made the referral as asked, and the potential risk to residents’ safety remained unmanaged. The inspector made the referral herself to the appropriate authority. Information from the company indicates the manager attended Safe Guarding of Adults training (abuse) in 2004, but the evidence from this visit indicates the manager has a lack of understanding of the referral process. This presents a risk to the health and safety of the residents and is not acceptable to the Commission for Social Care Inspection. Checks of the training matrix given in the pre-inspection questionnaire showed that training of staff in this area of care has not taken place. Four members of staff undertook NAPPI training four years ago (2003), but nothing appears to have taken place since this time. The responsible individual must take urgent action to ensure that the manager and staff understand their roles and responsibilities around Safe Guarding of Adults procedures and have knowledge of how and when to make referrals to the appropriate Social Service Teams. It is recommended that Safe Guarding of Adults Training is put into place as part of the home’s rolling programme of safe working practices and staff should undergo training around management of challenging behaviour, and dementia care. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 21 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, 20, 22, 25 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment within the home must be improved to ensure residents are provided with a warm, safe and comfortable place to live. EVIDENCE: Walking around the premises it was seen that the home is in two parts: the main home accommodates up to 30 residents and then there is a smaller unit for 3 more independent residents that is separate from the main building, called Garden Cottage. Garden Cottage This area of the home has three single rooms along a main corridor leading onto a lounge/kitchen area. Residents can make snack meals in this area, but Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 22 those spoken to prefer to eat their meals with the rest of the residents in the main building. Wyton Abbey The home has an ongoing programme of routine maintenance and renewal in place and currently work is taking place to refurbish a number of areas within the home. The quiet lounge has been provided with a new carpet, armchairs and window blinds, and the dining room off this space has new tables and chairs. The home provides accommodation on three floors and there is a passenger lift a stairs to all levels. Recently the lift has been out of action, but discussion with the manager indicated that it has been repaired and is fully functional. Areas where the home could improve are as follows: • The bathroom on the ground floor has missing tiles on its walls and the ceiling is stained from an old water leak. The floor covering is relatively new, but is stained despite regular cleaning. The responsible person must ensure the bathroom is kept in a good state of repair. The home has two mechanical sluices, but discussion with the manager and staff indicate that these have been out of action for a long time. Staff are having to hand wash the commode pans and this creates a risk of ‘splash back’ into their eyes. The responsible person must make adequate arrangements to ensure hygiene and infection control is maintained and staff’s health is protected. The laundry room is external to the main home and it was noted that there was no paper towels for staff to dry their hands with and maintain infection control. The responsible person must make sure that action is taken to improve the laundry area. Discussion with the manager indicated the staff; residents and visitors share a smoking facility in the home. The responsible person should consider how the regulations will affect the current arrangements and make the necessary changes to meet the legislation. • • • Wyton Abbey is a large house set back from the main road, in its own grounds, adjacent to the village of Wyton, in the East Riding of Yorkshire. The house is a listed building, has extensive grounds with a small walled garden area for service users to sit in and a large car park for approximately 10 cars. Access to public transport is from the adjacent main road, which is a short walk along the homes driveway. The home provides a lift and stairs for access to the three floors offering accommodation and communal living space. Information gathered during this visit indicates there are some problems in meeting the needs of the residents with physical disabilities and dementia. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 23 • • • • • • The home has two hoists provided, but staff reported to the inspector that one is not working properly and this causes delays in giving care to the residents. Staff said that the downstairs bathroom causes them moving and handling problems when giving residents care, as they feel the room is very cramped. There are fixed bath hoists, shower rooms, slide sheets and handrails in place to aid peoples’ independence, although some facilities are cramped and make care giving difficult (see comments above). The flooring to the ground floor is a polished surface that is discoloured and marked. The manager showed the inspector areas where work is being done to remove the layers of old polish and clean the surface. It was noted that some residents do not like walking on the corridor floor as it is patterned with dark squares and lines across the doorways. People with dementia may perceive these areas as gaps in the floor and this would make them very nervous about moving through the doorways and along the corridors. The grounds to the rear of the main home are not secure and staff said they are concerned that residents could wander into the nearby fields and get lost in the surrounding countryside. Residents have access to an enclosed garden, but staff said that they are concerned about the different ground levels creating a fall hazard to the people using this area. The responsible individual must ensure that disability equipment and environmental adaptations are in place, and suitable to meet the needs of the residents. Information given to the inspector and observation of the home indicates that some attention is needed to the central heating system within the home. • One resident from Garden Cottage asked the manager if anything was happening regarding the central heating in the unit. The system was making loud noises and bangs and the resident said this was keeping him awake at night. Bedroom 22 is unbearably hot due to the radiator valve needing repairs. This has been reported to the company but no action has been taken. Staff told the inspector that the heating system in the home is a problem as they cannot turn of the heating during the hot summer months and still have hot water. • • The responsible person must make sure the heating system is checked over and working correctly, as soon as possible. Comments from the residents show that the home is clean and they are satisfied with the laundry service provided by the home. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 24 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): People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Training and development of the staff must be improved to ensure they have the skills and knowledge to meet the needs of the residents. Failure to do so may result in the health, safety and wellbeing of the residents being put at risk. EVIDENCE: Comments from the staff, relatives and residents indicate that the home is extremely busy at times and individuals may wait for attention at peak times, but the friendly attitude of the staff and their wiliness to help make up for this. One relative commented that ‘Kim and the staff are great, they work under difficult circumstances at times, but are very caring’, another individual said ‘the staff are very caring and considerate to those in their care, but they could do with more staff as some residents need more time’. At the moment there are 27 residents living at the home, with 4/5 care staff on duty in a morning, 4 care staff in the afternoon and 2 care staff at night. The manager’s hours are supernumerary to these figures. Information from the pre-inspection questionnaire and staff rotas about the number of staffing hours provided and the dependency levels of the residents, was used with the Residential Staffing Forum Guidance and showed that the home is meeting the recommended guidelines. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 25 The manager said the home is in the process of introducing a new induction programme for employees, that the company has produced. This is in a booklet format and should meet the standards of Skills for Care. 43 of staff have achieved an NVQ 2 or 3 and others are going through this training. It is recommended that the home has 50 through the programme by the end of 2007. Checks of four staff files showed that one recently employed person has only one reference obtained by the home, the other is a general one entitled ‘to whom it may concern’. This was discussed with the manager and explained that the home must obtain references themselves and not rely on ‘open’ ones, as these could be fraudulent. Other checks and necessary documentation are in place and up to date in all the files. The training matrix supplied by the home in the pre-inspection questionnaire indicates there is a basic safe working practice training-programme in place. Checks of the staff training files and information from the matrix suggests that the majority of staff are up to date with fire, moving and handling and food hygiene. Discussion with the manager and staff indicated there is an urgent need for them to have dementia training, management of challenging behaviour, medication, infection control, health and safety and for the line manager to do an audit of the effectiveness of the training and knowledge of the staff on an ongoing basis. Staff lacking effective knowledge and skills around the dementia care needs and specialist conditions of the residents could have a detrimental effect on their care and place some individuals at risk. This is not acceptable to the Commission for Social Care Inspection and the responsible person must take urgent action to provide this training. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 26 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): People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager lacks the skills, knowledge and experience to run the home effectively and this compromises the health, safety and welfare of the residents. EVIDENCE: The registered manager for the home left in April 2007 and an acting manager was in post at the time of this inspection, having been promoted from her position as senior care assistant. She has little management experience, but has completed her NVQ 4 in care and is hoping to start her Registered Managers Award shortly. Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 27 The acting manager said that she receives weekly visits from her line manager, but from discussion this did not appear to be formal supervision or linked to her training, development and support needs. This needs to be in place as this inspection identified significant gaps in the manager’s knowledge around management and leadership, and the responsibilities of a manager of a care service. These could pose a risk to resident’s safety and welfare. This was highlighted as an urgent need with both the manager and by telephone with her line manager. The home has achieved Part 1 of the local Councils Quality Assurance Award (QDS). Discussion with the manager revealed that she has little knowledge about quality assurance and monitoring systems and has not been carrying out regular audits since she came into post. The manager said she has carried out one staff meeting and one resident meeting since April 2007 and she hopes to start doing these on a regular basis. Input from the residents about the service is gathered during the manager’s daily walks around the building and chats with the people living in the home. Information provided by the company indicates that the home has completed an Annual Development Plan based on feedback from the people using the service and reflecting the aims and outcomes for the residents. Checks of the financial records showed that residents are able to have personal allowance accounts in the home. These records are computerised and detail the transactions undertaken and the money held for each resident, the manager or administrator update these each week. Information from the manager indicates that the majority of the residents have a family member or representative who looks after their monies and these individuals make sure the personal allowances are sent/brought into the home. Where personal allowances build up above £100, arrangements are made for the families to collect this for safekeeping. An outside representative from the company visits monthly to audit the money held in the home and these visits are documented on the records. Discussion with the manager indicates that she is starting to carry out supervision with the staff and has completed two appraisals, however, she said that she had received no training in these areas and it is unclear what her knowledge base is to be able to do these efficiently and effectively. Information supplied by the company in October 2007 shows that 3 members of staff have not received supervision since April 2007. The responsible individual must make sure the manager receives training and support around the supervision/appraisal process for the staff and receives the same support for herself. In the last two reports (June 2006 and January 2007) a requirement was made that ‘The Registered Person must give notice to the Commission without delay Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 28 of all untoward occurrences as per the regulations’. At this visit it was seen that this has not been met. Discussion with the manager indicated that she was unsure about what type of incident was reportable under Regulation 37 and some time was spent discussing this with her. A serious incident report filed by staff in May 2007 had not been reported to the Commission for Social Care Inspection or the Safeguarding of Adults team, and the manager seemed unclear as to why the inspector felt this was important and represented a risk to the residents. The incident had not even been passed onto the managers line manager for discussion. This is not acceptable practice and the responsible person must make sure the manager receives adequate training and support around the reporting of untoward occurrences. Checks of the accident book found that incidents are accurately recorded, but the book does not promote confidentiality, as it does not have removable pages so information about different people is available to anyone using the book. Staff spoken to confirmed that all employees have access to the book within the manager’s office. The inspector recommended that the manager ask the company for the new ‘data protection’ type book where the pages detach from the book and can be filed away in the resident’s personal file or for access by the manager only. Maintenance certificates are in place and up to date for the utilities and equipment within the building, but there are some areas of the environment and equipment that need attention (see standards 19, 22, 25 and 26). Staff have undergone some training in moving and handling, fire safety and food handling, but further sessions are required in health and safety, infection control, medication, dementia and challenging behaviour and COSHH. The manager could not find any risk assessments for the environment within the home, nor could she find the fire risk assessment for the building. The responsible person must make sure these are in place and available for staff to read and follow. Wyton Abbey DS0000019777.V342733.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 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 2 2 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x 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 1 2 3 X 2 X X 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 1 X 2 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation 5(b)(c) Requirement The responsible person must ensure the homes Service User Guide meets the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. This is so the residents know how much they have to pay for their care, what they are getting for their money and the cost of any additional extra services they may wish to purchase. The responsible person must make sure the manager of the home receives support and training in doing needs assessments. So self-funding residents can participate in the assessment process and know that the home can meet their needs prior to Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 31 Timescale for action 01/09/07 Amended regulations 2006 2. OP3 14 (1)(a) 01/08/07 3. OP4 12 (1) them making the decision to come into the home. The responsible person must make sure that staff, individually and collectively, have the skills and experience to deliver the services and care which the home offers to provide. So residents with dementia can be confident that their needs relating to their mental health are recognised and managed appropriately. The responsible person must make sure that the assessed needs of the residents have appropriate care plans to address them. This will ensure that the residents receive the right care to protect their health and wellbeing, and their wishes, choices and rights as individuals are promoted and protected. 01/08/07 4. OP7 15 01/09/07 13 (1)(b) The care plans must include guidance and support around individuals’ older person and mental health needs and staff must seek guidance on this from relevant professional bodies and current legislation. So residents can be assured that they are receiving up to date care and support based on relevant clinical guidelines. The responsible person must make sure residents psychiatric and psychological needs are monitored regularly and preventative or restorative care is provided. So residents’ health and wellbeing is promoted and 5. OP8 13 (1)(b) 01/08/07 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 32 6. OP8 12(1) protected and their behaviours do not place others at risk. The responsible person must make sure staff are proactive in preventing residents form developing pressure sores and that risk assessments for this purpose are completed in full. So residents can be confident that their health and welfare is protected. The responsible person must make sure that all staff, including the manager, who are responsible for medication within the home receive appropriate medication training. So knowledgeable and competent individuals who promote and protect the residents’ health and safety administer medication. The responsible person must ensure the range of activities on offer for people using the service are individualised to meet age, mobility, disabilities and individual needs. So all residents are able to exercise their choice in relation to leisure and social activities and routines of daily living. The responsible person must consider how the home can provide individuals with a simple and clear complaints policy that is visible within the home and which is available in formats that they can understand. So residents are able to voice their opinions and concerns about the service at any time and understand how the process works. 01/08/07 7. OP9 13(2) 01/09/07 8. OP12 16(2) (m)(n) 01/09/07 9. OP16 22 (1)-(6) 01/09/07 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 33 10. OP18 13(6) The responsible person must make sure that the manager and staff undergo appropriate training in Safeguarding of Adults procedures, management of challenging behaviour and dementia care. To prevent residents from being harmed or suffering abuse or being placed at risk of harm or abuse. The responsible person must make sure that the environment of the home is accessible, safe and suitable to meet the resident’s individual and collective needs. So residents can be assured that the service is meeting their needs and minimizing any risks of harm. The responsible individual must ensure that disability equipment and environmental adaptations, required to meet the need of the residents, are in place. So residents can be as independent as possible within an environment that promotes their health, safety and welfare. The responsible person must make sure the heating system is checked over and working correctly, as soon as possible. So residents can live in a warm, safe and comfortable environment. The responsible person must make adequate arrangements to ensure hygiene and infection control is maintained and staff’s health is protected. The responsible person must 01/08/07 11. OP19 23(1)(2) (a)(n)(o) 01/09/07 12. OP22 23(2)(c) (n) 01/09/07 13. OP25 23(1)(a), (2)(p),(5) 01/08/07 14. OP26 13(3) and 16(2)(j) 01/09/07 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 34 15. OP29 19(4)(c) make sure that action is taken to improve the laundry area. So residents’ and staff health, safety and welfare needs are maintained. The responsible person must make sure that two authentic and satisfactory references are obtained for each prospective employee, before they are offered a job. So residents’ health and safety is maintained and the risk of harm or abuse is minimized. The responsible individual must make sure that staff receive appropriate training in safe working practices and/including dementia training, management of challenging behaviour, medication, infection control, health and safety. So staff have the knowledge and skills to meet the needs of the residents and understand the specialist conditions relating to old age and dementia. The responsible person must make sure the manager receives the support and training she requires to achieve the skills and knowledge expected of the person running the home. So the manager has the qualifications, competency and experience to run the home and meet its purpose, aims and objectives. The responsible person must make sure the manager receives training around Dementia Care, Alcohol related Dementia and conditions of old age. So the manager has the skills 01/08/07 16. OP30 OP38 18(1)(a) (c) 01/08/07 17. OP31 9(1)-(3) 01/08/07 18. OP31 10(3) 01/08/07 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 35 19. OP36 18(1)(2) necessary to recognise and meet the needs of the residents and offer staff the guidance and support they may need to give good care. The responsible person must 01/09/07 make sure the manager and staff receive recorded supervision at least every two months. So staff can receive feedback and support around their work practices and career development needs, and residents receive care from competent and experienced people who understand their roles and responsibilities. The Registered Person must give notice to the Commission without delay of all untoward occurrences as per the regulations. (Given timescale of 06/06/06 was not met) The responsible person must make sure there are risk assessments in place for the environment and for safe working practices including fire safety. So practices within the home protect as far as is reasonably practicable the health, safety and welfare of the residents and staff. 20. OP38 37(1)(a)(g)(2) 01/08/07 21. OP38 23(4)(5) 01/09/07 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 36 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. Refer to Standard OP2 OP8 OP9 OP9 Good Practice Recommendations The terms and conditions should include information around the terms of notice required by the home from the resident. The manager should ensure that staff receive appropriate training from the District Nurses around taking of blood sugar levels and this training is documented in their files. Transcribed medications should have two staff signatures on the MAR chart to indicate that the information written down has been checked and is accurate. The manager and staff should ask the pharmacist and GP about medication if they are unsure of why tablets are prescribed or how they work. The responsible person should make sure a more up to date formulary is purchased for staff use. The manager should find out about local advocacy service contacts and put their names and addresses into the Service User Guide. The responsible person should consider using a complaints form that is readily available to staff and people using the service at times when the manager is not in the office. The responsible person should consider how the Nonsmoking regulations will affect the current arrangements for residents within the home, and make the necessary changes to meet the legislation. 50 of care staff should achieve an NVQ 2 by the end of December 2007. The company should provide the home with an accident book, which meets Data Protection Legislation. 5. 6. 7. OP14 OP16 OP20 8. 9. OP28 OP38 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Wyton Abbey DS0000019777.V342733.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!