Inspection on 27/11/08 for Wyton Abbey

This inspection was carried out on 27th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wyton Abbey 20/11/07

Wyton Abbey 11/06/07

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

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Abbey The

Snydale Care Home

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wyton Abbey Wyton Bilton Hull East Yorkshire HU11 4DJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Prankitt     Date: 2 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 40 Information about the care home Name of care home: Address: Wyton Abbey Wyton Bilton Hull East Yorkshire HU11 4DJ 01482817610 01482815604 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Kim Dixon Type of registration: Number of places registered: Prime Life Ltd care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Garden Cottage, which is an unstaffed 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. 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) Date of last inspection Brief description of the care home 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 people to sit in and a large car park for approximately ten cars. Access to public transport is from the adjacent main road, which is a short walk along the homes driveway. Prime Life Ltd Care Homes for Older People Page 4 of 40 Over 65 33 33 6 0 Brief description of the care home owns the home, which is registered for thirty three people of either sex, the majority of whom are over 65 years of age. People may or may not have dementia. The majority of the bedrooms are single with five bedrooms being shared. The adjacent Garden Cottage has three bedrooms for people 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. We were told on the day of the site visit that the current weekly fees range from 371.50 pounds to 475 pounds. People pay extra for hairdressing (although the company pay on behalf of people every fourth week), chiropody, toiletries, individual newspapers and magazines, and optician services. People are given information about the home before they arrive. They can ask the registered manager for a copy of the service users guide and the report completed by the Commission for Social Care Inspection. Care Homes for Older People Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of Wyton Abbey took place on 20 November 2007. This key inspection included a review of the following information to provide evidence for this report: Information that has been received since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered provider thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Care Homes for Older People Page 6 of 40 Comment cards completed by five people living at the home, two health professionals and three staff members. A site visit to the home carried out by one inspector. The visit started at approximately 10am, and it lasted for about eight hours. During the visit to the home, several people who live there, some staff, the registered manager, and some relatives were spoken with. Three peoples care plans were looked at in detail, and one in less detail. As well as this, two staff recruitment files, some policies and procedures, and some records about health and safety were looked at. Care practices were observed where appropriate, and time was spent watching the general activity of the home, because this helps to get an idea about what it is like to live at Wyton Abbey. The registered manager was available throughout the day, and she was given detailed feedback at the end. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward as recommendations - but only when it is considered that people who use services are not being put at significant risk from harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? The registered manager is receiving ongoing support from her peers, and from her line manager, so that her skills in management develop further. She has completed a management qualification in order to underpin the skills she has already has to run the home successfully. Although some further work is needed, the care plans are improving. The registered manager has worked hard to transfer details about everyones care onto new paperwork, and there was some evidence seen that this is being considered in an individual person centred way. People all know how to complain, which suggests that they now get enough information so they know how to do this successfully. Although there are no more domestic hours provided, the registered manager has organised staff better. The home smells fresh, and looks clean and tidy. This makes it more pleasant for people. Care Homes for Older People Page 8 of 40 What they could do better: Risk assessments could be completed for people, particularly where areas of risk are identified with regards to falls, moving and handling, pressure care and nutrition. They could then be completed for those who do not have immediate problems, so that risk to them can be measured when their care is reviewed. People and/or their family could be more involved in the upkeep and review of their care plan. This would help staff to keep focused on each individuals needs when reviewing the plan, and what is important to them. Plans to keep information about each persons care together could be pursued. This would encourage staff to refer to, and to update the care plan as the needs of the person change, and as staff update the daily records. The way that the medication is audited could be reviewed to include checking that there is an adequate supply of creams in peoples rooms for staff to apply when they are giving care. This will help to make sure that there is no break in treatment prescribed by the doctor. All complaints could be held together in one place, so the manager can record the outcome of each investigation and whether the complaint was upheld. This information could be used when auditing the home, reflecting on areas which need to improve, and commenting on where improvements have been made. All staff could be provided with safeguarding training, so they are refreshed about what they should do if they think someone is being abused, and to whom they should report. There could be more bathing facilities for people to choose from. There is currently only one that people can use. The partially burned furniture that has been stacked in the grounds could be properly disposed of so the outlook is more pleasant for people to look out onto. The company could complete a survey to check peoples satisfaction with regard to the current care staff numbers. They could collect the results, and act where areas of dissatisfaction follow a common trend, so that improvements can be made, if applicable, in line with peoples direct views. The arrangements for the supervision of staff who have been employed at the home, and who await the return of the full police check, could be made more formal, and written down so that it is clear who is the supervisor and supervisee over the course of each shift. This will help to make sure that these staff are always supervised until all checks needed have been returned. The Skills for Care induction could be completed by new staff to underpin what they already learn, and to make sure that their practice meets current minimum standards in care. Care Homes for Older People Page 9 of 40 The recommendations of the fire officer following his recent visit to the home could be actioned in relation to all staff having regular fire training. This will make sure that staff know what to do should a fire break out. Door wedges must not be used, unless this practice has been agreed with the fire officer. Using these compromises peoples safety in the event of a fire. Hazardous chemicals must be kept locked away safely so that they do not cause people harm. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 40 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed before they are admitted to make sure their needs can be met at Wyton Abbey. Evidence: Peoples needs are assessed before they are admitted to make sure that the home has the resources to meet them. In an emergency situation, the home makes sure they get this information from other sources if staff do not have the opportunity to visit the person themselves. This helps to make sure that both the home and the person moving there make a good decision about whether the admission will be suitable. The registered manager said that she has received training from her line manager to help her complete good assessments which look at peoples overall needs. The pre admission assessment looked at in detail showed that the registered manager had considered the information provided by the persons care manager, and not just Care Homes for Older People Page 12 of 40 Evidence: that collected by the home, when compiling the care plan. This is good, because it makes sure that important information about the persons care is not lost. The registered manager has obtained information about advocacy services, which may interest people who want such support. She should consider including these details in the service users guide which is given to everyone. That way, they do not need to ask her for contact details should they want some independent advice. Of the five people who returned their surveys, three told us that they got enough information about the home before they were admitted. One of these commented Yes - visited - looked round and saw this bedroom - liked it and still do. One of the remaining two people was admitted in an emergency, and in the other case, the family arranged their placement on their behalf they said. The home does not provide intermediate care. Therefore standard 6 is not applicable. Care Homes for Older People Page 13 of 40 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples daily needs are generally met. But the way that risk to them is monitored, documented and communicated could be better. Evidence: The staff have finished transferring peoples care plans onto new documentation, and they had been reviewed monthly. The plans explain where people need assistance, and the actions that carers should take to support them. The registered manager recognised that peoples social needs could be written in more detail so that staff have a better understanding about what they are. A visitor confirmed that they had not been asked to help review their relatives care. This is an area where people and their families could be more involved. For instance, one care plan said that the staff should spend time talking to the person to find out what their hobbies were. This is the sort of information which makes peoples care plan individual to them. But there was no evidence to show that this had been done, or information written down to pass onto other staff who support the person. Care Homes for Older People Page 14 of 40 Evidence: Some of the care plan outcomes were very similar. In one case the name of the person in the body of the computer written care plan was different to that at the top. This made it look as if the same template had been used and adapted. Using generic care plans makes it more difficult for staff to describe peoples care in an individual way, and should be avoided. However, where a persons needs were very different to others, staff had described this need in a much more individual way. For instance, staff recorded that one person can change their mind quickly, which meant that they needed to be observed and supported, because they can get confused. In another it explained how certain difficult situations relied on staff to maintain the persons dignity. This way of writing down peoples care should be encouraged, because in makes the plans much more personal. and will prove to be a good working tool from which staff can offer person centred care. Not all of the information about peoples care was held together. This makes it more difficult for staff to refer to, and update the care plan, which is kept separate from the daily records. In one case a change to someones needs that morning had not been written down, nor reported to the registered manager. This makes it very difficult for her to put things right when they go wrong. She intends to address this with staff. Risk assessments are completed in a number of areas. They were especially good where the risk to the person was more unusual. For instance, where they chose to take over the counter medication not prescribed by their doctor, or where they chose to go out alone. Baseline risk assessments were not completed consistently however. For instance: Although people recognised as being at possible risk had been provided with preventative equipment, such as mattresses to reduce the risk from pressure damage, or equipment to keep them safe in bed, formal assessments had not been completed to monitor the risk to them. Where a person was identified as being at risk from falls before arriving to the home, an assessment had not been completed to see what could be done to minimise this risk. Although there was no suggestion from the records seen that the person had suffered any ill effects as a result. However, in another care plan, an assessment had been done for the same problem. Although staff appeared to assist people with moving and handling on the day of the Care Homes for Older People Page 15 of 40 Evidence: site visit in a competent way, some people did not have an assessment in place to show how this should be done to make sure the procedure was always carried out safely, consistently and proficiently. The registered manager agreed that this is an area which needs to be reviewed and improved upon. It is good practice for people to have baseline risk assessments completed when they are first admitted, and for these to be these reviewed as part of their ongoing care. This covers areas like falls, moving and handling, risk from pressure sores and nutrition. The registered manager now intends to give priority to completing these for those people who have already been identified as being at risk. It would be good practice to then make sure baseline assessments are in place for everyone as part of their initial assessment, and that they are subsequently reviewed along with their care plan. Despite the above shortfalls, people said that they were pleased with the care that they get. They say staff are flexible, which means that one day does not have to be the same as the next. And all five people who returned their surveys agreed that staff listen and act on what they say. Of these, three people said that they always get the care and support that they need. They made comments like Staff are caring and do their best. One said this is usually the case. The person who answered sometimes added The staff at Wyton Abbey have been very helpful and supportive. People on the day made comments such as Staff are nice and respectful.....they respect my privacy, Its lovely here, and You couldnt do better really. Very pleased. The girls are lovely, you know. Staff were observed speaking to people with respect and good humour during the visit. A family member commented that their relatives care was great. They continued The staff at Wyton are great. The support I get and the care .....gets is great. I cant speak highly enough of Kim (the registered manager) and her team. They are pleasant and helpful are and are there for you even when they are short staffed and working flat out. A health professional gave positive feedback in their survey, answering always to the majority of questions about whether their clients needs were met at the home. They said that during their clients stay, their doctor was always called immediately at familys request, and that the home gives overall good care and attention. The second health professional stated Two clients I have at Wyton Abbey are happy. Family are also happy with the care provided. These collective comments suggests that, although peoples care is not fully reflected in their care plans, they and their representatives are generally satisfied that they are receiving this on a daily basis. Care Homes for Older People Page 16 of 40 Evidence: Nobody at the home has been assessed as being able to manage their own medication. We were told that staff who handle it on their behalf have completed training so that they know how to do so safely. The records seen were tidy, and were kept up to date. Medication was key safely locked away. The exception to this was where staff are given the responsibility for applying creams. It was noted that they do not always sign when the cream has been applied, and in one case they had not informed the registered manager that it had run out. This part of the medication system needs to be better audited so that there are no breaks in peoples treatment. The registered manager also intends to speak to the pharmacist to see if there is an easier way that the record sheets can be organised so that staff can sign them when they have applied the cream. Staff administer insulin to those people who are prescribed it, using a special pen which delivers a measured dose of medication. The registered manager explained that these staff have been trained by the district nurse to do so. The district nurse monitors the persons bloods regularly, to make sure that no adjustments are needed to their prescription. There was lots of information on one persons file for staff to read so they understood more about the condition, and the signs to look out for which would suggest the person needed medical attention. The pharmacist has visited, and is satisfied with the systems in place, including the arrangement whereby medication which needs to be kept cold is stored in the kitchen fridge, but within a locked container. Care Homes for Older People Page 17 of 40 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily activities assist in meeting peoples social needs. The fact that visitors are welcomed at the home helps people maintain social links with those who are important to them. Evidence: People can see in advance what activities have been arranged for them, because they are displayed in the main hallway. There are also a number of photographs on display to show what activities have already taken place. This allows people to reflect on these activities that they have been involved in. The manager has tried to find age appropriate activities in the community for people. This included a recent trip to the theatre to see an Old Time Music Hall production, which she said people enjoyed. The company minibus takes people out on organised trips to places such as the local garden centre for a look round, and a cup of tea. And trips to the coast are organised in better weather. We were told that anyone who is able to join in these activities is given the opportunity to do so. The garden area has also been developed to include a nature trail and a sensory Care Homes for Older People Page 18 of 40 Evidence: garden. Relatives said that this was a nice addition, and that during the summer it was a pleasant area for people to walk round. On the day of the visit a musician provided entertainment, which people enjoyed. Staff joined in with the occasion, which helped to make it an enjoyable social event for those who joined in. Although there isnt an activities organiser, daily activities are planned in advance, and provided by staff each afternoon. This included group events such as skittles and bingo. The home buys magazines and papers for people who prefer quieter activities. These were seen around the home for people to enjoy. Some people go out on their own to pursue their interests away from the home. Staff had assessed any risk to them in doing so. The hairdresser visits weekly and the company pays for this service for each person living there once each month. Visiting clergy also visit. This helps to meet peoples spiritual needs. Of the five people who returned their surveys, two said there are always activities for them to join. One of these people said There are activities but choose not to leave bedroom to go down and join in. They said prefer own company, reading and watching TV. Two said there are usually activities, and one said they couldnt comment. Although one person commented that they would like to go out for more walks. As the care plans develop further, it is recommended that more about peoples individual social needs are written down. This will allow staff to understand these more, and will assist in tailoring the activities depending upon who lives at the home at the time, what their individual social needs and interests are, and how they can best be met. This is one area where involving people and their families in the development and review of their care plans will help to achieve this successfully. People spoken with, who were able to comment, said that they can make choices about what to do with their day, where they eat, what they wear, and when they have their visitors. Staff said that rising and retiring times are flexible to meet peoples wishes. Giving people choices helps to make their lives more interesting and tailored around their individual wishes. One person said Wyton Abbey was like home but just in the wrong location. The registered manager was aware of their thoughts and was making sure that these were relayed to other professionals. Visitors were seen coming and going. Two of these said that they are always made very welcome. They can stop and have a meal with their relative, and two said that they had already booked to have Christmas lunch with their family. This helps to maintain important family and social links with those who are important to people. Care Homes for Older People Page 19 of 40 Evidence: Three of those who returned their survey said they always like the meals at the home. One usually does, and added Meals could have a little more variety at teatime, but they are OK. One person said they sometimes like the meals. People are offered drinks between each meal and supper before they retire for the night. The kitchen is open all the time so staff can make people a snack if they get hungry, for instance, during the night. The company has introduced ways to involve people in choosing what food they are offered including sample menus and ideas. This may well improve their experience of the meals when fully implemented. The records showed that the registered manager regularly discusses the menu with people in their monthly meetings. This will help to make sure that changes are made to it according to their views. People get a choice of meals at each mealtime. Staff were heard asking people what they would like to eat, so the meal of their choice could be catered for. People said the food was good on the day of the site visit. Two relatives agreed, and commented particularly on the Sunday Roasts, which they said were very good. The dining room was nicely set out. The meal looked hot and appetising, and smelt very good. People were given appropriate assistance in an unhurried way, and they were provided with aids, such as special plates, to maintain their dignity and independence during mealtimes. The staff member spoken to said that there is always enough food to provide a well balanced meal. They told us that deliveries of fresh meat vegetables and fruit are made on a regular basis. They explained that people are offered fresh fruit on a daily basis. They said Its like a five star hotel here. Special dietary needs are catered for. This currently includes diabetic diets, and soft diets for those who have difficulty chewing their food. Care Homes for Older People Page 20 of 40 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by a management team who take their concerns seriously when brought to their attention. Evidence: There were a number of cards displayed in the office, where people had thanked staff for their care and attention. Everyone who returned their survey agreed that they know who to speak to if they are not happy, and they all know how to make a complaint. One person said in their survey that they would contact their relative if they were not happy. However, they continued but I do have a good relationship with staff. I have complained, and these have always been sorted out near enough straight away. This suggests that the registered manager tries to get things put right when they go wrong. Staff now have a form that they can fill in when the registered manager is not on duty, should a complaint be made to them. This will help to make sure that the registered manager gets clear information, should anyone raise concerns about the home. There have been no complaints made about the home to the Commission for Social Care Inspection during the last year. And there were no complaints recorded in the complaints record book kept at the home. However, the registered manager showed us a separate record which she keeps of discussions with visitors and relatives. Within Care Homes for Older People Page 21 of 40 Evidence: these records, there were some some discussions which had taken place, which it was agreed were in fact complaints. Although the action taken by the registered manager in response to these discussions was usually recorded, there was not always a clear record of the outcome, and subsequent discussion with the people concerned. It was agreed, in future, that such complaints should be recorded in the complaints book. This will help the registered manager to keep better track of her records, demonstrate properly the action taken following the complaint, including whether the complaint was upheld, and also whether the complainant was satisfied with the response. By doing this, she will be more successful when auditing the complaints received, and in identifying any similar trends about the way the home runs, which she may need to give further attention to in order to improve outcomes for people. An issue was brought to the registered managers attention by us after we were told about a concern which had arisen earlier in the day. She had not been made aware of this problem prior to this, therefore she had been unable to act upon it. This has been reported upon in Health and Personal Care. This was discussed once brought to her attention. She is going to treat this information as a complaint, and has given her full assurance that she will look into the areas of concern to establish what has happened to cause the concern, and why. She will also feed back to those who will need to know the outcome of her investigation. However, in future, it is vital that staff let the registered manager know quickly if things are not right, and to record in peoples care plans where their care needs have changed. By doing so, the registered manager will be in a better and more informed position from which to act. A number of staff have received training in safeguarding. (Protection of Vulnerable Adults). Some had not, although the registered manager said that this subject is covered in the training staff get about dementia. The registered manager should identify who has not had the training, and make sure that this is provided, so staff have a clear understanding not only about what constitutes abuse, but also who currently has the responsibility for investigating such matters. However, there was clear and easy to follow information displayed in the office about what to do, when, and who to report to, if such an incident was to arise at the home. This helps to keep people protected. The staff spoken to understood their responsibilities in reporting abuse. They also knew that they could not keep secrets where they suspected, witnessed, or were told about a potentially abusive situation, and that this must be passed on in order to keep people protected. Care Homes for Older People Page 22 of 40 Evidence: Such information was provided to us during the inspection. This was discussed with the registered manager and the director of the company, neither of whom had been informed previously about this historical incident. They assured us that this would be addressed taking the appropriate action, and by alerting the local authority without delay. The commission also informed the local authority about the information we were given, so this could be investigated. We have been told that the allegation has been looked into, and is not upheld. Despite this outcome, the home took the right action in reporting straight away, so the right people could reach this decision. Care Homes for Older People Page 23 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 is clean and comfortable, but the current bathing arrangements increase the possibility that peoples choice will be restricted. Evidence: The home is surrounded by pleasant grounds, which people can look out onto, and enjoy. The gardens have been improved to provide a sensory area and nature trail, which people can walk around when the weather permits. A relative said it was a very nice area for people. Some of the furniture within the home has been replaced. Some of the old furniture was disposed of in the gardens and had been partially burned. This should be removed to make the outlook more pleasant for people. The accommodation in the main building is provided on three floors. The registered manager explained that she attends the annual maintenance check of the home, which is carried out by the company. She said that her requests and priorities are listened to when deciding what improvements are needed to the environment to make it better for the people who live there. Since the last site visit, work has been completed to remove the excessive varnish Care Homes for Older People Page 24 of 40 Evidence: from the hallway flooring. People walked in this area with confidence. A sensory room has been created, which is used as a retreat for people who like to sit quietly or with their families, away from the general activity downstairs. The mechanical sluices have now been removed from the building. Staff now rely on open sluices when cleaning commodes. One staff member commented that they would like to have the mechanical sluices back. However, all staff have attended infection control training, and are provided with protective clothing to reduce the risk from cross infection. There have been no recent outbreaks of infection at the home. People had been able to bring in their own belongings with them, so their room felt more like home. Two people who returned their surveys said the home was always fresh and clean. Three said this is usually the case. On the day, the main building was warm, clean and free from unpleasant odours, except for the top floor bathroom, which although currently out of use, smelt fusty. As this smell was isolated in one area only, it was thought that this could be a problem with the drains. The registered manager agreed to report this to the company the following day, so that it could be attended to. According to the registered manager, the hoist in this bathroom had been put out of action a couple of months ago, after she had received an alert to tell her that this type of hoist was no longer deemed safe. We were told that it is planned that the hoist will be replaced, but no date had been fixed to get this done. The bathroom on the first floor is not used either, because it is not assisted. This means that only people who can climb in and out of it can use it. The registered manager said that the people currently living at Wyton Abbey need an assisted facility, so are also unable to use the shower facilities either, because they cannot climb into them. The possibility of a walk in shower has been considered by the company to replace the bath on this floor, but a decision has not yet been reached about whether to install this. It would be good practice to do so, as it would provide people with more options about whether to bathe or shower. Taking all the above into account, the end result for people is that they only currently have one usable assisted facility in the building, which is on the ground floor. The room in which it is situated is not designed in the best way, because the position of the hoist chair could potentially make moving and handling more of a problem. Two staff Care Homes for Older People Page 25 of 40 Evidence: spoken with said that they did not find this an issue, and gave assurance that they managed safely, and with ease, when assisting people into this bath. However, the problem remains that people who may choose to bathe at similar times cannot, because there is only one available facility. It also means that people have to leave the floor on which they live in order to take a bath. This need to be improved for people, and the top floor hoist replaced as soon as possible to give people more choice. In the longer term, consideration should be given to providing an assisted facility on the first floor. The Garden Annexe is separated from the main building by a walkway. People who have been assessed as being more independent live there. Staff from the main building check periodically, to make sure that the people there are safe and well. People living there have a call bell to ring if they need help from staff. Those spoken with said they do not have to wait too long for attention if they ever ask for it. This area of the home was very cold because there was an ongoing problem with the boiler. People relied on portable heaters for heat, and commented that it had been a number of days since they had any hot water supply. Although they agreed that the registered manager had offered the facilities in the main building for them to use. The registered manager agreed to carry out a risk assessment within one week for anyone at the home using these unguarded heaters, to make sure that there was no risk to them from burns. The boiler was being repaired on the day of the site visit, which should restore the temperature of the annexe to an acceptable level for people. The laundry facilities are separate from any area where food is stored. The facilities were appropriate for the service provided. There was protective clothing available for staff to use. Soiled linen is delivered to the laundry in bags, which dissolve in the wash. This reduces the need for unnecessary handling, and therefore reduces the risk from cross infection. The laundry is separate to the main building. Staff may work there in isolation, and should have a copy of the safety data sheets to hand, to tell them what to do immediately if they, for instance, accidentally spill chemicals on their skin, or splash back into their eyes. People wear their own clothes. Their clothes looked nicely laundered and pressed. The fire officer has recently visited. They made some requirements and Care Homes for Older People Page 26 of 40 Evidence: recommendations, some of which related to the premises. We have been given assurance by the home that the work relating to the premises has been completed, and that the fire officer was satisfied with the changes made to it. However, on the day of our site visit, there were several door wedges found around the building, and one door leading into an occupied sitting area was wedged open. This is not safe, and has not been agreed with the fire officer. This is discussed further in Management and Administration, because it is an unsafe working practice which affects peoples health and safety. The environmental health officer has also visited recently. Again, we were told that the requirements and recommendations made following this visit have also been met. Care Homes for Older People Page 27 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care from staff who are provided with ongoing training to meet their needs, but the number of staff who provide this care may not be be consistent. Evidence: The registered manager does not use agency staff. Staff sickness or holidays is covered by others who agree to work extra shifts. Sometimes these shifts cannot be covered, but we were told that in these cases, the domestic staff, who are also trained in how to care, provide assistance. This was the case on the day of the site visit, when the numbers were reduced from six to three care staff. Two domestic staff provided assistance. Domestic and laundry staff are provided five days out of seven. When asked how the domestic staff complete their own duties when asked to cover care duties, the registered manager gave assurance that she offers extra hours to make sure that the work is done. Whilst there have been no more domestic hours provided since the last inspection, the registered manager said they are now better organised, and staff are allocated specific tasks to complete. There were some mixed views about care staff availability. Two people who returned their surveys said that staff are always available when needed. Three said this is Care Homes for Older People Page 28 of 40 Evidence: usually the case, and made these comments: Problems do arise when two people are needed to help a client and someone else needs attention, Staff are busy on some times of the day and it can be hard to contact them, but the manager or senior is on hand. One staff member providing feedback thought that there was always enough staff available. Two said this was usually the case. Another said that they often had to work extra shifts to provide cover for absence. They said that Wyton Abbey is a nice place to work, but that We all end up feeling tired as a result. One relative said that home was nice, but they thought that they could do with some more staff - a bit thin on the ground sometimes, and another said that when they visit there is sometimes only three care staff on duty. A concern raised on the day about whether there were enough staff available to attend to peoples needs was discussed with the registered manager, who is going to look into this formally. Another concern was recorded whereby a visitor had waited for a length of time, which they found unacceptable, before a staff member was free to let them into the home. The action taken in response to this was not clear, because it was recorded as more of a discussion with the person concerned. These collective comments suggest there is some disagreement about whether the staffing numbers are, or are not, being maintained at an acceptable level for people. It is recommended that this is looked into further, and it is advised that the company carry out their own survey, where they will have a better opportunity to capture the views of more people. This will give them a better picture about peoples collective views, and where adjustments may need to be made based upon these views, and current dependency levels. The two staff files looked at showed that newly recruited staff are not deployed until satisfactory references are returned, including one from their most recent employer. The company also checks to make sure that the individual has not been barred from providing care. The full police check had not been returned before one of these staff started to provide care. This is acceptable in exceptional circumstances, which the registered manager explained was the case. She also explained that the staff member was supervised until such time that a satisfactory full police check was returned. This helps to protect people. Although she was advised to make clear on the rota who is responsible for the supervision of the new recruit during the course of each shift that they work. Care Homes for Older People Page 29 of 40 Evidence: One recently recruited staff member told us that she had completed a seven hour in house induction. We were told in the information provided before the site visit that the home now completes the full induction and foundation training for staff. This had not been completed, and it is advised that the registered manager accesses the Skills for Care website for details of this programme. This will assist in making sure that staff work in a consistent way in line with current minimum standards. There is an ongoing programme in place for staff to achieve National Vocational Qualifications in Care at Levels 2 and 3. One staff member was very pleased that their studies towards Level 3 would soon be completed. Those staff who returned their surveys agreed that they are being given training to help them in their role. This includes training in understanding dementia. They also agreed that the manager regularly meets with them to discuss their work and to give support. This will help to forge improvements at the home, and to identify problems at an early point which may require further training so that the care people get remains of a good, consistent standard. Care Homes for Older People Page 30 of 40 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by an enthusiastic manager who is listening to people when deciding how the service should be run. Evidence: The manager has been registered with the Commission for Social Care Inspection for the last year. She has worked at the home for some time, so understands the policies set out by the company. She has completed a management qualification. She knows the people who live at the home well. She is described as approachable and open. She has tried hard over the year to find ways of engaging better with people and their families. For instance, she holds regular meetings for people and their families, and keeps minutes to show everyone what has been discussed. She has developed a newsletter, which is on display in the hallway. And she holds a regular surgery where anyone can come and discuss problems they may have relating to the running of the home, and the care that is provided. Care Homes for Older People Page 31 of 40 Evidence: One staff member commented I feel that Wyton Abbey has improved to the best of its potential as I have worked here for a number of years. I dont feel there is much to improve on. Another said Since Kim (the manager) has started the staff morale is brilliant. And a relative said that they can see that things have improved since this manager has come into post. The regional manager provides regular support to the home. This includes regular checks to make sure that standards do not slip. The manager also attends management support groups, so that best practice can be shared amongst the homes owned by the company. Annual surveys are sent to people, their families and health professionals who support them. The collective results are published, so people can see what had been done about the comments that they have made. The home looks after peoples personal allowance if this is their wish. Computerised records are kept of peoples accounts, so that they can see at any time how much money they have. This money is kept in a special account specifically for the people living at the service. It is a simple account which does not accrue interest, thus avoiding difficulties in deciding how this should be shared between people. At the home, a small float is kept securely. This means that people can still have the opportunity to handle money. People who are able to can sign to say that they have received their money. This helps them to keep some independence and control over their affairs. There is no one currently at the home who handles their own affairs. However, the administrator said that they would be supported to do so if this was their choice, and they were able to do this safely. The information given before the site visit showed that major appliances such as the electrical systems and fire equipment are kept maintained. A sample of checks were made where the certificates would have expired from the date that the information was provided. This showed that these had been serviced since. The company maintenance man visits weekly to complete tasks that have been recorded in the maintenance book. In house checks of, for instance, the hot water, to check that it is not too hot, and of the fire alarm system, to make sure that it works properly when the alarms are sounded, are completed regularly. Both the fire officer and the Environmental Health Officer have visited the home recently to carry out their own checks of the service. Some requirements were made by the Environmental Health Officer which we were assured have now been addressed. Care Homes for Older People Page 32 of 40 Evidence: As well as making some requirements and recommendations about the premises, which we were told have been addressed, the fire officer also made some recommendations about improving the fire safety training that staff get. This was around making sure that the training is regular, and includes all staff. He identified, as we did at this inspection, that this was not currently the case. In some cases it was two years since staff had received any formal training. Although the registered manager said that fire drills are sometimes held, it cannot be guaranteed that this will capture all staff on a regular basis. Therefore this is a long time for staff to remember what action they must take in the event of a fire to keep people safe. We were told by the registered manager that his recommendations have not yet been implemented. It is important that they are, so that people are properly protected from the risk of fire by confident staff who know what to do in an emergency. The registered manager has agreed to plan and implement this. This will help to make sure that staff act correctly and confidently should a fire break out. The following matters, which affect peoples health and safety, were raised with the registered manager: There were a number of door wedges around the building. The registered manager was told that these must be removed. She said that the domestic staff used these when cleaning, and care staff when assisting people in and out of rooms. However, a sitting room was actually wedged open. This means that the door would not close if the fire alarm sounded, and would increase the risk to the person sitting in there. The registered manager was required to remove this wedge straight away, and to instruct staff that they must not be used in the future. A sluice was unlocked, and contained heavy duty cleaner which could harm people if they were to access the room. This was removed straight away. Staff must remember to keep the room locked when not in use, and to store hazardous chemicals away safely. A risk assessment had not been completed where bed safety rails were used. The manager agreed to check all the safety rails in the building straight away, to make sure that they were safe and properly fitted. From there, she must make sure that everyone who has been assessed as needing them has a risk assessment completed, to make sure that the safety rails are the best course of action to keep people safe. A record must then be kept that the rails are checked regularly by someone assessed as competent to confirm that they are safe and fit for use. Care Homes for Older People Page 33 of 40 Care Homes for Older People Page 34 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 35 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be completed for people, particularly where areas of risk are identified with regards to falls, moving and handling, pressure care and nutrition. This will make sure that: risk to people is identified at the earliest point staff take correct, consistent action to keep this risk to a minimum the risk to the person is formally reviewed over time, and any problems referred to the right professional quickly if concerns arise. 31/01/2009 2 19 13 A risk assessment must be 13/12/2008 completed within one week for everyone who has access to portable heaters. This is to make sure that Care Homes for Older People Page 36 of 40 people are not at risk from burns, and that corrective action is taken when people are found to be at risk. 3 21 23 Arrangements must be made to restore the number of usable assisted bathing facilities. So that people have a better choice of facilities, and so that staff have more usable space when it is necessary to assist people with moving and handling. 4 38 13 As discussed at the site visit, 13/12/2008 anyone who it is believed requires bed rails must first of all have a written risk assessment completed. Someone competent to do so must then check the rails on a regular basis, and record that this has been done. This will help to make sure that the rails are the most suitable option for the person, that this decision is kept under review, and that the rails are kept safe and fit for use. 5 38 13 As stated at the site visit, hazardous chemicals must be kept locked away. This is so that people who may be harmed should they come into contact with them are kept safe. 13/12/2008 31/01/2009 Care Homes for Older People Page 37 of 40 6 38 13 As stated at the site visit, door wedges must not be used, unless this practice has been agreed with the fire officer. This is so doors operate properly should the fire alarms sound, to keep people safe from the spread of fire. 13/12/2008 7 38 23 The recommendations of the 31/01/2009 fire officer following his recent visit to the home must be actioned in relation to all staff having regular fire training. This is so that the risk to people is kept to a minimum by staff who know what action to take in the event of a fire breaking out. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 People and/or their family should be more involved in the upkeep and review of their care plan. This will help staff to keep focused on each individuals needs, and what is important to them. Plans to keep information about each persons care together should be pursued. This will encourage staff to refer to, and update the care plan as the needs of the person change, and as staff update the daily records. 2 9 The way that the medication is audited should be reviewed to include checking that there is an adequate supply of creams in peoples rooms for staff to apply where applicable. This will help to make sure that there is no break in treatment prescribed by the doctor. It is recommended that all complaints are held together in 3 16 Care Homes for Older People Page 38 of 40 one place, so the manager can record the outcome of each investigation and whether the complaint was upheld. This information should be used when auditing the home, reflecting on areas which need to improve, and commenting upon where improvements have been made. 4 18 All staff should be provided with safeguarding training, so they are refreshed about what constitutes abuse, what action they should take, and to whom such matters should be reported to make sure that the right action is taken quickly. The partially burned furniture should be properly disposed of so the grounds are more pleasant for people to look out onto. The company should complete a survey to check peoples satisfaction with regard to the current care staff numbers. They should collect the results, and act where areas of dissatisfaction follow a common trend, so that improvements can be made, if applicable, in line with peoples direct views. The arrangements for the supervision of staff who have been employed at the home, and who await the return of the full police check, should be made more formal, and written down so that it is clear who is the supervisor and supervisee over the course of each shift. The Skills for Care induction programme shoud be considered for new staff to underpin what they already learn, and to make that this meets current minimum standards in care. 5 19 6 27 7 29 Care Homes for Older People Page 39 of 40 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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