Care Home: The Wedge

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What the care home does well The service provides a homely family run home with good food and comfortable surroundings. The building is being continually updated and improved. Staff in the home are well trained, competent, friendly and supportive. The home is well managed and is responsive to the views of people living in the home and to the views of their relatives. What has improved since the last inspection? There have been numerous improvements to the building, including new flooring, a new bathroom and the enlargement of the dining area. There is an ongoing improvement plan for the building and it is also well maintained. There has been the introduction of a new care planning and assessments processes that, the Manager hopes, will contribute to an improvement in the service people receive. What the care home could do better: No requirements or recommendations were highlighted as a result of this inspection, but we discussed with the Manager the need to find an alternative place for staff to smoke. CARE HOMES FOR OLDER PEOPLE The Wedge 8 Park Road Hayling Island Hampshire PO11 0JU Lead Inspector Nick Morrison Unannounced Inspection 26th February 2008 11:00 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 The Wedge DS0000011783.V357052.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. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wedge Address 8 Park Road Hayling Island Hampshire PO11 0JU 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) 023 9246 5225 Mrs Monica Joy Macey Mr John Henry Macey Miss J Macey Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: The Wedge is a large, detached building set in a quiet residential area of Hayling Island. Accommodation consists of sixteen single bedrooms, fourteen of which have an en-suite facility. Communal rooms include a large lounge area with a conservatory, smaller quiet lounge, dining room and attractive, wellmaintained gardens to the front and rear of the building. The home is in good decorative order throughout and provides service users with a comfortable, friendly environment. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report represents a review of all the evidence and information gathered about the service since the previous inspection. This included a site visit that occurred on 26th February 2008 and lasted four and a half hours. During this time we went into each room, looked at service users’ files and met with people living in the home. We also met with the Deputy Manager and spoke with two members of staff. All records and relevant documentation referred to in the report were seen on the day of inspection. We sent out a number of surveys to people living in the home, relatives, staff and Care Managers but received no response to any of these. We have also referred to the Provider’s Annual Quality Assurance Assessment (AQAA). Current fees in the home are £420 per week. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. What the service does well: What has improved since the last inspection? What they could do better: No requirements or recommendations were highlighted as a result of this inspection, but we discussed with the Manager the need to find an alternative place for staff to smoke. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 6 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. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs assessed prior to moving into the home. EVIDENCE: Examination of service users’ files showed that each person living in the home had had an assessment of their needs prior to admission. Assessments were comprehensive and contained input from service users, their families and relevant health professionals. The home is in the process of changing its assessment format and the new format is also comprehensive enough to identify all potential needs prior to admission. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs identified in a care plan and from having their healthcare needs met. They are protected by the home’s medication policies and procedures and are treated with dignity and respect. EVIDENCE: The home has recently introduced a new assessments and care planning package which is comprehensive and thorough. The care plans of people living in the home are in the process of being transferred to the new system. Some have been completed in the new format and some have not. Examination of files showed that there were care plans in place for each service user. The plans had clearly been written in response to those needs identified in the pre-admission assessment, as well as to those needs identified as staff in the home got to know service users better. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 10 The care plans were kept in a locked cabinet in the dining room so that they were accessible to staff when they needed them. On the day of the inspection visit staff were completing the care plans during the handover period in the afternoon and informing colleagues of the morning’s events and the well being of service users. The plans were all reviewed on a monthly basis and changes made where necessary. Changes were also made to the plans in-between the monthly reviews if it was clear that needs had changed. The healthcare needs of service users were monitored daily and formally monitored on a monthly basis. Records were kept to demonstrate any changes in the person’s health and staff in the home liaised with other healthcare professionals whenever necessary. Family members said that staff in the home were attentive to the health needs of people living there and responded to any concerns and that they involved external healthcare professionals when necessary. Care plans included risk assessments where necessary and these were also reviewed and updated on a regular basis and as necessary. There had been a recommendation from the previous inspection that medications in bottles and boxes should have the date of opening recorded on them. Examination of medication storage showed that this recommendation had been addressed. Medication in the home was well managed. There was a clear medication policy and staff spoken with understood it fully. Staff involved in administering medication had all received training. All medication was stored safely and securely in the home and good records were kept of all medication administered. Records were also kept of all medication coming into and going out of the home. Observation throughout the inspection visit showed that staff understood how to respect the privacy and dignity of service users. Staff were courteous at all times to all service users and service users and relatives spoken with confirmed this. All service users seen and spoken with on the day of inspection were well presented and, where necessary, had support from staff to maintain their appearance. The induction training for staff provided them with guidance on the rights of service users and on ways to actively demonstrate respect and maintain peoples dignity. Service users had locks on their doors so that they could maintain their own privacy if they felt the need to. Staff observed on the day of the inspection always knocked and waited for a reply before entering people’s rooms. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from being able to exercise choice and control and have stimulating activities. They also benefit from good support in maintaining contact with friends and families and a good, balanced diet. EVIDENCE: Staff had received training in communication and were skilled in communicating with people living at the home. Families confirmed that all the staff in the home were very good at communicating effectively with their relatives and that they were respectful of the choices they made. Observation of staff on the day of the inspection visit showed that they gave time and consideration to all service users and attempted to respond to their wishes at all times. They spent time listening to people and engaging them in conversations. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 12 There was evidence from service users’ files, activity records and from discussion with relatives and service users that there were a range of activities available in the home. Activities were varied and reflected the identified interests of people living in the home. Visitors were encouraged to come to the home at any time and family members confirmed that they felt able to visit whenever they wanted to. Families said they were always made to feel very welcome in the home and that staff made it easy for them to visit and spend time with their relative. They said it was a very friendly and homely atmosphere and that they always felt welcome. Observation on the day of the inspection visit showed that staff were conscious of the need to maintain good and professional relationships with relatives and to ensure service users had the opportunity to spend time with their relatives. Service users spoken with confirmed that the food available was of a good standard. Menus were available and alternative choices were always offered. Service users said that vegetables were always fresh and that snacks were available throughout the day. Nutritional needs were assessed on admission and specific diets were catered for where necessary. The meal seen on the day of the inspection visit corresponded with the menu for the day and people spoken with said they enjoyed the food in the home. There was staff support available to people who needed help with their food and staff took the time to explain the menu choices to people. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from a clear and effective complaints procedure and are protected by the home’s adult protection procedures and practices EVIDENCE: The home has a clear and effective complaints policy in place. The policy is made available to service users and their families on admission and a copy is also available in the front entrance of the building. Families of service users were aware of the complaints policy and how to use it. The home has a system in place for recording and responding to any complaints that may be made. Discussion with staff and examination of training records showed that all staff had received training in adult protection issues and were aware of their responsibilities within the adult protection procedures. The manager was clear about the reporting procedures and how to use them. Service users spoken with said they felt safe in the home and with the staff who supported them. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from living in clean, safe, well-maintained environment. Further work needs to be done to address the odour within the home. EVIDENCE: All parts of the building were kept very clean and the home retained a homely and comfortable appearance. The furniture in the home was of very good quality and was replaced whenever necessary. There was also a programme of routine maintenance and records were kept to demonstrate that maintenance issues were responded to swiftly. The home employs adequate numbers of domestic staff to maintain the appearance of The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 15 the building. Domestic staff on the day of the inspection visit appeared conscientious and attended to details very well. Infection control policies were in place and were posted in places throughout the building to ensure that staff were able to refer to them throughout their work. The Provider is undertaking an ongoing plan of improvement to the building which has included a new conservatory area, new laundry area and the enlargement of the dining room. Further plans included another sun lounge in the garden and redevelopment of the food storage area. Service users and families spoken with during the inspection visit said they felt the home was well-maintained and that standards of cleanliness were high. The home ensures that as rooms become vacated they are re-decorated and new carpets are laid before the next person moves in. Since the previous inspection new laminate flooring has been laid in the hallway and there are plans in place to have the stair carpet replaced. There has also been a new bathroom put in on the ground floor. We discussed with the Manager the need to find an alternative place for staff to smoke. They currently smoke outside near to the food storage area. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service Service users benefit from being supported by adequate numbers of sufficiently trained staff and are protected by the home’s recruitment policies and practices. EVIDENCE: There had been a recommendation from the previous inspection that a clear record of staff training should be kept at the home. Examination of staff files showed that this recommendation has been addressed. Training records were clear and demonstrated that staff training was wellmanaged. Staff spoken with confirmed that training was available to them and that the training they had received had been of good quality. Records showed that the home ensured staff training was kept up-to-date. Fifteen of the eighteen staffing the home have a National Vocational Qualification at Level 2 or above and one further member of staff is working towards it. There had been a recommendation from the previous inspection that staff rotas should be written in pen. The rota seen on the day of the inspection visit demonstrated that this recommendation has been addressed. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 17 The home employs sufficient numbers of staff to meet the needs of service users. Rotas showed that, in addition to this there were domestic staff including cleaners and a cook. Examination of recruitment records showed that the home ensured that all necessary pre-employment checks were in place for all staff before they were employed by the home. All staff were interviewed before being offered a job and clear records were kept of all interviews. Family members said every member of staff were always very supportive and were always able to answer any questions or concerns they had. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s financial procedures and by the management of health and safety issues. EVIDENCE: The Manager is registered and has the skills, knowledge and experience to manage the service. Health and safety was well managed in the home. Comprehensive workplace risk assessments were in place and these were monitored and reviewed on a regular basis. The Manager was clear about health and safety legislation and specific regulations were accounted for within the home’s health and safety The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 19 policies. Procedures for safe working practices were posted around the building and were covered in staff induction training. Staff spoken with were clear about the need for ensuring the health and safety of themselves, their colleagues and service users in all the work they undertook. Any incidents or accidents were recorded clearly and these records were regularly reviewed to ensure that practices were changed where necessary. All staff received regular training and updates in health and safety issues. All fire records within the home were up-to-date. Substances hazardous to health were well managed and stored safely. Staff had received information in controlling these substances. The laundry area was very well equipped and well managed. The home has a quality assurance system in place based on the views of people living in the home as well as their relatives and other stakeholders. Records were kept and showed that the service was responsive to the views of people with an interest in the service. Questionnaires are sent out to service users and relatives and then responses are analysed. What the service intends to do regarding the responses in the questionnaires is then shared with service users and relatives through a regular newsletter. The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Wedge DS0000011783.V357052.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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. 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