Care Home: The Wingfield Care Home

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What the care home does well The Wingfield cares for some residents with complex needs, particularly relating to dementia care, physical frailty and terminal care. Despite many residents not being able to communicate with ease, staff knew about residents` individual needs and preferences in detail. This was supported by an extensive activities programme, with designated staff whose role is to ensure that residents` diversional needs are met. The chefs work hard to provide meals which the wide range of residents can enjoy, providing a very flexible and responsive service. The home environment has been designed with the residents` needs in mind and there is a very wide range of equipment provided to meet the needs of people with disability and frailty. Furnishings and furniture are of a high quality and in resident areas, standards of cleanliness are high. People expressed their satisfaction with the service provided. One person reported that they were "just grateful that there are such places", another "I think it`s about the best" and another "there`s no chaos here, not like [my relative`s] last home." People expressed their appreciation of the staff. One person reported "I come in often, at all odd times, I always get the same treatment and there are always staff available", another "the girls are lovely, some of them even go about their work singing", another "there`s that nice sister who you can talk to" and another "the nurses are like part of the family". Some people were appreciative of the supports given. One person reported "they do make a fuss of" [my relative], another "when I`m here they always offer me a cup of coffee" and another "they quickly tell me about anything". One person summed up their opinion about the home by stating "If there were such a thing as a 6 star home, this would be a 6 star home". What has improved since the last inspection? At the previous inspection, one requirement was made and five good practice recommendations identified. The requirement and four of the five recommendations had been addressed by this inspection. Where frail service users need their position changing on a regular basis, there is now written evidence that this is taking place. Liquid paper is not being used to correct residents` records. Where staff are aware of the detail of individual residents` care needs, they have ensured that they are documenting these needs. Care plans relating to residents with complex conditions such as diabetes, now use precise, measurable terms and avoid the use of generalistic words such as "normal". All references inspected were dated. Ancillary staff had an interview assessment completed. CARE HOMES FOR OLDER PEOPLE The Wingfield Care Home 70 Wingfield Road Trowbridge Wiltshire BA14 9EN Lead Inspector Susie Stratton Unannounced Inspection 10:35a 18 and 21st July 2008 th 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 Wingfield Care Home DS0000032366.V364443.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 Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wingfield Care Home Address 70 Wingfield Road Trowbridge Wiltshire BA14 9EN 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) 01225 771550 01225 771559 sharon.lewis@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Ltd Ms Sharon Lesley Adams Care Home 89 Category(ies) of Dementia - over 65 years of age (57), Old age, registration, with number not falling within any other category (89), of places Terminally ill (2), Terminally ill over 65 years of age (2) The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. The manager for the registration must be registered on Level 1 (adult and mental health) NMC register. The 32 bedded unit may accommodate a maximum of 2 service users with a terminal illness, either over 65 years (TI(E)) or under 65 years of age(TI) The 32 bedded unit may accommodate persons with old age not falling within any other category (OP) over the age of 50 years. The 32 bedded unit may use only rooms S1, S3 or S8 for double occupancy. The 57 bedded unit may accommodate up to 5 service users in the age range 50-64 years. The registered manager must always be supported by a designated deputy for the 57 bedded nursing unit who is registered on Level 1 (mental health) NMC register or has demonstrated equivalent in qualifications/experience and by a designated deputy for the 32 bedded unit who is registered on Level 1 (adult) NMC register. The staffing levels set out in the Notice of Decision dated 7 July 2006 must be met at all times. 12/09/06 7. Date of last inspection Brief Description of the Service: The Wingfield is a care home providing nursing care for 89 elderly persons. There were 85 persons resident at the time of the site visits. Accommodation is provided in two buildings in a campus-like arrangement. The building at the front of the site is called the Lodge, it has 32 beds and is registered to care for older persons with general nursing and care needs. While it may admit service users over the age of 50 years, any persons who are under 65 have similar nursing and care needs as those over the age of 65. Some of the residents in the Lodge are very frail and have highly complex nursing needs. The main building at the back of the site has 57 beds and specialises in providing nursing and care to persons with dementia care needs. It may also admit persons over 50 and when such persons are admitted, they have dementia-related conditions. Some of the residents in the main building have highly complex needs relating to mental health nursing and care. A GP surgery is situated on the same campus, it is an entirely separate facility. The Wingfield is owned by Barchester Healthcare Limited, a national care provider. The main building was opened in January 2003 and was purpose built, in accordance with the National Minimum Standards for Older People. The The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 5 accommodation is over two floors, served by a lift and stairs. A security lock system is used on the doors to the stair wells and to the outer reception area, to reduce the risk to service users with dementia care needs. All rooms are single and have en-suite facilities. There are a variety of different communal areas and a central, enclosed courtyard garden. The Lodge has undergone a major refurbishment, which was completed in May 2005. The refurbished accommodation was completed to a high specification. Accommodation is provided over three floors, with a passenger lift in-between. All rooms are ensuite, three specified rooms may be used as double rooms if an established couple wish to share. There are communal rooms on each floor and a wheelchair accessible front garden. The Wingfield is situated on the outskirts of Trowbridge, a large town with good amenities. Car parking is available on site and a bus stop is close to the entrance. A railway station is about 5 minutes away by car. The home is managed by Mrs Sharon Adams, who is an experienced manager and registered nurse. She is supported by a deputy manager, a manager for the Lodge, a training manager, registered nurses, care staff, activities coordinators, catering staff, administrators, maintenance men and ancillary staff. The fee range is £885 - £950 per week. Service users guides are available in the two entrance halls and are given to prospective residents or their supporters. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 40 questionnaires were sent out and 14 were returned. Comments made by people in questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the home’s file was reviewed and information provided since the previous inspection was considered. We also received an Annual Quality Assurance Assessment from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the quality assurance assessment, the surveys and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during a visit to the home. As the Wingfield is a larger registration, the site visits took place over two days, on Friday 19th July 2008, between 10:35m and 5:00pm and Monday 21st July 2008 between 10:00am and 4:35pm. The Manager, Sharon Adams was on duty during the inspection. Mrs Adams and her deputy were available for the feedback at the end of the inspection. During the site visits, we met with seven residents, six visitors and observed care for nine residents for whom communication was difficult. We observed care provided in the lounge in the Lodge. We observed care provided on both floors of the main building, at different times of day. We performed a short observation of care in one lounge in the main building, using our established procedures. We reviewed care provision and documentation in detail for nine residents in the different parts and floors of the home and also looked at specific areas of care for a further five residents. As well as meeting with residents and their visitors, we met with the training manager, six registered nurses, seven carers, one agency carer who was funded to provide 1:1 care to a specific resident, the chef, two deputy chefs, the senior activities coordinator, a junior activities coordinator, the laundress, a hostess, the maintenance man and the administrator. We toured all the buildings and observed practice, including lunch-time meals in the different areas of the building. We observed two activities groups. We also observed systems for storage of medicines and observed a medicines administration The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 7 round. A range of records were reviewed, including computerised staff training records, staff employment records, accident records and complaints records. What the service does well: What has improved since the last inspection? At the previous inspection, one requirement was made and five good practice recommendations identified. The requirement and four of the five recommendations had been addressed by this inspection. Where frail service users need their position changing on a regular basis, there is now written evidence that this is taking place. Liquid paper is not being used to correct residents’ records. Where staff are aware of the detail of individual residents’ care needs, they have ensured that they are documenting these needs. Care plans relating to residents with complex conditions such as diabetes, now use precise, measurable terms and avoid the use of generalistic words such as “normal”. All references inspected were dated. Ancillary staff had an interview assessment completed. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 8 What they could do better: 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 Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 9 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 Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 10 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. The Wingfield does not admit people for intermediate care, so 6 is N/A Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Prospective residents are given a full assessment of need prior to admission, so that they can be assured that the home can meet their needs. EVIDENCE: All prospective residents are seen by the manager, Mrs Adams or her delegate before admission. Where a person lives some distance away, a manager from another Barchester home may be asked to perform the assessment. As the home cares for people whose prime need is for dementia care or who are very frail, most people could not remember the admission process. The manager reported in her annual quality assurance assessment that “People are encouraged to visit us at any time both with or without appointments and we spend time showing visitors around the home and answering any questions”. Relatives spoken with supported this, reporting that they had been able to visit the home before admission. One relative reported that they had visited the The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 11 home twice, once by appointment and once after that unannounced, but that on both occasions staff had been open, helpful and ready to answer their questions. One person commented in their questionnaire that their relative had been admitted in an emergency and that as a result they felt they had not been able to have answers to all the questions that they had prior to admission. One relative reported “we chose this place because the atmosphere was the best of all the places we looked at”. Mrs Adams reported in her annual quality assurance assessment that the provider has introduced new assessment tools since the last inspection. The assessments we saw had been completed in detail and reflected what was observed and what staff told us. Nursing staff reported that the manager informed them of prospective admissions, so that they could prepare to meet residents’ needs. Care staff reported that the nurse in charge of the shift told them about people who were coming in, so that they could prepare their room. Other staff such as activities coordinators and the chef also reported that they were informed of each new admission, so that they could start working to meet their assessed social care or dietary needs. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents will have their nursing and care needs met by staff who are keen to promote individualised care for this very frail and vulnerable group of people. Improvements in record keeping are needed in some areas, to ensure that managers can effectively monitor that residents are consistently receiving the medical and nursing care that they need. EVIDENCE: All residents have regular assessments of need. Where a person is assessed as having a need or a risk, a care plan is put in place to direct staff on how the person’s needs are to be met or their risk reduced. Care plans are regularly evaluated and up-dated when indicated. A review of records indicated that as much as possible, reviews included the resident and that relatives are also often involved. One relative reported, “we feel happy with the care, more than happy with the care”. Two residents in the Lodge commented particularly on the supports given to them by the night staff. One person describing them as The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 13 “perfect” and another as ”generally very good”. One person reported “they put me in a chair by my wash basin and let me do it myself, I have a shower in my room and they let me shower on my own but are on hand in case I need help”. Some people expressed reservations about the care. One person reported, “We feel the staff meet the essential care needs of the individual most of the time, but a number of aspects of their care are overlooked”. Generally such comments related to people considering that there were not enough staff on duty to meet their or their relative’s needs (see Staffing below). Nearly all staff spoken with had a very detailed knowledge about their resident’s needs and what they reported was reflected in residents’ care plans. Many of the residents in the main house experience complex nursing and care needs relating to dementia. One relative reported “nurses are qualified and have experience in dementia care”. All residents with dementia had very clear individual care plans. Care plans were highly individual in tone and nonjudgemental language is used. Residents were free to walk round the corridors as they wished. The issues of residents inadvertently accessing other residents’ rooms was discussed and staff reported that people did sometimes go into other residents’ rooms. If this distressed residents, staff would use a pressure pad by the resident’s door to alert them to this behaviour, so that staff could divert the resident away into other activity. The issue of complex behaviours, including violence was discussed. Staff reported that the levels of violence between residents was low, although occasionally such incidents did occur. If such incidents did occur, there were systems for managing them and reporting to the management. This was supported by documentation. Whilst it was observed that some residents did show noisy behaviours, these were noted to be time-limited and did not for anyone occur throughout the whole day. A short observation took place during the inspection, in accordance with our procedures. This showed that residents were generally relaxed and did not show signs of distress. Staff were observed to knock on residents’ doors before entry. They tried to ensure that if a person was not aware of maintaining their own dignity, for example, removing some of their clothes, that they took prompt action to preserve the person’s dignity. No people raised issues about residents clothing being put in other residents’ rooms or being worn by other residents. One resident reported, “the laundry is very good, I’ve never been given someone else’s clothes.” The home has clear systems for ensuring that residents’ clothes are marked and returned to them. As this is a large registration, the fact that no mistakes have been reported in this area is an indicator of good practice. During the late afternoon, we met with a resident who reported that they were cold and we went to find a member of staff. Whilst we were doing this, we observed another resident walking unstedily down the corridor. By the time we returned, a few minutes later, the first resident had already been given a cardigan by a member of staff and the second resident had been provided with a chair and had been given their zimmer frame. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 14 Many of the residents are very frail and have complex nursing care needs, particularly in the Lodge. Where residents are at risk of pressure damage, individualised care plans were put in place to direct how risk is to be reduced. Some care plans documented how often a person needed their position changing, but not all and improved consistency is advisable in this area. Where residents need their positions changing or to be offered regular fluids, this is monitored by the use of charts. Completion of these charts has much improved since the last inspection, however improvements continue to be needed. For example one person who sat out of bed for periods had no reference on their charts as to how pressure was relieved when they were sitting out. As risk of pressure damage does not reduce when sitting out of bed, this is needed. Records indicated that some people’s positions may not have been consistently changed in accordance with their care plans or assessed risks of pressure damage. One person’s chart documented that they were lying in bed, however when they were visited, they were sitting in a chair beside their bed. Some fluid charts were clearly regularly completed to show when residents were given or offered drinks but others were not. Some fluid charts were totalled every 24 hours but others were not. Records of care for people who are frail and have difficulty in communication need to be fully and accurately completed at the time care is given. These issues were discussed with Mrs Adams and her deputy and it was agreed that this would be addressed as part of care staff daily supervision by the registered nurses, who would actively review each frail resident’s chart at the end of each shift. Residents are all assessed for dietary risk and where risk is identified, care plans are put in place. Where people need their dietary intake to be monitored, records are maintained. Some records stated what a person had eaten, however others continued to document references to “pureed diet”, without stating what the person had eaten. The chef confirmed that residents who need pureed diets are not always given the same choice of meal, so what a person has eaten needs to be documented. Several residents with swallowing difficulties needed thickening agent in their drinks to enable them to swallow safely. Some care plans stated how thick the person’s drink needed to be but others did not, so more consistency is needed. Residents who needed thickening agent were observed to have their drinks thickened and all, apart from one member of care staff, was able to inform us of how thick different people needed their fluids to be. Where residents were not able to use the call bell, there were care plans to direct staff on how the resident’s safety was to be ensured. One care plan documented that the person’s room was close to the nurses’ station, so that staff could check on the person each time they passed. One relative reported, “staff are always popping in”. In many other homes where such checks take place, a record is maintained, so that senior staff can review that such vulnerable residents have been observed regularly. Such documents also inform visitors. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 15 The home cares for some very frail people, many of whom are assessed as being at high risk of falls. All people who were assessed as being high risk of falls had care plans in place to direct on how their risk of falling was to be reduced. It was noted as good practice that care plans did not include restricting a person from mobilising independently. People at risk of falling were supported by hip protectors and pressure pads were used to alert staff if a person who was at high risk of falling was moving independently. All accident records were completed in full and were monitored by Mrs Adams or her deputy. The home has computerised reporting systems to facilitate identifying trends and individual residents who are at high risk of falling. Some residents had additional complex medical conditions. All residents who had a diabetic condition had clear care plans, which documented how their condition was to be managed in the light of their individual needs. These records were clear and written in measurable language. Where residents had wounds, the home used standard monitoring systems for assessment of the wound. It is much to the home’s credit that they have successfully healed a resident’s very complex pressure sore, which they had been admitted with. As much as possible residents with continence needs were managed without the use of appliances, using continence products, which were clearly documented in their care plans. Where catheters had to be used, the clinical reason for this was clearly documented and full records of changes in catheter maintained, in accordance with guidelines. Staff reported on the good liaison with local GPs. Full records of consultations were maintained. Records also showed that residents received regular chiropody. One person reported on how helpful the staff had been in making arrangements for them to have their ear syringed. The home also consults with other external professionals, including the tissue viability nurse and continence nurse, when indicated. Several registered nurses reported on the close working relationships the home had with the old age psychiatry service. As this home cares for people with nursing needs relating to dementia, people who are very physically frail and people who have terminal conditions, as would be anticipated, there is a high death rate. Staff spoken with were aware of the importance of people ending their lives in their own surroundings. One of the registered nurses acts as liaison nurse with the local hospice and regularly attends up-dates relating to end-of-life care. All residents have assessments relating to their experience of pain. These were individual in tone and regularly evaluated, to ensure that any pain is reduced as much as possible. As many of the residents cannot express pain verbally, several staff reported that this is a complex area and that they needed to rely on observation and an in-depth knowledge of the individual, to ensure that a person did not experience pain. Two members of staff reported that if a person is dying, relatives are supported in visiting for as long or as much as they wish and that staff ensure that the person is not left alone. This was reported to be particularly important in the dementia care unit, to ensure that The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 16 residents with dementia care needs do not inadvertently wander into the room of a person who is dying. During the inspection, we observed a medicines round and systems for storage of medicines. One registered nurse was observed to be very kind and gentle with a frail person, not rushing them and supporting them throughout taking their medicine. One person reported “they always bring my medication when I need it – I’m so reliant on it”. All medicines were securely stored. The home has three storage facilities for medicines, one on each floor and one in the Lodge. Medicines rounds were performed in a safe manner and medicines trolleys were always locked when a registered nurse was in a resident’s room administering medication. Some records were well maintained, for example if a medicines record needed to be written or changed by hand, this was always signed and countersigned, all limited life medications inspected were dated on opening, so that they would not be used after their expiry date and where medicines needed to be administered by injection, there were clear records of rotation of injection sites, this prevents tissue damage. However some improvements are needed. A total of 17 medicines administration records had not been completed across all parts of the home, so it was not possible to identify of the person had been administered the medicine or not. Some records stated “O”, which was designated as “other” on the medicines chart. We were informed that the home’s policy is that where an “O” is documented on the chart, that the reason why the drug was omitted should be documented on the back of the medicines administration record. This did not take place in all cases, so the reason for an “O” could not be identified. We were also informed that it is the home’s policy that where a medicine is prescribed on an “as required” basis, that the medicines administration record should only be completed when the drug was given. This was not taking place consistently and many records stated “O” for an “as required” drug. Where a resident wished to self-medicate, as happens in the Lodge, a risk assessment was completed. These were regularly reviewed. Where a resident was prescribed a medicine on an “as required” basis, sometimes care plans were drawn up to direct registered nurses on when the drug was to be administered, but not always. Some residents were prescribed medicines which can affect their daily lives, such as aperients, painkillers or mood altering drugs. Again some people had clear care plans relating to the use of all such drugs, others had care plans which documented some but not all of the drugs and others did not have care plans. Improved consistency in this area is needed. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 17 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 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Residents will be supported as much as they are able to, to continue making choice about their lifestyles, choices and meals. Residents will be helped to continue maintain links with key people in their lives, including family members. EVIDENCE: The Wingfield employs activities staff seven days a week, they provide a range of large group, small group and individual activities. They also try to respond quickly to need. For example during the inspection, one resident with dementia showed complex behaviours and a member of the activities staff was contacted, so that they could support this person. The senior activities coordinator reported that activities programmes are developed according to the current resident group, therefore they may vary over time, depending on how physically active residents are and how much support they need in memory skills. One person reported “there activities here if you want them” and a relative reported “there is a positive activity programme at the home, which is well resourced”. One resident described a recent cheese tasting The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 18 session. A relative commented on the tea dances and a tea tasting session. The activities coordinator reported that the coffee morning was very popular and that she tried to include an activity with each coffee morning. A quiz session was observed to take place in the Lodge on the day of the inspection, activities staff were observed to encourage all people who wanted to, to take part. Mrs Adams reported in her annual quality assurance that the home had recently employed a music therapist to support activities and that this has been beneficial for residents. As part of our short observation, we observed the activities staff involving residents in enjoying the “guess the weight of the cake” prize which they had won at the recent fete at the home. Residents were observed to be actively involved with staff, laughing and talking about chocolate and for some of them, their enjoyment was evident. All residents have an assessment of their needs in relation to social care. All residents’ relatives are requested to complete a life history for their relative, so that this can inform activities staff of how to plan to meet the person’s recreational needs. Activities staff maintain records of which resident is involved in which activities and complete a monthly evaluation for each resident. The senior activities coordinator reported that her staff work actively to support the younger adults with dementia cared for in the home, encouraging them to become involved in recreational pursuits which are suitable for them and supporting them in going out of the home. The home maintains good links with the local churches and is now starting to take some residents out to a local Church of England church, to attend services. Trips out are organised and the home has its own minibus, which can take disabled people. Where residents do not wish to or are unable to leave their rooms, the activities staff report that they try to perform 1:1 support. One resident reported “I spend all my time in my room, I’ve got lots of my own things”. However other people felt that more support was needed in this area. One relative reported “The Wingfield has an activities programme but [my relative] does not enjoy group activities, therefore [my relative] lacks stimulation during the day other than during meal times (taken in [the resident’s] room) and care giving”. Activities staff agreed that 1:1 opportunities for people who needed them could be limited at times as other people, such as the resident who showed behaviours documented above, needed urgent attention. It was also reported that providing 1:1 activities by care staff to support activities staff was sometimes complex, due to the pressure on their time needed to give care. The Wingfield works hard to maintain its links with the local area. For example on the Saturday after the first day of the inspection, the home held their annual fete, which was reported to be well attended. As well as links with local churches, they use local entertainers and volunteers to support residents. All senior staff spoken with reported that residents’ relatives and other visitors are The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 19 regarded as crucial in helping residents to maintain links with their past lives. One person reported how much they appreciated that “My visitors come when they want, they will provide tea or even a lunch”. During the inspection, we met with many relatives, all of whom reported that they could talk to staff about their relatives’ needs. Staff were observed to try to foster choice in this complex speciality. Staff reported that they tried to support people in small but significant areas, such as choosing what they would like to wear or where residents were not able to express this, finding out from relatives how they had liked to dress in the past. This was supported by records. Most residents were not able to express choice of when they preferred to get up and go to bed, so staff reported that they used on knowledge of what a person had done in their past lives. For example one resident had been a farmer and staff reported that the person appeared to prefer to get up early, as that had been their former lifestyle. One resident reported “I like to be up by 10ish” and that staff respected this. We talked to a range of staff about daily routines and all assured us that there was no system for getting up a certain quota of residents by a certain time in the morning or putting a certain quota to bed by a certain time in the evening. The catering department have worked hard to foster choice. The home have stopped sending menues out and care staff now take the choice of meals to residents at mealtimes for them to look at, so that they can indicate which choice they would prefer, at the time of the meal. This was observed to operate effectively in practice during the inspection. Residents were also observed to be able to make other immediate decisions, for example, one resident asked for a particular meal but without the gravy and another asked for part of their meal to be pureed, so that they could eat it more easily and staff promptly responded to these requests. The chef is highly motivated. She showed a detailed knowledge of all of the residents in the home, including their specific preferences. This is good practice, considering this is a registration for 89 beds. She also showed a knowledge of special diets and reported that she had received recent training on diabetic diets. She reported that she had also been trained in dementia care and so was aware of the importance of texture, colour and flavour of meals. Most foodstuffs are locally sourced and fresh deliveries take place every day, apart from Sundays. All meals are cooked up from raw ingredients. Catering staff serve all meals, so that they can ensure that foods are properly presented, receive comments from residents and observe how residents who have a difficulty in communicating, responded to their meals. Residents can eat in one of three dining rooms or their own room. All three dining rooms were nicely presented, with a hotel-style appearance, including cloth tablecloths and hotel-style crockery and cutlery. Staff were available to support residents at mealtimes, sitting with them and assisting when needed. There were clear systems to ensure that all residents received their meals and The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 20 this is important in this field where a resident may find it difficult to sit down or remain in one area for the whole meal. For example one resident started their meal in the dining room, then got up and went to their room for their dessert. Staff were also observed to closely observe residents so that if they lost concentration on what they were doing during a meal, they could be supported in continuing to eat their meal. As would be anticipated in a large care home, where people have a range of opinions and needs, residents and their supporters expressed a range of opinions about the meals. Some comments were not favourable. One person reported “the food is of a poor quality. Especially considering the fees”. However this was not echoed by most people and other comments ranged from “provides good meals - good quality ingredients, well prepared”, “the food’s very good and varied”, “particularly the food’s very good” to “I’ve only had one meal that was not excellent”. People commented on the choice. One person reported, “if I don’t like it they give me something else, salad and the like”. Relatives commented on how well presented the meals were. One person reported “what I’ve seen of the food it looks pretty good”, another “the meals look very good, [my relative]’ll eat everything you put in front of [them], and another that their relative “likes the tea time – always home-made and smells delicious.” One relative commented on how staff understood what their relative liked to eat, reporting [my relative is] “confused at times but they know what [my relative] likes and how [my relative’s] drinks are and give it to [them]. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents and their supporters will be able to raise complaints and have their interests safeguarded by the home’s policies and procedures. EVIDENCE: The home has a complaints procedure, which is displayed and is available in the service users’ guide. Of the 14 people who responded to this section of the questionnaire, 12 reported that they knew how to make a complaint. People largely felt that complaints were listened to and acted upon by managers. One person reported “we have made a couple of formal complaints and they have been addressed satisfactorily”, another “you can talk to the manager, she’s very reassuring” and another “I went to see [the manager] about something I was not happy about, I thought it would take a while to sort but she did in two or three days”. However one person did report “often complaints are made but nothing is done about it”. People also felt that they could raise informal issues. One person reported, “If I’m not happy, oh yes I can talk to the staff”, another “petty little things but I’ve brought them up” and another “you can talk to the staff, they’re never defensive”. The complaints register was reviewed during our visit. The register only includes formal complaints made to the manager, not other issues. Those reviewed had been responded to in accordance with the home’s policies and The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 22 procedures. However the responses to the questionnaire and discussion with people, as detailed above, indicated that several people felt that they had raised matters as complaints or concerns but these were not documented in a formal manner by the home. It is advisable that this takes place, so that as part of her quality assurance process, the manager can assure herself that all matters which have been reported informally have been addressed and in a consistent manner by her staff. One concern has been raised with us by an external healthcare professional, this was referred back to the home and had been dealt with in full. One anonymous complaint was made to us since the last inspection. This was also investigated by the provider and a full report sent to us of the investigation carried out. No action points were identified following this anonymous complaint. The home has a clear safeguarding procedure for protecting vulnerable persons. Records showed that all staff have been trained regularly in this area. Staff spoken with were aware of their responsibilities in relation to this procedure, this included staff such as the chef and the laundress. Staff were aware that residents with dementia care needs can experience a range of behaviours, some of which may include verbal and physical violence. As noted in Health and Personal Care above, the home has systems for managing such behaviours, supported by full documentation. The incidence of violent behaviours between residents would appear to be lower than other such similar homes, although unfortunately, they do occur occasionally. Some staff experience violence from residents. Again, when this occurs, there are clear policies and procedures for staff to follow, supported by full documentation. Two of the registered nurses reported on how they supported junior staff if they were subjected to verbal or physical violence from residents and that they always allowed staff to take some time out, away from the floor if they reported that they were feeling stressed by a particular situation. The home have made referrals via safeguarding policies in support of vulnerable people, so that appropriate agencies can safeguard the resident. No safeguarding referrals have been made about the home by external agencies since the last inspection. One person did go missing from the home since the last inspection. The home contacted emergency services about this, in accordance with their procedures and the person was found later on in the day. A full investigation was then carried out into this occurrence and discussions held with the referring agency and necessary adaptations made to the home, to ensure the safety of the resident in the future. The home tries to reduce the use of restraints as much as possible. Most residents were cared for in profiling beds, as low to the ground as possible, with crash mats on the floor. Where safety rails were indicated, there were clear care plans about their use. These care plans are regularly reviewed. One resident was noted to have a lap belt. Their records showed clear evidence of an assessment for this belt. This was also regularly reviewed. As many of the residents in the home have dementia care needs, some are prescribed moodaltering drugs to support them. It was observed that use of such drugs, which The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 23 can be regarded as chemical restraints, were kept to a minimum and were generally only prescribed on the advice of a clinician with expertise in the area. While we did observe during the inspection, that some residents spent much of their time asleep, including during our short observation, records and discussions with staff indicated that this related to the advanced stage of their condition, not the use of mood altering drugs. As noted in Health and Personal Care above, whilst some residents had care plans relating to the use of moodaltering drugs, this was not consistently applied for all residents. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are cared for in a safe environment which meets their needs, with high standards of equipment to meet disability. While hygiene standards were high in some areas of the home, they were not in others, and this could have the potential to put residents at risk of cross infection. EVIDENCE: The Wingfield was purpose built as a care home and the Lodge was fully refurbished and up-graded to provide its present standards of accommodation. All rooms are single and all have ensuite, although certain rooms in the Lodge can be used as double rooms, if an established couple wish to share. All rooms exceed National Minimum Standards for room sizes. This means that each room can be laid out according to resident preference and nursing need. The maintenance person is enthusiastic in his role and was fully aware of his The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 25 responsibilities. He maintains clear maintenance records. Staff reported that he responded quickly when issues were identified. There are a wide range of communal rooms across both buildings. Some communal rooms are large and are supportive of large group activities, others are smaller, so that smaller groups can take place or a resident can just sit quietly with a visitor. The Lodge has a garden area at the front of the building and the main building has an attractive courtyard garden, with a range of features for residents to enjoy, in the centre of the building. The area is fully enclosed, so that residents can walk here as they wish, without risk to themselves. There is also a small garden to the side of the main building which is attractively laid out. The manager reported in her annual quality assurance that a wheelchair friendly pathway has now been completed in the garden at The Lodge, and the internal garden at the main building has been improved with the removal of the old fountain and the installation of a new one, the creation of more seating areas and the erection of an awning. All of the building is secured by number locks, which are linked to the fire alarm system. Stairways, lifts and support facilities like the laundry are also provided with number locks, to ensure that residents are kept safe from risks which they might not be aware of. It was noted as good practice that a member of staff who had not met with us before, stopped and asked us what we were doing, when we first came into their part of the building. Residents expressed their appreciation of the accommodation available. One person reported “I’ve got my own toilet and shower and that’s nice” and another “It’s a nice view”. Residents reported that they could bring their own items in from home if they wished and some rooms were highly individual, reflecting the person’s likes an preferences. We discussed with staff if residents who wander into other peoples’ rooms might take some of their personal items. Staff reported that this was comparatively rare and where it was an issue for an individual resident that they used pressure pads to alert them. Actvities staff have placed a range of different items in corridor areas which residents could handle and move. For example in one corrior area there was an old-fashioned pram, with baby clothes hanging on hooks above, in another area there was a chest of drawers with beads and items to handle, in another an old typewriter. The availability of such items in corridor areas reduced residents’ inclination to go into other residents’ rooms and handle or remove their possessions and also provided interesting areas for them to walk in. There is a very wide range of equipment provided to meet residents’ needs. All beds are variable height and fully profiling. A full range of equipment is provided to prevent pressure damage. Where residents need specialist wheelchairs, the home supports residents in obtaining assessments and ensures that the wheelchair is used only for them. A range of chairs are provided, including recliner chairs. Hoists are available to assist people who cannot move themselves. More equipment is provided when needed. One residents reported, “they’ve just got a new hoist here”. In areas where The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 26 specialist equipmment was not needed, the standard of furniture and fabrics remained high, similar in appearance to a good standard hotel. We reviewed the Lodge’s electronic monitoring system for response time to the call bell. The printout showed that for the 10 days before the inspection, no response times had been over three minutes, this included evenings and weekends. We also supported a resident who was not able to use their bell independantly and a member of staff attended in under two minutes. The Wingfield has a main kitchen, with three smaller support kitchens for heating up meals and providing small snacks and drinks. The standard of cleanliness in the man kitchen is high and the home recently achieved a five star assessment from the environmental health department. The standards of the support kitchens are not so high. During the inspection, we visited two of these support kitchens. In both of them the microwave ovens showed signs of splashes of food, which had dried on. One of the hand wash basins was not clean, it had a dripping tap and the surround showed signs of black staining in the edge sealant. The maintenance man reported he had not been informed of the dripping tap. A crack was visible in tiling under the dishwasher. In the other support kitchen, the sink was stained and some of the covering of the surfaces was coming away. The floors of both rooms showed white staining in places, presumably from lime scale. These issues were reflected in other support facilities. In one cleaner’s cupboard, parts of the floor were stained with white in the angles and some were showing signs of yellow/brown staining. A wet mop had been left in the bucket sink, the sink was stained yellow/brown. Leaving a mop in such circumstances can be a risk to cross infection. The main laundry showed a build-up of dust and debris behind the washing machines. It was reported that the area was awaiting repair after the installation of a new machine. This is appreciated, but in the meantime all dust and debris must be removed from all laundry floors, to prevent risk of cross infection caused by dust and debris being transferred out of the laundry on peoples’ shoes. The sink in the laundry was also stained. There is a small laundry in the Lodge. It was reported that items such as tablecloths and residents’ woollens were washed here. This room was inspected twice during one day, on both occasions, there was a net bag of residents’ clothes left on the floor and items were spilling out onto the floor. The floor was not clean, with washing powder and dust visible. It was discussed with Mrs Adams that all these matters could present a risk to cross infection. It was agreed that a member of staff would be allocated to perform an audit of subsidiary kitchens, laundries and cleaners cupboards and an action plan drawn up, including identifying responsibilities for performing certain roles and for supervising that they take place. All other parts of the home were clean, this included the undersides of dining tables, down the edges of chairs and the backs of bath hoists. Mrs Adams reported in her annual quality assurance that all curtains are now washed on a six monthly rolling programme. It was noted that from time to time, parts of The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 27 the home showed odour, however on return, the odour was not longer evident. This is much to the credit of cleaning staff, as many of the residents experience double incontinence and/or would not always be aware of how to use toilet facilities. Most of the wheelchairs were clean, however a few were noted to show encrusted items, probably contaminated food. Whilst the home has a procedure for cleaning such items, it may be that some wheelchairs will need more attention than others, due to the abilities of different residents. Staff were observed to wear protective clothing when needed. Different protective clothes were used at mealtimes. Whilst giving care, staff used gloves and aprons. It was observed that staff removed these and disposed of them correctly when they had finished giving care. Registered nurses reported that they had good supplies of sterile gloves for aseptic procedures. The laundress reported that she had a ready supply of gloves. She also reported that staff consistently followed the home’s policy and procedure on separation of infected and potentially infected laundry. It was also noted as good practice that the home has continued their policy for staff uniforms, where all staff uniforms are laundered in-house and staff come in on duty and go home in their own clothes, thus reducing risk of staff taking micro-organisms out of the home or bringing them in to the home. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 28 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Management is aware that action needs to be taken to ensure its own policies on safe recruitment of staff are always adhered to. Staff numbers and roles are regularly reviewed, to ensure that residents’ needs can be met. Residents are protected by the home’s staff training programmes. EVIDENCE: Both buildings and both floors of the Wingfield are staffed separately for care and registered nursing staff, although staff may work in any areas of the building if needed. There are separate teams of catering, housekeeping, maintenance, activities and administrative staff. People we spoke with expressed a range of opinions about staffing levels. These varied from “there are inadequate levels of staff in this home to the point where I have been seriously concerned about the safety and welfare of residents”, through “we feel strongly that most of the staff are dedicated and caring but are VERY overstretched” or “the main problem is lack of staff at times” to “staff are always available – there’s always someone about”. Similar responses were made about response times to the nurse call bell. One person reported “sometimes takes a long time to answer the bell”, while another reported “it’s a short response when I ring for [my relative]. This variance was echoed by staff, some feeling that there were enough staff on duty to meet residents’ The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 29 needs, others that there were not enough to provide individual support, particularly for 1:1 supports and activities. Mrs Adams reported that managers from Barchester Healthcare keep staffing levels and skill mix under review to ensure that residents’ needs can be met. For example carers no longer perform catering assistant roles such as giving out drinks. During the inspection we spent time in the lounge in the Lodge. For most of the time during the morning, there were no members of staff available to support residents. There was a hostess in the vicinity, but she had other duties to attend to as well. This was discussed with Mrs Adams, who reported that the hostess was supposed to supervise residents in the lounge more closely and that she would take action to ensure that this takes place in the future. It was also observed that a member of staff came into the lounge in the late morning, in her own time and sat with the residents, who visibly relaxed once she was there. During our short observation in the main house, we noted in the lounge we were in, that the residents spent much of their time without direct support from staff, who were occupied with their duties elsewhere on that floor. We did observe that all members of staff who went past the lounge consistently looked in through the door and the corridor window, to check that residents were safe and not in distress and that a member of staff did this at least once in every five minutes and sometimes more often. However as staff were engaged with other duties they did not come in to the lounge. None of these residents exhibited complex behaviours towards themselves or other residents. Two of them spent much of the observation period asleep, one was actively engaged in watching television, one spent some of the time quietly talking to some soft toys and another person was making folding, unfolding and patting movements with their hands or waving to members of staff in the corridor or people in the car park outside. Mrs Adams provided us with information in her annual quality audit about staffing. This showed that agency staff have not been used for a period of time. It also shows that the home has a central core of staff who have been employed in the home for several years and many of the staff on duty recognised us from previous inspections. The home does also have a turnover in staff. Figures included in the annual quality audit indicated that this is something in the order of 27 . However, there was evidence that some of this turnover relates to newly employed staff who find that this speciality is not what they want to do. Some turnover also occurs when employers, such as supermarkets, who tend to offer higher wages, perform recruitment drives. The home actively supports equal opportunities for all staff, including those from ethnic backgrounds. During the inspection, we reviewed files of three staff employed during the past few months. All files included police checks and application forms or cvs and had proof of identity on file. Some photographs were photocopies of driving licences or passports and as such would be difficult to use as proof of identity. All staff were given terms and conditions of employment and job The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 30 descriptions. We reviewed a file for a person from aboard and it showed relevant documentation to prove that they were eligible to work in this country. Only one of the files looked at showed evidence of a interview assessment record and this record did not indicate that the person’s strengths and weaknesses had been considered in any detail. Mrs Adams reported that since she came into her role, she has identified shortfalls in compliance with the providers recruitment polices and procedures, for example in checking gaps in employment records and correct references. As the home employs a large number of staff, she is planning that all staff files will be fully audited and all shortfalls addressed by early 2009. One of the administrative staff has been given the role of supporting her and her deputy in this action. During the inspection, we discussed training with staff and met with the training manager. The training manager works 20 hours a week and she is supported by a second person who works six hours a week. This person supports staff on induction. The provider has standard systems for induction of new staff, which complies in full with guidelines. All new staff are allocated to a mentor, who supports them and reports back to the training manager(s) on progress. During the inspection, we met with one person who had recently moved from being a member of the ancillary staff to being a member of the care staff. They reported that they had first supported the induction of the person who had come into their role and had then received an induction into their new role. They reported that they had found this support helpful in understanding their new role. We met with one of the senior care staff who were able to describe how they supported new staff in their role and they showed an understanding of how stressful it could be for a new employee who was unfamiliar with the complexity of caring for people with dementia. The annual quality audit indicated that over 50 of care staff are trained to National Vocational Qualification level two or above. It was reported that there had been a period when, due to the training manager’s absence, this had lapsed, but that now she was back, she is working to ensure that all care staff are supported in progressing towards the qualification. All staff receive mandatory training in areas such as fire safety or manual handling. This is supported by computerised records which use a traffic lights system to indicate when staff are due to be trained in these areas. Many of the current staff have been trained in dementia care, this includes the chef and there is a rolling programme to ensure that all staff receive training in this speciality. Staff spoken with reported that they felt that training was supported by the home. One registered nurse reported that she used handover to up-date care staff on matters relating to resident care and nursing needs. The training manager reported that training had been provided in a range of areas, such as tissue viability or dietary care. Attendance lists for such training are available, but these were not crossed over to individual staff records. We were advised that where a resident needed an appliance that could be fitted by a carer, such as a colostomy bag, care staff were trained in The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 31 the procedure. The home currently does document on individual staff files when training in such skills takes place. It was discussed that skills and topic training should be documented on individual staff records so that management can ensure that all staff have been trained in areas relating to resident need. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 32 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, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The manager is taking steps to ensure that the providers policies and procedures are followed. The provider is able, by its quality control systems to ensure that action is taken to address shortfalls and ensure that the principals of health and safety are up-held. EVIDENCE: The previous manager of the home left her post since the last inspection. Her deputy, Mrs Adams was appointed by the provider as the new manager, she was approved by us to be the registered manager in July 2007, in accordance with our established procedures. Mrs Adams is a registered nurse. Mrs Adams is supported by a deputy manager, who has come into post very recently. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 33 Since the last inspection, Mrs Adams has taken steps to address the one requirement and has addressed all, apart from one recommendation. People expressed a range of opinions about management availability. One person commented “I have never seen a member of the senior management team on the shop floor out of office hours or at weekends”, however another reported “when I come in the front there’s always some one there, it’s just the same at weekends.” The home does have management review systems in place, for example there are regular systems for review of residents records and it was clear from this inspection that much work as been put into improving the quality of resident records, to reflect the diverse needs of people in the home. The manager is also, as noted in Staffing above, in the process of performing a full audit of employment records and putting in an action plan to deliver improvements. Barchester Healthcare has standard systems for review of quality of care provision. This includes sending out questionnaires to residents, their supporters and staff. These are collated centrally and reports made back to the home if relevant. Mrs Adams reported in her annual quality review that the Wingfield recently came first in the whole of Barchester Homes in a survey for customer care when dealing with enquiries, scoring an average of 91 . Mrs Adams also reports that she uses care reviews actively as a method of assessing quality of service provision. Barchester Healthcare reviews, among other areas, incidences of pressure damange, infection and accidents. The home is visited reguarly by a senior maanger, who complies a report. Visits can take place throughout the 24 hour period and have been known to take place in the very early morning. They are always unannounced. Barchester Healthcare has standard systems for management of residents’ moneys. All charges for sundries such as hairdressing and chiropody are invoiced to residents’ supporters monthly. Full records of receipts are maintained, to ensure that charges can be properly tracked. Barchester undertakes annual audit of accounts and additional unannounced audits take place at times. Where issues are identified relating to payment of accounts by third parties, Barchester has established procedures to ensure that residents are supported and bills properly paid. All staff are regularly supervised and, as for training, Barchester Healthcare has a computerised system to ensure that staff are regularly supervised. Supervision is delegated by the manager to appropriate persons in the organisation. Records seen were brief but notes were made of matters discussed, particularly training needs. It was discussed that the manager might find it beneficial to regularly audit supervision records, so that she can identify particular issues raised and the quality of supervisions. Mrs Adams reported that there are systems in place for regular reviews of documentation, to ensure that they meet current guidelines and company The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 34 policy and the effect of this can be observed in developments in care plans. As noted in Health and Personal Care above, some records relating to changes of position for frail people and provision of fluids were not completed contemporaneously and did not indicate that care was always given in accordance with assessed need. A way forward to address this was identified during the inspection, ensuring that such records are reviewed by the person with responsibility for that area of the home at the end of each shift. The home have been working towards carers being more involved in completing documentation relating to the care they have given. Records reviewed showed a variance in quality of such documentation, some were very clear but others needed improvements, including the detail of the care given and observations made about residents’ conditions. Barchester healthcare has established systems which ensure that all equipment and systems are reguarly maintained, in accordance with manufacturers’ instructions. There are systems in place to ensure that hot water temperatures are monitred and electrical items tested for safety. All staff are trained in areas relating to health and safety such as fire safety and manual handling. Staff at all levels all reported that they had been trained regularly in such areas. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 35 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 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 4 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 3 The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 36 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. 1. Standard OP9 Regulation 13(2) Requirement All records of administration of medicines must be completed in full at the time drugs are administered to the service user. All staff must comply at all times with the home’s own policies and procedures on the documentation of omitted medicines and “as required” medication. An audit of all laundries, support kitchens and cleaning cupboards must take place and an action plan developed to ensure that all areas and equipment are clean, in full state of repair and that all staff perform their roles effectively, so as to reduce risks of cross infection. The chassis of all wheelchairs must be clean at all times and any encrusted matters be promptly removed. The manager must complete an audit of all staff files and rectify any shortfall in information, in accordance with the provider’s policies and procedures. All records of care given to frail DS0000032366.V364443.R01.S.doc Timescale for action 01/10/08 2. OP9 13(2) 01/10/08 3. OP26 13(3) 01/11/08 4. OP26 13(3) 01/10/08 5. OP29 19(4,b,i)S 2 28/02/09 6. OP37 17(1,a)S3 17/08/08 Page 37 The Wingfield Care Home Version 5.2 (k) people, must be completed in full, in accordance with care plans and service user’s needs. Records must be completed contemporaneously RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Records relating to a service user’s dietary intake should state what they have been given to eat, rather than just that the meal was pureed. This recommendation is un-met from the previous inspection. Where service users are assessed as being at high risk of pressure damage, all care plans should state how often each individual needs to have their position changed All fluid charts should be totalled once every 24 hours and the information used to assist in care planning and reducing risks of dehydration. If a service user’s needs indicate that they need regular observation to ensure their safety, a record should be maintained of these checks. Where service users need thickening agent in their drinks, all care plans should state how thick the individuals need their drinks to be to enable safe swallowing. Where service users are prescribed medication on an “as required” basis, there should always be care plans in place to direct staff on the indicators for their administration. Where service users are prescribed medicines which can affect their daily lives, there should always be care plans in place, to enable evaluation of the effectiveness of the drug for the individual. A documentary and monitoring system should be put in place for all concerns raised with staff, so that managers can review trends and effectiveness of response by staff. Documentary evidence should be developed to demonstrate that residents in the lounges in the main DS0000032366.V364443.R01.S.doc Version 5.2 Page 38 2. 3. 4. 5. 6. 7. OP8 OP8 OP8 OP8 OP9 OP9 8. 9. OP16 OP26 The Wingfield Care Home 10. 11. 12. 13. OP29 OP30 OP36 OP37 building are not left unobserved for extended periods of time. Photographs of staff held on file should be clear enough to be used as a proof of identity. All training given to staff should be included on their individual training records, so that managers can assess staffs’ ongoing competency to perform their role. Supervision records should be regularly reviewed, to identify trends and areas for development. All daily records relating to provision and observations of care made by care staff should be fully completed and to the same standard. The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Wingfield Care Home DS0000032366.V364443.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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