Care Home: The Winsor Nursing Home

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What the care home does well People spoke positively of the care at the home. One person who had recently come to live in the home said, "They are very good here. Very kind. There is plenty of food." Another person said, "People are kind, the room is lovely" but added "but this fish is awful. I wont have it again." It could be seen that people had a choice of meals and that some people were eating bacon and egg or salad. Some people have lived in the home for many years and have established as one lady said "my own way of going on."The home has 13 beds funded by Somerset Community directorate and a recently held review confirmed that the manager and staff at the home were pro-active in meeting peoples` needs. The environment of the home is pleasant and well maintained. There are bedrooms that are light and attractive with views of the surrounding town and countryside. A stable core of staff has enabled care practice to develop and improve. The manager Mr Iver Klingenberg and deputy act as advocates for people in the home and try to ensure that peoples` needs are met through liaising with other agencies. What has improved since the last inspection? The last visit to the home was a random inspection as a result of a complaint about inappropriate care. The manager had used the requirements made at this random inspection as the basis of one to one supervisions with all staff. The areas of discussion included knowing the procedures in the home to safeguard people and whistle blowing policies and procedures in the home. There has also been training provided around the care and management of people with some behaviour difficulties and person centred care. CARE HOMES FOR OLDER PEOPLE The Winsor Nursing Home 54 The Avenue Minehead Somerset TA24 5AW Lead Inspector Shelagh Laver Unannounced Inspection 2nd May 2008 10:00 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 Winsor Nursing Home DS0000061582.V362518.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 Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Winsor Nursing Home Address 54 The Avenue Minehead Somerset TA24 5AW 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) 01643 707870 01643 707871 iverkilngenberg@sanctuaryhousing.co.uk Sanctuary Care Limited Mr Iver Klingenberg Post Vacant Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named person aged 45 - 64 years for General Nursing Care Three places for Respite Care for people aged 45 - 64 years, for a period of up to 28 days 24th July 2007 Date of last inspection Brief Description of the Service: The Winsor Nursing Home provides nursing care for 43 persons over the age of 60 years. The home is situated in Minehead, a short walk from the seafront. The accommodation is arranged over three floors serviced by a passenger lift. The accommodation is provided in 38 bedrooms that include 33 single en-suite rooms. The home is adapted appropriately for the people who live there. There are assisted bathrooms and disabled toilet facilities. There is a spacious communal dining room and three lounge areas. A Registered General Nurse is on duty at all times and links are made with a network of health services to meet service users’ needs. The home has been owned by Sanctuary Care Ltd. since 27th July 2004. Fees range from £505 to £635 The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. Two visits were made to the home. The inspector was able to meet with people living and working at the home, observe care practice, tour the building and view records. The inspector was given unrestricted access to all areas of the home and all records requested were made available. An Annual Quality Assurance Assessment (AQAA) was received in 2007. This gave details of the homes achievements and plans for the coming year. It also supplied some numerical information. At the time of this inspection there were 29 people living in the home. The home has a block contract with the local authority for 13 beds. Comment cards were sent to a sample of people who use the service, their relatives, health professionals and care managers. Two comment cards were returned one from a person who lived in the home and one from a relative. What the service does well: People spoke positively of the care at the home. One person who had recently come to live in the home said, “They are very good here. Very kind. There is plenty of food.” Another person said, “People are kind, the room is lovely” but added “but this fish is awful. I wont have it again.” It could be seen that people had a choice of meals and that some people were eating bacon and egg or salad. Some people have lived in the home for many years and have established as one lady said “my own way of going on.” The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 6 The home has 13 beds funded by Somerset Community directorate and a recently held review confirmed that the manager and staff at the home were pro-active in meeting peoples’ needs. The environment of the home is pleasant and well maintained. There are bedrooms that are light and attractive with views of the surrounding town and countryside. A stable core of staff has enabled care practice to develop and improve. The manager Mr Iver Klingenberg and deputy act as advocates for people in the home and try to ensure that peoples’ needs are met through liaising with other agencies. What has improved since the last inspection? What they could do better: There is an on-going issue in the home with regard to the amount of time people spend in unadapted wheelchairs in the sitting room. This was discussed with the manager who feels that some people choose to stay in their wheelchairs. It is important that this practice is kept under constant review and that the practice truly reflects personal preference and not staff routine. People should be closely observed to ensure that they are comfortable and are offered a choice of seating. This issue was an item on the most recent supervision and is noted on the records. Staff should also be aware of how they address people in the main lounge so that private matters cannot be overheard. It is important that the date that a person actually starts duty at the home is clearly recorded. The manager confirmed that it is home practice that people do not start work until references are received however it took some time to verify this and it would be helpful if the actual date staff start work is clearly noted. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 7 The home has never had a private outside garden where people could sit. Plans have been submitted and it is to be hoped that the new garden area will enhance people daily living. 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 Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. There is a range of information available for service users and their representatives. Assessment documentation is available and there is a procedure in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of four people who lived in the home were examined. They contained evidence of assessment prior to admission. In addition to the documentation completed by the home files contained discharge letters from hospitals and assessment documents completed by other health professionals. There was evidence that assessments are up-dated to ensure the home can still meet peoples needs. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. Individual care plans are clear and regularly up-dated. People’s health needs are met by the home and visiting health professionals. People are treated with kindness and respect. There is a safe medication system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken with during the inspection said that they were well looked after and that a doctor would visit when they needed one. Four care plans were reviewed. A clear system of care planning is used and all people have a care plan in place. There is a formal system in place to ensure that plans audited and up-dated however one plan needed up-dating to show the increased care needs. There is attention to diet and the nutrition of people. One plan showed that a person with a low weight was receiving food supplements and was gaining The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 11 weight. Another plan showed that the person’s weight was recorded regularly and was increasing slightly. In peoples rooms there were records relating to the maintenance of nutrition and fluid balance feeds and drinks When frail people remain on one position for too long skin damage can occur. The home currently monitors people who have any pressure damage closely. People are supplied with pressure relieving mattresses. There were records that people had their position changed regularly. Whilst one file had a clear plan to prevent pressure damage for someone at particular risk but currently without damage others were not so clear. It is important that people at high risk have a robust preventative plan of care and that this is monitored as a priority. When a person is experiencing pain a care plan should be recorded as to how that pain may be relieved. One care plan for example mentioned a seating plan but did not refer to the medication the person received. It is also important that when a wound has healed it is clear from the records that this is the case. In one plan records ceased abruptly without any final outcome although the wound had healed some time ago. Peoples’ general appearance showed evidence of care and attention to personal care. Staff should be reminded to leave peoples combs and brushes clean following personal care. There was evidence that a range of health professionals visit the home on a regular basis. General Practitioners, specialist nurses and chiropodist’s visits and input were recorded. People who were frail were seen to be resting comfortably in bed. Staff were seen to speak respectfully and kindly to people. The medication system appeared safe and records kept were accurate and comprehensive. There are records of prescribed creams applied. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 12 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 adequate. People can chose how they spend their time in the home. There is an activities programme in place that could be further developed. Meals are wholesome and there are choices available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People confirmed they could choose where they spent the day although they are encouraged to come down for lunch. Ten people were in the sitting room at coffee time. Others preferred to spend time in their bedrooms and were able to talk about visitors, newspapers and the television. There was a list of trips displayed in the dining room. People had been to gardens and the seafront. There are activities in the sitting room however more attention could be given to meeting peoples’ individual preferences. All aspects of the home life can contribute to a person’s well-being and this includes choice of music. Visitors are welcome in the home at any time and some spend a great deal of time in the home. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 13 People confirmed that the meals were usually tasty and food was plentiful. There is a choice of food and people can have “something special” if they are not able to eat the main meal. People were observed eating meals in the dining room or in their rooms. People are given assistance when required. Staff sit down and are expected to give all their attention to the people they are assisting. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 14 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. People spoken to during the inspection knew who to speak to of they had any complaints. Staff has received training in protection of vulnerable adults. People told the inspector that staff were kind. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are policies and procedures in place to protect people in the home. The manager recently activated these procedures and has been vigilant in ensuring care practices in the home are monitored. The most recent supervision received by all staff was linked to issues raised at the last random inspection. There is a robust system to manage peoples’ finances in the home and examples of records and balances were seen. The company carries out a system of spot checks to ensure all records are accurate and current. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 15 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 26 Quality in this outcome area is good. People live in a safe well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following substantial recent substantial upgrading and decoration including a new kitchen the home is now organised and peaceful. Overall the home is clean and well maintained. Communal rooms and peoples bedrooms were attractive and comfortable. Some bedrooms have lovely views of the surrounding countryside. There was plenty of clean linen and towels available in the home. Attention should be paid to the cleaning of some items used regularly such as trays. Although the outside of the home is well maintained there has never been a private accessible garden for people to use. This is now being addressed by the development of the garden area at the side of the house and will provide a welcome addition to the home. Plans were seen for a space that can be The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 16 accessed directly from the home and will offer people chance to spend time outside. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 17 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 good. There is evidence of thorough recruitment practices in the home. Staff have received thorough induction and training in the past year. There is currently good retention of staff in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently no staff vacancies at the home. Over the past months the manager has ensured a balance of male and female staff that now allows people to make a choice if they feel strongly about who cares for them. These preferences are recorded. A new member of staff confirmed that there had been a structured induction and that checks had been completed before his employment had commenced. A trained nurse on duty confirmed that she had been on several training days recently. These included care for people with dementia, dealing with challenging behaviour and fire and manual handling up-dates. Four staff files were reviewed including those newly recruited and established staff. Files were well- organised and contained job profiles, appropriate preinspection checks and health checks. There are interview records and these should always be signed and dated. The home has recruited two people from accession states and the manager was reminded that “To whom it may concern references” are not acceptable and this must be addressed with the recruiting agency. POVA checks are The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 18 completed as soon as people from these areas have an address in this country and arrive with checks completed in their own country. The date that people actually start work at the home must be clearly displayed on files as the current system can be misleading. The established staff files showed performance reviews and supervision. Training is delivered in the home using a system of trained in-house trainers and standard assessments that can generate certificates. In this way staff had received training in Risk Assessment and People Centred Care. It is important that the manager regularly reviews the ways in which this training programme relates to practice. It is also important to ensure that all staff, but in particular the trained nurses have access to appropriate outside training and are supported to maintain and improve clinical skills. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 19 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. The home is well run in the interests of the people who live there. There is an organised system of maintenance. Recruitment of staff was found to meet with regulatory requirements This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is now well established and is supported by the comprehensive systems and paperwork of the corporate provider. The manager addresses issues that arise in the home in an open and forthright manner and works effectively with other professionals in the interests of people in the home. There are sound policies and procedures in the home regarding finance. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 20 The home has clear health and safety policies and implements regular checks and maintenance. Records are of a good standard and are easily accessible. The maintenance records for the hoists and lift were seen. Fire records and preventative systems are in place. The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 21 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 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 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 Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 22 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 OP8 Regulation 12 (1) Timescale for action There must be clear plans for the 01/08/08 prevention of pressure damage for all people who are assessed at being at risk. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP20 OP8 Good Practice Recommendations The external space at the home should be reviewed in order to provide an area that is accessible and suitable for service users. (Plans submitted.) The home should continue to review the practice of using unadapted wheelchairs to ensure that people do not sit in them longer than is necessary. There should be details in the care plan of the ways in which people can have their pain relieved. The home should not accept “To whom it may concern” references from any new staff. The manager must review the provision of social activities to ensure that people are consulted and involved in the choice music and entertainment. DS0000061582.V362518.R01.S.doc Version 5.2 Page 23 3. 4. OP29 OP12 The Winsor Nursing Home The Winsor Nursing Home DS0000061582.V362518.R01.S.doc Version 5.2 Page 24 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. 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