Care Home: Warberries Nursing Home

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What the care home does well The home provides good clinical care for people who live in the home. Staff communicate well with people living at the home and their relatives. The people who live in the home, and the relatives who were able to comment, appear to be happy and satisfied with the care and service provided. One relative commented, "I would recommend the Warrberries to anyone needing a caring home where they would be treated with respect and dignity" The organisation that goes into preparing the right meal for people was very good. One comment received form a person living in the home was, "I enjoy the meals, there are always very tasty, and I always have choice". The people, who responded in the surveys who live in, or visit the home, said that the staff are kind and caring towards them. Comments received included, "I`m very happy at Warrberries and everyone (all staff) should be congratulated for making it a very happy friendly place to be, home from home" There are various planned activities that are enjoyed by many of the people who live in the home, that have a therapeutic outcome or are just good entertainment. One comment received from a person living in the home said, "I prefer to read or watch the TV in my room, it`s my choice, but am offered activities if I wish" Staff receive the training they need to do their jobs well. They are given the opportunity to improve their knowledge and skills caring for people who have complex health care needs. One member of staff said that they had learnt more about health care and how to manage people`s care since joining the staff team. What has improved since the last inspection? The home has addressed the Requirements and Recommendations made at the last inspection. They accepted the issues as positive feedback about their performance and have worked towards changing practices since that time. Staff training has improved and was focused on the needs of the individual. External health care professionals have been involved with providing support and training for staff. This included the continence nurse advisor. The manager has delegated work to others employed at the home. This has freed up her time to concentrate on the business management and keeping an over view of the care and services provided in the home. The care planning includes social care needs of individuals in the home. The assessment process includes recording what was important to the individual as well as their health and personal care needs. Activities the person takes part in are recorded. The manager has introduced a checklist for regular inspection of the premises, which looks at the home from a service users perspective as well as health and safety. The clutter, which was a problem at the last inspection, has been resolved. Designated storage areas have been identified for equipment needed to provide care such as wheel chairs and hoists. The lounge has new curtains and has been rearranged to present a pleasant space for people who live in the home. Equipment is no longer stored in the lounge. CARE HOMES FOR OLDER PEOPLE Warberries Nursing Home Lower Warberry Road Torquay Devon TQ1 1QS Lead Inspector Rachel Proctor Unannounced Inspection 6th August 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 Warberries Nursing Home DS0000059901.V367669.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. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warberries Nursing Home Address Lower Warberry Road Torquay Devon TQ1 1QS 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) 01803 294563 01803 292219 warberries@yahoo.co.uk www.warberriesnursinghome.co.uk Red Healthcare Ltd Miss Vasanta Marni Suddock Care Home 49 Category(ies) of Dementia - over 65 years of age (2), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (49), Physical disability over 65 years of age (49) Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for Dementia over 65 years (2), Learning Disability over 65 years (1) Old age not falling within any other category (49) and Physical disability over 65 years (49). Two service users who are under the age of 65 years may be accommodated. 8th August 2007 Date of last inspection Brief Description of the Service: The Warberries is a large, extended, grade II listed Victorian property, situated in a quiet residential area of Torquay. The property has sea views across Torbay from some rooms including from the communal areas. The Warberries is currently registered to provide nursing and/or personal care to a maximum of 49 people of either gender who are over the age of 65 years. As nursing care is provided there is a Registered nurse on duty at all times. Red Healthcare Ltd owns the home and there is a Registered Manager, who is also a Registered Nurse, who is responsible for the day-to-day management of the home. The accommodation is provided over 3 floors that are accessed by passenger lift, stair lift or stairs. Adapted toilets and bathing facilities are available for the people who live in the home. The home has nursing equipment, such as height adjustable beds and hoists, to meet the needs of people who require nursing. Communal rooms comprise of a large lounge and a separate dining room on the ground floor, and a large conservatory. There is also a small ‘quiet room. A large entrance hall and reception area provides further seating and contains a pool table. Bedroom accommodation is offered in 41 single rooms and four double rooms, of which the thirty-seven rooms have en-suite facilities. The grounds include seating areas and a swimming pool. Information about the home was found in the entrance hall, people can request a copy of the latest inspection reports from the administration office. There is also an internet website and brochures that provide information about the service and the colourful history of the building. Information given to the Commission by the provider indicates the current range of fees is from £490 to £560 per week. Additional charges are made for chiropody, hairdressing, newspapers/magazines and personal toiletries. Warberries Nursing Home DS0000059901.V367669.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. This was a key unannounced inspection which took place on the 6th and 7th of August 2008. The manager was aware of the second day of the inspection. During the visit a tour of the home was completed. People living at the home and staff were spoken to and some records were inspected. Four people had their care followed as part of this inspection. Their records of care were seen, the individual rooms they occupied were visited. The people whose care was followed were spoken to about their experience of care. Visiting health professionals were also spoken to during the inspection. Information received from the home since the last inspection was reviewed, this included the AQAA (Annual Quality Assessment Audit). Survey forms were returned from three relatives, two staff members and two people living at the home. Some of the comments made during the inspection and from returned surveys have been incorporated into this inspection report. What the service does well: The home provides good clinical care for people who live in the home. Staff communicate well with people living at the home and their relatives. The people who live in the home, and the relatives who were able to comment, appear to be happy and satisfied with the care and service provided. One relative commented, I would recommend the Warrberries to anyone needing a caring home where they would be treated with respect and dignity The organisation that goes into preparing the right meal for people was very good. One comment received form a person living in the home was, I enjoy the meals, there are always very tasty, and I always have choice”. The people, who responded in the surveys who live in, or visit the home, said that the staff are kind and caring towards them. Comments received included, Im very happy at Warrberries and everyone (all staff) should be congratulated for making it a very happy friendly place to be, home from home There are various planned activities that are enjoyed by many of the people who live in the home, that have a therapeutic outcome or are just good entertainment. One comment received from a person living in the home said, I prefer to read or watch the TV in my room, it’s my choice, but am offered activities if I wish Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 6 Staff receive the training they need to do their jobs well. They are given the opportunity to improve their knowledge and skills caring for people who have complex health care needs. One member of staff said that they had learnt more about health care and how to manage people’s care since joining the staff team. What has improved since the last inspection? 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. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Warrberries nursing home are given sufficient information to make an informed choice about whether the home can meet their needs. The assessment process adopted by the manager and staff team ensures that people’s needs are assessed and the care they need identified clearly. This should ensure that people have their care needs met. Warrberries nursing home does not provide intermediate care. EVIDENCE: The statement of purpose was available in the reception area of the home. This provides information for people living at the home and those visiting. The manager confirmed that people living in the home have a copy of the service users guide in their individual room. A tour of the home revealed this to be the case. Four people spoken to during the inspection said they were given information about the home before they came to stay. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 9 Also on display in the reception are the certificates of registration and public liability insurance, and several training certificates for courses staff had completed. Four people had their care followed. All had clear assessments of need, which had been fully completed. One person who had been admitted recently to the home had a pre admission assessment, which had been followed up with a full assessment of their need after their admission. The person said a senior member of staff had visited them before they came to the home. They also said staff had discussed their care needs with them and asked what was important to them. Individual assessments included the health and personal care that a person needed, their dietary preferences and what sort of activities they were interested in. Risk assessments were an integral part of the assessments completed for the four people whose care was followed. These included manual handling risk assessments, nutritional risk assessments, pressure sore prevention risk assessments and risk of falls. The manager advised that individual activities that people chose to take part in were also risk assessed. These included going outside the home and smoking. Warberries Nursing Home DS0000059901.V367669.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): Quality in this outcome area is good. People have a plan of care, which has been developed from an assessment of their care needs - this should ensure that people’s care needs are met. People receive the health and personal care they need. The manager and staff team are knowledgeable about the health care needs of people living in the home. People have appropriate access to health professionals who influence the way their care is provided in partnership with the staff at the home. Medication practices in the home are safe. People are treated with dignity and respect by the staff team who care for them. Their personal preferences and choices are taken into account when care is provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four people living at the home had their care followed. The way their care had been recorded in the plan of care was looked at in-depth. Discussion took Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 11 place with the manager regarding the way two other people’s care was being managed. The care plans reviewed had copies of care management assessments with the home’s assessment where these have been completed. These provided clear information about the assessed needs of the person. Since the last inspection social care planning has been included as part of the care planning process. This provided information about the activities the person enjoyed and what was important to them. Two people spoken to said they had been asked about what was important to them. Care plans had been signed by the person or their representative where possible. The care plans viewed included the person’s self-care abilities and what staff should provide help with. One of the people whose care was followed said staff encouraged them to do the things they could do for themselves and helped them with those they couldn’t. A system for reviewing care plans on a monthly basis was in place. This involved recording the date and the signature of the staff member who had reviewed the care plan. The four people whose care was followed had had their care reviewed monthly or sooner if they care needs had changed. The records of health and professional visits and recommendations made were being recorded separately. These showed that people have access to the health care they need. The manager advised that one person whose care was followed had had their care needs discussed with the continence specialist nurse. The specialist nurse had provided advice and support regarding how to manage this person’s problems with constipation. The advice given by the continence specialist nurse had been incorporated into the person’s plan of care. This included advice on diet, which had already been implemented by the manager. However because so many changes had been made to the person’s plan of care regarding their health care needs it was difficult to follow. A registered nurse was on duty for each shift over a 24-hour period. They provide clinical support and advice to manage people’s health care. The manager confirmed that the registered nurses assess people’s health care needs on a regular basis and when changes occur the care plan was updated. Risk assessments are an integral part of the care planning process. Pressure sore risk assessments are completed and reviewed monthly. When a person has been identified at risk pressure sores equipment was provided. Two people whose care was followed who had been identified at high risk of developing pressure sores had high dependency pressure relief mattresses on their beds. Manual handling risk assessments are completed for each person. These showed a type of equipment and number of carers needed to move the person safely. The manual handling assessments in the four peoples’ care Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 12 plans seen had been reviewed monthly. Five staff spoken to confirmed that they had received manual handling training. One member of the staff spoken to said they had received a manual handling update when they started work at the home. The care plans had a record of the person’s weight. The manager said that these are completed regularly and used as part of the nutritional assessment for individuals. People have access to healthcare professionals. The care plans seen had a record of the health professionals the person had seen. One person whose care was followed said they saw a physiotherapist each week who gives them exercises to do to help them improve. They also said staff helped and encourage them to do the exercises the physiotherapists have recommended. Two people whose health care problems had resulted in a low mood had information in their care plans to direct staff how to assist the person to come to terms with their illness. One person spoken to who had had a stroke said the manager had discussed the care with them and had been really helpful helping them to look at what they were able to do for themselves. They said this had helped them to focus on the positives rather than the negatives. An NHS nurse visiting the home at the time of this inspection was completing the NHS funding assessments for two people living in the home. They said the staff were knowledgeable about the persons health care needs. And were always supportive and helpful when they visited and they had access to all the information they needed. They said they were satisfied that people’s health care needs were being met well. Comments received included Excellent care and support, treated with respect and dignity at all times. All staff very kind and friendly. Always very helpful, nothing too much trouble, cant speak too highly. I would recommend the Warrberries to anyone needing a caring home where they would be treated with respect and dignity. The way medication administration records were completed for the four people whose care was followed were seen. The registered nurse giving the medication had signed these. The reasons for medication not being given were also being recorded. The home has four medication trolleys and two lockable storage cupboards in locked treatment room. The nurse in charge of the shift advised that the trolleys were organised to cover a set area of the rooms people occupied. Two small trolleys, which were to be used for five people each had only just been purchased and had not been put into use. Individual people’s medication were being kept in separate storage trays. Some people had some of their medication in blister packs others were in bottles. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 13 The controlled drug records were checked against the stock for one person as correct. Two other entries in the book identified when medication had been destroyed. The nurse in charge of the shift advised that the ordering system for medication was linked to the medication record sheets and one of the night registered nurses takes responsibility for ordering and disposal of unwanted medication. It was clear from the records being kept in the People’s care plans seen that the registered nurses monitor people on medication and report any concerns to their GP. Staff observed were speaking to people respectfully using their preferred name, which had been recorded in their plan of care. Staff appeared to have a good rapport with the people they were caring for. Staff were involving people in their conversations while they were providing care. Two people spoken to said staff were very friendly and helpful, one saying “I can’t fault the care of the staff give”. Another said “although staff are very busy they always try to help”. People were seeing health professionals in the privacy of their own rooms during the inspection. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 14 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 good. The activities provided are suitable for the people living in the home. People are provided with sufficient information about the activities provided to enable them to make a choice about whether they participate or not. This means that the staff are responsive to what people have told them about the activities they like. Mealtimes are a pleasant experience for people who live at Warrberries nursing home. They are given choice about where they eat their meals and are given the opportunity to choose what they like to eat. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the information about what people are interested in has been recorded clearly in their plans of care. The manager has developed a checklist, which shows what activities people take part in. During the inspection a member of staff took three people out for a drive to Brixham. One of the people who went said they really enjoyed being able to get out. The member of staff said they speak to people before they arrange trips out to find out where people would like to visit. The manager advised that a member of Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 15 staff had been appointed to provide one-to-one support for people on a regular basis to ensure they had the opportunity to take part in activities they enjoyed. The manager advised that questionnaires are completed regarding personal preferences about entertainment and activities when the person is admitted. Examples of these were seen in the care plans view during the inspection. The four plans of care seen contained information about what the person’s interests were and how staff could facilitate this for the person. One person whose care plan was viewed stated they enjoyed painting. Their room had been arranged to enable them to use a small area to carry on with their painting if they wished. During the afternoon of the first day of the inspection and entertainer was playing the organ for people in the lounge. Some were joining in and singing along with the music being played. Two people spoken to during the inspection said they were aware of entertainment being arranged every day on their behalf. However they said they did not always want to take part in the activities provided, as they liked staying in their own room. Information regarding planned activities for the year were provided in the service uses guide, which was available in each person’s bedroom. This gave information about the planned activities for each weekday. These included exercise classes, bingo, organ music and other activities. Two people spoken to during the inspection said there are always things going on and they could choose if they wanted to take part or not. One person said they look forward to the weekly exercise classes. People were seeing visitors in the privacy of their own rooms. One relative spoken to during the inspection said the staff at the home were always very friendly and supportive towards them and their relative. They commented “nothing seems too much trouble for them”. Individual people’s rooms entered during the inspection had been personalised with items of their choice. These included pictures, photographs and ornaments. There was a pay phone in the home and the home has a cordless phone that can be used to receive calls by people who cannot use the payphone. People can have their own telephone line in their room that they pay for and several had taken up this arrangement. The home does not manage the affairs of any of the people who live there but they do collect the pensions for four of the people and have suitable arrangements in place for this. People are able to choose where they have their meals. Some people were eating their meals in the privacy of their own rooms; others were sitting in one of the communal areas or the dining room. Very little wastage was seen at the lunchtime meal served during the inspection. People said the food was usually good and a choice is given. One comment received indicated, I enjoyed the Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 16 meals, there are always very tasty, and I always have the choice. Jenny (Cook) comes to my room and asked me what I would like. The cook on duty at the time of the inspection provided information about individuals likes and dislikes of food and any special diets they had. They said the information was reviewed regularly with the manager or senior person on duty to ensure they had all the information they needed about people’s personal choice and preferences for food. They also said the choice of meals was always available for people. If they didn’t like what was on the menu that day and alternative would be found for them. The kitchen was well set out with distinct areas and good food storage practices. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 17 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 who live at Warrberries nursing home can have confidence that any concerns they have will be dealt with in a sensitive way by the staff team who care for them. Staff have received training in the protection of vulnerable adults and have an understanding of how to ensure people are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home manager has ensured that a robust complaints procedure was easily available for people living in the home and their representatives. The complaints procedure contains information about how to contact the Commission. The manager keeps a record of concerns and complaints raised by the people living at the Warrberries nursing home. These provided information about how individual concerns are taken into account and what actions are taken to address the concerns raised. The preinspection information AQAA (Annual Quality Assurance Assessment) provided information about the number of complaints and concerns received since the last inspection. The record of complaints and concerns was available for inspection. This showed that little things, like drinks not being hot were taken seriously and actions taken to prevent this happening again. People spoken to said they felt staff listen to them and acted to address any concerns they Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 18 raised. The Commission has not received any complaints about Warrberries nursing home since the last inspection. The survey’s return to the Commission prior to this inspection indicated that people knew how to raise concerns if they had any. Comments received included, “The matron always listens and acts on any concerns the family have, likewise the carers on the floor”, Very helpful and friendly care staff, all staff are always ready and willing to listen and they are extremely helpful, I have not had any concerns about mums care, all staff were very efficient, and Im sure that the Warrberries would respond very quickly to any problems. There was evidence in the staff files that showed that all staff had received protection of vulnerable adult training. We talked to two staff who told us what they understood about adult protection, and what constituted abuse. They understood their responsibilities in relation to reporting issues of concern and protecting vulnerable people. Reference material for adult protection was available in the office of the home for staff use. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 19 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 who live at Warberries nursing home have access to several communal areas. This enables people to choose where they spend their time and what activities they take part in. The home’s communal areas are pleasantly furnished and decorated. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located in a residential suburb of Torquay about one mile from the town centre. It has an elevated position that commands good views of the town and Torbay from the front of the home. There is a steep curved driveway to a parking area at the top that has a slight gradient upwards to the front entrance of the home. The exterior of the home has a patio area with seating, and a timber decked area that over looks the swimming pool. The home is a large listed Victorian building that has an interesting history that is given in the homes brochure. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 20 Inside the home there are a number of communal areas of various sizes including a separate dining room and a conservatory that opens out onto the patio area. There are four double rooms and the rest are single rooms of various sizes and with a variety of outlooks. The majority have en-suite facilities or are near toilet and bathing facilities. There are two shaft lifts that provide access to the rooms above ground floor level. The manager advised that the shared rooms were being used as single rooms at the time of the inspection. A tour of the home was completed. Communal areas, bathing and toilet facilities were viewed. Some individual peoples rooms were entered, included all those whose care was followed. The home was found to be fresh and clean in all areas viewed during the inspection. People asked said their rooms were kept fresh and clean. One commenting, “My room is cleaned daily”. People living in the home and their relatives were using all the communal areas during the inspection. One person sitting in the conservatory said they liked to be able to sit quietly and read or look at the view. The preinspection information indicated that repairs and renewals have continued since the last inspection. These included, providing new curtains for the lounge, locks provided for showers and bathrooms and providing selfclosing fire doors. The lounge had been de-cluttered; the fireplace now forms a central focal point for the lounge. This has improved the overall look of the lounge and provides a pleasant place for people to sit. The requirements and recommendation made at the last inspection relating to the environment of the home had been met. Individual peoples rooms entered had been personalised with items of the person’s choice including photographs pictures and ornaments. The manger confirmed that height adjustable beds had been provided for people who needed them. One person whose care was followed had a hospital profiling bed with a high dependency air flow mattress fitted. Cleaners were busy working in the home during both days of the inspection keeping it clean and odour free. There were antibacterial hand gel and protective clothing for staff to use in all parts of the home including people’s private rooms. We did comment on finding some cleaning fluids in easy reach. One sluice room had not been securely closed to people who live in the home, there were cleaning chemicals within easy reach on worktops. One disabled access toilet had a bottle of hand wash Hibiscub on the floor. These risks were addressed before the end of the inspection. The laundry was sited away form peoples individual rooms and kitchen. It was well equipped. Washing machines were capable of washing at high temperatures. Domestic and laundry staff are employed in addition to the care Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 21 staff. The manager provided information that the external laundry contractor had been changed since the last inspection. Bed linen was cleaned under contract and not in the home. The home laundry provides a service for personal clothing, towels, etc. People’s clothes had been labelled so that when they are ironed they can be placed in baskets with people’s names on and delivered to their rooms. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. The staff team are knowledgeable about the health and personal care needs of the individuals they care for. This means that people have access to a staff team who understand their care needs. Staff are actively encouraged to improve their knowledge and skills for care. This means that the staff who care for people at Warberries have the opportunity to develop and improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager provided the duty rota, which showed the number of staff on duty each shift, and in what capacity they were employed. This showed that more staff are on duty at peak times during the day. In addition to care staff and registered nurses the home employs ancillary staff, which included cleaners, laundry personal, chefs, kitchen assistance, maintenance personnel and office staff. The manager advised that since the last inspection more support has been provided for office work. This had freed up her time to concentrate on business management and keeping a clear over view of the people’s health and personal care needs. The five staff spoken to during the inspection said they had sufficient staff each shift to complete the care tasks for individuals. They also commented that they are allocated people to work with and this enabled them to get to know the person and their health and Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 23 personal care needs well. They also said it gave them the opportunity to provide the support for the little things that were important to the person. The pre inspection information provided indicated that over 50 of the care staff have achieved an NVQ level 2 or above in care. A further 4 were working towards this qualification. The staff spoken to said they had been encouraged to completed training relevant to their role. One new member of staff said they had learnt a lot about how to manage people’s health care since they started at the home. Four staff files were seen during the inspection. This showed that the manager had followed safe recruitment practices when employing staff. This included obtaining two references and completing police checks. This should protect people from unsuitable staff. All five staff spoken to said they had good access to training, they confirmed that they had received manual handling training, protection of vulnerable adult training and fire training. They also said they had access to training relating to the health care problems people they were caring for had. The office of the home has reference material, which was available for staff to use. The manager advised that she encourages staff to read information about the how the health problems a person had could affect their wellbeing. Examples of care plans for different health problems were also available for staff to read. Two members of staff spoken to who had started work at the home since the last inspection confirmed they had or were in the process of completing their induction programme. The manager provided an example of the induction programme staff complete. People who returned survey forms all made positive comments about the staff team at Warberries nursing home. These included, Im very happy at Warrberries and everyone (all staff) should be congratulated for making it a very happy friendly place to be, home from home. I have a call bell system, and staff are always helpful and cheery on arrival, and pleased to help. Friendly team of care staff and kitchen staff, making it feel like home nothing is too much trouble. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 24 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, 38 Quality in this outcome area is good. The manager has ensured that the home was being run in the best interests of the people who live there. People’s health and safety was protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is a degree level Registered Nurse who has a qualification in management. She has worked hard to address the requirements and recommendations made at the last key inspection. The manager has delegated some tasks to others since the last inspection. The manager advised that she was concentrating on ensuring the clinical care and the training staff receive for health care was good and reflected in the care people receive. Three other office staff were assisting with management tasks. These included developing computer information records for audit and managing health and safety. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 25 There were clear lines of accountability in the home. The manager has appointed a head of care to lead the health care assistants. They take responsibility for allocating work and monitoring working practices. When the head of care was spoken to they advised that the staff are split into team who have responsibility for one designated area in the home. They are allocated to a group of people living in the home. The hand over between the head of care and the manager was observed. This was a structured handover, which concentrated on the personal and health care needs of individuals. The registered nurse on duty also received hand over with the manager when she started her shift. Staff spoken to said they were well supported to do their work. The results of the quality audit were provided for people living in the home and their representatives. This was available in the reception area of the home for people to read if they wish. The quality audit shows that people who live in the home are consulted and involved in changes that affect them. Positive comments were seen from people who had completed questionnaires. The information provided during the inspection gave evidence that the home manager has continued to monitor the quality of the services provided at Warberries nursing home. People spoken to said they were consulted about changes to the menu and the activities provided for them. The manager advised that the policies and procedures for the home had been reviewed. The dates of the review of named policies were provided with the pre inspection information. The home does not manage the affairs of any of the people living at the home. However, a named member of staff was the appointee for four people who have no friend, relative, or advocate who was willing to be responsible for the collection of their pension. There were clear records that account for the pension collected. The home does not charge the people for this service. The Registered Manager has ensured that the staff receive training appropriate to the job that they are expected to do. The manager confirmed that equipment used had been serviced as required by legislation. A record of dates equipment was serviced was provided with the pre inspection information. The records seen in the home confirmed this. External providers provide fire safety checks and training for staff. The manager has completed a health and safety audit for the home, which was linked to the individuals living in the home as well as the environment. An external health and safety assessor had completed an audit of the home and a report had been provided for the manager. Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 26 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 3 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 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 Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that the registered manager continue to re write people’s care plans that have had several changes to the plan of care. This would make the care plans easier for staff to follow. The redecoration and refurbishment of the home should continue to ensure all the people living in the home have the same high standard of décor as those refurbished since the last inspection. 2 OP19 Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 28 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 Warberries Nursing Home DS0000059901.V367669.R01.S.doc Version 5.2 Page 29 - 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. 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