Care Home: Wessex House Nursing & Residential Home

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well Wessex House is divided into smaller units and this allows the service to be delivered in a more homely way. The home although not an ideal layout and design it is suitably adapted and well equipped to provide nursing and personal care. The home was found to be clean at each visit and records indicated that it is well maintained. No unpleasant odours were detected at any of the three visits. The home has an established manager and core staff team. Staff recruitment is through to reduce the risk of harm from unsuitable people working at the home. People living at the home looked to be well cared for and said they were happy to be living or staying there. Visitors are welcomed and were satisfied with the care of their relatives. Visitors said that they have been included in meetings where their feedback was sought. This was part of the overall service review which was made to improve the rating of the home. Families valued this involvement and the openness of the homes management during this process. The home provides respite care, this is a valuable service for people managing mostly at home but coming in for short breaks. What has improved since the last inspection? There have been environmental improvements with new carpets and ongoing maintenance of the premises. Improvements have been made to the service delivery.Staffing was monitored the random inspection visit after the last key inspection and was still below what had been agreed. The shortfall was being addressed. At this key inspection the evening staffing level has been addressed and the inspectors observed sufficient staff on duty at the evening visit and on the duty rotas seen. Clinical waste bins were seen to be in place in all bathrooms, this was required at the last key inspection to help lower the risk of cross infection. The manager has introduced and accident audit, as recommended to monitor for accident patterns to help reduce any identified risks. Pre admission assessment was raised as a requirement at the last key inspection, deficits were found in the respite care management. A letter received on 24/09/08 in response to this inspection confirms the action the home will take to improve this. Care monitoring for people in bed who require frequent attention to their position and regular fluids were checked at every visit and were found to up to date and well managed. Prescribed dietary supplements and skin creams are now recorded on the Medication Administration Records (MAR). Staff recruitment files were sampled and were found to have photographic identification of staff member and interview records. Recommendations made at the last inspection have been acted upon. Care plan reviews have been made and care plans and records examined were found to be up to date. A training matrix has been made and a copy of this document was given to the inspectors at this visit. This highlights training staff have received and require. People are weighed on a monthly basis and their weights recorded in the care plan. The widely opening ground floor windows were further discussed at the random visit and attention has been paid to improve their security. What the care home could do better: Pre admission assessments for all respite care should be made before the people are admitted for their stay to ensure their needs can be met. Very dependent people should have more detailed person centred care planning. The plans should include all aspects of care and more detail of their care delivery. Staff should be reminded that staff should visually check equipment such as the bed and air mattresses after each care intervention, to ensure they are leaving it functioning properly. One person was seen who did not have a risk assessment for their particular behaviour. This was requested at the inspection. CARE HOMES FOR OLDER PEOPLE Wessex House Nursing & Residential Home Pesters Lane Somerton Somerset TA11 7AA Lead Inspector Barbara Ludlow Unannounced Inspection 9th September 2008 19:40 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 Wessex House Nursing & Residential Home DS0000003307.V368385.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. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wessex House Nursing & Residential Home Address Pesters Lane Somerton Somerset TA11 7AA 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) 01458 273594 01458 273665 shelagh.underwood@somersetcare.co.uk Somerset Care Limited Mrs Shelagh Anne Underwood Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 50. 11th March 2008 Date of last inspection Brief Description of the Service: Wessex House was purpose built in 1981 as a residential home. The home now accommodates up to fifty people with nursing and personal care needs. Day care is also provided at the service for up to six people. The service is divided into four units. Greenlawns, Meadowview and Camelot all provide nursing care with Brookside providing residential care and day care. People from the units are able meet together to socialise and for events and activities. Range of fees are from £368.00 (Social services residential) to £630.00 (private nursing with the free nursing care payment refunded) Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘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. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This key inspection took place on two dates, the 9th and 22nd September 2008 both visits were unannounced. The registered manager had completed the Annual Quality Assurance Assessment about all aspects of service provision and a detailed data set. The Commission for Social Care Inspection (CSCI) had sent out surveys to people living at the home, relatives/carers, in March. Staff and health care professionals responded to CSCI surveys A good level of very positive responses were received, comments are included in the body of the report. Since the last key inspection there had been a random inspection of the service on 29th May 2008, this evening visit was made to monitor the progress made with staffing levels and care giving since the key inspection. CSCI Inspectors Barbara Ludlow and Kathy McCluskey visited the service. The first visit was made during the evening to confirm an adequate staffing allocation and the standard of care delivery in the evening. The second was a daytime visit made to spend time observing daily life and to meet with people in residence, their visitors and staff on duty. Records were also sampled and inspected on the second visit. Mrs Shelagh Underwood, the registered manager attended the home on both visits to support the inspection process. There was also company input from an assisting manager and the operations manager from Somerset Care Limited. There were 32 people in residence at the start of the inspection home, 25 in nursing places and 7 receiving residential care only. Tours of the home were made at both visits. A selection of bedrooms, communal areas, the kitchens and the laundry were seen. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 6 As a result of this inspection 1 requirements and 3 recommendations have been made. What the service does well: What has improved since the last inspection? There have been environmental improvements with new carpets and ongoing maintenance of the premises. Improvements have been made to the service delivery. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 7 Staffing was monitored the random inspection visit after the last key inspection and was still below what had been agreed. The shortfall was being addressed. At this key inspection the evening staffing level has been addressed and the inspectors observed sufficient staff on duty at the evening visit and on the duty rotas seen. Clinical waste bins were seen to be in place in all bathrooms, this was required at the last key inspection to help lower the risk of cross infection. The manager has introduced and accident audit, as recommended to monitor for accident patterns to help reduce any identified risks. Pre admission assessment was raised as a requirement at the last key inspection, deficits were found in the respite care management. A letter received on 24/09/08 in response to this inspection confirms the action the home will take to improve this. Care monitoring for people in bed who require frequent attention to their position and regular fluids were checked at every visit and were found to up to date and well managed. Prescribed dietary supplements and skin creams are now recorded on the Medication Administration Records (MAR). Staff recruitment files were sampled and were found to have photographic identification of staff member and interview records. Recommendations made at the last inspection have been acted upon. Care plan reviews have been made and care plans and records examined were found to be up to date. A training matrix has been made and a copy of this document was given to the inspectors at this visit. This highlights training staff have received and require. People are weighed on a monthly basis and their weights recorded in the care plan. The widely opening ground floor windows were further discussed at the random visit and attention has been paid to improve their security. What they could do better: Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 8 Pre admission assessments for all respite care should be made before the people are admitted for their stay to ensure their needs can be met. Very dependent people should have more detailed person centred care planning. The plans should include all aspects of care and more detail of their care delivery. Staff should be reminded that staff should visually check equipment such as the bed and air mattresses after each care intervention, to ensure they are leaving it functioning properly. One person was seen who did not have a risk assessment for their particular behaviour. This was requested at the inspection. 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. Wessex House Nursing & Residential Home DS0000003307.V368385.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 Wessex House Nursing & Residential Home DS0000003307.V368385.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): 1,2,3,6 is N/A Quality in this outcome area is adequate. There is a good level of information and pre admission assessment. This enables an informed choice of home to be made and an appropriate admission decision to be made at the home. Respite care pre admission assessment could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home produces a colour brochure and there is a statement of purpose and a service user guide, all information is readily available in the home. These documents provide prospective people and their families with the information they need when considering moving into the home. A welcome pack is given to people in residence. A copy was seen in a bedroom, this pack contained a service user guide, a copy of ‘seeking your Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 11 views’ which invites people to make a suggestion, raise a concern or make a complaint about the service and the previous week’s activities list and menus. People who were asked said that they had been given enough information about the home. Relatives said enough information was available to them, one person knew the home was happy to come here to live and described themselves as being ‘content’. People and their families are encouraged to visit the home when they are considering coming to live here. Two contracts were sampled, one for a privately funded place and one for a Somerset funded place, and both were satisfactory. At the last key inspection in March five people in residence who responded to the CSCI survey said they had been given a contract. Six care plans were sampled. One was for a respite period where the assessment that had been completed on the day of admission. This place had been arranged by a social worker and a Single Assessment Plan (SAP) had been received as a pre-admission process. Other respite care planning was discussed and a letter sent to CSCI confirmed the information gathered pre admission for four respite places. The AQAA reports there being sixty-two short stay admissions in the past twelve months and twenty admissions into permanent placement. Preadmission information gathering for respite care should be tightened so it is clear to all that care needs can be met prior to admission to the home. The care home is addressing the systems for people coming to the home for respite care or day care. There is to be a lead member of staff for nursing and a lead for residential, short stay admissions; this should be beneficial and will enhance the current system. Visiting health professional opinions were taken up. CSCI heard that ‘my experience and those of my clients and families have been very positive’ and ‘the level of care provided and assessed on individual needs is good.’ One social worker reported that ‘They always insist on having a SAP (Single Assessment) and visiting clients prior to admission’. Wessex House Nursing & Residential Home DS0000003307.V368385.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 Quality in this outcome area is good. People are treated with respect and in a dignified manner. People have their needs assessed, care is planned and the plans are regularly reviewed. Medications are safely managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a computerised care planning system with hard copies are printed off as needed. The computer records are accessible on all units. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 13 The inspectors saw staff accessing the computer records and updating them. The inspectors were assisted to sample the computerised records and hard copies with staff on request. The systems are password access only and staff were seen to be mindful of this in their careful use of the system. Care planning has improved and the records for people who were case tracked were seen. These records showed preadmission assessment and specific health care risk assessment made for wound care, nutritional assessment and weight monitoring. Pre-admission information gathering for respite care should be tightened up to demonstrate clearly that a persons care needs can be met prior to their admission to the home. Risk assessments were in the care plans, one person required a risk assessment for their particular behaviour and this was to be addressed after the inspection. Care plans had details of wound sites and care but there was a deficit of wound mapping so it was difficult to tell from the care plan entries whether the wounds were improving or not. This needs to be addressed to provide an audit trail for the effects and outcome of treatments used. Visiting health professional opinions were taken up. CSCI heard that ‘Wessex House demonstrate interest and ongoing concern for individuals welfare’. Clients have reported that ‘they always knock on my door’ and carers are ‘always sensitive and gentle when providing personal care’. There is a good level of equipment for manual handling and pressure relief. Equipment servicing was confirmed. Pressure relieving equipment was appropriately put into use. One alternating air pressure mattress was seen that was not pressurised properly; this was because the pump piping was poorly positioned. Staff should be reminded that care must be taken whenever a bed is moved, a bed is made or care is delivered, to ensure that the mattress is functioning properly before the staff leave the bedroom. Medication management was inspected. The Medication Administration Sheets were examined on Meadowview. Photographic identification of the individual people in residence was seen; there were two signatures to verify hand transcribed entries. Self-medication risk assessments were in place. Where people have chronic health conditions such as diabetes there was evidence of insulin administration and capillary blood sugar monitoring. Where medication doses are variable such as with Warfarin there were clear instructions faxed from the doctors surgery and blood-testing dates were noted. Medication storage was appropriate and safe. One visiting health professional said their client self-administers their medication and ‘her wishes are respected’. Other clients have reported being treated with ‘dignity and respect’. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 14 At the last inspection dietary supplements and creams were required to be recorded on the MAR charts, this was happening at this inspection and running records were seen in the evaluation information. One person was seen whose personal hygiene was not of a good standard. A reasonable explanation was given for their appearance, personal care giving was confirmed. The home are reminded that personal care giving must be sufficient to assist a person in maintaining a good level of personal hygiene. All the people seen were appropriately dressed and with the one exception, were well groomed. Visitors that were seen said their relatives receive ‘good health and personal care’. One said their relative’s health and well being had improved since their quite recent admission to Wessex House, the relative said they had ‘confidence in the staff’. The inspectors heard about ‘regular care reviews’ and that ‘minor health issues are dealt with straight away’. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 15 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 home offers a range of activities and opportunities to people living at the home. Families and friends are made welcome and are invited to be involved with the home. The catering is well managed, food looked appetising, there is menu choice and special diets are catered for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is divided into smaller units with seating and communal areas this is helpful in making Wessex House feel quite homely. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 16 People can spend their time as they choose and one person said they prefer to opt out most of the time and this is their preference. Activities are varied, one to one activities take place and there are organised events. The activities timetable was seen which had games, shopping opportunities, art, reminiscence singing and one to one events such as hand massage. The church service at St Michaels was indicated, one person attending regularly said someone collects them from the church. One health care professional reported that their client said that when there was no activities organiser there was little to do. Another professional reported that people said they had been taken out shopping. It was reported that where people have particular likes and dislikes they have been responded to ‘sensitively’ by staff. Families were seen visiting. They confirmed that they are made welcome. The inspectors heard that staff listen to them when they raise any concerns with them. People visiting confirmed that they are offered refreshments. One person said they are ‘treated like friends’ and are kept well informed. The menu is varied and is displayed. For lunch it read: Chicken and thyme pie or vegetarian crumble with creamed potatoes, spinach and mixed vegetables. Dessert was lemon pudding and custard, milk pudding or fresh fruit. The teatime menu was Butterbean and sardine salad, beef and horseradish sandwiches, crumpets and butter and mandarins and ice cream. The supper menu was cheese and biscuits, bread and butter with jam or marmite. Special diets are catered for and one person who was case tracked had a liquidised diet. The cook was seen and confirmed how dietary needs are met and addressed if people have weight loss or special dietary needs such as allergies, diabetes, and vegetarian. Hot trolleys with separate dishes are taken to the units and the food is served from them. The cook confirmed having good food stocks and said that fresh fruit is put out after dinner each day. There is access to food at night and the fridges on each unit are monitored by the domestic staff and are stock checked weekly by the cooks. Since the last inspection the contents of named dishes has been added to the food lists to explain for example Huddersfield hash. Lunch is served in the dining room at 12:30 and in the units at 13:00. The cook said there had been a recent ‘positive inspection’ of the kitchen and the food processes by the Environmental Health Officer. Hot drinks and biscuits/ snacks were seen to be available and served to people outside meal times. Hot suppertime drinks are offered. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 17 The dining tables were nicely laid for meals. Where staff assisted people with their food this was done with in a dignified way with care and one to one attention. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 18 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. There are clear complaints procedures for people to raise their concerns. People are safeguarded from abuse by the adherence to the policies and procedures in place for safe practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has not received any complaints since the last inspection and no complaints or concerns have been made to CSCI. People asked said they would be able to raise any concerns at the home. Visitors asked were also clear about reporting any concerns they may have with the care of their relative. Staff recruitment was found to be robust, supporting good practice and adherence to the procedures that will reduce the risk of people living at the home from harm from unsuitable people being employed at the home. Staff files identified that staff have received training in abuse awareness and the protection of people in their care (POVA training). Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 19 The manager confirmed having access to Somerset’s Safeguarding people guidance, which has to be followed in the event of anyone raising an abuse alert at the service. This was made available to staff by being in the staff room. Feedback from seven health care professionals was received. The professionals reported that ‘ I have raised issues in the past and these have been dealt with efficiently and sensitively’ and that difficult situations have been handled ‘with professionalism and caring attitudes’ towards all involved. Another reported that ‘at no point have I known Wessex House to fail to respond to myself or a clients request’. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 20 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. The home is not an ideally designed building but is divided into four distinct smaller, homely units. The home is clean and comfortable, equipped for nursing and people can personal their private space. Infection control is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 21 A tour of the home was made at each visit by the inspectors, a selection of bedrooms, all communal areas and facilities and service areas were seen. People asked confirmed that the home is always clean and tidy. Feedback from visitors was positive about the environment and no concerns were raised with the inspectors. The communal areas are pleasantly decorated and the home was seen to be clean throughout at each visit and no unpleasant odours were detected other than from a full en-suite waste bin. One requirement at the last inspection for a clinical waste bin in a communal bathroom on Greenlawns, this was confirmed as in place. Hand wash facilities with liquid soap, paper towels and waste bins are available for staff to use. Personal protective clothing such as gloves and aprons are provided and available to staff as an infection control measure. Infection control policies and procedures are in place to reduce the risk to people using the service and staff of infection. Bedrooms seen were comfortable and some had been personalised to make them more homely. The garden area outside Camelot had been refurbished at the last inspection and it was noted that it ‘provides a pleasant accessible area for residents and their visitors’. The kitchen is equipped to a good standard and looked clean and well organised. The units have kitchen facilities for providing drinks and snacks. This looked to be a particularly good facility in the evening when drinks were readily available and were seen to be made on request by people staying up later to watch television in the communal areas. The home has a call bell system throughout the building. The fire alarm and fire safety equipment around the home is well maintained. Wessex House Nursing & Residential Home DS0000003307.V368385.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): 27,28,29,30 Quality in this outcome area is good. The home has a dedicated staff team, their training and supervision is well managed. The home schedules for a sufficient number of staff to be on duty at the home by day and at night. Recruitment is safely managed to protect people from the risk of unsuitable people being able to work at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing has been reorganised alongside the changes in nursing / residential arrangements for use of the accommodation. At the last evening inspection the home was staffed to the level agreed with CSCI. There have been times when the residential unit has been covered by staff from the unit above, this was not judged to be safe or satisfactory. The management must closely monitor dependency levels to ensure that the staffing level remains sufficient for care and safety particularly at night. Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 23 Staff recruitment files for two recently recruited members of staff. All had a photograph for identity purposes, a completed application form, health questionnaire, two satisfactory references, POVA First and CRB checks, were in place. There was a record of the interview process and appointment details. The home employs agency staff to cover staffing level deficits. Agency staff were seen on duty at the inspection visits. There was a difference in their experience of the introduction to working at the home. The induction of agency staff was discussed with the manager, the induction list and fire plan procedure for agency staff was seen. The process was adequate but agency staff induction or updating remains reliant upon the senior member of staff on duty at the time agency staff are deployed to the home. The AQAA indicated that 63 of staff are qualified to NVQ level 2 or above. The manager gave the inspectors information about the training all staff have undertaken. Staff training and supervision files sampled indicated mandatory training had been given this included the protection of vulnerable adults (POVA) and supervision was recorded. Staff comment cards were returned to CSCI. Staff mentioned that training and development had been given. Staff were spoken with at each visit to the service, they all expressed their commitment to proving a good service. Staff were pleased with the improvements they had seen at Wessex House and no concerns were raised about staffing levels. Relatives and people living at the service were complimentary about the staff, we heard that ‘staff are kind’ their relative receives ‘plenty of attention’, ‘carers are very good’, ‘always someone there at night’, ‘staff are very good’ and they are all ‘kind and patient’. Health care professionals said that staff at the home are a ‘hardworking team’, providing good support and quality care’. ‘Wessex house staff are flexible and helpful in emergencies’, ‘the level of care is excellent’ and the attitude of staff was described as ‘exemplary’ and staff were commended for working hard to improve the service for the ‘benefit of the clients’. Wessex House Nursing & Residential Home DS0000003307.V368385.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. There has been considerable management input to improve the service at Wessex House. The home is well run. Quality assurance and control has been monitored and there has been a lot of positive management contact with the people in residence, others who use the service and families. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Wessex House Nursing & Residential Home DS0000003307.V368385.R01.S.doc Version 5.2 Page 25 The registered manager of the home is Mrs Shelagh Underwood. Mrs Underwood is an experienced senior nurse and has previous experience as a registered manager. The input of Mrs Underwood was helpful to the inspection process; she attended each of the inspection visits. Mrs Underwood has worked some night shifts to monitor the work and management of care at night. There has been management input from the company to support the homes improvement planning following a poor inspection rating in March 2008. Regulation 26 monthly inspection visits by the company are undertaken and reported on. The company has also brought in management expertise from a residential home to support a staffing change on the residential wing. This has been done to allow delegation of some tasks by the trained nurse in charge of a shift. The changes will also provide suitably qualified and experienced National Vocationally Qualified (NVQ) care staff with more career opportunities. The change is reported to be progressing well. Visitors were spoken with about the management of the service they expressed their satisfaction with the open and inclusive approach in recent quality assurance meetings held for families. Follow up meetings for families have been held to reassure them of the work being undertaken. No concerns were raised with the inspectors about the management of the home. Health professionals reported service improvement and satisfaction being reported to them from people using the service. Finances were examined with the help of the homes administrator. Small amounts of money are held for thirty people, no one has a company appointee. The balance of a sample account was checked and this was accurate and corresponded with the receipts held for purchases. Two signatures are recorded at each transaction but there was no monthly audit of the accounts, this is recommended. The AQAA indicated that the maintenance and servicing of equipment was up to date. This included the fire alarm and fire safety equipment. Nurse call alert system. Electrical and gas safety and portable hoists for patient handling. At the last key inspection it was reported that the water system is serviced by a contractor and measures in place to reduce the risk of legionella and scalding. Accidents are recorded and are now audited by the manager to detect any patterns or areas where preventative measures could be taken. These records were seen. The home has made appropriate reports to CSCI under regulation 37 (Care Home Regulations 2001) Wessex House Nursing & Residential Home DS0000003307.V368385.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 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 15 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X 2 2 X 3 Wessex House Nursing & Residential Home DS0000003307.V368385.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. 1 Standard OP8 Regulation 15(1) Requirement Care delivery and planning should be more detailed, always person centred. Care must include specialist equipment monitoring to ensure it is working at all times. Timescale for action 25/11/08 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 3 Refer to Standard OP3 OP36 OP35 Good Practice Recommendations Pre admission assessment should be more closely monitored for people coming in for short stays and respite care. Care should be taken to ensure agency staff are given sufficient information about the home and shift handover when they come on duty. Money held for people in residence should be audited each month. Wessex House Nursing & Residential Home DS0000003307.V368385.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 Wessex House Nursing & Residential Home DS0000003307.V368385.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!