Care Home: Wessex Lodge

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What the care home does well The home assesses the needs of prospective service users before they move into the home. Healthcare professionals visit the home when necessary and medication is stored and administered appropriately. Service users are happy with the way staff work with them. They are also happy with the meals and activities provided. Bedrooms are personalised and the home is kept clean. Service users are aware of the complaints procedure and feel able to make their views known. Procedures are in place to protect service users from abuse. The recruitment processes also protect people. Staff are qualified and well trained. The manager is experienced and qualified and continues to update her training. There is a quality assurance system in place which seeks the views of service users and social/healthcare professionals. The home takes note of responses and changes practice accordingly. Equipment such as hoists are maintained and fire safety checks are in place. What has improved since the last inspection? Following the last inspection, care plans and risk assessments have been improved and the manager continues to develop them to ensure individual needs are met. CARE HOMES FOR OLDER PEOPLE Wessex Lodge Jobson Close Newbury Road Whitchurch Hampshire RG28 7DX Lead Inspector Beverley Rand Unannounced Inspection 20th May 2008 10:50 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 Lodge DS0000065491.V363758.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 Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wessex Lodge Address Jobson Close Newbury Road Whitchurch Hampshire RG28 7DX 01256 895982 01256 893523 wessex@hestiacare.co.uk 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) Hestia Care Limited Mrs Veronica Sharon Bovill Care Home 40 Category(ies) of Dementia (10), Old age, not falling within any registration, with number other category (40) of places Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2007 Brief Description of the Service: Wessex Lodge is a large purpose built service registered to provide nursing care for up to forty people who are over the age of sixty-five. The home can also admit up to ten people who may have dementia. The home is owned and managed by Hestia Care Ltd and the registered manager is Mrs Veronica Bovill. Accommodation is provided on three floors and there are forty individual bedrooms with en-suite facilities. The home is located close to the village of Whitchurch and its local amenities. The home shares a site with another registered nursing home Berehill which is also owned by Hestia Care Ltd. The manager provided information for the inspection to indicate that the fees for the home range from £560 to £900 per week. Wessex Lodge DS0000065491.V363758.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 an unannounced key inspection. Prior to the inspection we looked at the last inspection report and the Annual Quality Assurance Assessment (AQAA). We also received three completed surveys from service users. During the inspection we looked around the home, talked with two service users, two staff and the manager. We also looked at records such as care plans and recruitment records. What the service does well: What has improved since the last inspection? Following the last inspection, care plans and risk assessments have been improved and the manager continues to develop them to ensure individual needs are met. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 6 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. Wessex Lodge DS0000065491.V363758.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 Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply, so has not been assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures prospective residents have their needs assessed before they move in. EVIDENCE: The home undertakes pre-admission assessments and gathers information from the prospective service user, their relatives and health and social care professionals. The manager is planning to develop the assessments further to identify dependency levels more clearly. The manager undertakes the assessments. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has improved care plans so that they better reflect the individual needs of service users. Healthcare professionals visit the home when needed. Medication systems ensure the safety of service users. Staff respond to service users with respect. EVIDENCE: We looked at four care plans which showed details of personal preferences and individual choices. There were risk assessments for items such as bed sides and general observation assessments such as fluid intake. When we spoke with staff they had a good knowledge of individual needs which related to the care plans. Three of these care plans included more detail than care plans seen at the last inspection and the fourth one was further developed and improved. Current service users vary greatly in their ages but care plans did not overtly identify different needs associated with age. This was brought to the attention Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 10 of the manager who said that staff were aware of individual needs in this respect and worked with service users with this in mind. We spoke to a staff member who was able to describe the musical tastes and hobbies of a particular service user, which were different to the other service users living there. This was confirmed when we spoke with a service user about this. The home has been working on gathering information (where given voluntarily) to form life histories, so that staff know the service users better. This is also linked with offering relevant activities. Records showed that healthcare professionals such as doctors, chiropodists, gastronomy nurses, dieticians and so on visited the home when needed. Equipment was provided and maintained as necessary. We were told that the registered nurses administer medication and that the records are signed after the medication has been given. The records were fully completed with no gaps. There is also a photograph on each service user’s medication record to ensure medication is given to the right person. The storage of medication was satisfactory and the manager told us that the storage for controlled drugs met the legal requirements. The manager said that whilst care staff do not administer drugs it is expected that they undertake the medication module if they are working towards the National Vocational Award (NVQ) level 3. We saw how staff interacted with service users and respected their privacy and dignity. Service users we spoke with confirmed that there was, ‘always somebody about if you want anything’ and that they came quickly when they rang the call bell. Staff gave us examples as to how they ensured doors and curtains were closed before giving personal care and that they talked to service users about what they were doing. We saw two staff using the hoist when we were there and did hear the staff telling the service user what they were doing, in a reassuring way. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy the activities and meals. Visitors are welcome in the home. EVIDENCE: The home employs a full time activities co-ordinator and we spoke with them on the day of the inspection. They said that there was something going on every afternoon and that new ideas were tried. If people did not wish to join in with organised activities, the co-ordinator said they tried to have a daily chat with them. On the day of the inspection some service users went out to a garden centre and one of the service users took some photographs of the group. Service users have access to a computer and a craft room, where oil paintings were on display. A service user told us they had not tried oil painting before but enjoyed it. The three completed service users’ surveys we received said the home provided suitable activities. A staff member has set up a shop area where service users can purchase toiletries, sweets and so on. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 12 The home has an open visiting policy and holds relatives meetings. Service users are able to go into the wider community alone and maintain friendships. The home employs a chef who provides meals appropriate to individual needs. The chef meets with the service users regularly to discuss menus. A butcher and greengrocer provide fresh food. Care plans identified if someone needed their food cut up or pureed and this was done. The manager and a staff member noticed a service user was not eating their meal. This was discussed and time was given for the person to eat. A staff member later asked them if they would like a sandwich and persuaded them to have some fruit salad. Both the service users we spoke with said they liked the food. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel able to complain and are protected by the home’s procedures. EVIDENCE: The home has a complaints procedure and there is a copy in all the service users’ rooms. We spoke to a service user who said they felt able to complain. The home has not received any complaints since the last inspection and neither have we. The three service users’ surveys which were returned said they always knew who to talk to if they were unhappy about something and that they knew how to complain. The safeguarding adults policy was clear and the manager was aware how to refer allegations or suspicions of abuse. We spoke with a staff member who was also clear as to the home’s safeguarding procedures. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well maintained environment although they may benefit from more homely bathrooms. EVIDENCE: As we walked around the home we saw that service users’ rooms were personalised and some had photographs of them on their doors. The photographs were either taken recently or when they were younger, as these can be more easily recognised by people with dementia. Most people make use of the large lounge on the ground floor and a small lounge is available on each of the other two floors in the home, equipped with tea and coffee making facilities. Specialist bathing facilities are provided but the bathrooms have little or no homely touches to them: one had two pictures. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 15 We spoke to a service user who did not like to use the bathrooms and identified that they were, ‘big, cold rooms’. One of the bathrooms also had a stained wall directly in front of the bath. We spoke to the manager about these issues and she said she was aware and that it was on her list of things to do. The home has a dedicated craft room and a hairdressing salon. We received three completed surveys from service users who said the home was always fresh and clean. There is a laundry with suitable washing machines and two sluice rooms. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by well trained staff and are protected by the home’s recruitment procedures. EVIDENCE: The staff rota is designed to include eight staff (registered nurses and care workers) in the mornings, six in the afternoons and four at night (all awake). The manager told us there is always one registered nurse on duty at night and two during the day. We spoke to a service user who felt they received the right level of support from staff. There is a training programme in place which includes core training such as moving and handling, food hygiene, safeguarding adults and fire safety. Other training includes Parkinsons disease, multiple sclerosis, MRSA, strokes, challenging behaviour, continence and tissue viability. Some of the training is undertaken in-house by staff who are qualified to train and some is done through external providers which is often self directed. New staff undertake a thirteen week induction course. Out of nineteen staff, ten have achieved the National Vocational Award (NVQ) in care to level 2, and two Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 17 more are working towards it. The manager and registered nurses undertake supervision sessions and each has responsibility for supervising named staff. We looked at the recruitment records for three new staff. Two of these had started work and one was due to start in a few weeks. All the files contained completed application forms, two references and Protection of Vulnerable Adults checks. References were dated to indicate when they were completed but the home did not record when they were received. As the references were in place for the person who was due to start work in the future, it was evident that the usual procedure was to have references in place before new staff began work. We discussed with the home that they should record the date when references are received to evidence this fully for new staff in the future. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well run home but some may benefit by improvements in the way their money is handled. Service users views are sought and acted on. EVIDENCE: The manager has completed an NVQ level 4 in management and is a registered nurse. She has continued her training since the last inspection by undertaking certificates in palliative care, dementia care and equality and diversity. She also attended an all day event about the Mental Capacity Act. The manager completed and returned the Annual Quality Assurance Assessment, (AQAA) on time and it was completed well. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 19 The home has a quality assurance programme in place and has asked service users, healthcare professionals and care managers to complete surveys. All the results were positive. The manager explained how the service user’s survey had highlighted some issues about the service user’s guide and activities, and what she had done in response to this. The manager is currently seeking a suitable staff survey. The AQAA identified a concern with regard to how service user’s money is kept for safekeeping on behalf of service users. We spoke with the manager about her concerns and she is trying to find a better way to support service users. The home physically looks after the money for two service users and we looked at the records for these. We found they matched the amount of money held, which was kept appropriately and separately. However, the manager told us that for the remaining service users, money is held in a central account and a record is kept of individual spending. Service users can have their hair done, or request money for purchases and so on, this is provided and then taken from the central account to re-imburse the home. Individually, service users have relatively small amounts but together it adds up to a substantial amount, which may be in an interest bearing account. The manager told us she would find another way of looking after the money, to ensure that service users’ financial needs are safeguarded. We looked at records which showed fire safety checks were up to date and maintenance checks had been completed for equipment such as the hoists and nurse call systems. An Environmental Health Officer had inspected the kitchen recently and made some requirements. We spoke to the manager about this and she confirmed that the required action had been taken. The cupboard where potentially harmful cleaning fluids were kept was locked. However, the cleaners were taking a break and had left their cleaning trolleys unattended. One of these was in a place where service users could have accessed it and the other was on the stair landing, where service users were unlikely to be on their own. The manager was aware of this before we raised the issue with her and said they were not usually left out in this way. She undertook to deal with it. Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Wessex Lodge DS0000065491.V363758.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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