Care Home: Wexford House

What the care home does well An assessment of the person`s needs is carried out previous to admission being arranged. People`s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Care plans are being reviewed, professional visits and risk assessments are being recorded and people are supported to access the health care they are in need of. One relative said in a CSCI survey form they sent to us that "great effort is made to accommodate the varying needs of people, who are all treated as individuals". Five care staff have attained the national vocational qualification (NVQ) in care at level 2 or above, and one member of staff is presently undertaking NVQ training. The home has a good atmosphere, and one relative told us in their survey form that it "has a very homely feel". Another relative said in their survey form that "there is good interaction between staff and residents". What the care home could do better: Kitchen units and flooring are in poor condition, and present a safety risk. The number of staff on duty should be reviewed to ensure that people`s needs can be met. More activities and outings would contribute to people in the home having a better quality of life. CARE HOMES FOR OLDER PEOPLE Wexford House 44 Shakespeare Road Worthing West Sussex BN11 4AS Lead Inspector Ed McLeod Unannounced Inspection 31st March 2008 11:30 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 Wexford House DS0000070053.V359569.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. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wexford House Address 44 Shakespeare Road Worthing West Sussex BN11 4AS 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) 01903 231 450 Hazelwood Care Ltd Mrs Geraldine Thorp Care Home 10 Category(ies) of Dementia (0) registration, with number of places Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 10. Date of last inspection New service Brief Description of the Service: Wexford House is a care home registered to accommodate up to 10 people who suffer from dementia. The accommodation provided is on ground and first floor levels. There is a sitting stair lift, but no passenger lift. The premises are situated in a suburban part of Worthing with local bus and rail links. The registered manager is Mrs Geraldine Thorp, and the home is operated by Hazelwood Care Ltd. The minimum fee is £494 per week and the maximum fee is £535 per week. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit was carried out by one inspector and was arranged as a first inspection six months after the service had been registered. The inspection visit was arranged to assist us in assessing the home’s compliance with the key standards of the national minimum standards for care homes for older people. Planning for the visit took into account information received on the service, including the annual CSCI self-audit completed by the home manager. Survey forms received from five people living in the home, seven relatives and seven members of staff also contributed to our planning. On the day of the visit we were on the premises for four and a half hours, and spoke with four people living in the home, the manager, and two members of staff. We sampled three sets of admission assessments and the individual plans of care for three people living in the home. Other records sampled included recruitment and training records for three members of staff, the record of complaints and records relating to health and safety issues in the home. We visited the main areas of the care home and nine bedrooms. We observed a number of interactions between people living in the home and staff, and observed the arrangements for lunch. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Improvements to the service have included the introduction of a notice board for activities and menus. The manager believes that staff are chatting more to people in the home, learning more about each other’s lives, and that more activities and quizzes and music are being provided by staff. Improvements to the premises since registration include new carpets in the hall and on the stairs and in some bedrooms, and more comfortable chairs have been provided for the dining room. The electrical system in the property has also been rewired. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 7 All people now have wash hand basins in their rooms, and two bedrooms have been redecorated. A new door alarm panel has been installed, and a new fire alarm system has been installed. New equipment for the laundry room has also been provided. Following suggestions made by people living in the home or their visitors, new things have been introduced such as art and craft sessions, snakes and ladders, and occasional curries. Six of the eight care staff are now qualified to National Vocational Qualification (NVQ) in care at level 2 or above, and one member of staff is presently undertaking this training. 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. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident the home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 10 home that includes how much they will pay and what the home provides for the money. EVIDENCE: During our visit we found that copies of the statement of purpose and service user’s guide which provide information on the service are displayed and available in the entrance hall. We found that terms and conditions of residence, including the fee to be paid, were recorded and held on each of the three care records which we looked at. The manager tells us in her CSCI quality self-audit (the AQAA) that pre-admission assessments are carried out by people trained to do these, and the views of the person, their relatives and involved professionals are sought as part of this assessment. We looked at three sets of admission records for people who have come to live at the home in the past year, and found that assessments of the person’s needs had been carried out previous to admission being arranged. The AQAA advises us that usually residents would view the home before admission but on occasion this is done by the placing agency or relative, and that people are admitted on a four-week trial basis. The manager told us that intermediate care (for people on a rehabilitative programme) is not being provided in the home. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 11 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. People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, people manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each person is being provided with an individual plan of care, although the person accommodated or, if appropriate, their nearest relative, was not always receiving a copy of this. The manager agreed that it would be good practice to do this. A requirement was not made as the manager indicated this would in the future be done. The manager gave examples of what is being done to encourage people living in the home and their nearest relative to contribute to reviews of the care plan. The AQAA tells us that new care plan formats have been introduced, and that continence needs are monitored and assessors are called in for incontinence assessment and advice. The manager has told us that relatives are notified by letter of the content of the care plan. We looked at three sets of care records, which indicated that care plans are being reviewed, and that professional visits and risk assessments are being recorded and that people are supported to access the health care they are in need of. For example, the AQAA tells us that when it was noted one person had a red area on their heel the district nurse was contacted and treatment and equipment to meet the person’s needs were obtained The AQAA tells us that there has been an increase in staff awareness of the need for people to stay in bed later or go to bed later if they wish. People’s dignity is also being encouraged by things such as people’s art work being framed and displayed, and by people making their own name card for their bedroom door. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 13 One relative said in a CSCI survey form they sent to us that “great effort is made to accommodate the varying needs of people, who are all treated as individuals”. Training for staff in the administration of medicines is being provided, and we sampled medication audits which are carried out to help ensure that medication arrangements are safe. Wexford House DS0000070053.V359569.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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability and sexual orientation. They are part of their local community. The care home could do more to support people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks at a time and place to suit them. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 15 EVIDENCE: The AQAA tells that improvements to the service have included the introduction of a notice board for activities and menus. The notice board indicates that activities are usually being provided in the afternoons, once staff have finished their other duties. An activities person works in the home, and according to the notice board arranges an activity for one morning per week. The manager believes that staff are chatting more to people in the home, learning more about each other’s lives, and tells us in the AQAA that more activities and quizzes and music are being provided by staff. There was not any provision at the time of our visit for people to go on outings, and a relative said in their CSCI survey form that “more activities would be welcome”. On the afternoon of our visit staff were supporting people to play games. In the AQAA the manager tells us that if someone living in the home is in need of advocacy support, this can be accessed. Visits are made to the home from different religious dominations, such as Methodist, catholic, Church of England, Church Army and Jewish faiths. The manager told us that two residents in wheelchairs are encouraged to join in activities such as visits to the park and shops with more able bodied people. The manager advises in the AQAA that cold drinks are always available in the lounge and that snacks and hot drinks can also be brought. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 16 People we talked to during our visit said their visitors were always welcomed and offered a cup of tea. The only communal area available where people can meet with their relatives is the dining area, which is not ideal as this area is directly off the kitchen and does not offer much privacy for families. The provider should review how better facilities for people meeting their relatives and visitors could be provided. We observed a lunch sitting. People we talked to said they liked the food. Staff we talked to gave examples of alternative meals that are provided when a person does not wish the main meal or dessert being offered. While the meal was relaxed and unhurried, and people were receiving assistance or prompts with eating if they needed this, for some people their food was going cold while they were awaiting this assistance. Wexford House DS0000070053.V359569.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people have concerns about their care, they or other people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. EVIDENCE: Complaints can be recorded in a complaints log book held in the hall, or submitted more confidentially. We found that no complaints have been recorded in the past year. The manager tells us in the AQAA that staff have received training in what constitutes abuse, and the Mental Capacity Act 2005 has been discussed with staff. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 18 During our visit the manager advised us that she has attended a briefing meeting on changes to local safeguarding procedures, and that the home has copy of these new procedures. There has been one safeguarding referral made by the home to support the rights of one of the people living in the home, and the person was said by the manager to have been happy with the outcome of that referral. This indicates that the home is helping ensure that people living in the home are being protected. Wexford House DS0000070053.V359569.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, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People stay in a well-maintained home that is homely, clean, pleasant and hygienic. Their rooms feels like their own, it is comfortable and they feel safe when they use it. EVIDENCE: Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 20 The manager has advised us in the AQAA that improvements to the premises since registration include new carpets in the hall and on the stairs, all bedrooms are now carpeted, and more comfortable chairs have been provided for the dining room. A new carpet has been provided in the lounge. All people now have wash hand basins in their rooms, and two bedrooms have been redecorated. We are told by the manager that a new door alarm panel has been installed and that a new fire alarm system has been installed. We are also advised the electrical system in the property has been rewired. During our visit we noted that new laundry equipment has been provided. The AQAA also tells us that some new beds, bed linen and curtains have been purchased. The manager has advised us that further improvements planned include a new conservatory, and redecoration to brighten up areas of the home. Records we looked at indicate that routine maintenance is done on a regular basis, and the maintenance book is updated when the work has been carried out. We looked at the needs of wheelchair users, and found that they would have difficulty in accessing some of the toilets and bathrooms provided. We discussed with the manager the arrangements in place to ensure the people who are wheelchair users receive appropriate support with their hygiene needs. There are risk assessments in place, and the manager believes that the need for dignity and respect can continue to be met. The home is not registered to provide care for people with a physical disability, and the home needs to regularly reassess the care provided to wheelchair users to ensure their care continues to observe their need for dignity and respect. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 21 We found safety concerns in the kitchen, such as a missing drawer, missing tiles, and a cupboard under the sink which had not been repaired and where there was unprotected wiring. The kitchen flooring was also found to be in poor condition. All areas of the home visited were found to be clean and free from odours. Wexford House DS0000070053.V359569.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People do not always have safe and appropriate support as there are not always enough staff on duty. People have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. EVIDENCE: We found that there are four full time and four part time care staff, and one member of domestic staff. The AQAA tells us that five care staff have attained the national vocational qualification (NVQ) in care at level 2 or above, and one member of staff is presently undertaking NVQ training. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 23 We looked at staffing rotas for week commencing 28th March 2008. We found that two care staff cover each morning shift, afternoon shift and night shift. We also noted that cooking and kitchen duties are undertaken by care staff, which also limits the time available for providing care and interacting with people in the home. During our visit we found indications that there were not enough staff available to meet people’s needs. For example, during the morning staff did not have time to interact socially or do activities with residents. Also, at lunch time some people’s meals were going cold while they were waiting for the assistance they needed. Six of the eight care staff are now qualified to National Vocational Qualification (NVQ) in care at level 2 or above, and one member of staff is presently undertaking this training. One domestic assistant is undertaking an NVQ in hospitality. We looked at recruitment records for three members of staff who had begun work in the home during the previous fifteen months. We found that records of safety checks, references and previous employment were being obtained before the person commenced work in the home. We looked at staff training records, and found that staff were attending training appropriate to the work they are to perform. We asked if there were plans to provide more in-depth training on dementia for staff, and the manager told us they were presently negotiating with training providers concerning this. Wexford House DS0000070053.V359569.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, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager Mrs Thorp is appropriately qualified and experienced to manage the home, and continues to update her training and skills. The home has a good atmosphere, and one relative told us in their survey form that it “has a very homely feel”. Another relative said in their survey form that “there is good interaction between staff and residents”. Staff we talked to said they enjoyed working in the home, and during the visit we observed good communication between managers and staff. We looked at records from a survey of the views of visitors and relatives which was carried out in January 2008. The manager gave us some examples of things in the home which had been improved through suggestions made by people living in the home or their visitors, such as art and craft sessions, snakes and ladders, and occasional curries. Staff records we looked at indicated that staff are receiving regular sit-down supervision which is recorded. The manager informs us in the AQAA of the maintenance checks and services which have been carried out since June 2007. There are also environmental risks assessments carried out on a regular basis. Arrangements are in place for fire system checks and for training staff in fire evacuation procedures. Wexford House DS0000070053.V359569.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 3 x 3 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 2 3 x 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/a 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 OP19 Regulation 23.2 (b) Requirement Timescale for action 30/07/08 2 OP27 18.1 (a) 3 OP7 14.2 4 OP12 16.2 (m) Kitchen units and flooring are in poor condition, and present a safety risk. The provider must ensure that the kitchen area is safe. The number of staff on duty 30/07/08 should be reviewed to ensure that people’s needs can be met, including their social and activity needs. The provider must regularly 30/07/08 review the needs of wheelchair users to ensure they can continue to be supported in a manner which offers them dignity and respect. More activities and outings would 30/07/08 contribute to people in the home having a better quality of life. The provider needs to review the arrangements in place for this. Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 28 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 Wexford House DS0000070053.V359569.R01.S.doc Version 5.2 Page 29 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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