Care Home: Winchester House

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What the care home does well The home was clean, bright and welcoming on the day of the inspection visit. Decoration and maintenance tasks are completed to a high standard. There was a relaxed and homely atmosphere in the home with an established staff group. Admission processes in the home were managed well, with visits and interviews arranged prior to the new resident moving in. Care planning and record keeping for the people living at the home was in good order, with consideration given to all aspects of health, personal and social care needs. People living in the home spoke of being able to make choices around what they wished to eat, what they wished to do and where they liked to spend their time. Within the survey work completed, residents were complimentary regarding the way they were supported to maintain their independence. One resident said `The home gives me a good degree of independence that I wish.` Another relative said that `the home is perfect for my mother` and they went on to say `Lovely people with a home from home environment.` What has improved since the last inspection? Care planning documentation has been revised and reviewed since the last inspection and medication administration, storage and management have been reviewed and improved. Staff recruitment practices and documentation has improved since the last inspection, with new staff files holding full recruitment checks and paperwork. This ensures that residents are safeguarded and protected. A staff training and development programme has been developed with both basic training courses planned and National Vocational Qualification (NVQ) training on offer. The home is now meeting the minimum requirement that 50% of care staff have obtained a NVQ Level 2 in care. This ensures that care staff are equipped with skills and knowledge needed to care for the residents. CARE HOMES FOR OLDER PEOPLE Winchester House 90 Frinton Road Kirby Cross Frinton On Sea Essex CO13 0HJ Lead Inspector Pauline Dean Unannounced Inspection 9th June 2008 10:15 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 Winchester House DS0000017998.V366095.R02.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. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winchester House Address 90 Frinton Road Kirby Cross Frinton On Sea Essex CO13 0HJ 01255 678813 01255 679196 lee.saunders@btinternet.com 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) Mr Lee Saunders Mrs Elizabeth June Saunders Mrs Elizabeth June Saunders Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 8 persons) 26th June 2007 Date of last inspection Brief Description of the Service: Mr and Mrs Saunders own Winchester House. Mrs Saunders is the Registered Manager. A large detached property; the home is registered for 8 older people. All accommodation is at ground floor level and all bedrooms are single, with most having en-suite facilities. Winchester House is well decorated and well maintained throughout and is very welcoming and homely in appearance. There are extensive, well-maintained gardens to the rear of the property. The current scale of charges as at June 2008 ranges from £455.00 - £499. 00 per week. The highest fee is for a single en-suite room with a garden view. Hairdressing, chiropody, foot massage, toiletries are all charged at extra at cost. Winchester House DS0000017998.V366095.R02.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 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection of Winchester House took place on 9th June 2008 over an 8¼-hour period. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last key inspection in June 2007. At the site inspection, records and documents were inspected and the inspector spoke to the registered manager, care staff and the people living at the home. Mr Lee Saunders, joint provider was also present at the inspection. In addition the Annual Quality Assurance Assessment (AQAA) completed in April 2008 was considered as part of the inspection process and a tour of the premises was completed. Surveys were sent to the home prior to the inspection. Nine surveys were completed by the people living at the home, four surveys were completed by relatives, two by local GPs and five staff surveys were completed and returned to the Commission prior to writing this report. Their comments are reflected in this report. During the inspection three people who live at the care home, one carer, a relative were spoken with and a second relative spoke to the inspector on the telephone. What the service does well: The home was clean, bright and welcoming on the day of the inspection visit. Decoration and maintenance tasks are completed to a high standard. There was a relaxed and homely atmosphere in the home with an established staff group. Admission processes in the home were managed well, with visits and interviews arranged prior to the new resident moving in. Care planning and record keeping for the people living at the home was in good order, with consideration given to all aspects of health, personal and social care needs. People living in the home spoke of being able to make choices around what they wished to eat, what they wished to do and where they liked to spend their Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 6 time. Within the survey work completed, residents were complimentary regarding the way they were supported to maintain their independence. One resident said ‘The home gives me a good degree of independence that I wish.’ Another relative said that ‘the home is perfect for my mother’ and they went on to say ‘Lovely people with a home from home environment.’ What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 7 be made available in other formats on request. Winchester House DS0000017998.V366095.R02.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 Winchester House DS0000017998.V366095.R02.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, 3 & 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who come to live at the home can be confident that their needs will be fully assessed and these will be met. EVIDENCE: The manager showed us a new ‘Welcome to Winchester House’ file, which had been developed since the last inspection. This document was in large print font and was easy to read. It gave information about the proprietors and a history of Winchester House since they had taken over the home approximately twenty years ago. In the file there were photographs of the proprietors and the home. The manager said that they plan to add more Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 10 photographs of the home including staff photographs, photographs of meals and detail of the food offered in the home’s menus. A list of useful telephone numbers is to be found in this file. In conjunction with the ‘Welcome to Winchester House’ file a new A4 brochure has been developed. This was also in a large print font and was easy to read. This was a useful document for it gave detailed information about the home such as the care and facilities on offer in the home. Photographs found in this brochure illustrated the document well. Within the Annual Quality Assurance Assessment (AQAA) it was said that the home had improved the information on offer when a person is choosing a home. This was seen at this inspection. In addition it was stated that they are to review other documents such as contracts producing them in larger print and are considering adding additional information such as a timetable of activities on offer. Since the last inspection there have been three new residents admitted to the home. There are currently eight residents living at Winchester House. The manager said that each prospective resident had been given a copy of the home’s new brochure and before entering the home they had met with them to undertake a pre-admission assessment. A document entitled – ‘Service User Assessment and the Pre-admission Questionnaire’ was used. Copies of all three completed assessment paperwork were seen on their individual files. The manager said that these were completed prior to them moving into the care home, either in their own private home, another care home or as they had visited Winchester House. All three new residents had been able to visit the home, view their bedroom and meet other residents and staff. At the inspection visit these three residents were spoken with and all confirmed that they had been helped by the staff and management to make this process run smoothly. One person said that they were ‘marvellous’. Within the survey work conducted by the Commission, all seven residents who had completed the survey had said that they had received enough information about the home before the moved in to make an informed choice. One relative spoken to on the day of the inspection said that they had found the management and staff very supportive and helpful as they had moved their relative into Winchester House and a relative who had completed the Commission‘s surveys said that they had received enough information about the care home to make an informed decision when moving their relative to Winchester House. Within the AQAA it was stated that the home endeavours to offer a ‘friendly, welcoming atmosphere’. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 11 Winchester House does not offer intermediate care. Winchester House DS0000017998.V366095.R02.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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can be assured that their care needs will be met through their individual plan of care and they can be assured that their medication will be administered in a safe and secure way. EVIDENCE: New care planning files and formats have been devised since the last inspection. Three care plans were sampled and inspected as part of case tracking care in the home. An assessment of care with a care plan was found on file. This covered all aspects of care including health, personal and social care needs. Consideration is now being given to social care needs and the manager said that the home has appointed an activities co-ordinator who has Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 13 started working with the residents. This was noted in our conversation with residents and the co-ordinator and is detailed later in this report. Within the care-planning file records were kept of cash, valuables and furniture brought into the home, medical appointments and visits, daily care needs, accident report records, a completed contract/agreement, a weight chart and a completed missing person form with full details should the person go missing. In addition consent had been sought from each resident for the home to hold a photograph on their care planning file and each file had a clear photograph of the individual. In addition, a record of informal chats had been introduced. A good example of this was seen on one file when the benefits and pleasure of having a daily bath had been discussed with a resident and this had been considered in a monthly review of their care to ensure that they met that person’s needs. Some risk assessments have been considered within the care-planning file. These related to daily care issues such as mobility and the prevention of falls. Whilst the format used detailed the level of risk, it did not analyse the risk and detail the action to minimise the risk. Further work is required on this as is required around risk assessing the risk posed by the garden ponds. This is considered further in the Environment section of this report. Three residents spoken to at the inspection spoke highly of the care they received at the home. Each had been able to maintain contact with their family, friends and the local community and they were still able to access outside activities and functions. Eight people living at the home had completed the Commission for Social Care Inspection (CSCI)’s survey and four out of the eight said that they usually received the care and support they needed. The remaining four residents said that they always receive the care and support they needed and one said they were ‘ very well supported. The home gives me a good degree of independence that I wish.’ Within the AQAA it was stated that the home plans to continue ‘to improve the Person centred approach to documentation and involve the staff by using the key worker system to review care plans and risk assessment with individual clients’. This was confirmed by management and staff who spoke of being introduced and involved in individual’s care. Records were seen on the care-planning files of visits to healthcare professionals such as GPs, chiropodist, Diabetic Nurse and Community Nurses. Two residents confirmed that they were supported and assisted to access their local GP surgery located next door to the home. Each spoke of receiving very good health care from their GP who they had been able to remain with when they entered the home. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 14 During the inspection a Community Nurse visited the home to attend to a resident. They spoke briefly with the Inspector and said that they found the home always willing to follow instructions as given by them to care for their patients and all staff took an interest in their work. Two local GPs had completed and returned the Commission for Social Care Inspection (CSCI) survey form. Both were very complimentary about the care residents receive at Winchester House. One said that Winchester House was ‘Our most homely home for elderly residents’ and the other said ‘Excellent sensitive personal care of all residents at all times’ and they added ‘Also Care Staff skilled and experienced’. Medication administration, record keeping and storage was sampled and inspected for the three people who were part of the case tracking exercise. All eight residents were said to have medication, with one resident able to selfmedicate. Since the last inspection, the home has a new pharmacist supplying their medication and they have acquired a medication trolley for storage of medicines. This was secured to the wall in the utility/laundry room. On the day of the inspection, there were no Controlled Drugs in use. Prior to this inspection Controlled Drugs has been administered in the home and evidence was seen of this in the Controlled Drug Register. A safe had been purchased for the storage of Controlled Drugs. This does not comply with requirements. Secure storage in a Controlled Drug metal cupboard is required under the Misuse of Drugs (Safe Custody) Regulations 1973. The home’s manager was advised of the need to install a Controlled Drug cupboard to ensure that the home is able to store Controlled Drugs correctly. The Monitored Dosage System (MDS) is used in the home, with the majority of medication held in blister packs. The Medication Administration Records (MAR) were sampled and inspected for three residents and records and medication were found in good order. These record sheets were used for the auditing of medication as it enters the home and any changes to medication administration were seen to be noted on these records. One resident has diabetes and they manage both their Blood Glucose testing and Insulin injections. The manager said that the home supports the resident to do this, ordering and storing insulin supplies in a fridge and then into secure storage in their room. The resident is seen regularly – six monthly by both a Diabetic Nurse and a Consultant. In December 2007 all staff received training on Diabetes’s Awareness. Some medications such as insulin and eye drops are held in a designated fridge. The manager said that the home had overlooked the need to record the temperature of this fridge to ensure safe and appropriate storage of these Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 15 medicines. However, during the inspection a fridge thermometer was purchased and is to be brought into use immediately. Throughout the day, staff were seen to treat residents with respect and dignity. Working in a small care home staff were aware of individual needs and residents were seen to be treated sensitively. From speaking to a carer it was evident that they had a good understanding of the need to treat all residents with respect and ensure that their right to privacy is upheld. Staff were seen to knock on bedroom doors and wait to be asked to enter, before going into the room. Two residents spoken to had their own telephone and both said that they liked having their own telephone for they were able to make and receive calls as they wished and this enabled them to keep in touch with family and friends. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 16 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service People who live at the home can expect to be given choices about how they spend their time, visiting arrangements and meals. EVIDENCE: Within the AQAA it was stated – ‘We have listened to feedback from clients and relatives, and tailored our activities to meet their requests. One of the main improvements has been an increase in staffing levels to ensure the provision of more frequent outings’. One resident said that they were able to attend their local church and the home supported and assisted them in this, either by providing transport or by arranging transport with the church. Residents spoken to at the inspection were able to tell us of the choices they are able to make. One person said that they continued to go out to their Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 17 Gardening Club and had just returned from a week’s holiday with them. Another resident said that they enjoyed close family ties and they had just returned from holiday with their family too. All three residents were aware of a monthly activity programme created by the home’s manager and the newly appointed Activities Co-ordinator. One person said that they had really enjoyed an exercise session with them and another said that they had had an opportunity to discuss with them what they would like to do. Later in the day, the inspector was able to have a brief conversation with the Activities Co-ordinator and they spoke of developing a weekly programme of events. They said that they were planning to use two record sheets to detail who attended and what was enjoyed. This could them be reflected in the individual’s care plan. The home’s manager said that they were planning to introduce discussion on activities in the regular resident meetings. All three residents spoken to said that they enjoyed the garden and during the day three residents were seen to sit out in the sunshine. The animals in the home are welcomed. One resident said they were very pleased to see the two dogs in the home and the homeowner said that several of the residents enjoy patting and feeding the dogs at mealtimes. During the inspection, the inspector was able to speak with a visitor. They said that they visited the home weekly and often popped into the home during the week. They said that they were always made very welcome with refreshments offered. They found the home to be bright and clean and they were very impressed with the care their friend received. They added that they felt that their friend’s health had improved and they had ‘lost 5 years off their age’ for their friend felt secure and was receiving regular meals. One resident in the survey work completed by the Commission for Social Care Inspection (CSCI) said ‘I am really happy.’ Within the AQAA it stated ‘We have an open visiting hours so that friends and relatives can come in at any time of the day. Refreshments are offered to all visitors’. This was evidenced at the inspection. All three relatives who had completed the Commission‘s survey said that the care home always ensured that their relative kept in touch with them and one added ‘The door is always open and we are always welcome.’ The manager said that they encourage residents to manage their own financial affairs. They said that some are assisted by their families and friends, whilst others manage their own affairs. Residents are encouraged and assisted to bring in some of their own personal possessions. Two residents confirmed that they had brought in items of furniture, personal belongings such as photographs, pictures, books and Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 18 ornaments. All three residents spoken to at this inspection said that they had their own television in their room. Records are held on care-planning files of items brought into the home. At Winchester House, menu planning is done day by day. The menu for the day is decided on on the previous day. The manager said this is normally following discussion with the residents and consideration is given to individual dietary needs e.g. diabetes. A main choice is offered at lunchtime, but an alternative is also offered. On the day of the inspection, lamb chops were offered with an alternative of Ham Salad. One resident took up this alternative. The menu for the day is displayed in the lounge/dining room. Daily nutrition records are kept and these detailed the food eaten. Residents are offered a cooked breakfast each day, which is occasionally taken up. The teatime menu comprises of a hot and cold choice each day. One resident told us that they did not want tea at teatime and so they had come to an arrangement with the home that a supper of soup and bread and butter is served later in the evening. This is to their liking and much appreciated. The manager confirmed that this was the situation. The homeowners said that food supplies are brought from both wholesalers and local supermarkets, with deliveries of milk and bread to the home. Individual preferences and ‘treats’ are considered when planning menus and offered as residents wish. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 19 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect their concerns to be taken seriously by the care home. EVIDENCE: The home’s complaint procedure has been reviewed and revised since the last inspection. This procedure was in a simple, clear format and was to be found as a separate document in the home’s policies and procedures file and in the home’s brochure and the ‘Welcome to Winchester House’ file. A shortfall was noted regarding the contact details for the Commission. The manager said that this would be changed immediately. All 3 residents spoken to said if they needed to complain they would raise their complaint with the manager who is in day-to-day contact with them. Three out of the four residents who completed the survey work sent by the Commission said that they knew how to make a complaint. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 20 A new Policy on Abuse has been updated and revised since the last inspection. As with the Complaints Procedure there is a need to update the Commission ‘s details and this too was to be dealt with immediately. This policy outlined different types of abuse and clearly outlined the action to be taken when making a referral. A staff member spoken to was able to detail how they would make a referral and they had a good understanding of the roles of other agencies in safeguarding issues. They said that they and another member of staff had attended Safeguarding Adults training in the last year. This was confirmed in the staff survey work completed by staff members. One carer said that they had recently attended safeguarding training and all five were aware how to raise a concern in the home. Two carers spoke of raising their concerns with the manager and that the home had a complaints procedure. With both a clear Policy on Abuse and training opportunities the home is ensuring the safety and welfare of their residents. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 21 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, 24 & 26. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at Winchester House have homely, comfortable and safe surroundings, which are kept clean and tidy. EVIDENCE: A tour of the premises was conducted at the inspection. All of the communal areas and some private bedrooms were seen. Winchester House was light, bright and clean. Decoration and maintenance were in order; with further maintenance tasks identified and planned e.g. the external decoration of the home in 2008-09. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 22 All three residents spoken to at the inspection said that they were very pleased with their room. They had been able to personalise it with items of furniture, ornaments, pictures and photographs. Four out of the seven surveys completed by residents said that the home was ‘always’ fresh and clean; whilst the remaining three said that the home was ‘usually’ fresh and clean. Storage facilities have been introduced into each room for storing medication, valuables and money. Six out of the eight single bedrooms have en-suite facilities of a wash hand basin and a toilet. One bedroom that had originally been a double room had two wash hand basins. The provider said that the home was planning to replace a wash hand basin. This was seen in the manager’s office awaiting a plumber. In addition they said that they are looking to install en-suite facilities of a toilet in this room. The large garden at the rear of the home was tidy and well maintained. It was laid to lawn with scrubs, trees and some flowerbeds. There are fruit trees at the bottom of the garden. As found at the last inspection, Winchester House has raised ponds and a water feature located close to the house. Since the last inspection the home had completed a brief generic Pond Risk Assessment to cover all residents, staff and visitors. Warning notices have been placed near the access to the garden from the lounge/dining room and at the ponds to alert all of the dangers. Whilst some work had been completed around identifying a risk for all, there was no evidence of consideration being given to identifying individual risks for residents. This is considered further in the ‘Management and Administration’ of the home section of this report. Winchester House has a laundry/utility room in the centre of the house. There is an industrial washer and an overhead ceiling dryer for drying clothes or the washing is hang out on the line to dry. Care staff covers laundry duties during the day, with ironing being completed in the afternoon and evening. All three people spoken to at the inspection said that they experienced a good laundry service, with laundry returned promptly and laundered well. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 23 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect to be supported by sufficient staff with skills and knowledge to meet their needs. They can be assured that appropriate recruitment practice has been followed to safeguard their welfare. EVIDENCE: Staffing levels were considered and discussed with the manager at the inspection. Whilst there have been some changes to the resident group the dependency needs of the residents continue to be low with three residents able to go out alone in the community. Current staffing levels are two carers on duty throughout the day and one awake carer on duty at night. The manager said that this is sufficient to meet residents’ needs and should escorts be needed or outings be planned additional staff are timetabled on. Within the survey work conducted by the Commission five people living at the home said that staff are ‘always’ available when needed and two said that they were ‘usually’ available when needed. Two residents had commented that Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 24 Winchester House is a small care home for only eight residents and ‘our staff are very good and come as soon as they can, which we quite understand.’ The other person said ‘we are well cared for, I have no complaints about the home.’ Within the AQAA it was stated that 65 of care staff delivering care have a National Vocational Qualification (NVQ) Level 2 or above in care. On the day of the inspection the manager said that five care staff have a NVQ Level 2 in care and a sixth member of staff is about to start this qualification. This was noted on the staff training file. In total there are nine care staff at the home. Staff files for two care staff were sampled and inspected. These carers had commenced employment at the home in June 2007. These files were found to be in good order with a photograph of the carer on each file, a completed application form contained detailed employment history and the names of two referees who had been approached for a reference. These references were in good order as were the Criminal Record Bureau (CRB) disclosures. The manager said that they have commenced re-checking all CRBs for all care staff. Appropriate recruitment practices including an interview and an inhouse induction had been completed for each carer. New staff training files have been developed since the last inspection. This listed training attended, staff development, staff supervision and appraisals. One of the two carers who commenced work at the home in June 2007 had completed both an in-house and Skills for Care Induction training programme. The second carer still needs to complete this. Whilst it is recognised that this carer has attended some basic training courses since starting work at Winchester House, they do need to complete this induction training programme to evidence that they are trained and competent in their job. The manager said that all staff had been asked to complete an annual appraisal in the May 2008 staff meeting. This was evidenced in the staff files seen and confirmed in discussion with a staff member. The manager said and confirmed in the AQAA that the home has a planned staff training programme. All staff had completed distance learning Infection Control training course, seven staff had attended a Diabetes Awareness training course and six staff had attended Medication training in the past year. Further planned courses are Food Hygiene, First Aid and Person Centred Care in 2008-09. All five staff members who had completed the Commission‘s survey said that they received training relevant to their role. Two people said that they had just completed an Infection Control training course and Safeguarding Adults training and one said that they were about to start on a manual-handling course. Another carer said that ‘there is always ongoing training courses.’ Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 25 With ongoing supervision and appraisals and a training development plan in place the home is working to ensure that all staff are equipped with the skills and expertise to care for the residents at the home. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 26 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home should be assured of good management with an ongoing quality and monitoring system in place and health and safety systems to ensure that the people living in the home are protected. EVIDENCE: The registered manager/provider of Winchester House has many years of working in the care sector and has managed and owned Winchester House for Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 27 nearly twenty years. We were told that they hold a qualification, which is equivalent to a NVQ Level 3 in Care. Whilst they said that they had considered completing a NVQ Level 4 in care and management, they said that this was not something they were currently pursuing. They did recognise however that they needed to update their management and care knowledge and practice. The management of the home however was seen to be good. The manager is in day-to-day charge of the home and has a good understanding of the management and running of the home. Both care staff and residents spoke positively regarding the management of the home and comments such as the manager ‘is always available to talk’ were noted on a resident’s survey. Winchester House had conducted survey work in April 2008. Surveys were given to residents, relatives and local GPs. On receipt of the returned surveys a simple scoring system had been completed to collate the results and an analysis completed. As a result of this quality assurance some action had been taken as result. An example of this was that the presences of home’s complaints procedure had been raised through residents meetings and individual letters of response to each resident and an action plan completed. Evidence of resident’s meeting were seen at the inspection and minutes were kept. Discussion topics were handled sensitively and the minutes were shared with all residents and relatives who had attended the meetings. The manager said that the home does not hold any money or valuables for any of the residents. They make their own arrangements for this, with the majority having relatives to assist. The manager ensures that the health and welfare of residents at the home are promoted and protected through an on-going training programme. This has been detailed earlier in this report. Evidence was seen at the inspection of health and safety certification relating to a mobile hoist, a Parker Bath, Portable Appliance Testing (PAT) of electrical appliances and Legionella testing completed. An Essex Fire Service Assessment Tool had been completed and the Fire Service had visited in June 2007. The provider said that some minor defects had been found and action had been taken. A visit was planned for June 2008 to check compliance. These safety checks ensure the safety and welfare of both residents and staff. As stated in the ‘Environment’ section of this report, some consideration had been given to the risk the ponds and water feature present in the garden. This general risk assessment did not identify the risks in full or the level of the risk and it did not analyse the risk or detail the action to be taken to minimise the risk for individual residents. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 28 The manager should review the current risk assessment arrangements and develop individual risk assessments so that the people living at Winchester House as safeguarded at all times. Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 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 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP30 Good Practice Recommendations People living in this home should be assured that staff are trained and competent to do their job. This is with regard to the completion of Induction training for one member of staff. A 12-week maximum period is set for completion of this training. People living in this home should be assured that their safety is safeguarded through the introduction of individual risk assessments around accessing the garden and the risks presented by the ponds and water feature in the grounds. 2. OP38 Winchester House DS0000017998.V366095.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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