Care Home: Windsor Rest Home

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What the care home does well Windsor Rest Home provides a friendly, supportive and homely environment for the residents. The home is clean and well maintained. The residents feel that they are well cared for and that their medical needs are met. They also told us they enjoy the food. Comments we received from residents include; “I think it is a caring home.” “I feel safe and content.” “The cares are very kind and helpful. I’m very happy here.” A GP commented; “One of the best rest homes that I have patients in.” This is the first home that the manager, Mrs Luci Jane Spears, has managed. She was eager to know how to improve the home and meet the requirements that have been made. What has improved since the last inspection? Windsor Rest HomeDS0000072975.V374847.R01.S.docVersion 5.2This is the first inspection since the home was registered under new management in October 2008. What the care home could do better: The home needs to ensure that pre-admission assessments are more thorough and detailed to ensure that they are able to meet the needs of prospective residents. Care plans need to have the religious and cultural needs on residents recorded in them. Risk assessments need to be more detailed and include the action that will be taken to minimise identified risks. Moving and Handling risk assessments need to be drawn up to protect residents and staff. Key inspection report CARE HOMES FOR OLDER PEOPLE Windsor Rest Home 52-54 Windsor Road Worthing West Sussex BN11 2LY Lead Inspector Jo Hartley Key Unannounced Inspection 28th April 2009 09:45 DS0000072975.V374847.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windsor Rest Home Address 52-54 Windsor Road Worthing West Sussex BN11 2LY 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 235594 Cantonfield Ltd Mrs Luci Jane Spears Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Windsor Rest Home DS0000072975.V374847.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. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 13. Date of last inspection N/A First Inspection Brief Description of the Service: Windsor Rest Home is a care home registered to provide accommodation for up to thirteen residents. Mrs Luci Jane Spears is the registered Manager in charge of the day-to-day management of the establishment. Windsor Rest Home is situated in a quiet residential area approximately a mile from the town centre and half a mile from the seafront. The care home is a large property originally designed as two terraced houses with a paved front garden and a large secluded rear garden with flower borders and a summerhouse. The accommodation is arranged in one double and eleven single rooms on two floors with a lift providing access between floors. All rooms are currently being used for single occupancy with four of these rooms having en-suite facilities. The current fees range from £345 to £410 per week. Windsor Rest Home DS0000072975.V374847.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 that use this service experience good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. It was carried out by Jo Hartley. The findings of this report are based on several different sources of evidence. These include: the Annual Quality Assurance Assessment (AQAA) completed by the home, surveys received from residents, a health professional and staff, and an unannounced visit to the home, which was carried out on the 28th April 2009. During the visit we looked at policies and procedures, staff records and residents records. All regulatory activity since the home was registered six months ago was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. This is the first inspection on this service since it was registered in October 2008. What the service does well: Windsor Rest Home provides a friendly, supportive and homely environment for the residents. The home is clean and well maintained. The residents feel that they are well cared for and that their medical needs are met. They also told us they enjoy the food. Comments we received from residents include; “I think it is a caring home.” “I feel safe and content.” “The cares are very kind and helpful. I’m very happy here.” A GP commented; “One of the best rest homes that I have patients in.” This is the first home that the manager, Mrs Luci Jane Spears, has managed. She was eager to know how to improve the home and meet the requirements that have been made. What has improved since the last inspection? Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 6 This is the first inspection since the home was registered under new management in October 2008. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Windsor Rest Home DS0000072975.V374847.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 Windsor Rest Home DS0000072975.V374847.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. The home does not provide Intermediate Care therefore Standard Six does not apply. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Windsor Rest Home provides enough information to prospective residents so they can make an informed choice about where to live. All residents have a contract that states the terms and conditions of the home. Pre-admission assessments are in place but they need to be more detailed. EVIDENCE: Windsor Rest Home has a Service User Guide and Statement of Purpose that are given to new residents. They contain all the required information; however they need to be updated to reflect the change in the name of the Commission to the Care Quality Commission. All five residents who returned surveys said that they received enough information prior to moving into the home. One Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 9 resident said, I wanted to be in a small homely home and liked Windsor straight away. It was the only one I looked at. Residents told us that they have received contracts from the home. Contracts include a statement of terms and conditions. We looked at the files of three residents. Each resident had an assessment that took place prior to admission. The assessment includes information about residents’ needs, however these are very basic. For example, for one resident under personal care the assessment said “help with washing and dressing”. There were no details of what help was required with these tasks. There was also no information recorded in the section regarding mobility and dexterity or mental state. These assessments had been undertaken by the previous owners of the home. In the future the home needs to ensure that pre-admission assessments are more detailed to enable them to provide for individual needs when residents first move in. A requirement has been made regarding this. Residents are encouraged to visit the home prior to moving in so that they can see whether the home is the right place for them. All residents have one month’s trial period when they move in. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are met by the home. However, individuals’ religious and cultural needs should be recorded and risk assessments need to be put in place for moving and handling. Other risk assessments need to be more detailed. The new owners are in the process of updating these records. EVIDENCE: We looked at the care plans for three residents who live at Windsor Rest Home. The care plans we saw were basic but included individual preferences for care and support. For example, there are details of people’s food preferences, including how and when they like their drinks served during the day and their hobbies and interests. However, there are no details of religious and cultural needs. The home needs to ensure that these are included in care plans. A Requirement has been made regarding this. Care plans are reviewed Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 11 on a monthly basis and are updated to reflect changing needs. Care plans are signed by residents to show that they are happy with the content. The home has just started to complete profiles of individuals’ “typical day”. These are in a more narrative style, more person centred and detailed than current care plans. When they are completed they will give staff detailed, personalised information on residents’ routines and care preferences. Each care plan includes basic risk assessments including falls and pressure areas. Risk assessments are very basic, they need to include more detail on how to minimise risk. For example one resident had a risk assessment of a medium risk of violent and abusive behaviour. There was no information on what triggers this, how it manifests, any warning signs or what staff need to do if the behaviour occurs. There were also no moving and handling risk assessments for residents. Requirements have been made regarding these issues. The care plans and risk assessments that we saw dated back prior to the new owners of the home. However, there was evidence that the new owners are in the process of updating these documents. All the residents who returned surveys said that they always receive the care and support they need. Daily records and care notes show that residents receive the support from healthcare professionals such as General Practitioners, District Nurses and opticians that they need. All the residents who returned surveys said that they always receive the medical support they need. Comments include; “I need to have cream applied to my toes and the girls will always do that patiently for me.” “The manager always takes me to hospital and doctors appointments and stays with me.” A General Practitioner who returned a survey said that individuals’ health care needs are always met by the home. The homes medication storage was seen and found to be tidy, clearly labelled and with no over stocking. The recording of the administration of medication was accurate with no gaps. All staff who administer medication receive training. The home does not have a procedure in place for the self administration of medication. At present no-one in the home administers their own medication but the manager is going to put a procedure in place in case anyone wishes to in the future. Throughout the visit staff were seen and heard respecting the residents’ privacy and dignity, for example by closing bathroom doors when undertaking personal care and knocking on bedroom door before entering. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 12 Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a variety of activities and enjoy the food provided. Visitors are made welcome. EVIDENCE: Care plans, daily records and observation during the visit showed that residents are able to make choices about how they live. For example they get up and go to bed when they choose, where what they like and decide what they want to wear each day. A variety of activities is provided by the home including film club, reminiscence, games and exercise to music and board games. One resident said, “I’m not really interested in entertainment but I enjoyed making pots and planting bulbs.” Another resident said, “Quizzes – I would like more of those. I enjoy the bingo and I like most of the entertainers, especially Peter and Allan.” Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 14 Residents and staff told us that visitors are welcomed to the home. A member of staff said that visitors are always made a drink when they arrive. Residents told us that they enjoy the food provided at the home. In the survey responses three residents said they always enjoy the food and two said they usually do. The menu for the lunchtime meal on the day of the visit was chicken and ham pie, mash potatoes, carrots and swede or cod in butter sauce. For pudding there was a choice of ice cream or chocolate mousse. A resident said, “I think I am a bit fussy, the girls will cook me something different if I don’t like the main choices.” Another resident said, “I am offered a choice if the main course isn’t what I like. For supper I am always asked what I would like.” Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know how to make a complaint if they need to. They are protected from abuse from the homes policies, procedures and staff training. EVIDENCE: The complaints procedure is displayed in the hall of the home and is also printed in the Service User Guide and Statement of Purpose that all residents receive. All the residents who returned the survey we sent out said that they know who to speak to if they are not happy and they know how to make a complaint. Staff and training records seen confirmed that staff receive training in Adult Protection. The West Sussex Guidance for Safeguarding Adults is available for staff. There are also robust policies and procedures for staff to follow. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, well maintained environment that is clean and hygienic. EVIDENCE: Windsor Rest Home provides a homely, clean and comfortable environment for residents. All of the residents who responded to the survey said that the home is always fresh and clean. Furnishings and fittings are of a good quality and in good condition. Residents’ bedrooms were personalised with their own belongings. The home has a well tended garden with a greenhouse, summer house and tables and chairs so residents can enjoy it in fine weather. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 17 Most of the radiators in the home are covered. The manager said that she would look into covering the ones that are not. In the meantime she will draw up risk assessments. Equipment such as ramps, bath seats and rails are situated throughout home where needed. The home has recently installed an assisted bath for the residents. The laundry facilities are situated away from food preparation areas and are easy to clean. There is a communal lounge and dining room on the ground floor and a quiet lounge on the first floor. The lounge on the ground floor has a fish tank and residents help to feed the fish. There are accessible toilets located close to the lounge and dining area. Staff have received training in fire safety and are booked onto an infection control training course. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by well trained, experienced staff who are competent to do their jobs. At present there are enough staff on duty to meet the needs of residents, however if the level of needs of residents increases this will have to be reviewed. EVIDENCE: We talked to two members of staff at the home who told us that there is enough staff on duty to meet the needs of the current residents. We also received three surveys from staff, one said there is always enough staff in duty, one said there usually is and one said there never is. Responses from residents in our survey told us that four residents felt that there are always enough staff available when you need them and one resident felt there usually is. Support staff are also responsible for cleaning and cooking as well as caring. This was discussed with the manager. She told us that if the needs of the residents increase she will employ more staff. Thought should be given to employing domestic staff to relieve care staff from these duties. The home has an induction and staff training programme in place. All three staff who replied to our surveys said that the induction they received when Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 19 they started their jobs covered everything they needed to know very well. Mandatory training includes Adult Protection, Infection Control, Medication Administration and Food Hygiene. Staff confirmed that they receive training that is relevant to their role, keeps them up to date with new ways of working and helps them understand and meet the needs of individual residents. The home has over fifty per cent of staff with a National Vocational Qualification in Care at Level Two or above. We looked at the recruitment records for three members of staff and found them to include most of the required documentation including Criminal Records Bureau Checks and two written references. One member of staff did not have an application form on file. One application form didn’t include a written history of employment. The manager explained that the staff in question had been employed by the previous owners of the home and said she will ensure that any future staff employed will have this information. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and provides a safe environment for residents. Staff say they are well supported by the manager. EVIDENCE: The registered manager has enrolled on the LME award which replaces the Registered Managers Award. All but one member of staff who we talked wit or responded to our survey said they feel supported by the manager. Comments we received include, “Management respond to any training needs or requests for information that we make.” “Management respond quickly to any concerns Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 21 we may have.” “I don’t feel I get support, does not feel that anyone is in charge.” The home has a Quality Assurance system in place that seeks the views of residents, visitors, staff and other stakeholders. The outcomes from the next Quality Assurance audit should be published when they have been collated. Residents or their representatives manage their own money. Some residents need assistance from staff to collect their money from the bank or Post Office. This is all documented and signed for by the residents. We saw records that show that staff receive regular supervisions. This was confirmed by staff we spoke with. The home has health and safety procedures in place. Any accidents and incidents are recorded thoroughly. Checks on equipment and services such as electricity and fire systems were seen to be up to date. Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 23 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 OP3 Standard Regulation 14 (1) Requirement Pre-admission assessments need to be more detailed to enable them to provide for individual needs when residents first move in. Care plans need to include the religious and cultural needs of residents. Risk assessments need to contain more detail including action to be taken to minimise identified risks. Risk assessments need to be carried out regarding moving and handling. Timescale for action 28/06/09 2 3 OP3 OP7 12 (3) 13 (4) 28/06/09 28/06/09 4 OP38 13 (4) 28/06/09 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 Windsor Rest Home DS0000072975.V374847.R01.S.doc Version 5.2 Page 24 Care Quality Commission South East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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