Care Home: Wingates Residential Home

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What the care home does well Residents felt they were well looked after. Relatives agreed, one felt residents were "in very good hands...Wingates is always first class". The staff team was small. This meant residents, relatives and staff all got to know each other very well. Staff were kind, warm and friendly. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Wingates was homely, clean, safe and comfortable. Residents enjoyed their meals. What has improved since the last inspection? The manager, with the support of the staff team, had worked hard to make the following improvements. There was more staff on duty in a morning and care records were getting better. These changes made sure all residents got the care and support they needed. New social activities were being tried, helping residents enjoy their day. A new staff photo-board helped relatives identify staff, making it easier to talk to them and feel part of the home. There was better support for staff, making sure they got the help needed to do their jobs well. Staff described the manager as supportive and approachable. Fire safety had improved, helping keep residents, staff and visitors safe. What the care home could do better: To make sure private residents can be looked after, the home needs to have more information about the help they need before they are offered a place. The home still needs to make sure the scales it uses to weigh residents are working properly, helping keep residents well. Any major changes then found should always be looked at. Medicines were being looked after better. Although further improvements were still needed, to make sure they were given as prescribed by the doctor. Better records were still needed to show what social activities residents took part in. A weekly activities timetable would also help everybody know what was planned, making sure there were a variety of things on offer. A central complaints` record would show how the home listened to concerns and sorted them out. To make sure staff know how to do their job properly, safety training must be kept up to date and new staff should have more of an introduction to the homeWingates Residential HomeDS0000009309.V376790.R01.S.doc Version 5.2 (to meet standards set down by the government`s training body for care homes). Key inspection report CARE HOMES FOR OLDER PEOPLE Wingates Residential Home 95 Chorley Road Westhoughton Bolton Lancashire BL5 3PG Lead Inspector Sarah Tomlinson Key Unannounced Inspection 07:20 15th July 2009 DS0000009309.V376790.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. Wingates Residential Home DS0000009309.V376790.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 Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wingates Residential Home Address 95 Chorley Road Westhoughton Bolton Lancashire BL5 3PG 01942 813840 01942 811506 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 Sabir Khan Mrs Shila Khan Carrie Ann Ashton Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is registered for a maximum of 25 service-users to include: Up to 25 service-users in the category of OP (Old Age not falling within any other category). The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 7th August 2008 2. Date of last inspection Brief Description of the Service: Wingates is a private care home, registered with us (the Care Quality Commission), to provide care for up to 25 older people. The home is on two floors and has a lift. There are 23 single bedrooms and 1 double bedroom (which is used as a single); 8 on the ground floor and 16 on the first. All have wash hand basins and 2 also have en-suite toilets. There is a large, main lounge with an adjoining conservatory lounge, a further separate third lounge, and a dining room. There is an assisted shower room on both floors and an assisted bathroom on the first floor. The home is on a main road in the Westhoughton area of Bolton. The entrance is at the rear, where there is a car park and a garden with mature trees, a lawn and a small patio area. There are local amenities, including shops, a church, a restaurant and pubs, nearby. The home is on bus routes for the town centre. Current fees (at July 2009) range from £373.38 to £378.66 per week (hairdressing, dry cleaning and toiletries are extra). A copy of our latest inspection report is available from the home. Wingates Residential Home DS0000009309.V376790.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. Our inspection visit, which the home was not told about beforehand, took place over 1 day (lasting approximately 12 hours). It was carried out by a lead inspector plus a pharmacy inspector (who looked at medication). (References to ‘we’ or ‘our’ in this report mean the Care Quality Commission). During our visit we spent time watching how staff cared for residents. We also talked with 6 residents and 2 relatives (and received written feedback from a third relative). We looked around parts of the building and at some paperwork. We also talked with the home’s owner and with staff (including the manager, 5 carers, 2 senior carers, the chef, a domestic/part-time cook and the laundry worker). We also received feedback from the local District Nurse team who visit the home. Their views are included in the report. We have also used information from an Annual Quality Assurance Assessment form (AQAA). The home has to complete this each year. It includes information about what they think they do well, what they would like to do better and what they have improved upon since our last visit. We carried out 2 short (random) inspections (on 7/11/08 and 13/2/09) after our last main (key) inspection on 7th August 2008. The first was done by a pharmacy inspector to check on medication issues. The second was in response to concerns raised by the District Nurse team. Both these inspections are referred to in this report. What the service does well: Residents felt they were well looked after. Relatives agreed, one felt residents were “in very good hands…Wingates is always first class”. The staff team was small. This meant residents, relatives and staff all got to know each other very well. Staff were kind, warm and friendly. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 6 Wingates was homely, clean, safe and comfortable. Residents enjoyed their meals. What has improved since the last inspection? What they could do better: To make sure private residents can be looked after, the home needs to have more information about the help they need before they are offered a place. The home still needs to make sure the scales it uses to weigh residents are working properly, helping keep residents well. Any major changes then found should always be looked at. Medicines were being looked after better. Although further improvements were still needed, to make sure they were given as prescribed by the doctor. Better records were still needed to show what social activities residents took part in. A weekly activities timetable would also help everybody know what was planned, making sure there were a variety of things on offer. A central complaints’ record would show how the home listened to concerns and sorted them out. To make sure staff know how to do their job properly, safety training must be kept up to date and new staff should have more of an introduction to the home Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 7 (to meet standards set down by the government’s training body for care homes). 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. Wingates Residential Home DS0000009309.V376790.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 Wingates Residential Home DS0000009309.V376790.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. 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. Prospective residents and their families received clear, helpful information about the home. Information the home gained about self-funding residents needed strengthening to ensure their needs were fully understood and could be met. EVIDENCE: The home provided both long and short (respite) term care. Although registered with us to provide up to 25 places, the occupancy maximum was 24, as the one double room was used as a single. At the time of our inspection, 23 residents were living at the home. The manager said the vacancy would probably not be filled in order to facilitate forthcoming building work. This was due to start late summer, with a 2 storey extension going out over the garden at the rear of the home. We confirmed the home must formally notify us when Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 10 this work was due to start (including comprehensive details of how disruption to residents would be managed and kept to a minimum). Prospective residents and their families were given information about the home in its brochure (a combined Service User’s Guide and Statement of Purpose). This brochure was easy to understand and had helpful larger type size for its target reader group of older people. Most of the residents living in the home had been referred by Social Services, with detailed assessment information provided (via a Care Management assessment summary and care plan). We discussed the recent admission of a new resident who was self-funding (private). They had been unable to visit Wingates before they moved in, although their family had done so. Good practice was noted, as the manager had visited the prospective resident beforehand and carried out an assessment of their needs. However, we advised this needed to be more detailed. We discussed the necessity and value of obtaining as much information as possible - as it is the sole responsibility of the home to ensure this assessment, which involves the prospective resident and their family whenever possible, is a comprehensive one. The home needs to be able to understand the prospective resident’s care needs (and any associated risks), so it can decide if it can meet them, and thereby be able to offer a place. An initial care plan should also be in place before they arrive, ready to guide staff in the first few days of a new resident’s stay. The new resident had received appropriate information setting out the terms and conditions of living in the home. The impact of moving into a care home could be overwhelming and stressful. The home was aware of this and the manager explained how she and the senior carer would spend time with a new resident to help them settle in. (Intermediate care is not provided by the home. Consequently standard 6 does not apply and was not assessed). Wingates Residential Home DS0000009309.V376790.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. 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’ health and wellbeing were benefiting from improvements to care practice, care records and medication management. Continued improvements and greater consistency were needed to further strengthen these areas. EVIDENCE: We spent time watching how staff spoke to and looked after residents. Residents were cared for by a small staff team, most of whom had worked at the home for a number of years. This meant they had a very good understanding of the help and support residents needed and how they liked this to be given. Staff on duty were generally very warm, kind, patient and respectful (e.g. crouching down to make eye contact when talking to residents who were seated; discreetly asking residents about using the toilet). Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 12 Residents were neatly and appropriately dressed. Staff supported residents to walk rather than use a wheelchair, helping to retain and improve mobility. We talked with 6 residents, who all felt they were well looked after. Relatives also spoke positively about the care provided and confirmed they were kept well informed of any changes in ‘their’ resident’s health or welfare. One relative felt their mother was “in very good hands. I come at different times everyday and Wingates is always first class”. Earlier in the year, the home’s District Nurse team had raised some concerns with us about care practices. This included an increase in minor skin wounds being referred to them. We had visited the home to look at this matter. Although an increase in skin tears was found, the cause was unclear. Moving and handling practices had appeared satisfactory. There had been a change in the home’s referral practice, with the manager requesting staff to refer all skin breaks to the District Nurse team, no matter how minor. This may have accounted for the increase. However, the home had not been monitoring this, which we advised them to do (in order to identify and track any individual or group issues). Two staff also had false nail extensions, and at times, one wore large earrings. To keep residents safe and reduce the risk of causing skin tears, we had advised staff should keep their fingernails short and only wear a minimum of close fitting jewellery. The home had since taken action to address the above concerns. The district nurse team had also been concerned about the late referral of a resident with a small foot ulcer. The home had acted promptly and appropriately when the resident had brought the matter to the attention of staff. However, the District Nurse team felt the wound was not new and therefore should have been identified earlier by staff (e.g. during routine intimate personal care). There had also been concerns about accident reporting. We had found minor skin wounds, although reported to the District Nurse team, were not always recorded in the accident book. The general quality of entries had also varied (as some did not describe the actual injury or confirm whether the resident had been checked for (further) injuries). At this inspection, the number of referrals for skin wounds had fallen; all referral forms were now being kept by the home; senior care staff were more closely involved in any treatments provided by the District Nurse team (enabling a better understanding of residents’ health needs); and the manager was having regular discussions with the District Nurse team (where any issues could be raised). There was a better standard of completion of accident records. There was evidence of a health care needs being appropriately identified and promptly responded to (e.g. a sacral skin break for one resident). A recent pattern of falls for another resident had been noted and acted on (with their care plan and risk assessment updated to identify the Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 13 higher risk, plus practical steps taken with a GP visit requested and subsequent referral to the falls clinic). We did have an ongoing concern about monitoring and responding to changes in residents’ weight. At our last inspection, one resident’s significant weight loss had been acted on but another resident’s apparent significant loss had not (potentially putting their health at risk). The manager had felt the loss was a result of the inaccurate domestic weighing scales. We had been concerned as this had not been confirmed. The home had since purchased seated weighing scales. However, at this inspection, we again found an apparent significant weight loss that had not been acted on. Although the manager felt this again reflected a fault with the new scales, we were again concerned this had not been confirmed. We looked at 3 residents’ care files in detail. At our last inspection, whilst care records had generally been satisfactory, some information needed to guide staff had been out of date. At this inspection, we found care files had generally improved. As noted, care plans and risk assessments were up to date, and were generally a more accurate reflection of residents’ care needs. However, we again discussed the need to clearly identify and record where residents had high risk or complex needs. For example, if a resident displayed aggression, there should be a description of what behaviour was displayed and how often, with clear guidance about possible triggers and helpful responses. This will provide the necessary guidance to the staff team and confirm such issues are taken seriously. In addition, the language in care forms should be as positive as possible. So instead of a resident’s ‘obsessive routines and cleaning habits…not causing any problems’, it could be explained as routines and habits that were important to the resident (with guidance for staff about how they then help). We discussed the care provided to residents at the time of their death. The home had recently worked closely with the District Nurse team to ensure a resident had avoided hospital admission, spending their final days cared for in their own room, pain free and with close staff attention. Relatives spoke very positively about the care provided. One relative’s comment kept by the home said how they had felt supported and that the home had “seemed to go the extra mile to comfort her during a difficult time”. The manager was working hard to ensure the wishes of residents and their families were met at this difficult time, with the sensitive issue of terminal care and funeral arrangements openly raised at a recent relatives meeting. The home had recently applied for a nationally recognised training and accreditation programme for end of life care. The application had been unsuccessful, but the home was planning to re-submit as soon as possible. In the meantime, senior care staff were to undertake palliative care training (with plans for all staff to attend in the future). After our inspection, we gave details of Help the Aged’s free ‘My Home Life’ bulletins. These are aimed specifically Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 14 at care home staff, with a recent edition focusing on how to provide good end of life care. We regard to medication, we had visited the home earlier in the year to check on progress made against changes previously requested. There had been general improvements. Although we had also found medicines being preprepared and handwritten medicine administration records (MARs) not always signed and countersigned (both of which increase the risk of mistakes). There had also been unclear recording when medicines were not given; and there continued to be a lack of guidance for individual residents about giving their ‘when required’ (PRN) medicines. At this inspection, we again looked at how medicines were handled. Suitable arrangements were in place. Medicines policies and procedures provided written guidance for staff to follow and most senior staff had completed certificated training in the safe handling of medication. Checks had been made to make sure staff were able to handle medicines safely. The home had made arrangements so residents could look after their own medication if they chose to. Records for the receipt, administration and disposal of medication were generally good and there were only a few gaps in information. This meant that on the whole it was easy to see what treatment residents had received. We checked a sample of medicines and records. We found medicines could be accounted for and appeared to be administered correctly. MARs were generally up-to-date but there were some areas that could be improved to ensure their completeness and clarity. For example, not all creams and external products were recorded. When details are missing, medicines are more likely to be missed out or not signed for. We saw an example where a resident’s medicines had not always been given because she had been asleep when the morning medications were given out. Some staff had given her medicines later when she woke, whilst others had missed them out altogether. The manager must ensure staff have a consistent approach in this situation, whilst respecting the residents right to get up when they choose. Medicines were stored in a locked room. However, people other than senior staff sometimes used this room. This meant any medicines that were not stored in locked cupboards or trolleys were not secure. Keeping medicines locked up helps to ensure they are not misused or mishandled. Creams and dressings were stored in individual baskets for each resident. Not all these items were labelled and some products had been put into the wrong basket. One resident was not having the right cream used for their skin condition because the basket did not contain the right creams. Residents are at risk of having the wrong product applied if products are unlabelled; staff do not carefully check the medication records before using the creams; and if they do not remove products that have been stopped by the doctor. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 15 Records were completed immediately after administration to help ensure they were accurately maintained. This reduces the risk of mistakes. Staff were careful to record the exact time of administering painkillers so the correct gap was left between doses. This reduced the risk of residents being given too much medicine. Other medicines however, were not always given at the correct time with regard to taking food and other medicines. We saw an example of a medicine used to strengthen bones being given alongside other medicines, even though the label clearly stated it should not be given at the same time as other medicines. It is important warning labels are followed carefully so medicines work properly. Staff spoken to showed a good understanding of how and when to administer only ‘when required’ (PRN) medicines. However, as previously advised, having clear written directions for these medicines helps to ensure all staff use them correctly and consistently. Wingates Residential Home DS0000009309.V376790.R01.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. 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 were benefiting from continued improvements in social activities. Better record keeping was needed to support this. Residents enjoyed the good food provided. EVIDENCE: The home did not employ an activities co-ordinator. Rather, care staff carried out social activities, which usually took place in the afternoon. Several moreable residents followed their own hobbies and interests, such as knitting, reading and crocheting. However, most residents were reliant on staff to provide social stimulation. At the last inspection, residents were starting to benefit from a greater variety of activities. We found these improvements were being maintained. An external activities co-ordinator continued to visit once a fortnight to provide reminiscence and armchair exercise sessions. Plus the home’s staff organised quizzes, word games, bingo and sing-a-longs. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 17 There was monthly communion, with links also being established with a local church guild for two residents who were previous members. The home had also recently been involved in 150 year worship celebrations of a local church. Good practice was noted, as new activities were being tried. Another external organiser had held a ‘music for health’ activity, which had been enjoyed. Cake making was also being introduced. Staff had worked hard to take 14 residents for an enjoyable short break holiday to Blackpool. Calendar events such as Easter and Mother’s Day continued to be celebrated. Further planned activities included creating memory boxes for residents, with families asked to bring in items and photographs that held significant and happy memories. Whilst we were pleased to find the programme of organised activities was developing, the home needed to ensure particular consideration was given to meeting the needs of less able, more confused residents. Relevant information also needed to be kept up to date, as one file had social interests from 2005, which did not reflect the resident’s current capabilities. It would also beneficial if the frequency of some activities increased, e.g. daily rather than fortnightly armchair exercises. This would create a fun and enjoyable start to the day, whilst maintaining and improving residents’ balance, muscle strength and mobility. Informal activities could also continue to be developed further. These particularly benefited residents unable to join in organised activities, with regular practical involvement with familiar, everyday household tasks helping them feel useful and involved in home life. We discussed the apparent indiscriminate use of the television in the main lounge. It had been on for most of our visit, with the sound turned down at times. The manager felt this was not typical and said it was usually off for long periods of the day. We continued to have difficulty in confirming what social activities (formal or informal) residents took part in. At our last inspection, we had advised the home’s recording system was reviewed. Although slight changes had been made, at this inspection we were still unable to confirm what activities many residents and particularly less able residents had taken part in. Better recording would allow the home to ensure the social care needs of all residents were being met. We also discussed the need to display up to date information, in a suitable format, about the social activities being provided (e.g. a weekly timetable). With regard to residents’ right to participate in the political process, the manager confirmed one resident had been supported by her daughter to vote in the recent European elections. Other residents had not wished or been unable to use their postal votes. Visitors felt they were made welcome. A quarterly, large print newsletter helped to keep them informed of activities, events and changes in the home. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 18 Residents and their families were able to personalise bedrooms (e.g. with photographs and ornaments). Four residents were up when we arrived in the home (at 7.20am), enjoying a hot drink. Staff confirmed residents could choose when to rise and retire. We discussed the new task timetables for staff, including specific allocation of residents to help get up. Staff generally felt these were working well, with things feeling more organised. The manager confirmed she was reminding staff these timetables were flexible, with residents retaining control over when to get up and go to bed, and when to shower or bathe. The new morning timetable addressed previous problems with inadequate staffing levels at breakfast (including inappropriate reliance on the manager, who needed to remain supernumerary). The timetable identified 4 day staff were now needed to ensure residents were properly supported. However, staff said until recently this had not been achieved, as only 3 staff had often been on duty. The manager confirmed 4 would now be the usual morning minimum staffing level. We joined residents for lunch. This took place in a calm and unhurried manner, with residents being given time to enjoy their food. Staff generally gave help appropriately, although some staff stood over residents to help them eat rather than sit beside them (although the manager felt this usually did not occur). We also discussed, where possible, to promote dignity and lessen embarrassment, food was cut up before placed in front of residents. Residents spoke positively about the food. With regard to menu choice, only one main meal was served at lunchtime. Although the chef and staff knew residents’ likes and dislikes extremely well, with daily records showing alternatives were provided. A range of diets was also provided, including vegetarian, low sugar and pureed (with catering staff working hard to ensure the latter was presented in an attractive manner and was of high nutritional benefit). The daily menu was displayed on the dining room. This provided useful information, particularly for visitors. We advised menus on dining tables were re-started. In a suitable format these would be both an orientation and a conversation tool with residents. A new cook had started, covering the chef’s days off. They were about to complete their food hygiene training immediately after our visit (which the home later confirmed). The home had been working hard during recent hot weather to ensure residents received adequate fluids, with additional cold drinks provided. We discussed recent national guidance from the National Patient Safety Agency, asking all care homes to ensure staff have the skills to deliver effective first aid, in particular the management of choking. Staff confirmed this was the case. Wingates Residential Home DS0000009309.V376790.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 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. Arrangements for protecting residents from abuse or harm and for taking concerns seriously were in place. This would be strengthened by clearer record keeping and abuse awareness training for all staff. EVIDENCE: Information about how to make a complaint was in the home’s brochure and displayed, in helpful large print, in the entrance. Two complaints had been received by the home since our last inspection. These had been promptly and appropriately investigated, with neither upheld. Although details had been kept in staff and resident files, we again advised a brief summary should be kept in a central complaints record. This should show when and what issues were raised; how they had been investigated; and the outcome, with any remedial action taken. This will provide quality assurance information for the home and also demonstrate concerns were listened to and acted upon. As noted, concerns about care practices were raised with us by the local District Nurse team, with some issues partially upheld. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 20 No safeguarding alerts had been made concerning the home. We discussed the need to strengthen staff understanding and knowledge (thereby increasing resident safety), formal abuse awareness training for all staff, including domestic and catering staff, should be considered. We discussed recently introduced legislation (Deprivation of Liberty Safeguards (DOLs)), which ensured residents who lacked capacity were not prevented from doing things unless absolutely necessary for their own safety. It also introduced a new specific legal role and responsibilities for managers of care homes. The manager confirmed she had attended relevant training. Wingates Residential Home DS0000009309.V376790.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 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. Wingates provided residents with a clean, comfortable, safe and homely place to live. EVIDENCE: Wingates was homely, comfortable and welcoming (helped in part by the wide use of wallpaper). Bedrooms were well decorated and furnished. Communal areas and rooms had an acceptable standard of décor and furnishings. These latter areas were affected by a general lack of storage space, with a photocopier kept in the third lounge, one hoist kept in the ground floor shower room, and 2 hoists permanently stored outside a first floor toilet. As noted at Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 22 previous inspections, this situation was due to be remedied by the forthcoming building extension (with improved storage facilities). Since our last inspection, the main lounge area had been repainted and a missing lock on the first floor bathroom replaced. Aids and equipment had improved, with the provision of two new stand aid hoists; a trigger/pressure mat; and one bedroom door was now fitted with a more suitable external lock for the resident concerned. Good practice was noted, as a helpful staff photoboard was also now on display in the entrance, helping introduce staff to visitors. Further good practice was noted, as bedroom doors were also about to be personalised, with photographs and residents’ names. At our last inspection we had found the main lounge carpet was very worn and advised it needed replacing. The District Nurse team had also later raised concerns about its appearance. The home had been waiting to replace it during the extension works, but had brought this forward and now changed it. Several minor maintenance issues were identified at this inspection. The carpet in the conservatory lounge was very worn in places (the home confirmed this was replaced shortly after our visit); door locks were broken in a toilet near room 5 and in the ground floor shower room (which also had staining to some ceiling panels); many pillows were lumpy after washing, and needed replacing; and some corridor and bedroom doors banged very noisily into their rebates. Some bedrooms had a helpful towel rail and a shelf for residents’ toiletries. We advised these were provided in all bedrooms. We found the home was clean and smelt fresh, which visitors agreed was usual. The District Nurse team had raised concerns about the cleanliness of the treatment room, which the home was addressing. After discussing with staff practical routines, we again advised hand washing facilities should be provided for them in residents’ bedrooms (to enable hand hygiene to be easily maintained). We also discussed the need to go through hand hygiene procedures with new staff. Wingates Residential Home DS0000009309.V376790.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. 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. Improvements in staffing levels meant residents’ dependency levels were better met. Improved training for staff would further strengthen care practices. EVIDENCE: At our last inspection we had concerns about inadequate staffing levels and the skill mix of the staff team. These matters had been addressed. However, as noted, the manager had now identified a further increase in morning staffing levels was needed. This was confirmed by staff, who consistently told us they had difficulty meeting residents’ needs when only 3 worked in the morning. Consequently, staffing levels had very recently increased to 4 in the morning (remaining at 3 in the afternoon/evening and 2 at night). Shift patterns continued to provide a 1 hour overlap between night and morning staff to also help meet residents’ request to rise. Good practice was noted, as the rota supported staff communication, with senior care staff having a paid handover when the manager was not on duty. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 24 The staff team remained generally stable with little change. Consequently, as noted, residents benefited from a familiar team of staff who knew their needs and care preferences very well. There had been some changes, with 4 new staff starting since our last inspection. This was in part to meet the increased morning staffing levels. Also, 3 staff had left, 2 were on maternity leave and 1 on long term sick. There had been minor use of agency staff to meet these shortages, particularly as some staff had left without notice. A further night carer was currently being recruited to ensure adequate staffing levels at night. We looked at the recruitment files of the 4 new staff. Good practice was noted, as these showed a panel of two had asked standardised interview questions, with responses noted and scored. They also contained proof of identity; a health declaration; application forms with full employment histories and any employment gaps or sickness explored. Photographs were about to be added. Criminal record checks and references were in order. We confirmed the former should now be destroyed, with a record kept of their reference numbers of each staff file. Those obtained for staff employed after this visit must be kept until our next inspection. We advised the manager of the new forthcoming additional requirement (from July 2010) for any new staff employed by the home to be registered with the Independent Safeguarding Authority (with registration for existing staff coming into force from October 2010). We discussed the induction provided to new staff. After working in a supernumerary role for their first week, they shadowed senior staff for a further week. One starter said they had found this useful and had felt supported. The home had on occasion also sent new staff on a comprehensive 7-day induction training programme, provided free from Bolton Social Services. However, the manger said it was very difficult to book places and when available, only very short notice was provided, resulting in staff not always being able to be released. Consequently, none of the new staff had attended. They had completed an induction checklist with the manager on their first day. We advised as no other induction training was attended, this checklist needed developing to meet the Common Induction Standards set by Skills for Care. We also looked at training for existing staff. With regard to NVQ training, 50 of care staff had an NVQ level 2 award in care or above (3 staff now held the level 3 award). With regard to basic mandatory training, the manager had now developed a matrix to help monitor training needs. We were concerned this showed annual fire safety training was out of date for half the staff team. However, 2 fire drills had been held so far this year, helping staff understand fire safety procedures and a refresher course had been booked for September 2009. Several staff also needed annual moving and handling refresher training (with no date yet arranged at the time of our visit). The manager explained training anniversary dates varied considerably within the small staff team and she was in the process of streamlining them. Although this was reasonable and a practical necessity, we advised training dates needed to be set to avoid Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 25 any staff becoming out of date with basic safety training. Good practice was noted, as first aid skills had recently been updated for most staff, plus an optical awareness course attended, which staff felt had been very useful. The home was proactively seeking feedback about the value of training courses, with staff completing new training evaluation forms. Wingates Residential Home DS0000009309.V376790.R01.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 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. Residents and staff now benefited from a well managed home. EVIDENCE: The Registered Manager, Miss Carrie Ashton, had now been in post for just over a year. Miss Ashton had a background in elderly care and had completed the Registered Manager’s Award (NVQ level 4). Miss Ashton remained motivated, enthusiastic and had been working hard to address concerns raised at previous inspections. Miss Ashton was aware of the need to protect her Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 27 supernuamry hours in order to achieve change and to also carry out her routine management duties (particularly as a formal deputy post no longer existed within the home’s staff structure). We received a range of positive comments about Miss Ashton. Relatives and staff spoke highly of her. Staff described her as supportive and approachable. One said she was “brilliant”. A relative commented “we now have a new manager, who is absolutely spot on”. One staff member also described how the general atmosphere, including staff morale, had improved. At our earlier random inspection, we became aware the home had not been notifying us of all the major events that happened (e.g. when residents visited the accident or emergency department; and when serious practical problems occurred such as the heating breaking down in winter). We had referred the manager to Regulation 37 of the Care Homes Regulations 2001, and her duty to give us notice of the events listed under it. At our last inspection, the manager had started to introduce formal staff supervision. Good practice was noted, as this was now taking place regularly, providing the opportunity for 1 to 1 support; discussion of training needs; and performance feedback. Staff also had the opportunity for group discussion and support via team meetings. The manager had responded to a staff request for these to be held without senior staff, although after this was tried staff had requested a return to full staff team meetings. Since our last inspection the home had been reassessed and retained its Investors in People standard. Feedback about how the home was being run was sought from relatives at twice yearly meetings, with surveys sent out to those who were unable to attend. The manager planned to return to the previous practice of surveys being sent out beforehand to enable issues and ideas raised in these to be discussed at the meeting. We confirmed feedback from the meetings and surveys would be made available to residents and their families (e.g. displayed in the hallway and detailed in the home’s newsletter). We advised the home to ensure all minor issues raised were clearly documented, demonstrating comments were welcomed and all issues were taken seriously and acted on. With regard to seeking feedback from stakeholders, as noted the manager was meeting regularly with the District Nurse team. Feedback was requested from other bodies and agencies as they visited. We advised this became more proactive and was widened to include others the home had regular contact with (e.g. GPs, social work and Social Services review teams). The home’s owner, Mr Khan, held formal monthly quality monitoring meetings with the manager, and visited the home on daily basis. Small amounts of money were held on some residents’ behalf. These were stored safely and securely, with appropriate records kept. Three cash balances were checked at random and found to be correct. Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 28 With regard to safe working practices, at our last inspection we had been concerned to find fire drills were not being held and there was no fire safety risk assessment. The home had since rectified these omissions. At this inspection, we confirmed weekly fire safety checks were being carried out (as noted, annual staff fire safety training refresher training was due to take place). In their AQAA, the home formally confirmed all other safety and maintenance checks were up to date. Wingates Residential Home DS0000009309.V376790.R01.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 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X 2 X X 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 3 3 X 3 3 X 3 Wingates Residential Home DS0000009309.V376790.R01.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. 1 Standard OP3 Regulation 14 (1) (a) Requirement To ensure they can be fully met, a more thorough assessment of prospective self-funding residents’ needs must be carried out. To ensure they are used correctly, medication record sheets must contain details of all currently prescribed medicines, including creams and other external products. To ensure staff competence and resident safety, annual refresher safety training must take place every 12 months or less. Timescale for action 31/10/09 2 OP9 13 (2) 31/10/09 3 OP30 18 (1) (c) 31/10/09 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 Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 31 1 OP8 To ensure residents’ health is properly monitored and not put at risk, the accuracy of the home’s scales should be monitored (carried over, in part, from our last inspection) Any significant change in a resident’s weight should be confirmed (and then properly acted on). 2. OP9 Medication should be stored securely at all times, to ensure that it is not misused or mishandled. There should be clear guidance for staff to follow to ensure residents do not miss their medication just because they choose to go to bed or get up at a time that does not coincide with medication rounds. Reasons for the late administration or omission of medicines should be clearly documented. Risk assessments should be completed where this is a regular occurrence. There should be clear written directions for the use of medicines prescribed on ‘when required’ (PRN) basis to ensure these medicines are given correctly and consistently. 3 OP12 To show residents receive social stimulation that meets their needs, preferences and capabilities, clearer records should be kept. To provide information for residents and to help staff provide a wide range of social, mental and physical activities, a weekly activity timetable should be displayed. 4 OP16 To allow the home to audit complaints and show how they are taken seriously and acted on, a central complaints record should be kept, with a summary of any concerns raised and action taken in response. To ensure new staff understand their role and are able to work safely, they should have an induction that meets Skills for Care’s Common Induction Standards. 5. OP30 Wingates Residential Home DS0000009309.V376790.R01.S.doc Version 5.2 Page 32 Care Quality Commission North West 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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