Care Home: Winifred Dell House

What the care home does well Winifred Dell Care Centre is a large, modern and spacious building that was very clean and clear of malodours. Residents and relatives praised the staff team for being friendly and kind. Comments included: "No concerns whatsoever, very helpful, very accommodating staff, they try everything they can to make (Person`s name) comfortable" and "They keep us up to date with anything that is going on with (Relative) they are always well looked after, washed and clean and they enjoy the food there". There are ample communal areas for people to enjoy, including a cinema and hairdressing salon. Visitors are always made welcome at Winifred Dell Care Centre. What has improved since the last inspection? This is the first inspection of this service since registration in September 2009. What the care home could do better: The management team at the home need to ensure that they work to provide consistency and stability in order to get things done and improve standards in the home. Whilst residents and relatives are generally happy, there is work to do in order to bring the service up to the required standards. Work is needed on care planning and management for residents, and ensuring that the care is delivered in a way that is resident led and flexible to meet their needs. Some shortfalls in the administration of medication need addressing and the social activities programme needs development to ensure that it takes into account individuals needs, preferences and abilities. Relatives told us: "I think in general they could do more to keep people busy" and "The only things I have seen in the way of activities is a singer and carol singers at Christmas" and "Sometimes (relative) seems a bit bored". The staff training programme has some significant gaps and this needs to be addressed to assure people that staff have the necessary skills and knowledge to care for them safely. The management of complaints, including staff awareness relating to complaints raised verbally with them, needs improving so that residents and their relatives can be assured their concerns are listened to and taken seriously. Staff need to be aware of the need to promote and protect peoples` dignity, this will increase peoples` self esteem and feeling of self worth. The management need to review the level of staffing and deployment of staff alongside a thorough assessment of peoples` dependency levels so as to ensure sufficient staff are available to meet peoples` needs at all times, including mealtimes to support people to eat their meals. Relatives told us: "The only thing I would say is that maybe they could do with more staff, when I visited recently (Person`s name) wanted to get back into bed and had to wait an hour for a second person to come back from their break to assist" and "They are short staffed and have been since (relative) has been there. Mind you sometimes I go in there are so many staff they are falling over each other" and "Quite a few of the staff are really lovely to me. Some are so exasperated because the level of staffing is so bad". Key inspection report br Care homes for older people br Name: Address: Winifred Dell House Essex Way Great Warley Brentwood Essex CM13 3AX br br     br br The quality rating for this care home is: br   br br one star adequate service br br A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Greaves br     br br Date: 1 8 0 1 2 0 1 0 br br This is a review of 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. br br The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor br br There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. br Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things br br This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. br This is what people staying in this care home experience: br br Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People br Page 2 of 38 br br 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. br br Reader Information br 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 br br Internet address br br Care Homes for Older People br br Page 3 of 38 br br Information about the care home br Name of care home: Address: Winifred Dell House Essex Way Great Warley Brentwood Essex CM13 3AX 0 br br Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): br br Winifred Healthcare Ltd br br Name of registered manager (if applicable) br br Type of registration: Number of places registered: br br care home 76 br br Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 76 The registered person may provide the following categories of service: Care Home Nursing (Code N), to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Older People Code OP, Dementia - Code DE Date of last inspection Brief description of the care home Summary br This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service br br Choice of home br br Health and personal care br br Daily life and social activities br br Complaints and protection br br Environment br br Staffing br br Management and administration br br peterchart br br Poor br br Adequate br br Good br br Excellent br br How we did our inspection: This was an unannounced key site visit undertaken over 8 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Views expressed by visitors to the home during the site visit and in subsequent discussions have been incorporated into this report. Feedback on findings was provided to the management team throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the management team, the staff team and Care Homes for Older People br Page 6 of 38 br br visitors for the help and co-operation throughout this inspection process. br br Care Homes for Older People br br Page 7 of 38 br br What the care home does well: What has improved since the last inspection? 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. br br Care Homes for Older People br br Page 9 of 38 br br Details of our findings br Contents br br 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) Outstanding statutory requirements Requirements and recommendations from this inspection br br Care Homes for Older People br br Page 10 of 38 br br Choice of home br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. br br This is what people staying in this care home experience : Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had access to sufficient information to enable them decide if the home was right for them however cannot be assured their needs will be met by the numbers and deployment of staff. br br Evidence: Before people moved into the home they were provided with detailed information, enabling them to make an informed decision about whether the home will meet their needs. The Statement of Purpose clearly set out the objectives and philosophy of care, detailing the specialist services provided, quality of the accommodation, qualifications and experience of the staff and how to make a complaint. The management team told us that prospective residents and their families/representatives were invited to view the home and discuss their requirements to help them decide if the services and facilities provided at Winifred Dell Care Centre were appropriate to meet their needs. br Care Homes for Older People Page 11 of 38 br br Evidence: We spoke to family members visiting the home on the day of this visit and subsequent to this inspection visit. Family members told us that a representative from Excelcare visited their relative at their own home prior to admission to undertake a thorough assessment of the persons needs and choices. The family said they had visited the care home twice prior to their relative moving in to confirm it was the right place for the person. Another family told us that their relative was visited in hospital by representatives of the home in order to do a pre admission assessment of the persons care and support needs. They told us the home had confirmed they could meet the persons needs however the relatives told us but they just arent doing so. Other comments included: I was not involved with the pre admission assessment, that was done by social services but I did visit the home to have a look and ensure it was suitable for (Relative). We looked at pre admission assessments for some of the people living at the home. In the main these were in a tick box format with very little personalised information about peoples individual support needs and preferences. There was a free text box however, where the person undertaking the needs assessment could add more detail. The quality of information gathered varied considerably depending on who had undertaken the assessment. Some examples we saw included clear person centred information to enable staff to provide individual care and support as soon as the person came to live at the home. Limited information in some assessments we saw would mean there would be a period of time where staff did not have the knowledge to be able to meet peoples needs in the way they needed or wished them to be met. This is a newly registered service and consequently the staff team was new with many of the staff being new to care. Staff training in the basic core areas such as moving and handling, fire safety, safeguarding vulnerable adults and infection control was being provided, as the staff complement grew, to give them the skills necessary to care for people safely. However records showed there were gaps in key areas such as moving and handling and fire safety, staff starting work at the home in November and December had not yet received training in these areas. Our observations, discussion with staff members and comments received from relatives of people living at the home indicated that the numbers of staff on duty, or the deployment of staff within the home, did not effectively meet peoples needs. Detail to illustrate this is included within the Health and Personal Care and Staffing br br Care Homes for Older People br br Page 12 of 38 br br Evidence: sections of this report. br br Care Homes for Older People br br Page 13 of 38 br br Health and personal care br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. br br This is what people staying in this care home experience : Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure they will receive all the care and support they need or that daily practice within the home will promote their dignity and privacy. br br Evidence: The home was divided into four units, a residential wing, a nursing wing, a high dependency dementia wing and a low dependency dementia wing. At this visit the nursing wing was not open and the home had not yet started to admit people with nursing needs. There were 10 people living in the residential unit and 16 people in each of the dementia units. On one of the units we saw there were 6 people in the dining room unsupervised. One person was walking around the dining room clutching a bowl looking for cereal. There was a hot teapot and hot porridge pot in the dining room, the door was open to the kitchenette meaning that people could be at risk from scalds, burns or other accidents. It took many minutes until we were able to locate some staff. We found that staff had called in sick shortly before the shift was due to start and an agency staff member had not turned up for duty leaving the home understaffed first thing. This meant that staff br Care Homes for Older People Page 14 of 38 br br Evidence: were in disarray trying to ensure people were safe whilst getting others washed and dressed and giving people their breakfast, especially on the dementia units. The manager arrived on the unit at this point and discussion took place around redeployment of staff until reinforcements arrived, the staff were doing their best with limited resources. As we walked around the dementia unit a resident said to us: Been here for ages waiting for someone to help, I feel like giving up. In one room we saw care instruction taped to cupboard door (Persons name), doublebase apply every morning, Dermol 500 use with water to wash, no soap to be used. This information should be in the care plan, having personal care instructions taped to the bedroom wall does not serve to promote peoples dignity. One person was lying in bed with no night wear on and with their room door wide open. We checked the persons care plan and found that it was their choice not to wear night clothes, however, their dignity would be better promoted if their door was closed or pulled to. We saw another person who, unable to move themselves, had been laid on the bed with their clothing around their waist, continence pad exposed. This was further example of the lack of attention to peoples dignity. On each of the units there was a desk area for records to be kept so they were accessible to staff members. We saw that communications and handover books containing personal information about the people living at the home were on the desktop accessible to anyone passing by. We looked at 4 care files, including a sample from each of the three units operating at this time, to assess how well peoples care is planned and the detail available for staff to follow to deliver personalised care to meet peoples needs. It was clear that residents, or their representatives, had been involved with the initial development of their care plans. Information within the care plans we saw showed that regular monthly reviews were undertaken to ensure that the care regime remained appropriate to meet peoples needs. The homes Statement of Purpose stated Regular audits of care plans and regular care plan review are held in consultation with residents and his/her family/representative where appropriate. Relatives we spoke with told us they were not invited to take part the monthly reviews of the care plans. One person told us: Would like to be invited to be involved with the br br Care Homes for Older People br br Page 15 of 38 br br Evidence: monthly reviews of the care plan. Elements of individual risk were assessed as part of the care planning process. These included the basic core activities of daily living such as mobility, safety, falls, use of bed rails, moving and handling, emotional well being, cognitive ability, nutrition and dietary needs, medication and communication. Risk assessments were reviewed monthly alongside the care plans. There were records to show where people received care from external professionals such as GP, chiropodist and community nurses. Care plans we looked at included evidence of weight monitoring and a record of meals eaten and how much was eaten. In the files we looked at there were care plans in place for areas including: Moving and handling, Falls, Emotional well being, Cognitive ability, Nutrition and dietary needs, Medication, Communication, Night routine/ sleep pattern, Social care interests/activities and End of life wishes. None of the care plans we looked at contained information within the plan for dying or death, whilst it is acknowledged this is a sensitive area it is also one of great importance for individuals. Care plans identified peoples abilities and the care and support needed. For example: (Persons name) needs assistance with personal hygiene, 1 carer to help wash and dress. Allow (Persons name) to choose what clothes they wish. Assist and prompt to clean their teeth. There was then detail of the identified goal to be achieved in each section of the care plans such as: To promote a good level of personal hygiene, for (Persons name) to look neat and tidy each morning. Ensure (Persons name) is happy with their appearance, let (Persons name) choose their clothing each morning. There followed detail of the action needed to meet the identified needs and goals such as: give (Persons name) a towel and flannel so they are able to wash and dry themself. Let (Persons name)choose which toiletries they would like to use, prompt and assist to clean teeth. Encourage (Persons name) to remain as independent as possible. Where people required management of pressure areas there were regular Waterlow assessments and detail of the equipment provided such as pressure relieving mattresses, profiling beds and pressure cushions to be used in armchairs. There was detail for carers to follow when transferring residents by means of hoists. Care plans included detail of accidents/incidents that had occurred in the home. One care plan we looked at included good person centred information within the pre admission assessment stating that the person required a shower alternate days. This information had not been carried forward into the care plan. Daily records did not br br Care Homes for Older People br br Page 16 of 38 br br Evidence: confirm that the shower regime identified in the pre admission assessment was followed. There was a bath/shower record book maintained on the unit, this showed that one shower had been provided for the person in the preceding 2 weeks. Staff said that personal hygiene was delivered each day however the recording did not detail what support had been provided so it was not possible to be sure this persons needs had been effectively met. A member of the management team told us that this may be a recording issue rather than a shortfall in delivering personal care. One care plan we looked at included professional notes to say that a persons feet remained very dry and that they may have a fungal infection. The notes advised care staff to soak the persons feet in a bowl of water and cream them. There was further recording from the professional a week later advising care staff to continue with this practice. There was no care plan developed relating to the care of the persons feet. Daily records showed one date during this period of a week where legs and foot cream had been applied. One care plan we looked at identified that the person could demonstrate behaviours that challenge. There was no detail to inform staff of potential triggers for these behaviours or outlining any strategies to employ should the person become agitated or anxious. The daily records for this person related mainly to eating and sleeping. Good daily recording would help to provide an overview of the persons behaviours, help to identify triggers and assist with monthly care plan reviews to develop strategies to manage potentially challenging outbursts. Care plans we looked at included nutritional risk assessments and records of weight monitoring however some relatives we spoke with had concerns in this area. Comments received included: Our relative didnt eat the food at the home, this was their choice, we have taken food into the home for them and needed to record it because the home were supposed to be monitoring their weight and nutritional input. There were no nutrition charts in the room to do this, our relative ate all their meals in their room. We looked at medication administration and storage at the home. There was an individual trolley and medical room on each unit. Senior carers administered the medications on the residential and dementia units, qualified nursing staff would be responsible for this on the nursing unit when it opened. One staff member responsible for administering medications that we spoke with confirmed they had attended medication training within the past year, this was Pharmacy led training delivered in house and supported by E learning. br br Care Homes for Older People br br Page 17 of 38 br br Evidence: A more recently recruited staff member told us they had received 1 1/2 days of supervision whilst administering medications in their 1st week of employment, undertaken a 3 hour E learning session and then had a workbook to be completed. The person said they had not yet been assessed for their competency to administer medications and that the manager continued to provide 1:1 support with this part of their duties. We saw that the majority of the medications within the home were supplied in blister packs from a local pharmacy. We saw that some bottles and packets of medication were signed and dated to indicate when they had been opened. This is good practice as it could assist in providing an accurate audit trail of medications maintained within the home however this practice was not routinely followed throughout the home. The monthly medication audits undertaken in the home showed this issue had been identified regularly since October 2009. Medication Administration Records we looked at did not provide accurate records of what medications had been administered and when. This was because there were gaps in recording that meant it was not possible to be sure if peoples medication had been refused, omitted or given without being signed for. We looked at the storage and recording for controlled medications at the home. We found these were safely stored and accurately recorded. There were thermometers mounted on the walls in the clinical rooms where medication was stored. Daily temperatures were not recorded for monitoring purposes however we noted that, despite this being a cool day in January, and there was no heating in the clinical rooms, the temperatures were 24.5 degrees and 25 degrees in these rooms respectively. We were concerned that summer temperatures may mean that medications would not being stored within a safe range. Relatives told us during this visit and via subsequent telephone conversations: No concerns whatsoever, very helpful, very accommodating staff, they try everything they can to make (Persons name) comfortable and The only thing I would say is that maybe they could do with more staff, when I visited recently (Persons name) wanted to get back into bed and had to wait an hour for a second person to come back from their break to assist and There is no pro-active dementia care taking place, I have seen people being asked direct questions and then when they are too confused to find an answer staff just assume what people want rather than offer meaningful choices and I feel they are caring for (Relative) well, it helps me to relax br br Care Homes for Older People br br Page 18 of 38 br br Evidence: safe in the knowledge they are looking after them. br br Care Homes for Older People br br Page 19 of 38 br br Daily life and social activities br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. br br This is what people staying in this care home experience : Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People experienced restricted social stimulation and activity. People generally enjoyed the food however did not always receive the support they needed to eat. br br Evidence: With regards to activities the homes Statement of Purpose stated: We aim to provide as varied a programme as possible. This is, in addition to one to one activity based on social assessments undertaken to identify interests and abilities. Pre admission assessments did explore peoples previous pastimes and things they used to enjoy doing however the activity programme had not been developed to take peoples personal and individual hobbies into account. We were provided with a copy of the activity menu, this showed that people could participate in organised games, colouring pictures and making cards, have hand massages and manicures, Newspaper discussions and reminiscence sessions At the time of this inspection site visit there was one activities person employed to provide stimulation and occupation for the people living at the home. We spoke to people on the residential unit who told us that the majority of the activity coordinators time was dedicated to providing activities for the people living on the br Care Homes for Older People Page 20 of 38 br br Evidence: dementia units. They did say they enjoyed being involved with a project knitting hats and scarves for a charitable concern and that this had been organised by the activity person. We observed one person on the residential unit receiving some 1:1 time playing a game of cards during this visit. At frequent intervals during the day we noted people sitting in the lounge on the dementia unit quietly staring into space or sleeping with nothing to occupy them and a number of people remained in their rooms which meant there was a risk of them becoming isolated with limited staff available to interact with them. Relatives of residents from all units within the home felt there could be more meaningful stimulation for people. Comments made included: Not enough activities for them, not meaningful activities with a purpose, no involvement with activities of daily living. Id like (Relative) to be encouraged to do a bit more. Sometimes (Relative) seems a bit bored. I think in general they could do more to keep people busy, I know they have not got the full staff team yet, but maybe just some music the residents like playing in the lounges The only things I have seen in the way of activities is a singer and carol singers at Christmas. Staff meeting minutes of December 2009 showed that care staff had been reminded to give assistance with setting up for parties, entertainment and booked activities and were reminded that this is part of their role. Our observation and discussion with staff, residents and visitors showed that care staff did not engage with residents regarding daily activities, and there was little understanding that activity related to providing spontaneous opportunity of stimulation and engagement for people as well as organised activity such as arts and crafts and bingo. Minutes of a relatives meeting held in November included detail about a discussion around the development of memory books for the people living on the dementia unit and that relatives may be able to assist with this. We did not see any evidence of these books at this visit however, these would be useful tools to enable care staff to interact with residents in a meaningful way and create social diversions to help prevent people from becoming anxious or distressed. A report of the registered providers visit to the home in December 2009 showed that ten people went out for a Christmas Lunch with the local Rotary club and seven people went to the local church for a Carol service. The local primary school visited the home to sing Carols for the residents and other outside entertainers came into the home to perform a play and facilitate sing alongs. br br Care Homes for Older People br br Page 21 of 38 br br Evidence: Family members we spoke with confirmed they were able to visit people living at the home at any time and were always made welcome. We looked at the visitors book, this showed us that there were regular visitors to the home at various times of the day. We took lunch with some of the people living on the residential unit. There was confusion because the meal options they had chosen from the night before had changed from Chicken pie to Shepherds pie. People told us this was the first time this had happened. The Chef told us this was because an agency Chef on duty at the weekend had taken the wrong ingredients out of the freezer in readiness for todays meal. The Chef told us that the food stocks were of a very good quality and never seen such a well equipped kitchen. The meal given to us was piping hot, this was brought to us direct from the kitchen however residents said theirs was not very warm, this was served up from a hot trolley in the dining room. One person told us the food was often luke warm by the time it was served to them. Relatives told us that people living in the dementia units did not receive encouragement to eat their meals. They told us that food was placed in front of people and taken away at the end of the meal time regardless of whether people had eaten anything. We did not observe this at this visit however, at breakfast time on the dementia unit we saw that people were left in the dining room unsupervised due to staff shortages. One person asked us to help them find some cereal as they didnt know where it was kept and there was no-one around to help them. One person who was concerned their relative was not eating properly told us they had informed staff of what food their relative liked to eat and even visited the kitchen to pass this information on direct, however nothing had happened. One relative told us My relative is in the dementia unit, they need encouragement to eat. This is not forthcoming, there was one instance I saw where my relative didnt want the meal on the day but no alternatives were offered to them. A relative told us how they had entered the communal lounge one day and overhead care staff compiling the supper list on behalf of the residents saying Oh shell eat that wont she. This indicated that people were not offered meaningful choices. We were provided with copies of the menu to take away with us for further scrutiny. These showed that people were offered an option of a cooked breakfast twice a week. There was a choice of two cooked main meals daily, and the evening meal consisted of a daily soup option, a cooked option such as cheese and potato pie, sardines on toast br br Care Homes for Older People br br Page 22 of 38 br br Evidence: or corned beef hash and assorted sandwiches and cakes. We noted that every Friday the options available were fried fish and chips or steamed fish with mash potatoes. These choices did not allow for those people who did not like fish. A milky drink and biscuits were offered at supper time. The report of the registered providers visit to the home in December 2009 stated that overall comments about the food were positive. The homes Service User Guide outlined that The home offers breakfast, lunch and an evening meal with snacks and drinks provided each day and night and that Drinks and snacks are available throughout the evening and night. One resident we spoke with confirmed they were able to have a snack if they woke during the night and fancied something to eat. Relatives told us they were encouraged to take meals with residents for a nominal charge. They told us: I have eaten a meal with my relative, it was lovely. People living at the home, who were able to express an opinion, told us they generally enjoyed the food. br br Care Homes for Older People br br Page 23 of 38 br br Complaints and protection br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. br br This is what people staying in this care home experience : Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that complaints raised verbally will be listened to and taken seriously. People were protected from abuse by staff training provision and robust recruitment practice. br br Evidence: The service had a Policy and Procedure in place in relation to how to make a complaint and this was included within the Service User Guide. We looked at the complaints folder, there had been one complaint made in writing to the service, this had been responded to by the operations director. One verbal issue that had been raised was documented showing what investigation had taken and place and the outcome. One further issue had been referred to the Essex County Council adult safeguarding team and an investigation was underway at this time. The complaints policy stated: If a complaint is raised with a member of staff, the matter will be brought to the attention of the Home Manager who will proceed to look into the matter in order to resolve the issue. The Home Manager will also take steps to minimise the risk of a recurrence of the issue. A relative told us they had made verbal complaints to senior staff over various issues, there was no evidence that these complaints had been taken seriously or passed to the Home Manager as they were not recorded. One person told us of an instance when they had brought their relative home in the br Care Homes for Older People Page 24 of 38 br br Evidence: evening after a home visit and found there were 3 residents sitting in the lounge with 2 staff members asleep in the lounge. We were told that a complaint had been made to the manager about this the week prior to this visit however there was no record of the complaint. The manager did not provide a clear response when asked about this. The staff training matrix confirmed that the staff team received training in adult safeguarding within the first month of working at the home. Staff we spoke with at this visit demonstrated a clear understanding about what constituted abuse and what they would do should they have any reason to suspect abuse taking place. Staff recruitment practices had recently been strengthened to ensure that people employed to work with this vulnerable group of people were safe to do so. br br Care Homes for Older People br br Page 25 of 38 br br Environment br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant and well maintained environment that can meet all their needs. br br Evidence: The homes Service User Guide detailed that Winifred Dell Care Centre provided 76 fully furnished single bedrooms and that people were encouraged to bring their own items of personal belongings. There were living, recreational and dining areas for relaxing, activities and entertainment. The home also included quiet areas, cinema/activities suite, hairdressing facilities and residents smoking rooms. We took a physical tour of the home during the course of this inspection. The home was generally clean and fresh with no malodours present. We noted that the entrance foyer and communal hallways were pleasantly decorated and appointed. We saw a cinema room with a large viewing screen and a selection of videos for residents to watch. We saw a well equipped hairdressing salon, the home had a visiting hairdresser or people could have their own hairdresser visit the home and use the facility. All bedrooms had en suite facilities and people were able to individualise their own space with personal items. On the dementia unit there were memory boxes sited outside peoples bedroom doors, br Care Homes for Older People Page 26 of 38 br br Evidence: some contained personal items such as photos or mementos that meant something to them and would help then identify their own room. The signage on bedroom doors on the dementia units were clear with peoples names and photographs in most cases, not all. The management told of plans to introduce this format on the residential unit as the small brass signs with room numbers were not clear enough for people with visual impairments to easily identify their own rooms. The home was generally tidy however we did see some peoples rooms that would benefit from being tidied. For example one room we looked at had a wheelchair, a wheeled commode chair with the seat abandoned on the floor, a bed cover roughly folded and on the floor, a Zimmer frame, bag of wipes, 3 dirty cups and one dirty plate, and tissues strewn around. Bathrooms were pleasantly tiled and appointed. In one bathroom on the residential unit we observed there were red bags, yellow bags, aprons, kidney bowls, commode liners, a sliding sheet, a hoist and a box of gloves making the facility appear unkempt and scruffy. The management told us there were ample storage facilities around the unit so staff had no need to clutter up communal bathing facilities in this manner. We saw there were open display boxes fixed to the wall in the communal hallways in the dementia unit. These contained items such as scarves, beads and sunglasses for people to access, touch and feel. These were carefully and neatly arranged and appeared more as a form of decoration rather than meaningful opportunities for engagement for the people living on the unit. We saw that there were well stocked linen stores on all units in the home. The well equipped laundry had two doors allowing for soiled laundry to be taken in one door and clean laundry to be taken out of the other door. The person in charge of the laundry on this day was not able to demonstrate an awareness of an infection control policy however was able to tell us of the systems in place in the laundry to deal with soiled/infected laundry. Relatives we spoke with were generally satisfied with the laundry service within the home however one person told us of clothing losing its colour, for example a yellow jumper changing to cream and one cream jumper was now pink. br br Care Homes for Older People br br Page 27 of 38 br br Staffing br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. br br This is what people staying in this care home experience : Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents cannot be assured they are supported by sufficient numbers and deployment of staff or that the staff team have all the training needed to promote peoples health, safety and well being. br br Evidence: As mentioned earlier in this report the home was short staffed on this day due to a member of permanent staff giving short notice of being ill and a member of agency staff not turning up for work. When we arrived at the home there were two care staff on duty on the high dependency dementia unit to assist 16 people to get up, washed, dressed, to have breakfast and to give them their morning medication. Staff told us this was not unusual and that they were constantly working under extreme pressure and not able to look after people as we should. Staff told us there were often 2 care staff and 1 senior on the high dependency dementia unit supporting 16 residents. Bearing in mind the challenges of the geographical layout of the unit, and the level of dependency of the residents, staff said they felt that that minimum levels should be 1 senior and 3 care staff. We looked at staff rotas, these did not demonstrate consistent staffing levels on any of the units. For example,according to the rota, staffing numbers of the lower dependency dementia unit varied between 0 and 4 care staff on morning and afternoon shifts, the higher dependency dementia unit varied between 2 and 4 staff on br Care Homes for Older People Page 28 of 38 br br Evidence: the morning shift and 1 to 5 on afternoon shifts. The residential unit staffing numbers fluctuated between 1 and 2 day staff on both shifts. Night staff rotas showed there were usually 1 Team Leader and 5 care staff on duty covering all the units in the home however this also fluctuated with records showing there were sometimes 6 carers plus 1 Team Leader and other examples of 5 carers with no Team Leader. Meeting minutes from a staff meeting held on 30th December stated there had been just 1 senior and 2 care staff on duty upstairs on 2 occasions over the Christmas period and that care staff were becoming stressed. Relatives told us: Never can find anybody, you can walk round in circles but not find anyone. My relative needed the toilet, it took us 10 minutes to locate a member of staff and then they said my relative would have to wait as they were too busy It was a further 20 minutes before my relative was helped to the toilet, by then it was too late. Relatives told us about one resident who had been crying out for help constantly and consequently causing distress to the person they were visiting. The relatives went to find a staff member to help the person and were told X is a nuisance so we tend to leave them in bed Staff training records showed that 4/34 care staff employed to work at Winifred Dell Care Centre had achieved the NVQ level 2 in care, 2 of these had also achieved NVQ level 3. This does not meet the recommended minimum ratio of 50 of staff having achieved this qualification. We looked at three staff files to assess if the recruitment practices in the home were thorough to promote the safety of the people living there. We noted that one persons reference contained information limited to confirming dates of employment and that no contact had been made with the referee to validate the reference or to seek any further information about the person. We were shown records of people currently being recruited to show that procedures have now changed to include a telephone call to the referee to validate the references provided. We were provided with a record of the training attended by the staff working at the home. This showed that, whilst training in the basic core subjects such as moving and handling, health and safety, infection control, food hygiene, safeguarding vulnerable adults and first aid, had been provided for many of the staff team there were still some significant shortfalls remaining. For example: 13 staff had not attended moving and handling training, 15 had not attended fire safety training and 22 had not br br Care Homes for Older People br br Page 29 of 38 br br Evidence: attended training in Control of Substances hazardous to Health (COSHH). 22 members of the staff team had attended training to provide them with some skills to care for people with dementia. The report of the registered providers visit to the care home of 31st December 2009 stated All statutory training has been completed and further induction/training for staff starting work in the home is being undertaken. Further training on dementia and challenging behaviour for new staff is planned. E learning is taking place and training for various courses has been booked with external providers. We were provided with a schedule of planned training courses for 2010, these included Care planning, emergency first aid, supervision, moving and handling, pressure sore prevention, dementia, health and safety and managing challenging behaviours. br br Care Homes for Older People br br Page 30 of 38 br br Management and administration br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. br br This is what people staying in this care home experience : Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team continue to work towards developing the service in the best interests of the people living at Winifred Dell Care Centre. br br Evidence: The home had a new general manager with effect from 29th December 2009, there was also a care manager in post. The general manager had previous experience of managing care homes and received good line management support from the Business Development Manager and the Regional Manager. Due to staff shortages on the day of this visit the manager was involved with supporting the staff team, the line management team assisted us with the inspection process. Relatives told us they had not been notified of management changes and were not aware who was the manager of the home. Residents that were able to express their opinion told us they were aware there was a new manager but they didnt know much about her. Overall, relatives we spoke with told us they felt the home was well run however this view was not unanimous with one person telling us I have very little br Care Homes for Older People Page 31 of 38 br br Evidence: confidence in anyone at Winifred Dell, they tend to say what they think we want them to say The service had only been operating for 129 days at the time of this visit therefore we are mindful they may not have commenced their annual quality assurance system. The regional manager told us that Head Office would be distributing surveys to all stakeholders involved with the home and a report of the findings would be given to the service to develop an action plan to meet any identified shortfalls and a copy would be submitted to the commission. We saw that regular internal audits took place within the home and a monthly visit to the home was undertaken by a representative of the provider organisation. Reports were developed as a result of these monitoring visits, we were provided with a copy of the December report. Areas of improvement identified within this report included a) The manager/care manager will ensure that care plan and medication audits are completed monthly. b) The manager/care manager will ensure reviews of care plans are undertaken in a timely manner, and c) The care manager will work with senior staff to ensure care plans are reflective of the residents changing needs. We were provided of copies of minutes from residents meetings, staff meetings and relatives meetings. This showed us that the ethos of the home was to involve all parties in the running of the home as much as possible. We saw that relatives meetings were scheduled to take place quarterly, residents meetings planned bimonthly and staff meetings monthly. We looked at how the home looked after personal monies held on behalf of the people living at the home. We checked the balance held for two people at the home, these agreed with the records. Receipts were kept with the record and money together in a see through plastic wallet in a secure cupboard in the administrators office. The homes administrator told us that residents monies were audited as part of general home audit however, there were no initials or signatures on the records to confirm that this took place. We saw there were organised folders in the managers office containing up to date Health and Safety certificates for the premises and equipment and records confirming that routine safety checks were being undertaken. Overall, the management of the home has not been consistent since the service was first commissioned in September 2009. We found areas such as staffing levels and deployment of staff, managing complaints, providing social stimulation, medication and care planning arrangements that need structured management input to improve br br Care Homes for Older People br br Page 32 of 38 br br Evidence: peoples experiences, safety and well being at Winifred Dell Care Centre. br br Care Homes for Older People br br Page 33 of 38 br br Are there any outstanding requirements from the last inspection? Yes £ No R br br Outstanding statutory requirements br These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. br No. Standard Regulation Requirement Timescale for action br br Care Homes for Older People br br Page 34 of 38 br br Requirements and recommendations from this inspection: br Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. br No. Standard Regulation Requirement Timescale for action br br Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. br No. Standard Regulation Requirement Timescale for action br br 1 br br 7 br br 15 br br Care plans need to include 31/03/2010 all the information staff need to support the people living at the home. This is so people can be assured the care they receive meets their assessed needs. br br 2 br br 8 br br 13 br br Where medical advice is obtained this must be followed as per the instructions from healthcare professionals and recorded appropriately. This is to ensure the health, safety and welfare of people living at the home. br br 28/02/2010 br br 3 br br 9 br br 13 br br The management of medication systems and recording needs to improve. This is so that it is possible to undertake an accurate audit of medications maintained within the home br br 28/02/2010 br br Care Homes for Older People br br Page 35 of 38 br br Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. br No. Standard Regulation Requirement Timescale for action br br and to ensure that recording reflects accurately when people have received their medication. 4 12 15 The activity provision needs to be developed to take into account individuals needs, abilities and choices, including those residents living with dementia. This is so that people are stimulated and enabled to live as fulfilling a lifestyle as possible. 5 15 12 There needs to be sufficient staff available at meal times to provide support and encouragement to help people eat their meals. This is to ensure that all residents have the support to eat and drink a healthy diet. 6 16 17 All complaints, including those issues raised verbally with staff must be recorded and investigated in accordance with the homes policies and procedures for dealing with complaints. This is so people can be confident that their concerns are taken seriously and acted upon. 28/02/2010 28/02/2010 30/04/2010 br br Care Homes for Older People br br Page 36 of 38 br br Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. br No. Standard Regulation Requirement Timescale for action br br 7 br br 27 br br 18 br br The numbers of staff and deployment of staff on duty must be reviewed alongside a robust assessment of the dependency levels of people living at the home. This is so that people can be assured that sufficient numbers and skills of staff are made available to meet their needs all through the day. br br 28/02/2010 br br 8 br br 30 br br 18 br br The whole staff team need 31/03/2010 to be provided with the basic core training they need. This is so people can be assured that staff have the skills to care for them safely. br br Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. br No Refer to Standard Good Practice Recommendations br br Care Homes for Older People br br Page 37 of 38 br br Helpline: 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). 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