Care Home: Winscombe Hall Care Home

Similar services:

• Fairfields Country Rest Home
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well Whilst at Winscombe Hall we noticed that staff continued to have a very friendly but professional rapport with people living in the home. There was cheerful chatter between staff and residents with a relaxed and homely approach. On both days of our visit to the home we saw people enjoying various activities being provided by staff. People we spoke to who could voice an opinion said they were well cared for, one person said `sometimes they need to be more organised but generally they are all right.` On the first day of the inspection we observed a qualified member of staff diffuse a potentially challenging situation well. This showed good practice on that persons part. People indicated that they enjoyed the meals and lunch time was unhurried and relaxed. What has improved since the last inspection? The Dementia Unit has now opened and there were adequate staffing levels to cover both units. A fortnightly visit from the local GP surgery has been arranged to maintain people`s health needs. Bedrooms continue to be refurbished as they become available. What the care home could do better: We have made 12 requirements and 7 best practice recommendations following this inspection. The main area that needed improvement at Winscombe Hall was the provision of training. We noted that although Dementia Care Training had been identified as an important area it had not progressed beyond the last inspection. We also noted that some basic nursing skills were not up to date for the qualified staff. Mandatory training was also behind schedule for some staff. Observed practices in the home showed that this training was essential to meeting the needs of people in the Dementia Unit. Care staff were not aware of the best way to deal with challenging behaviours or how to address people with Dementia. We discussed the need to provide a letter to prospective residents indicating that following a full assessment the manager feels the home can meet their needs, the manager was confirming this by telephone but this must be done in writing. We looked at care plans and identified areas that need to provide guidance for staff such has triggers and coping strategies for challenging behaviours. We also noted that following advice from the community nursing team care plans for pressure area care had not been reviewed and did not reflect the treatment required. (However we did note that staff had followed the advice given and the resident`s condition had improved.) We discussed the use of cot sides the manager must ensure consistent use of cot sides, that risk assessments are completed and obtain signed agreement for their use. When we looked at medication we noted that one persons medication had been out of stock for 7 days. Since the inspection the manager has investigated and found that this was due to communication issues with the surgery involved who had been asked on more than one occasion to replace the prescription. However the manager must ensure that this does not occur again and improve communication between the home and the surgery. We also recommended that the packets for creams and tablets must be dated to enable an audit so that staff can ensure creams are still within their effective date of use.We identified a door that did not provide appropriate safety for the resident from smoke inhalation in the event of a fire and a window that needed to be restricted to maintain the safety of people in the home. We also discussed the need for accessible outdoor facilities for people, the garden area is not accessible due to uneven paths and unkempt lawns, whilst the agreed courtyard area for the Dementia Unit has not been started and is still in the planning stage. With regard to staffing we have required that the home have more than the one RMN who was providing both shift work and on call cover for Dementia Care advice. It is unreasonable to expect one person to provide all this cover. CARE HOMES FOR OLDER PEOPLE Winscombe Hall Care Home Winscombe Hill Winscombe North Somerset BS25 1DH Lead Inspector Juanita Glass Unannounced Inspection 09:30 18 and 19th December 2008 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winscombe Hall Care Home Address Winscombe Hill Winscombe North Somerset BS25 1DH 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) 01934 843553 Cedars Care (Winscombe Hall) Ltd Mrs Susan Jane Welsh Care Home 39 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (39) of places Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) - maximum number of places is 17 The maximum number of service users who can be accommodated is 39. 18th July 2008 2. Date of last inspection Brief Description of the Service: Winscombe Hall is registered with the Commission for Social Care Inspection to provide care for 39 older people requiring nursing care. The home is owned by The Cedars Care Group, which is a family owned company. They specialise in dementia and nursing care for older people and run various homes throughout England. Winscombe Hall admits male and female residents over the retirement age, which requires personal and nursing care. Part of the home also allows for 17 residents who have dementia and may require nursing. These rooms are located in a separate wing over two floors. They can also provide short-term respite care. The Statement of Purpose says they aim to provide a stimulating atmosphere in which service users can extend their quality of life through social activities, visitors and stimulating surroundings, whilst preserving their independence and choice for as long as possible. The registered manager is Miss Susan Welsh who is a qualified Registered General Nurse with many years experience managing care homes and working in the nursing home sector. A team of qualified nurses, and care assistants supports the manager in the provision of care. Winscombe Hall is an attractive 18th-century converted building retaining many of its original features and character in six acres of ground close to the Somerset Levels and Cheddar. Several of the rooms have en-suite facilities, there are two passenger lifts enabling disabled access to upper floors, however five bedrooms have restricted access, as they are only accessible by stair. The Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 5 home has three comfortably furnished lounges and two dining rooms. Limited care parking is available for visitors outside the entrance to the home. Current fees are. Residential £369.34 - £425 Dementia residential £428.05 - £450 Nursing £545.86 - £570 Dementia Nursing £580.90 - £605 Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was the second key inspection carried out since Winscombe Hall was re registered to provide nursing care. The reason for this inspection was two fold, initially to follow up progress since the last inspection (as stated in the last report) with the opening of the Dementia Unit. Secondly it was agreed following concerns raised with The Commission. An Annual Quality Assurance Assessment (AQAA) was previously completed by the home manager and forwarded to the Commission for Social Care Inspection (CSCI). We The Commission also carried out a review of documentation in the home. This included documents in peoples care plans, staff personnel records and records maintained for the day-to-day running of the home. Whilst in Winscombe Hall we discussed the care provided with 7 people living there on a one to one basis and as a group. We also observed staff working practices and spoke to 4 staff members over the two days. What the service does well: Whilst at Winscombe Hall we noticed that staff continued to have a very friendly but professional rapport with people living in the home. There was cheerful chatter between staff and residents with a relaxed and homely approach. On both days of our visit to the home we saw people enjoying various activities being provided by staff. People we spoke to who could voice an opinion said they were well cared for, one person said ‘sometimes they need to be more organised but generally they are all right.’ On the first day of the inspection we observed a qualified member of staff diffuse a potentially challenging situation well. This showed good practice on that persons part. People indicated that they enjoyed the meals and lunch time was unhurried and relaxed. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: We have made 12 requirements and 7 best practice recommendations following this inspection. The main area that needed improvement at Winscombe Hall was the provision of training. We noted that although Dementia Care Training had been identified as an important area it had not progressed beyond the last inspection. We also noted that some basic nursing skills were not up to date for the qualified staff. Mandatory training was also behind schedule for some staff. Observed practices in the home showed that this training was essential to meeting the needs of people in the Dementia Unit. Care staff were not aware of the best way to deal with challenging behaviours or how to address people with Dementia. We discussed the need to provide a letter to prospective residents indicating that following a full assessment the manager feels the home can meet their needs, the manager was confirming this by telephone but this must be done in writing. We looked at care plans and identified areas that need to provide guidance for staff such has triggers and coping strategies for challenging behaviours. We also noted that following advice from the community nursing team care plans for pressure area care had not been reviewed and did not reflect the treatment required. (However we did note that staff had followed the advice given and the resident’s condition had improved.) We discussed the use of cot sides the manager must ensure consistent use of cot sides, that risk assessments are completed and obtain signed agreement for their use. When we looked at medication we noted that one persons medication had been out of stock for 7 days. Since the inspection the manager has investigated and found that this was due to communication issues with the surgery involved who had been asked on more than one occasion to replace the prescription. However the manager must ensure that this does not occur again and improve communication between the home and the surgery. We also recommended that the packets for creams and tablets must be dated to enable an audit so that staff can ensure creams are still within their effective date of use. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 8 We identified a door that did not provide appropriate safety for the resident from smoke inhalation in the event of a fire and a window that needed to be restricted to maintain the safety of people in the home. We also discussed the need for accessible outdoor facilities for people, the garden area is not accessible due to uneven paths and unkempt lawns, whilst the agreed courtyard area for the Dementia Unit has not been started and is still in the planning stage. With regard to staffing we have required that the home have more than the one RMN who was providing both shift work and on call cover for Dementia Care advice. It is unreasonable to expect one person to provide all this cover. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 9 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 Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 5. 6 does not apply Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents benefit from adequate written information, a chance to visit the home and a full assessment of their needs. They cannot be confident that the needs of people with Dementia can be met due to lack of staff training; they do not receive written confirmation that the home can meet their needs. EVIDENCE: We looked at the records held in the home for people living there we noted that people had contracts or statements of terms and conditions setting out the conditions of residence. The manager confirmed that new contracts and statements of terms and conditions had been issued and they were awaiting the return of these from residents or relatives. We asked the manager at the previous inspection about how they would assess a person who wished to move into the home. She said they would visit the Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 11 person either at their home or in hospital. They would talk to them, a relative or advocate and staff at the hospital or a social worker. They would also look at existing care plans for the person. This process had not changed. We then looked at the records held in the home for people who had not lived there very long. They all had completed assessments and community or hospital care plans. We spoke to the people living in the home; nobody commented on their experience of moving into the home. We asked the manager how she confirms with people wishing to move into the home that a place is available and that they can meet their assessed needs. The manager stated that she confirms this over the telephone however understood that this should be done in writing. We looked at the training provided for staff working in the home. Some people had not received up to date training in Dementia Care and managing challenging behaviours, which meant they did not have the knowledge to meet the diverse needs of people with Dementia related illnesses, and challenging behaviours. This means the home cannot consistently meet the needs of people being admitted into the Dementia Unit. Training in Dementia Care for all staff had been a condition set out in a letter to the provider when registration of the Dementia Unit had been granted by CSCI. We also made a recommendation at the last inspection that training for staff in managing challenging behaviours needed to be arranged. We also noted that some training relevant to the specific needs of people in the home such as colostomy care had not been provided for care staff. People wishing to move into Winscombe Hall can visit and spend some time to meet other people living there and staff who will be looking after them. This is often done by a relative or advocate on their behalf. If the manager and staff feel they can meet the needs of the person they will offer a trial period when both the person moving in and staff can decide whether the home is really the best placement for them. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from personal and specialist healthcare support that is provided in a person centred way respecting their privacy and dignity. However some care plans did not reflect guidance provided and wound care, and staff did not understand the dignity needs of people with Dementia. They benefit from and are protected by the homes policies and procedures for the administration of medication which staff had not followed putting them at risk of medication error. People no not benefit from support in making end of life decisions. EVIDENCE: We looked at the care records for five people living in the home. We saw that they continued to be person centred and reflected the personal likes and dislikes of the person rather than task led roles for staff to follow. The care plans were easy to read and meant you could tell very quickly when reading Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 13 them how a person preferred to be looked after. All residents had a named nurse and key-worker that was responsible for gathering information and making sure the care plans were kept up to date. However we noted that some social and life histories had not been completed. This meant that staff would not have an understanding of why a person may act in a certain way. Care plans reviewed for one person with challenging behaviours did not contain clear guidance for staff showing what triggers had not been identified that preceded an incident and there were no coping strategies they could follow to defuse a situation. We noted that following consultation with the district nurse team guidance had been provided regarding the prevention of pressure sores for a specific individual. The original guidance was included in the file but the care plan had not been up dated to reflect the guidance and the wound care plan did not reflect the needs of a person with a pressure sore and the progress that was being made following treatment. We did note that staff had followed the guidance provided and the person had improved. When looking at the care plans we saw some very clear risk assessments for people these included risk of falling, manual handling and pressure area assessments. We found that they gave very clear guidance to staff. Following the requirement made at the last inspection pressure area care plans included the type of preventative equipment being used. These corresponded with the equipment observed in people’s rooms. We did discuss with the manager the need to identify in Manual Handling assessments the size of hoist sling to be use so that staff are fully informed. We saw assessments that said why bed rails needed to be used but there was no risk assessment on whether the use of bed rails may put that person at risk or not. We also did not see signed consent for the use of bedrails. We spoke to staff about the use of bedrails for one individual as they would get up during the night, the nurse stated that the person did not climb over the rails and if staff did not use the bed rails the individual would remind them to put them in place. However when we spoke to the manager they indicated that they did not used cot sides for this individual, so there was a lack of consistency of care due to poor communication. The manager agreed to review the use of care plans for this person. All staff spoken to understood the likes and dislikes of the people in the home. They knew what they liked and how they liked to be cared for. They were also aware of the need to recognise cultural differences and a work manual for anti discriminatory practice supported this, promoting good working practices between staff as well as for residents. People living in the home have access to health care specialists and care plans showed that the district nurse could be consulted when the home felt they Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 14 needed some expert advice. Residents were helped to attend out patient appointments, the dentist and the chiropodist. Regular reviews are carried out with the GP looking at specific health needs and medication. The GP surgery in Winscombe now provides a fortnightly GP visit to carry out regular clinics and health checks. We observed staff administering medication and they followed the correct procedures. We did note whilst carrying out a tour of the premises that some creams in peoples rooms where not dated when they were opened therefore people might be using cream that has been opened too long reducing their effectiveness. When looking at stock in the medicine trolleys we noted that there were also creams there that had not been dated when opened. One cream had been dispensed and started in October 2008, used a few times and then left. We also noted that boxes containing tablets had also not been dated when opened making an audit of medication impossible. One medication necessary for reducing gastric acids meaning it prevents heartburn and possible stomach and duodenal ulcers had been out of stock for 7 days. We discussed this with the manager who agreed to investigate, since the inspection the manager has confirmed that staff had contacted the surgery to obtain a new prescription and the manager was looking into ways of improving communication. It is still not good practice for medication to run out so that people do not benefit from the continued cover needed. People we spoke to said they were happy with the way staff cared for them. We observed staff respecting people’s private space knocking and waiting before entering a person’s room. We also observed some very good staff/resident interactions and some staff had a very good rapport with people living in the home. However we also over heard a member of staff on the dementia unit tell a resident to ‘sit down’ in an ordering fashion and then to another resident ‘you’ve already had a cup of tea’ in a tone that was not understanding, respectful or compassionate. This indicated that the member of staff did not have an understanding of the way to communicate with people who have a dementia type illness. We also observed an occasion when a male resident displayed challenging behaviour towards care staff and another resident. The care staff did not display an understanding of how to prevent the situation getting out of hand and in fact helped fuel the situation rather than diffuse it. However the situation was very well handled by the qualified nurse in charge, who diverted the person’s attention and prevented it from getting more heated. This member of staff demonstrated an understanding of the person’s needs and personality and acted appropriately. As previously mentioned we saw that although the paperwork was available for people to indicate their wishes and likes and dislikes end of life decisions had not been completed. Staff appeared reluctant to discuss this area as they felt it could upset people, however people would prefer to have their wishes recorded when they are able to make their decision known. This means that Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 15 people may become too ill to make their wishes known in time and not receive the care they would have preferred. Winscombe Hall Care Home DS0000071367.V373546.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from the development of meaningful activities which recognises their diverse needs, likes and dislikes enabling them to maintain some control over their lifestyle. They benefit from continued contact with family, friends and the community. A well-balanced menu means people benefit from a healthy and nutritional diet. EVIDENCE: On both days of the inspection we observed people taking part in organised activities such as quizzes, newspaper reviews and general discussion groups. We noticed a full activities programme advertised on the notice board and a display of craft in the dining room. People we spoke to said there was always plenty to do. On both days there was a ‘general buzz’ of activity that residents said was an everyday event. The activities organiser keeps a record of activities attended however we noted that this had not been completed for a few months. We also observed the people in the Dementia Unit did not have an organised activity session. We asked the manager how the activities Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 17 organiser was going to ensure that people in the Dementia Unit also take part in meaningful activities. She stated that the organiser was setting tasks for care staff to follow and that some residents will continue to go to the main building to join in activities. We will continue to monitor this, as it is a concern that people in the Dementia Unit may not enjoy the same level of meaningful activities as other people in the home. People confirmed that they could keep in touch with family and friends. People can also attend a regular church service and monthly communion provided in the home. If people express the wish they can receive religious support from their own minister of religion either in their place of worship or in the home. People spoken to indicated that they could keep some control over the way they lived and spent their day at Winscombe Hall. One person said staff respected and supported their choices. Staff confirmed that they could work flexibly to accommodate personal choices. The menu showed that people are offered a choice of healthy and nutritious meals, including fresh meat, fruit and vegetables. People spoken to said they enjoyed the meals. One person said they thought they must have put on weight as they had eaten very well during their stay. Another person said that they could have a choice and felt comfortable telling staff if they did not like anything on the menu. Staff were aware of the need to be flexible with mealtimes especially breakfast, and the need to recognise personal and cultural preferences. Any dietary requirement such as medical, personal or cultural could be accommodated. Meal times in the home were observed to be relaxed and people were offered assistance in a dignified way. Nobody was hurried to finish and one person said they were always a bit slower but no one insisted they hurry up. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from and are protected by the complaints policies and procedures in the home. People benefit from and are protected by the policies and procedures for safeguarding adults however they do not benefit from staff knowledge and training. EVIDENCE: We looked at the homes complaints policy and procedure. It was easy to read and made available in the home and service user guides, when asked about raising concerns or making a complaint residents said they knew whom to approach and would be happy that any concerns were dealt with immediately. The manager maintains a record of all complaints and compliments received, no complaints had been received since that last inspection. The home also has a robust policy and procedure for Safeguarding Adults who may be vulnerable to abuse. Staff spoken to said they knew what action to take, they were aware that there was a local authority procedure and where to access the information if they needed to. Training on the North Somerset policy and procedure had been provided for some staff it was noted that some staff still needed to attend training. The Commission was concerned that a Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 19 recent event in the home had not been reported to the North Somerset Safeguarding Officer as a possible safeguarding issue until the manager was advised to do so by the Link Inspector. The manager has attended POVA training and stated that she intended to attend the update in POVA Investigators training and Mental Capacity Act training. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from a comfortable, well-equipped and homely environment, which is well maintained and decorated. People do not benefit from going outdoors as access to outdoors areas is limited. People are protected by staff awareness of appropriate infection control guidelines. EVIDENCE: Winscombe Hall is a large listed building which has been adapted to provide accommodation for 39 people. The homeowners have provided equipment and adaptations as required to meet the needs of the people living in the home. One person said they had a very nice room with a good view. All rooms were bright and well lit. Another person said they had all their own possessions, which made them feel more at home. We noted in the main part of the building one fire door that did not close fully meaning that smoke could get Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 21 into the bedroom in the event of a fire. Also one window half way up the stairs is not restricted and opens onto a flat roof. This does not protect people in the home from falls from height or from people who may want to access the home illegally, the manager agreed to arrange for restrictors to be put in place as soon as possible. Access to outside areas for people in the main part of the house is restricted due to poorly maintained paths and garden areas. There is a separate wing that provides care for people with dementia. Since the last inspection this unit is now up and running. All bedrooms seen were well decorated and some people had bought in their own furniture and belongings. The dementia wing has its own dedicated lounge and dining room, both of which were being used during the visit. People living in the Dementia Unit would benefit from the communal areas having more pictures on the walls and clocks. We noted that there was not one clock in the Unit meaning that people had no idea of the time of day unless told by staff. We discussed the provision of outdoor access, when the Dementia Unit was registered the provision of a courtyard patio area was agreed. The manager stated that this was still in the planning stage as the home was a listed building and they had to agree with local authority planners how they would tackle the area within planning law. All areas of the home were clean and well maintained with planned redecoration of rooms as they become available. Staff were seen to observe good Infection Control procedures using personal protective clothing and cleaning materials appropriately. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from adequate staffing levels but they do not benefit from the skill mix in the home, they are not supported by well-trained staff that have specific knowledge of specialist care needs. People are supported and protected by the recruitment policies and procedure followed in the home. EVIDENCE: We looked at the personnel files for people working in the home, these were for both qualified nursing staff and care staff and included recruitment and training. We also looked at the staffing rotas to ascertain the numbers of staff in the home on each shift. We found that the manager is still advertising for staff to enable her to provide enough staff to cover both units separately. We noted from the rotas that the home has adequate numbers of staff at anytime to meet the needs of the current resident group. One GP spoken to said they felt the home was well staffed. There was a good mix of staff with qualified staff, senior carers, care staff and new staff who work supervised until they have completed their induction. All new staff completes an induction that is linked with the Common Induction Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 23 Standards for Skills for Care and underpins the NVQ 2 In Health Care. Care staff are encouraged to obtain an NVQ qualification. However the skill mix of staff was not of a high standard we noted that Dementia training which had been started earlier in the year had not progressed as the deputy manager had left and the only other person qualified to provide the training had been working long hours and providing on call cover. Care staff had not been trained in how to manage challenging behaviours which was evident in observed practices in the home and had been a recommendation at the last inspection. The personnel files for qualified staff did not evidence that they had maintained their knowledge of basic nursing skills, which was evident in their need to seek advice regarding basic pressure area care from the community nursing team. We noted that some staff had not attended the mandatory up dates for manual handling, infection control and Safeguarding adult training. Dementia training had been discussed when it was agreed that the Dementia Care Unit could be used towards the end of May 2008. At the last inspection it was noted that Dementia Training had started and that the Yesterday, Today and Tomorrow training package was going to be used. However no progress had been made in this area hence people were being cared for in the Dementia Unit by staff who did not have a clear understanding of how to meet their needs, or how to manage challenging behaviour. When the Dementia Unit was agreed we also agreed that qualified staff in charge of shifts could be Registered Nurses suitably trained and experienced in working with people with Dementia supported by RMN’s (Registered Mental Nurses) who would be available on call. At the time of the inspection the home only had one RMN, it is unreasonable to expect one person to be the sole on call contact when Dementia Care advice is needed. We looked at employment files and found that the manager follows the homes strict policy and procedure on staff recruitment, obtaining all the required documentation before they commence work. This protects residents from the possibility of abuse by ensuring all new staff are appropriately checked. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well run home when the manager is on duty, with an appropriately qualified manager. People do not benefit from appropriately supervised staff. Both people working and living in the home are protected by robust health and safety procedures. EVIDENCE: The registered manager is Miss Susan Welsh who is a Qualified Registered General Nurse with many years experience managing care homes and working in the nursing home sector. A team of qualified nurses, and care assistants supports the manager in the provision of care. However the qualified staff do not maintain the level of management in the home when the manager is on Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 25 days off or on holiday. It was evident that the manager works hard to maintain a level of care she would prefer but this is not consistent. We discussed the need for qualified staff to be supported by more people with Dementia Care experience and for the care in the home to be consistent even when the manager is not there. The manager confirmed that she had interviewed one qualified person and had been approached by some one she had previously worked with so qualified cover should improve. People spoken to said they felt they could talk to anybody at anytime. They felt they could go to the manager and speak to her in confidence. Staff also said they felt that the approach to managing the home was open and inclusive. We looked at the supervision records maintained in the home. We discussed with the manager that staff supervision needs to take place six times a year, identifying strengths, weaknesses and training needs. We also discussed the fact that supervision can be delegated to other staff if the training is provided to lighten the load on the manager. Health and safety within the home is generally satisfactory. The fire log was reviewed and showed that all the relevant checks were being carried out appropriately and that all staff had attended training. The home policies and procedure for health and safety to safeguard residents and staff had been reviewed and up dated as necessary. We discussed the fact that some staff still appear to be using inappropriate manual handling techniques despite training the manager was required to investigate and up date their training. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X 2 X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X 2 Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 27 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 OP4 Regulation 12 (1a) Requirement The provider must ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. This refers to providing staff that are adequately trained to meet the diverse needs of people in the home such as dementia and specific care needs such as managing challenging behaviours. Timescale for action 07/02/09 2. OP4 14 1 (d) 3. OP7 15 (2) The registered provider must 07/02/09 ensure that following an assessment, the home is suitable and can meet the health and welfare needs of the prospective resident and confirm this in writing to the prospective resident or representative. The registered person must 07/02/09 ensure that care plans are reviewed and up to date. This refers to specific care plans for pressure area care and Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 28 4. OP7 15 (1) wound care including treatment and progress. The registered person must ensure that a plan or care for specific needs is drawn up and provides the basis for the care to be delivered. This refers to care plans for challenging behaviours identifying triggers and coping strategies for staff to follow. The registered person must ensure that the use of bedrails has been risk assessed for each individual to show that residents are not at risk when they are being used i.e. climbing over and falling from height. These must be agreed with the resident or representative and signed agreement obtained. The registered person must ensure that prescribed medications are available for staff to give so that the health of people in their care is maintained. The registered provider must ensure that the identified window is restricted to protect people living in the home from falls from height or from people who may wish to gain entry by stealth. The registered provider must ensure that residents have access to well maintained outdoors areas. The registered provider must ensure that there is sufficient RMN cover. This refers to all RMN input either shifts in the home or on call cover provided by one person. Which is insufficient for the continued well-being of the 07/02/09 5. OP7 13 4 (c) 07/02/09 6. OP9 13 (2) 07/02/09 7 OP19 13 (4) 07/02/09 8. OP20 23 2 (o) 07/02/09 9. OP27 18 (1)(a) 07/02/09 Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 29 10. OP30 18 1 (c) people living in the Dementia Unit. The registered provider must ensure that all staff attends mandatory training and updates, and that qualified staff maintain their knowledge and skills relevant to the specific needs of the people in the home. This refers to staff who have still not attended a manual handling, infection control and safeguarding adults up date or course. For qualified staff this refers to wound care, pressure area care, dementia care and maintaining basic nursing skills. The registered provider must ensure that all staff working in the Dementia Unit receives training in managing challenging behaviour. To protect both residents and staff from incidents that may occur. The manager must investigate the inappropriate manual handling techniques, which continue to be followed by some staff in the home despite training. 07/02/09 11 OP30 18 1 (c) 07/02/09 12. OP38 13(5) 07/02/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Manual handling care plans need to include the type and size of sling to be used. Creams and boxed/bottled tablets need to be dated when DS0000071367.V373546.R01.S.doc Version 5.2 Page 30 Winscombe Hall Care Home 3. 4. 5. 6 OP10 OP11 OP12 OP19 7. OP27 opened to provide a date for audit and length of effectiveness of creams. The registered person needs to ensure that staff are aware of the way they speak to residents even if it is well meaning. The registered person needs to ensure that peoples end of life wishes are recorded. The registered person needs to ensure that a daily record is maintained of activities attended by people in the home. The registered person needs to ensure that the one bedroom door that does not close properly is repaired to protect the resident from possible smoke inhalation in event of a fire. The manager needs to ensure that qualified staffs deploy care staff so residents are not left unobserved in communal areas. Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Winscombe Hall Care Home DS0000071367.V373546.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!