Care Home: Winstonian House

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What the care home does well At the last key inspection we found: Residents are admitted to Winstonian House on the basis of an assessment of their individual needs. Prospective residents and their families are able to visit the home to view its facilities and services prior to coming in here. Residents we spoke to were happy with their care, confirming they got help when they needed it, and had good access to the doctor when necessary. One resident spoke particularly of their appreciation of being able to keep their independence and control of their own personal circumstances. Visitors are actively encouraged to join in the life of the home, and a welcoming atmosphere is provided for them. Winstonian House promotes residents` choice and states that it "wants residents to bring their own individuality to the home". Residents confirmed to us that staff were respectful of their choice, and also made good comments about the standard of the food. One resident told us that her particular dietary preferences and special needs were "well catered for." The home has policies and procedures in place for the protection of the vulnerable residents and staff receive specific training in this area. Residents spoke well of the staff here making comments such as "they are helpful and kind". Staff are encouraged to develop professionally and have access to training opportunities that include the National Vocational Qualification (NVQ) training programme. We have no reason to believe this has changed. Comments from surveys included, "carers are very caring," "feel secure and feel I can ask for help if needed" and "we look after residents and make them feel at home." What the care home could do better: Care plans should indicate whether people have any preferences for the gender of staff providing their personal care. The storage arrangements for medication need to be reassessed so that the cabinets comply with the Misuse of Drugs (Safe Custody) Regulations 1973. A secure container must be provided to transport medication around the home. (The registered manager immediately contacted the pharmacy for supply of a secure Nomad carrier). The temperature of the medication cabinet should be monitored and recorded at least daily. The problems in the bathroom on the ground floor must be dealt with as soon as possible. (The registered manager confirmed that this was in hand).When new staff start working at the home without a CRB check in place a risk assessment should be produced to describe their role and responsibilities. Random inspection report Care homes for older people Name: Address: Winstonian House 42 All Saints Road Cheltenham Glos GL52 2EZ one star adequate service 11/05/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lynne Bennett Date: 0 2 0 6 2 0 1 0 Information about the care home Name of care home: Address: Winstonian House 42 All Saints Road Cheltenham Glos GL52 2EZ 01242577927 01242577927 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Sarah Rachel Andrews Type of registration: Number of places registered: Conditions of registration: Category(ies) : CTCH Ltd care home 18 Number of places (if applicable): Under 65 Over 65 18 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Winstonian House consists of three terraced houses, which includes an end of terrace; all have been modified to create one property. The home is in the All Saints residential area of Cheltenham, close to local shops and the parish church, and is part of the CTCH Ltd group of homes. The centre of Cheltenham and Pittville Park are close by. It Care Homes for Older People Page 2 of 11 1 1 0 5 2 0 0 9 Brief description of the care home is registered to provide personal care to eighteen older people, and can provide respite care if this is wanted. Any elements of nursing care that may be needed are sourced from the local community nursing service. Accommodation is on three floors all served by stair lifts. The lower ground floor has two bedrooms, a bathroom and a small lounge/diner. The remaining bedrooms are located on the ground and first floors, with communal bathrooms on each. The communal accommodation consists of two open plan lounges leading to the dining room. Patio doors from the lounge provide access to the small garden. There is a pond, flowerbeds and a paved area where residents can sit. The front of the house has a ramp for easy access and a few parking spaces. Information about the home is available to prospective residents and interested parties in the printed Service User Guide, and a copy of the most recent CQC report is available in the home for anyone to read. The charges for Winstonian House range from 479.00 pounds (lower Local Authority rate), to 534.00 pounds per week. Hairdressing, Chiropody, Toiletries, Magazines and Newspapers are extra charges. Care Homes for Older People Page 3 of 11 What we found: This random inspection took place in May/June 2010 and included two visits to the home on 25th May and 3rd June. The registered manager was on holiday during our first visit. She had completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). We had received surveys from 9 people living in the home and 10 members of staff. The inspection focused on the requirements issued at the last inspection, case tracking two new admissions including their medication records, examining recruitment and selection documents for two new members of staff and notification and accident records. We were also shown around the communal areas of the home. Two people had been admitted to the home in the last six months. The AQAA stated, residents are admitted on the basis of a full pre-admission assessment. Each person had a full pre-admission assessment of need completed by the home in addition to an assessment and care plan provided by the placing authority. One person also had discharge notes from hospital. In addition to this relatives were requested to fill in a selection of forms to provide an overview of the persons likes/dislikes, interests and hobbies. This had been completed in full for one person but not for the other. The home had also introduced a new document which staff used to collate information about peoples history, memories, education, employment, beliefs and interests. Each person had a copy of the contract in place with the placing authority. They also had a document which they had signed indicating that they had received a copy of the homes service user guide and terms and conditions. These are kept in their rooms and were not seen at this visit. The AQAA stated that we encourage residents to come to us when we do their preadmission assessment as it allows them to see the home and how it works. Surveys from one person said, they look after residents and make them feel at home. The AQAA stated, each resident has an individual care plan that is reviewed regularly. We examined the care plans for each person which had been developed from their activities of daily living profile. Assessments were in place identifying peoples risks of falls, nutrition, pressure sores and moving and handling needs. Where risks were identified care plans and risk assessments had been developed. Care plans were person centred providing a description of how the person wished to be supported with their physical, emotional, social and intellectual needs. Where necessary they identified further records to be read in conjunction with them such as other care plans or risk assessments. They were being evaluated each month. Comprehensive summaries were noted on this review of the care plan. People had signed some documents on their files. They had also signed a record indicating that their key worker had discussed their care plans with them. Care plans indicated how people would like to be supported with their personal care needs. These reflected how staff should treat people with dignity and respect. They did not mention whether people had any particular preference for the gender of staff providing their personal care. For one person who occasionally became anxious or agitated there were care plans and risk assessments in place describing how to support them and enable them to become calm. Incident records were kept when they had become anxious and staff described how they used de-escalation and diversion to distract them. This was in line with their care plan and risk assessments. Records were being kept Care Homes for Older People Page 4 of 11 for peoples health care appointments with a range of health care professionals. They also had access to chiropody and optician appointments at the home. People spoken with said they were happy living in the home, staff were good and that they enjoyed the meals. Accident and incident records were comprehensively completed with evidence that they were being monitored to assess whether further intervention was necessary or they were a one off incident. For one person their General Practitioner (GP) had been contacted with a positive outcome preventing any further incidents. Likewise falls were being monitored and it was evident that falls prevention was being implemented in the home. There had been 5 accidents recorded this year. Only one of these had been notifiable to us and we had received a Regulation 37 notification. Systems for the administration of medication were inspected. No controlled drugs (CDs) are kept in the home although a cabinet is in place. Medication was being kept in a filing cabinet. This locked cupboard does not comply with the Misuse of Drugs (Safe Custody) Regulations 1973 so consideration must be given to upgrading this so that the correct storage is in place. We discussed with staff how they transport medication around the home and they were using a basket. They must transport medication around the home in a secure container to prevent the possibility of harm to people living there. Staff confirmed they had completed training in the safe handling of medication. Monthly medication audits were in place which identified any concerns or errors. Stock control was monitored on the medication administration record for blister packs and in an additional book for other medication. The temperature of the cabinet was being monitored albeit irregularly. For the first two weeks of May there were no entries on the record. Some people had been assessed as able to self-medicate and were provided with lockable facilities in their rooms. Records confirmed that the use of homely remedies had been agreed with the GP. Protocols were in place for the use of as necessary medication and the administration chart was being completed correctly. Handwritten entries on the medication administration record were being countersigned as correct. A signature list was in place for all staff administering medication. At the time of our visit the homes housekeeper was on holiday. The home was clean and tidy and there were no offensive smells. We were told that the kitchen had been identified for refurbishment. Some bathrooms had been upgraded and provided either a shower or assisted bath. One bathroom on the ground floor was out of use and we were informed this was being dealt with. The room nearby does not have en suite facilities and although the person has access to a bathroom on another floor and has been given a commode, this bathroom must be back in action as soon as possible. Specialist adaptations were provided where needed and there were stair lifts in situ. Communal areas were plentiful and people were observed using them during our visit. There were also dining areas on two floors. The gardens were well kept providing an area of lawn and patio. The laundry area is compact. It was tidy and clean at the time of our visit. Staff confirmed laundry bags were being used and they had access to infection control training. Personal protective equipment was being used. Files were examined for the last two members of staff appointed to work at the home. Each had completed an application form and the registered manager had evidenced where she had researched gaps in their employment history. A summary sheet confirmed that two references had been received before they had been appointed. References requested the reason for leaving former employment. Proof of their identity was on file and a photograph had been obtained for one person. There was evidence that an ISA Care Homes for Older People Page 5 of 11 (Independent Safeguarding Authority) Adult First check had been obtained for each person before appointment. Their CRB (Criminal Records Bureau) checks had been received after appointment. The registered manager described the restrictions which were in place until the CRB check was returned. There were no risk assessments in place detailing this. Copies of certificates for training completed prior to working at the home had been obtained. The registered manager confirmed that an electronic training database was being maintained for training completed at the home. Copies of certificates were also on their files. Staff had completed an induction programme about the home and also the Skills for Care Common Induction Standards. They had access to a NVQ (National Vocational Qualification) programme and training relevant to peoples needs such as Dementia awareness. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 11 Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: 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. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 03/07/2010 make sure that the storage arrangements for medication complies with the Misuse of Drugs (Safe Custody) Regulations 1973. This is to make sure that medication is stored securely. 2 9 13 The registered person must make sure that medication taken around the home is stored securely and safely. This is to safeguard people from possible harm. 03/07/2010 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. No Refer to Standard Good Practice Recommendations 1 7 Care plans should indicate whether people have a preference about the gender of staff providing their personal care. The temperature of the medication cabinet should be Page 9 of 11 2 9 Care Homes for Older People 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. No Refer to Standard Good Practice Recommendations monitored and recorded each day. 3 29 A risk assessment should be in place for new staff working at the home without a CRB check in place. This should describe their roles and responsibilities. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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