Care Home: Winterton House

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What the care home does well People using the service are thoroughly assessed prior to admission and have a range of useful information available to them to help make a decision about moving in. The health and personal care needs of people living at the service are generally well met, promoting health, well-being and taking into account their preferences and religious or cultural requirements. The service was taking into account people`s diverse needs and meeting these. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting people`s preferences and religious or cultural requirements. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. The building is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. Adaptations have been provided to assist people with daily living tasks. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. What has improved since the last inspection? Medication administration records were being completed at the time of administering and the correct administration procedures were being used for controlled medicines. Improvement had been made to the environment through better management of odour in bedrooms and damp treated and made good on some walls. A copy of the service`s fire risk assessment had been forwarded to us, as requested. A copy of the quality audit had been forwarded to us, as requested. What the care home could do better: Care plans are detailed and being kept up to date at the service and outline people`s needs. The manager was advised to review storage arrangements for files in one of the lounges as these were readily accessible to people and also to make sure one person`s weight loss has been referred on or to make arrangements for it be to referred to her doctor. Medication practice has not been consistently in line with the organisational policy and The Royal Pharmaceutical Society guidelines. Improvement to practice is needed to ensure that people receive their medicines in a safe and consistent manner. Sampling of recruitment files showed gaps to required checks that need to be in place and satisfactory before staff start working at the service. Some agency staff had been used to cover gaps in the rota. Verification that agency workers have been thoroughly checked was not in place for a sample of people recently used at the service. Improvement is needed to make sure that people using the service are not placed at risk of harm. Some gaps to staff training records were evident. A requirement was made at the previous key inspection in 2007 to address shortfalls. The manager must make sure that training is kept up date to make sure staff have the knowledge and skills they require in supporting people at the service. Records showed that some monitoring visits have been taking place by the provider and a quality audit has been undertaken to assess quality of care. Records of monitoring visits did not show that these are always undertaken monthly and the provider is advised to address this. Key inspection report Care homes for older people Name: Address: Winterton House Hale Road Wendover Buckinghamshire HP22 6NE     The quality rating for this care home is:   two star good service 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: Chris Schwarz     Date: 1 0 0 8 2 0 0 9 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. 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 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. 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 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. This is what people staying in this care home experience: 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 Page 2 of 31 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Winterton House Hale Road Wendover Buckinghamshire HP22 6NE 01296622203 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.winterton@fremantletrust.org www.fremantletrust.org The Fremantle Trust The registered provider is responsible for running the service care home 41 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 41. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category (OP). Date of last inspection Brief description of the care home Winterton House is registered to provide care and accommodation for up to forty one older people. It is situated on the outskirts of Wendover, where it is reasonably convenient for local amenities and is accessible by public transport. The accommodation is over three floors and the service is set in very pleasant grounds with garden areas and seating at the front and rear of the building which are accessible to Care Homes for Older People Page 4 of 31 Over 65 41 0 Brief description of the care home service users. The building has some adaptations to meet the needs of people with disabilities, including ramps, handrails, adapted bathing facilities and two lifts serving all floors. Parking is available to the front and side of the building. Fees at the time of this inspection ranged from £565 to £643 per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day from 8.50 am until 5.50 pm and covered all of the key national minimum standards for older people. The last key inspection of the service took place on 10 September 2007 and an Annual Service Review was carried out on 10 September 2008. Prior to this visit, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment, was sent to the manager for completion. It was returned in good time and provided us with details and statistical information to help plan and assess quality of care at the service. Surveys were sent to a selection of people living at the service, staff and visiting professionals. Fourteen replies were received from a mix of staff, service users and a health care professional, which have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into Care Homes for Older People Page 6 of 31 account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, examination of some of the required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager and external line manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care plans are detailed and being kept up to date at the service and outline peoples needs. The manager was advised to review storage arrangements for files in one of the lounges as these were readily accessible to people and also to make sure one persons weight loss has been referred on or to make arrangements for it be to referred to her doctor. Medication practice has not been consistently in line with the organisational policy and The Royal Pharmaceutical Society guidelines. Improvement to practice is needed to ensure that people receive their medicines in a safe and consistent manner. Sampling of recruitment files showed gaps to required checks that need to be in place Care Homes for Older People Page 8 of 31 and satisfactory before staff start working at the service. Some agency staff had been used to cover gaps in the rota. Verification that agency workers have been thoroughly checked was not in place for a sample of people recently used at the service. Improvement is needed to make sure that people using the service are not placed at risk of harm. Some gaps to staff training records were evident. A requirement was made at the previous key inspection in 2007 to address shortfalls. The manager must make sure that training is kept up date to make sure staff have the knowledge and skills they require in supporting people at the service. Records showed that some monitoring visits have been taking place by the provider and a quality audit has been undertaken to assess quality of care. Records of monitoring visits did not show that these are always undertaken monthly and the provider is advised to address this. 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. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home 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. 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 using the service are thoroughly assessed prior to admission and have a range of useful information available to them to help make a decision about moving in. Evidence: We were advised in the Annual Quality Assurance Assessment that a statement of purpose and service users guide are in place and that all prospective users are assessed by the manager or another senior member of staff before they are admitted. The manager advised us in the Annual Quality Assurance Assessment that the home is moving in 2011. This is part of the providers reprovisioning plans in partnership with Buckinghamshire County Council. People using the service are being prepared for this and we were told that a consultation meeting held in March this year gave families and service users opportunity to discuss any issues about the move. A copy of the statement of purpose and service users guide were available in the entrance hall to look at. Both had been produced to a professional standard and gave Care Homes for Older People Page 11 of 31 Evidence: a good range of information to help people decide if the service is the right place for them. Both documents contained a service users charter, the aims and objectives and qualifications of staff. The service users guide provided photographs of the accommodation and outlined the admission procedure. It contained details on meals and mealtimes, visitors, arrangements for meeting needs such as health care, activities and spiritual needs and informed people how they can make telephone calls and access advocacy services. Other information was also provided to give people a good outline of what to expect. The pre-admission assessments of three service users were looked at. All three had been assessed by the manager and were signed and dated. Essential information such as peoples name, preferred name, doctor and next of kin details had been ascertained and an outline of their current circumstances described. A corporate assessment format was used to look at areas such as mobility, health care, mental health, continence and dietary requirements. Each of the files contained an assessment report undertaken by a care manager from the local authority and received before the service user had been admitted. Information in each file was detailed and showed that proper arrangements are in place to assess needs before people are admitted to Winterton House. Through looking at these records and other peoples files during the inspection, it was possible to see that the manager was admitting people within the permitted registration category, and in line with the services statement of purpose. Intermediate care is not provided at this service. People using the service said in surveys that they had received enough information about the service before deciding to move in. Care Homes for Older People Page 12 of 31 Health and personal care 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. 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. The health and personal care needs of people living at the service are generally well met, promoting health, well-being and taking into account their preferences and religious or cultural requirements. Some improvement is needed to medication practice to ensure people receive their medicines in a safe and consistent manner. Evidence: The Annual Quality Assurance Assessment informed us that care plans are in place for people using the service. The manager described good health care arrangements and said that records are kept of medical consultations and important information is fedback to peoples next of kin. We were advised that the service has made use of different health care professionals to improve peoples health and well being, such as a speech and language therapist, physiotherapists and a neuro-geriatrician. The information that was provided included that there are medication policies and procedures to refer to and that the manager and senior staff monitor medication administration at the end of each shift. Care plans were seen to be in place for each person. These contained a photograph of Care Homes for Older People Page 13 of 31 Evidence: the person and followed a corporate format and included needs relating to areas such as mobility, washing and bathing, getting up and going to bed, general physical health, physical illness, mental health needs, spiritual beliefs and social and leisure interests and needs. In each of the six files looked at, there was a date the care plan had been produced and staff signature. Night time care plans had also been put in place to promote continuity of care. Monthly review sheets showed that care plans were being reviewed regularly and updates made to sections of care plans as necessary. Dependency level assessments were also being undertaken regularly. The manager was advised to review storage arrangements for care plan files in one of the lounges as these were readily accessible to people and could compromise confidentiality. Senior staff were heard speaking on the telephone to relatives and a care manager from the local authority to update them on peoples conditions and alerting them to potential problems. Risk assessments were seen in each persons file covering moving and handling, likelihood of developing pressure damage (apart from one file brought to the managers attention), use of stairs, leaving the building, use of creams, access to disposable gloves and having a key to their room. A falls register was being maintained in the duty office. Staff had access to various health care related policies and procedures in the operations manual, such as on promoting continence and dementia care. Records were seen summarising visits to hospitals and from health care professionals and weights were being recorded on a regular basis. One persons records showed that she had lost 4.2 kg since March last year. It was not indicated in her health care notes or care plan review notes that she had been referred to her doctor or other relevant health care professional about the weight loss; there were records to show that her medication could be a contributing factor and the assistant manager advised that the service user had been taking food supplements. The manager was advised to make sure the weight loss has been referred on or to make arrangements for it be to referred to her doctor. District nurses and a physiotherapist were seen visiting the service during the course of the inspection. The manager has notified us of four medication errors since December 2008. The reports showed that appropriate action had been taken to reduce likelihood of further errors. The operations manual contained a medication policy for staff to refer to. Staff training records showed that they receive training on medication practice, where this is part of their role. Medication was looked at in one of the lounges. A secure medication trolley was being used to store medicines and kept locked when not in use. Medication administration records contained a photograph of each service user and Care Homes for Older People Page 14 of 31 Evidence: where one person was prescribed warfarin there was useful information available to staff, including foods that need to be avoided. Records showed that one person was managing some of her prescribed medicines. One persons day 28 medication had been taken out of the pack in advance with no record to explain why. The controlled drugs cabinet and register were looked at. All quantities of controlled medicines tallied with recorded balances in the register. It was observed that some unwanted controlled medication was signed out to a district nurse to dispose of. This is contrary to the services medication policy and good medication practice. Requirements made at the last key inspection in 2007 had been addressed. A requirement is made on this occasion to make sure that medication is administered, recorded and disposed of safely and in accordance with the organisational policy. People using the service who completed surveys said they usually receive the support they require, including medical support. A health care professional who returned a survey said that the services assessment arrangements sometimes ensured that accurate information is gathered and that social and health care needs were usually properly monitored, reviewed and met. The said the service usually sought advice to meet peoples needs and improve well being. They described peoples privacy and dignity as usually being respected and considered that staff usually had the right skills and experience to meet care needs, including those arising from equality and diversity. The person said the service could improve its management of catheter care but added care of a few palliative care patients has been excellent. Staff have delivered excellent two hourly care and been compassionate to relatives and liaised with nursing staff. Care Homes for Older People Page 15 of 31 Daily life and social activities 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. 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. Activities are available to people using the service to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences and religious or cultural requirements. Evidence: We were informed in the Annual Quality Assurance Assessment that a relief activity co-ordinator has been recruited and that a structured programme of activities has been put in place. A second hairdresser had been recruited to meet peoples needs. The manager indicated that nutritional screening is carried out for everyone admitted to the service and this is repeated where people are at risk of malnutrition. Flexible meal times were described with menus reflecting a healthy and balanced diet. We were told that visitors are welcome to the service and no restrictions are placed upon visitors, unless at residents request. We were advised that residents and consultation meetings take place. An Age Concern advocate chairs the residents meetings with a representative for the user group. The activity co-ordinator was not on duty at the time of this visit. A record of activities Care Homes for Older People Page 16 of 31 Evidence: from one of the lounges was looked at. It showed that service users had been involved with activities such as making hats, painting, playing dominoes, taking part in a reminiscence group, playing card games and bingo, using arts and crafts, bowling and playing darts. There was also a gardening club and cognitive therapy group plus visiting entertainers such as an American Stars and Stripes show. Posters around the building showed that a trip was booked to Eastbourne for September and a 50s and 60s singer was also booked to come out. A programme of activities on a service users notice board showed that there are also gentle exercises and a cookery club. Posters reminded people there was a shopping trolley once a week, monthly reflexology, a Saturday bar night and a clothes shop visiting in August. Several people were seen reading daily newspapers which they have delivered and some had books to keep them occupied. A couple of service users who were asked said there are books they can borrow to read and some book cases were seen close to lounges with a variety of novels. People spoken with said there was a range of activities they can take part in if they wish. One person said she liked watching television as her main pastime and was using a quiet corner of a dining room, at her choice, to watch programmes she was interested in. A hairdresser was visiting the service during the inspection. Staff confirmed that there are two hairdressers who visit each week. Posters around the building reminded people that an Age Concern volunteer visits regularly to help chair residents meetings. There were some reminiscence items around the building such as a dressed mannequin and books on royalty and the war years. Two rabbits were in residence, plus goldfish and a cat. People were seen visiting service users. There are quiet areas of the building they can make use of and a drinks machine to use. People spoken with said their relatives can come when they wish although they are asked to avoid mealtimes. There was a mobile pay phone which people can use. Each lounge had its own dining area. Tables were attractively set for breakfast and lunch, using table cloths and napkins. Each table had the menu of the day for people to refer to. Service users said there are additional choices if they are not keen on the two options for lunch and tea time; this was seen in practice. Service users were enjoying a range of breakfast foods such as cooked breakfast, cereals and toast. Lunch was chicken fried rice with mashed potato, broccoli, carrots and gravy, or an egg salad. One person was enjoying soup and bread as an alternative to these choices. There was chocolate sponge and custard for pudding. Bowls of fruit were readily available to people in their lounges. Drinks and biscuits were seen being Care Homes for Older People Page 17 of 31 Evidence: offered to people in between meals. A four week menu showed that there are various meals prepared for service users. Staff and service users said the food was good and that there were different things they can try such as curries and lasagne. Nutritional screening assessments were in place in each of the care plan files looked at. People using the service said in surveys that there are activities arranged which they can take part in and they enjoyed the meals provided for them. A member of staff said in a survey the home has plenty of activities for the residents. Care Homes for Older People Page 18 of 31 Complaints and protection 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. 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: The Annual Quality Assurance Assessment showed that there had been four complaints at the service in the past year, all resolved within 28 days. None of the complaints was said to be upheld. The manager said there had not been any use of restraint. One safeguarding referral was indicated. We were informed that there are complaints and safeguarding procedures at the service and the assistant manager arranges for regular in house staff training on safeguarding. The operations manual in the duty office contained the complaints procedure. A complaints and compliments log was being maintained. There were five complaints going back to April 2008, four in relation to clothing/laundry and one on loss of hot water supply. Records showed that these had been handled appropriately and promptly. Service users who were spoken with said they are listened to if they mention any concerns and that action is taken to improve things. There was a procedure for safeguarding vulnerable adults. The manager had made an appropriate referral to Social Services for one service users circumstances and this had been resolved satisfactorily. Staff receive input on safeguarding as part of their induction programme. Some safeguarding training needed to be refreshed according Care Homes for Older People Page 19 of 31 Evidence: to training records. People were not fully being protected by the services recruitment procedures, detailed under the staffing section of the report, and action is needed to improve this. People who returned surveys said they knew to make a complaint if necessary. Care Homes for Older People Page 20 of 31 Environment 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. 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 building is clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. Adaptations have been provided to assist people with daily living tasks. Evidence: We were advised in the Annual Quality Assurance Assessment that the service is kept tidy, safe and comfortable and that people using the service are encouraged to personalise their rooms. The manager said he facilitates training on infection control to reduce the risk of infection within the service. New furniture, laundry equipment and television aerials had been bought to improve facilities. Winterton House is a short walk from Wendover village and close to shops, pubs and village facilities. There is a church and public transport links nearby. The building is a manor house style set in extensive grounds with a more modern extension. There is some parking although this can be tight at busy periods. The need to provide accommodation which meets modern standards has already been identified by the provider and they have been working with Buckinghamshire County Council to reprovide all of their services for older (and other) people in new, purpose built accommodation. They expect to move to new accommodation some time in 2011. Accommodation for service users is on three floors, one a lower ground level. There Care Homes for Older People Page 21 of 31 Evidence: are four lounge groups; two have their own dining and kitchen area and two smaller ones share facilities between them. Each lounge has been arranged to feel comfortable and look homely. Additional seating areas have been created where there is space outside some of the lounges, in a corridor section and by the entrance hall, which people were seen making use of for conversations. The majority of bedrooms are single occupancy. Two double rooms have been provided. One room has en suite facilities. Bedrooms that were seen were personalised and people spoken with said they were comfortable and they had the things they needed. There are communal bathrooms and toilets close to bedroom and lounge areas and these have been fitted with adaptations to assist people. There is a passenger lift between floors. Dining chairs have gliders to enable people to get up more easily. Armchairs that were tried were comfortable to sit in. The kitchen and laundry were being kept in good order. Cleaning products were locked away to prevent accidental ingestion. The building was being kept clean and toilets stocked with essential supplies. Locks were provided to ensure privacy. The staff training records that were looked at did not show that they had attended any courses on infection control; action is set under the staffing section to improve this. Requirements made at the previous key inspection regarding odour and damp had been addressed. People who completed surveys said that the premises are kept fresh and clean. Care Homes for Older People Page 22 of 31 Staffing 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. 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 service provides staff cover to meet needs. More robust recruitment practice is needed to safeguard people from the risk of abuse. Staff training needs updating to ensure staff have the right skills and competencies to support the people who live at the service. Evidence: We were told in the Annual Quality Assurance Assessment that half of the permanent care team had achieved National Vocational Qualification at level 2 or above. Six staff had left in the last year and some shifts had been covered by temporary or agency workers. The manager advised that all staff are recruited using robust procedures. We were told that the service is staffed effectively and all staff receive an annual development review/appraisal. The manager said one of the things that could be done better was to continue to ensure that all staff have undertaken mandatory training. A rota was being maintained at the service. It showed some use of agency workers to cover gaps, using the providers own agency as well as an external one. The manager was unable to produce individual proformas of external agency workers training and verification of thorough recruitment checks. Recruitment files of five new staff were looked at. Two files had evidence of the full range of checks in place. One file for a member of catering staff did not have Care Homes for Older People Page 23 of 31 Evidence: confirmation that a Criminal Records Bureau check had been returned; confirmation was sought from the human resources department who confirmed by email that a check had now been returned and was satisfactory. One file contained a peer reference and one addressed to whom it may concern; there was no reference from the persons previous employer to comment on recent work related performance. The fifth file was for a member of staff from overseas. There was no proof that the person was entitled to be or work in the country, the references that had been obtained were difficult to tie in with work history and as they had not been addressed to any companies (and the addresses did not readily correspond with information on the application form) there was doubt that they may be from recent places of employment. There was also no Criminal Records Bureau or POVAfirst check on the file. Confirmation of Criminal Records Bureau clearance was sought during the inspection and an email from the human resources department said a disclosure had been returned but as there had been a spelling mistake in the surname on the returned disclosure certificate, it needed to be re-done. Issues with recruitment were highlighted to the manager and external line manager as a significant weakness in practice. A requirement is made to ensure that all required recruitment checks are undertaken and received back before staff start working with service users, this includes seeking and obtaining verification from agencies who supply staff to the service. Staff names and photographs were displayed outside of lounges and there was a Fremantle Trust family tree of head quarters staff and their photographs on a notice board. Recipients of the employee of the month awards, voted for by relatives and service users, were also displayed. People who were spoken with said that staff treated them well and that they were around when they needed assistance. Service users said that they usually have the same staff working with them in their lounges. One person said the building may be old but that was not what mattered, it was quality of care that was important and she was happy with the support she receives. Induction of new staff follows the Skills for Care standards. A newer member of staff confirmed that she had undertaken a structured induction and had shadowed experienced staff to begin with. She said she was really enjoying her work and that it was a pleasure to come into work. Training files for nine staff were looked at. A requirement had been made at the previous key inspection to review the core training for all staff and take steps to address identified shortfalls, where plans were not already in place to do so. Some gaps to mandatory courses were still evident, such as fire safety training (although Care Homes for Older People Page 24 of 31 Evidence: booked to take place shortly) and safeguarding. The manager had an up to date certificate to train staff in infection control but there was no evidence from files looked at that they had received this training. Moving and handling training was taking place during the morning to update some of the staff team although it did not include one person whose records showed she last attended training in 2006. Most files showed that staff had received input on dementia awareness, and this is now included in the six day induction for new staff. A requirement is made to address gaps in training, to make sure staff are up to date with the knowledge and skills they require in supporting people at the service. Development reviews/appraisal and supervision notes (neither read) were seen to be in place in most of the staff files examined. People using the service said in surveys that staff are usually available when they need them and that they listen and act on what they say. Staff said in surveys that they are given up to date information about peoples needs and their induction had covered the areas they needed to know about very well. All who replied said they receive training which is relevant to their role, helps them to understand and meet individual needs and keeps them up to date with new ways of working. They all considered their training equipped them with enough knowledge about health care and medication. They said they receive regular support with their manager to meet and discuss how they are working and considered the ways in which information is shared worked well. They said there are usually enough staff to meet peoples individual needs and that they had enough support, experience and knowledge to meet different needs such as those arising from equality and diversity. Additional comments from staff included the manager has regular staff meetings and lets staff know about training, the home caters for all the needs of residents very well and listens to all their opinions and requests, Winterton House is an excellent home and the majority of residents are very happy here. Relatives and visitors often comment on the lovely atmosphere when they visit, the manager and deputy manager are brilliant and do all they can to help staff as well as to ensure that service users have all the support they need, the staff at Winterton House really made me feel welcome and helped me to settle in when I started working here and we have a good staff team and a good manager and head office. We are encouraged to do a lot of training to help us give our residents the best possible care that we are able to give. Care Homes for Older People Page 25 of 31 Management and administration 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. 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. The management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. Evidence: The manager said in the Annual Quality Assurance Assessment that he had nearly completed National Vocational Qualification level 4. Other information showed us that there is monitoring of the quality of care by the provider and annual quality auditing. Systems were described for managing peoples money effectively. Policies and procedures were indicated as being in place to provide staff with guidance. Statistical information showed that electrical hard wiring, gas appliances, fire equipment, hoists and portable electrical appliances were being serviced routinely. It also showed that written assessments are in place for hazardous substances and that there is an action plan to deliver best practice in prevention and control of infection. The manager is registered with us and has worked at the service since 2007. He has Care Homes for Older People Page 26 of 31 Evidence: obtained the Registered Managers Award and was waiting for verification of his National Vocational Qualification level 4 in care. Training records showed that he undertakes courses to keep his skills fresh; he was reminded that his safeguarding training needs to be updated. The certificate of registration was being displayed and the details on it were accurate. There were reports of monitoring visits undertaken by the provider although there were some gaps; eight visits were reported on for a period of fifteen months. The provider is reminded to make sure the visits take place at least monthly and for a report of the visits to be made available at the service. A quality audit had been undertaken in October 2008 which reflected good outcomes for people using the service. There was evidence that the views of relatives, service users and other interested parties had been sought and these were incorporated into the findings. A couple of people had commented that food needed to be improved at that time and feedback and observation on this occasion showed that this had been addressed. Peoples money was being managed using a residents savings scheme. The administrator, manager and assistant manager have access to the computerised records. It was not possible to look at these records as work was taking place on the computer system at head quarters. Manual records showed that receipts and invoices are kept to verify expenditure. The administrator had financial policies and procedures to refer to and said that finance staff at head quarters are always available if there are any queries. There were well written policies and procedures available to all staff in the duty office. Emergency procedures were contained in a separate file for easy access in the event of any untoward circumstances, such as a missing person. Health and safety was being well managed. Certificates were looked at to verify gas and electrical safety, maintenance of hoists and the lift. The manager forwarded us a copy of the fire risk assessment, as required at the last key inspection. Systems were in place for safe disposal of clinical waste and sharps, soiled laundry was being kept separate, staff had disposable protective items to use when carrying out personal care and house keeping staff made use of yellow hazard notices where floors had been cleaned. Anti bacterial gel was available to cleanse hands. Individual risk assessments were in place on care plan files. The manager was advised to make sure the use of a stair gate was covered by a risk assessment. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 The manager must review 10/11/2007 the core training for all staff and take steps to address identified shortfalls, where plans are not already in place to do so. Care Homes for Older People Page 28 of 31 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, Care Homes 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 Medication is to be administered, recorded and disposed of in accordance with the organisations policy. This is to ensure that people receive their medicines in a safe and consistent manner. 30/09/2009 2 29 19 All required recruitment 30/09/2009 checks are to be undertaken and received back before staff start working with service users, this includes seeking and obtaining verification from agencies who supply staff to the service. This is to ensure that people using the service are protected from the risk of harm. 3 30 18 Mandatory training needs to 01/12/2009 be brought up to date and infection control training undertaken to address gaps. Page 29 of 31 Care Homes for Older People 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. No. Standard Regulation Requirement Timescale for action This is to make sure staff are up to date with the knowledge and skills they require in supporting people at the service. 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 Care Homes for Older People Page 30 of 31 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). 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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