Care Home: Wishmoor

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What the care home does well The atmosphere of the home is friendly, warm and welcoming. People using the service appear relaxed and were seen interacting well with all the staff. Choices of meals are offered and food is well presented. The home can cater for special diets, including individual preferences, dietary and cultural needs, which means people should receive food that they like. Accommodation for people is on two floors and a passenger lift assists people with mobility problems to access all areas of the home. People are encouraged to personalise their rooms with items of their own so that they live in an environment which is familiar to them.WishmoorDS0000065693.V376856.R01.S.docVersion 5.2There is a committed staff team some of whom have worked at the home for many years so people have people they know looking after them. Comments from people using the service included: `it is very good` `help the residents who need help and listen to them.` `always friendly and helpful` What has improved since the last inspection? Since the last key inspection the home has made progress with refurbishing the home. The extension work has been completed providing six en suite bedrooms which provide a good standard of accommodation. There is an ongoing maintenance programme in respect of decorating and purchasing new furniture and equipment to bring the remainder of the home to the same level of accommodation. Some floor coverings have been replaced which has improved the appearance of these areas. What the care home could do better: Further develop the environment to assist people with cognitive or sensory impairment, such as appropriate signage, colour schemes and fabrics. Staffing arrangements need to be reviewed to ensure that staff are always deployed effectively and in sufficient numbers so that people in the Home have the individual care and attention they need. Provide a more structured program for activities so that people have a choice and can go out when they wish to. Develop a garden area with suitable garden furniture for the residents to use when the weather permits. Key inspection report CARE HOMES FOR OLDER PEOPLE Wishmoor 21 Avenue Road Malvern Worcestershire WR14 3AY Lead Inspector Chris Potter Key Unannounced Inspection 29th July 2009 11:00 DS0000065693.V376856.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wishmoor Address 21 Avenue Road Malvern Worcestershire WR14 3AY 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) 01684 569162 Wishmoor Limited Mrs Anne Mary Montgomery Care Home 25 Category(ies) of Dementia (12), Old age, not falling within any registration, with number other category (25), Physical disability (25) of places Wishmoor DS0000065693.V376856.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 Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical Disability (PD) 25 Old age not falling within any other category (OP) Dementia (DE) 12 The maximum number of service users to be accommodated is 25 2. Date of last inspection 1st August 2007 Brief Description of the Service: Wishmoor residential Home is a traditional detached Victorian Building located in a residential area of Malvern that has been developed to accommodate 25 elderly people . The home is registered to provide accommodation, and personal care for a maximum of 25 people of either sex over the age of sixty-five years. The registration allows the home to accommodate up to twelve people out of the 25 with a dementia type illness. The home provides accommodation in single and two shared bedrooms some of which have en-suite facilities. People are accommodated on two floors with a passenger lift providing access to first floor rooms assisting people with mobility problems to access all areas of the home. Other areas of the home used by people include lounges, dining room, toilets and bathrooms. Handrails are appropriately fitted to assist people to walk around the home. Ramps are fitted to assist people in wheelchairs to go outside of the home. The home is looking to develop the garden areas. The registered manager for the home is Mrs Anne Montgomery who has been at the home for many years and has twenty years experience working in residential care homes for the elderly. Anne has completed the Registered Managers Award. The home is owned by Wishmoor Limited and the provider spends at least one day per week at the home. A range of activities are provided for the people living at the home and to assist people to maintain links with the local community. Information regarding the home can be obtained from the Statement of Purpose and Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 5 Service Users Guide, which are available from the home. Information about the fees are not included in the Service User Guide, for up to date information about the fees please contact the home direct as the fees are based on individual needs and assessments. Additional charges are made for hairdressing, daily newspapers and chiropody. Wishmoor DS0000065693.V376856.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 2 star. That means the people who use the service experience good outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is upon outcomes for the people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. We visited the service during the day on the 29th July 2009 the last Key inspection was the 1st August 2007 and this rated the home as good. We did an annual service review in September 2008. During this inspection we spent time observing daily life, and we met with people and relatives who use the service. We spoke to the manager, and many staff who were present on the day of the inspection. We looked at care files and records completed by the service which must be kept by the home to show that it is being run properly. Before we visited the service we looked at the information we had about the service since the last inspection. This included an annual service review, surveys sent to us by people using the service and the Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment is completed by the manager and informs us how well the home think they are performing and provides us some information about the home, staff and people who live there, improvements and plans for improvement which we would take into consideration. What the service does well: The atmosphere of the home is friendly, warm and welcoming. People using the service appear relaxed and were seen interacting well with all the staff. Choices of meals are offered and food is well presented. The home can cater for special diets, including individual preferences, dietary and cultural needs, which means people should receive food that they like. Accommodation for people is on two floors and a passenger lift assists people with mobility problems to access all areas of the home. People are encouraged to personalise their rooms with items of their own so that they live in an environment which is familiar to them. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 7 There is a committed staff team some of whom have worked at the home for many years so people have people they know looking after them. Comments from people using the service included: it is very good help the residents who need help and listen to them. always friendly and helpful What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 the home does not have an intermediate unit so standard 6 is not applicable. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is sufficient information available for people to decide whether Wishmoor Residential Home is right for them. There are opportunities for people to visit the home before making up their minds. The home carries out assessments of peoples needs before they move in, so that staff can provide the care that is needed. EVIDENCE: The certificate of registration was clearly displayed in the entrance area of the home along with the insurance certificates. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 10 A coloured brochure containing photographs of the home is available in the entrance area of the home with copies of the service user guide. We were told by people using the service and relatives that they had been provided with copies of the information to take away and look at. Feedback from surveys and people using the service confirmed that they had been provided with sufficient information to assist them with their choice. It was recommended that the service user guide is produced in alternate formats to assist people with sensory impairments to understand the information more easily. We looked at the pre admission assessments for three people who had live in the home. The assessments provided sufficient information for the service to decide whether they would be able to meet the persons needs if they chose to move into the home. People using the service and relatives confirmed that the manager had visited and assessed their relative prior to them being admitted to the home. Comments and feedback about the home included: family caring atmosphere very good staff cheerful there is a welcoming atmosphere The Annual Quality Assurance Assessment returned to us from the home accurately reflected how the service was meeting these standards. It provided basis details of the homes improvements in the last 12 months which included: They have improved by insisting on the care management information for emergency admissions is available prior to the person being admitted to Wishmoor. Homes for improvement in the next 12 months include continuing to do a complete and detailed assessment of all new residents. Continue supporting and enabling the staff with their training needs. This will benefit not only the care staff but the residents as well. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: We looked at the experiences of three people using the service in detail. This included looking at their care files, meeting them, and speaking to relatives where possible. The individual care files contain a range of information relating to the health and care needs of people using the service. The manager researches information on individuals medical conditions so the care staff have some information to assist them in looking after the person. The care plan format detailed the actions and interventions needed to meet the continuing needs of each person. The care plans clearly represented information gained through the homes assessment process. The staff review and update the risk assessments monthly whilst appreciating that people care needs do not change Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 12 significantly it was recommended that the care plans are reviewed and updated more frequently to ensure that they include any changing needs and circumstances. Care staff told us that they find the care plans really useful in assisting them to meet the needs of individuals, and helps them get to know the persons history so that they can have meaningful conversations with the individual about things that interest them. Comments received from people using the service included: always friendly and helpful it is very good and ‘all staff are caring and helpful’. Risk assessments are completed for individuals to cover a range of health and care needs. The assessments are used by the staff to promote the safety and welfare of the individual. People are registered with a range of local community health services that are appropriate to their needs. Systems are in place to ensure that all health appointments and arrangements are monitored and completed. Liaison between the home staff and visiting health and social care professionals is good. The home is able to access a range of advice and guidance that may be needed about matters relating to individuals health and well-being. Wishmoor residential home has appropriate policies and procedures in place for the receipt, administration and disposal of medication. We looked at how the home managed peoples medication and we checked the medication for three people. The majority of medication records seen were well documented either with a signature for administration or a code to explain why the medication was not administered. The home was commended on having a protocol for medication in place for medication prescribed for as required It was recommended that for all handwritten entries on the medication administration record that two staff countersign to minimise the risk of mistakes being made. People seen were appropriately dressed for the temperature of the home, and in keeping with their gender and personal preferences. We observed staff respecting peoples privacy and dignity - for example, knocking on doors before entering private rooms, and speaking to them courteously. We were told by people using the service and relatives that all staff were respectful and courteous when addressing them. We observed good interaction between staff, people using the service and relatives, we were told by a relative: ‘the staff are all wonderful from the manager to the domestic you can’t fault them’ The Annual Quality Assurance Assessment received form the home for this inspection stated: that they improved in the last 12 months by introducing procedures for all aspects of personal care. The carers are working with the residents to encourage them to be more independent which in the long term gives the clients the feeling of achieving things for themselves. The staff have had more training to enable them to have the qualifications and the knowledge to make them more aware of the clients in the home. The homes plans for improvement in the next 12 months include: To introduce the key worker system, giving the senior members of staff the opportunity to further their knowledge with assessing new clients for their needs. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 People using the 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 home provides a limited range of activities which are not suitable for all the peoples needs. People are able to keep in touch with family, friends and representatives. They have nutritious and attractive meals and snacks, at a time and place to suit them. EVIDENCE: We were told by people living at the home, relatives and staff that the quality and choice of food they rated between adequate and good. Since the last key inspection in 2007 the home has decorated their dining room and the manager is in the process of choosing suitable nostalgic pictures for the walls. We were told that the kitchen is covered by one dedicated person seven days to cover the lunch and prepare the teas. The carers assist with breakfasts and teas for the residents. During the inspection we spoke to the cook who confirmed that they have sufficient supplies of fresh food daily which enables them to prepare the planned meal from the menu. The care plans include information about the individuals dietary likes and dislikes and the cook and carers are aware of this when serving the meals. The cook told us that Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 14 the residents always have a cooked lunch and pudding and with their afternoon tea they serve homemade cakes. Tea times are usually a lighter option and include soup, cheese on toast, sandwiches, jacket potatoes, with the desert. We were told that diabetics have the same meal without the sugar added. The cook told us she has worked at the home for about a year and was initially appointed as a cleaner and from this knows the people living in the home really well. Residents are given a menu choice the day before but for some people with short term memory loss they have forgotten what they ordered by the time the meal is served. The cook confirmed that the home are completing and maintaining records of the required health and safety. The last inspection from the environmental health rated them as a three. Comments received about the food included: The residents can have drinks whenever they wish we have a water cooler so people who are able can help themselves to cold drinks at any time. The food is all right some people have to have their meal liquidised and we assist people with their meal. the food at the weekends is generally better than in the week however the overall quality of food is above adequate at all times. The home does not employ dedicated staff responsible for social activities. We were told that the carers include activities for the residents as part of their daily responsibilities. The carers told us that this was limited given the number of staff on duty and restricts people who may wish to go out. Activities include outside entertainers who sing, play musical instruments, exercises, quizzes and ball games. Staff read daily newspapers to some people. They have just started doll and textile therapy in one of the lounges. The owners have provided them with a game console to trial with a view of purchasing one if it is well used. It is recommended that the home provides a more structured program for activities to ensure that all individuals choices are included especially people suffering with dementia. We were told that the home keep a folder providing information about activities to assist people with their choice of what they might like to do. Comments received about the activities included: Would like to see more garden furniture for people to use when the weather permits. We saw visitors coming and going throughout the day and we were told that the home make them welcome at whatever time they visit. The Annual Quality Assurance Assessment received from the home told us their plans for improvement over the next 12 months to include the residents in preparation of meals with a risk assessment in place. The Annual Quality Assurance Assessment told us that their plans for improvement in the next 12 months Having the outside area of the home completed with flower beds, researching other avenues that may interest the residents giving them more choice of outside interests. Day trips to places of interest to individual residents. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to the home’s complaints procedure, and are confident that their views will be listened to and acted upon. EVIDENCE: People who use the service told us that they were confident that they could approach the manager with any concerns and that these would be dealt with. One person told us I am aware of how to make a complaint, I would talk to Anne she is very understanding The manager told us she has an open door policy, and throughout the day we saw people who use the service, their relatives and staff approaching her. She dealt with everyone in a kind and cheerful manner. The Service User Guide clearly explains how to make a complaint, and copies of these were available in the reception area of the home. Since the last Key inspection in 2007 and the Annual Service Review in 2008 the home has received no complaints. We were told by staff that they had received “safeguarding” training and were aware of the home’s whistle blowing policy. Staff also confirmed that they would have no hesitation in reporting any concerns to the manager. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 16 The manager confirmed that they had attended a training course on the Deprivation of Liberty training and was aware of the homes responsibilities in ensuring people are protected. The Annual Quality Assurance Assessment received from Wishmoor told us of their plans for improvement which included putting a suggestion box in an area accessible for the residents and visitors, so that they dont have to speak to a member of staff. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20,23,24 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With the extension completed and the attractive appearance of these rooms it is the intention of the home to provide that level of accommodation for all people living in the home. EVIDENCE: Wishmoor is a traditional Victorian building which the current owners are in the process of developing to provide a safe homely environment for the people who live there. They have invested large amounts of money to update the accommodation and provide a home suitable for the peoples needs. The bedrooms have been personalised by the people living there with their own personal possessions, including photographs and ornaments. The manager told us that the ongoing refurbishment causes minimal disruption for the people living at the home. Comments from people were positive about the changes and people in the new bedrooms were pleased with the standard of accommodation. It was Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 18 recommended that the service review wardrobes and risk assess the need to secure them to a wall to reduce the risk of accidents occurring. Generally all areas used by people living in the home were clean and tidy; we observed that areas not used by residents were not cleaned to a good standard. We were told that the home employs one cleaner and there was not enough time to clean all areas of the home. The service is currently not providing a cleaner for the seven days, and the cleaner prioritises on the hallways, bathrooms, toilets, and floors. We were told that the carers are asked to do some cleaning duties when the cleaner is not working. We were told that carers work additional hours to their contracted hours so that the care hours are not compromised. It is recommended that the service review the cleaning hours for the service to ensure that there is sufficient time to maintain the cleanliness of the home for the people living there. We were informed that the uncovered radiators in the hall were no longer in use and would be removed as part of the homes refurbishment. The completed Annual Quality Assurance Assessment received from the home told us how the home has improved in the last 12 months including: • • Completing the extension providing six bedrooms with en-suite facilities. They have made internal changes to some of the toilets to provide shower rooms which allow residents a preference in bathing. Another two toilets have been incorporated into a large bathroom enabling the residents to have more space when bathing. The flooring in the ground floor hallway has been replaced and the new conservatory has been decorated and is now in use. The dining room has new flooring fitted and has been decorated. The manager is looking for suitable pictures for the walls to assist people with short term memory loss. • • The Annual Quality Assurance Assessment also told us of the homes intentions to bring the rest of the home to the same standards as the refurbished areas. In considering improvements to the other areas of the house, the service should consider current good practice in setting up an environment suitable for those with short term memory loss or sensory impairment, such as appropriate signage, colour schemes and fabrics. Throughout the day of the inspection, it was apparent that people who live at the home regard it as their home, and the informal and friendly atmosphere adds to the sense of homeliness. Just prior to the inspection the hedges had been cut down which provides a better outlook and view for people living in the home. The service is planning to invest in the garden and a comment was received that they would like some garden furniture for people to use when the weather permits. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 19 People were suitably dressed for the temperature of the home, we were told that the only issue with the laundry provision was that clothes tend to take a long time to return to people. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that staff are kind and caring. Staff receive sufficient training to ensure that they are equipped to meet needs of people using the service. Failure to employ sufficient staff at certain times may result in the needs of the residents who use the service not being met. EVIDENCE: We talked to members of staff they told us that they enjoyed working at Wishmoor and that all staff were friendly and supportive. Staff demonstrated a good knowledge and understanding of the peoples care needs, and informed us that they referred to the care plans to assist them in understanding residents more. All the staff are friendly and helpful The manager showed us the training matrix has been completed to assist in ensuring that staff receive appropriate training and refresher courses. The staff told us that they receive regular training updates including moving and handling, adult abuse, fire, and infection control. People using the service told us that the staff were appropriately trained to meet their care needs. The service have exceeded the standard for having more staff with NVQ level two or three qualification in care We checked the recruitment records for three staff and found that the required procedures had been followed to check the suitability of the people involved to work in a care setting. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 21 This helps to ensure that people who are unsuitable to work with older people are not able to gain employment in the Home. In the surveys we received from people who live in the Home only one person said staff were always available when needed, the rest said they are usually available. During the inspection there were parts of the day when people did not have much contact with staff. In the afternoons the staffing levels are currently two, and this is the time dedicated to activities for people living in the home. However with only two staff on duty in the afternoons this could prevent staff giving the people the necessary time and support. As the carers duties in the afternoons includes assisting with catering, domestic and laundry work which with the current staffing levels could place people at risk if an emergency situation occurred. We were also told that people could not go out of the home in the afternoons which restricts peoples choice. The Annual Quality Assurance Assessment (AQAA) received from the home told us under the section ‘what we could do better’ that they should encourage involvement from the residents or their families in the recruitment process. The AQAA also told us that they intend to request feedback from the residents about new members of staff who have been recruited. In the section ‘how we have improved in the last 12 months’ included enabling the staff to partake in core training to enhance their knowledge of the needs of the residents. All staff have had training in dementia care, and are doing a course in challenging behaviour. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32,33,35,36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have confidence in the management and organisation of the care home. EVIDENCE: The manager is Anne Montgomery who has been in post as the manager for the past year. Anne has many years experience working with elderly people, she has completed the Registered Managers Award and is in the process of registering to do NVQ level 4 qualification in care. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 23 Staff and relatives complimented the manager on her management skills and how approachable and supportive she was. One person told us: the manager is excellent the manager is wonderful and so very kind and she listens to what we say. The maintenance person works two days at the home and is responsible for ensuring health and safety checks are completed. The maintenance records we sampled showed that regular servicing and repairs are arranged so that essential equipment is kept in good working order. We looked at the fire records and these showed that the regular checks were being completed, so that in the event of a fire people are protected by living in a home where smoke detection systems and evacuation procedures are regularly reviewed and tested Staff keep a written record for all accidental occurrences that occur within the home. It was recommended that the service complete a monthly audit of all accidents that have occurred in the home to see whether there are any patterns developing. There is a regular supervision program in place for all the staff, and a record is maintained in the staffs personal file. Staff confirmed that they have regular supervision which they find helpful, and confirmed that the manager is always approachable and supportive. The home has no involvement with peoples personal finances. The responsibility for this remains with the relatives or advocates of people using the service. Wishmoor have a quality audit in place for the residents the results from these were shared with us it was recommended that this is further developed to include feedback from other professionals using the service. The home has residents and staff meetings the minutes from these were shared with us at the inspection. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X 2 3 x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 25 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 OP27 Regulation 18 Requirement Staffing arrangements need to be reviewed to ensure that the skill mix is correct, and staff are always deployed effectively and in sufficient numbers so that people in the Home have the individual care and attention they need. Timescale for action 31/08/09 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 OP19 Good Practice Recommendations To ensure that the care plans provide accurate information about the individuals needs it is recommended that they are reviewed more frequently and dated when the review is next due. Further develop the environment to assist people with cognitive or sensory impairment, such as appropriate signage, colour schemes and fabrics. As part of the development ensures that risk assessments for individuals bedroom furniture are completed given that wardrobes are not secured to walls. As part of the development review outside space for people to use when the weather permits. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 26 3 4. OP12 OP26 Further develop the activities for the home to provide more structure and choice particularly for people with short term memory loss. Review the cleaning hours for the home, to provide domestic cover for the seven days so that care staff hours are not being reduced which could result in the needs of people not being met. Wishmoor DS0000065693.V376856.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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