Care Home: Wisteria House

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What the care home does well Wisteria House is a small home and has a relaxed family atmosphere. People living at Wisteria House told us they were happy with the service provided and praised the staff employed. All areas of the home are extremely clean. The home is furnished and decorated in a homely and comfortable way. People have been able to personalize their own rooms with their own furniture and possessions. Staff turnover is low and this means that people are cared for by staff who are familiar to them and who understand their needs. What has improved since the last inspection? Since the last inspection, the manager has become registered with the Care Quality Commission. A staff training and development programme is ongoing, and staff had received the training they required to do their jobs. What the care home could do better: Care plans were not in place for all assessed needs, staff need clear instructions on what actions to take in the event of challenging behaviour in order to promote safety and keep people safe. Staff must also report any incidents of aggressive behaviour to social services as a safeguarding concern. Medication storage arrangements did not comply with all pharmaceutical regulations, these requirements must be adhered to in order to manage medication in a safe way. Key inspection report Care homes for older people Name: Address: Wisteria House 9 Ayston Road Uppingham Oakham Rutland LE15 9RL     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: Debbie Williams     Date: 0 9 0 3 2 0 1 0 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 21 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 21 Information about the care home Name of care home: Address: Wisteria House 9 Ayston Road Uppingham Oakham Rutland LE15 9RL 01572822313 01572823651 geoffkirk@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Kirk,Mr Geoffrey Kirk care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: No rooms at Wisteria House Care Home should be used for double occupancy other than those stated The registered provider may accommodate a maximum of 12 service users at Wisteria House Care Home when single persons occupy rooms The registered provider may accommodate a maximum of 13 service users in Wisteria House Care Home when a married couple occupies the double room To be able to admit the named person in category DE(E) subject of variation application V19363 dated 05/07/2005. Date of last inspection Brief description of the care home Wisteria House is a small family-run home, registered to accommodate up to thirteen older people. The home is situated in the market town of Uppingham, close to shops and other local amenities. It is a detached house built in 1880 and retains many original features. The home has twelve bedrooms, the majority of which are spacious. Care Homes for Older People Page 4 of 21 Over 65 13 0 Brief description of the care home Nine are over twenty square metres in size. The upper floors can be accessed by stairs or a passenger lift. There is a large open plan lounge dining room, which overlooks a private patio garden. All areas of the home are accessible to people using walking aids. There is a car parking area to the side of the building. Information about Wisteria House is available for people who are considering moving to the home. A copy of the last inspection report was available at the home. Care Homes for Older People Page 5 of 21 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 key inspection took place on the 9th of March 2010. The main method of inspection used was case tracking which meant selecting three residents and tracking the quality of their care by checking records, discussion with them and with staff and observation of care practices. We spoke with five residents who live at Wisteria House, two relatives and two staff members. We also used information sent to us in the providers annual quality assurance assessment. This document tells us about any changes that have been made at the service since the last key inspection and any plans for improvement. Care Homes for Older People Page 6 of 21 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 21 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 8 of 21 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 are provided with the information they need to make an informed choice before moving in. People have their needs assessed before moving in and this ensures their needs can be met. Evidence: We spoke with one person who had recently moved in and they told us they had been provided with the information they required to make an informed decision before moving in. The providers have produced a service users guide and Statement of Purpose, these documents set out the facilities and services available and provide information about terms and conditions of residency and how to make a complaint. We looked at assessment records for the people we case tracked. People have their needs assessed before moving into Wisteria House, this ensures that the service can meet their needs. Care Homes for Older People Page 9 of 21 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. People living at Wisteria House have their health and personal care needs met. Medication storage arrangements did not adhere to the pharmaceutical requirements. Evidence: We case tracked three people living at Wisteria House, we looked at their care records and care plans. Each person has an individual plan of care, where possible people are consulted about and involved in the care planning process. Care plans and care records provided staff with details of peoples individual preferences and daily routines. Care plans were not in place for all assessed needs and we made a requirement about this. Care records included risk assessments such as the risk of developing pressure sores and moving and handling risk assessments. We looked at medication management procedures and storage. All staff responsible for the administration of medication had received training and had been assessed by the registered manager to ensure they were competent to do so. Medication records Care Homes for Older People Page 10 of 21 Evidence: seen were accurate and up to date. People told us that staff managed their medication efficiently. We made two requirements regarding the storage of medication which requires refrigeration and the storage of controlled medication. We observed interactions between staff and residents and found these to be positive and respectful. People spoken with praised the staff employed. People spoken with told us they had access to all necessary health care services and could see their GP whenever required. Community nurses visit the home and provide nursing care when this is required. Care Homes for Older People Page 11 of 21 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. Daily life and social activities met the needs and expectations of people living at Wisteria House. Evidence: We spoke with five people living at Wisteria House, people told us they were happy with the range of opportunities to participate in recreational and social activities and that they could choose how to spend their day. There were no restrictions on visiting and visitors spoken with said they made welcome when they visited their relatives. We observed the lunch time meal and this appeared appetizing and nutritious. People spoken with were satisfied with with the quality and range of meals provided. Staff had been trained in food hygiene and the cook had completed a course in nutrition. Care Homes for Older People Page 12 of 21 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. People living at Wisteria House were mostly protected by safeguarding policies and procedures. Evidence: People spoken with told us they could approach the registered manager with any compliant and she would listen and take appropriate action. The providers complaints procedure is included within the service users guide. All staff have competed training in safeguarding vulnerable adults, Staff spoken with were aware of the correct procedure to follow in the event of suspected abuse. However, we found that some incidents of physical aggression against staff had not been reported to social services as a safeguarding concern and we made a requirement regarding this. Care Homes for Older People Page 13 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Wisteria House provides a homely, comfortable and well maintained environment which is suitable for the needs of people living there. Evidence: We undertook a partial tour of the premises, this included communal areas and the private rooms of people we case tracked. All areas of the home seen were extremely clean. The home was furnished and decorated in a homely and comfortable manner. People spoken with praised the standard of cleanliness at the home and were happy with their rooms and communal areas. Routine maintenance work and equipment checks were carried out to ensure that fire alarms and fire fighting equipment were in good working order. All staff had received training in infection control, this minimizes the risk of cross infection for people living at Wisteria House. Care Homes for Older People Page 14 of 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by well trained competent staff. Evidence: We looked at staff rosters and spoke with residents about staffing levels at Wisteria House. People told us they were happy with the service they received. There is only one member of staff on duty at night with one person on call. The manager told us that staffing levels were sufficient to meet the needs of people living at Wisteria House. However, this was contradicted by the providers lone worker policy which stated that staff should not work alone. We made a recommendation that this policy be reviewed. We looked at staff training files and found that staff had received the training they required to do their jobs and meet peoples needs. Staff recruitment procedures promoted safety for people living at Wisteria house, all necessary checks were carried out and references obtained to ensure that staff were suitable to work at the home. All staff receive induction training when they first commence employment. Four staff had achieved a National Vocational Qualification in care and five staff were working towards this qualification. Care Homes for Older People Page 15 of 21 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. Wisteria house is managed in the best interests of people living there. Evidence: The manager has recently been approved as the registered manager with the Care Quality Commission and has achieved the Registered Managers Award which a National Vocational Qualification. Staff and residents spoken with said the manager was approachable and would listen to their concerns. The provider offers a facility to securely store small amounts of residents personal money. We looked at transaction records, two signatures are obtained for each transaction. This minimizes the risk of financial abuse. A system of quality assurance was in place and this included seeking the views of people living at the home and their relatives. We looked at nine quality assurance questionnaires, all were positive. Care Homes for Older People Page 16 of 21 Evidence: Staff had received all mandatory health and safety training such as moving and handling and food hygiene. This promotes safety for people living and working at Wisteria House. Records are maintained of all accidents that have occurred at the home. Care Homes for Older People Page 17 of 21 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 7 15. Care plans must be in place for all assessed needs. This is to ensure people have their needs met. Controlled drugs must be stored in a controlled drug cupboard which complies with the Misuse of Drugs Safe Custody Regulations (1973 and 2007 amendments) 30/11/2009 2 9 13. 30/11/2009 Care Homes for Older People Page 18 of 21 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 7 12 Care plans must address all assessed needs and provide clear instructions as to what action staff must take to meet peoples needs and keep people safe. In particular, staff must know how to respond to challenging behaviour in order to keep people safe. This is to ensure that people have their needs met and their safety promoted. 30/04/2010 2 9 13 Controlled drugs must be stored in a controlled drug cupboard which complies with the Misuse of Drugs Safe Custody Regulations (1973 and 2007 amendments) This requirement is outstanding from the last key inspection 30/04/2010 Care Homes for Older People Page 19 of 21 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 ensure the safe storage of controlled medication. 3 9 13 A separate and secure mediation fridge must be used for the storage of medicines that require refrigeration. This is to ensure the safe storage of medicines. 4 18 12 All incidents of suspected abuse including aggressive behaviour must be reported to the appropriate authority in line with safeguarding policies and procedures. This is to protect people from harm. 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 21/05/2010 14/04/2010 1 27 The providers lone worker policy should be reviewed and amended appropriately. Care Homes for Older People Page 20 of 21 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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