Care Home: Wisteria House

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What the care home does well Wisteria House provides a small homely atmosphere for the people who live there. People are able to make choices about their day to day lives and their opinions are sought and acted upon where appropriate. Everyone has access to an independent advocate. There is a complaints policy in place and people living at the home said that they would be comfortable to raise any worries or concerns with a member of staff. One person said “they always listen to you” another person said “you just tell the staff if something isn’t right and they put it right.” People felt that they were always treated with respect and dignity. People asked said that all the staff were polite and friendly. The home has good relationships with local healthcare professionals and everyone asked was happy with the support they received with physical healthcare difficulties.Wisteria HouseDS0000058877.V376281.R01.S.docVersion 5.2 What has improved since the last inspection? Since the last inspection the home has increased training opportunities for staff. An outside trainer facilitates training at the home on a monthly basis. Staff spoken with were happy with the level and quality of training they received. Annual appraisals highlight the training needs of each individual staff member. One person has undertaken a training course in nutrition and menus have been adjusted in line with good practice guidelines. A second activities worker has been employed giving people more opportunities for social stimulation. The staff are now more able to support people to continue with their chosen hobbies and interests. After an analysis of accidents in the home, additional staff have been made available between 7am and 9am. What the care home could do better: Many areas of the home require redecoration and refurbishment to improve accommodation for the people who live there. Some rooms, particularly bedrooms, would benefit from new furniture. The carpet in the lounge is in need of deep cleaning or replacement. Care plans give good information about the likes and dislikes of people but would benefit from further development to ensure they give clear guidelines for staff. Key inspection report CARE HOMES FOR OLDER PEOPLE Wisteria House Montacute Road Tintinhull Yeovil Somerset BA22 8QD Lead Inspector Jane Poole Unannounced Inspection 9th July 2009 09:45 DS0000058877.V376281.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. Wisteria House DS0000058877.V376281.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 Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wisteria House Address Montacute Road Tintinhull Yeovil Somerset BA22 8QD 01935 822086 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) wisteriahouse@tesco.net Mrs Siobhan Cecilia Wortley Mr Stephen John Wortley Mrs Siobhan Cecilia Wortley Mrs Maria Carolyn Goodland Care Home 13 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (13) of places Wisteria House DS0000058877.V376281.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 either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Dementia (Code DE) maximum of 5 persons The maximum number of service users who can be accommodated is 13. 26th July 2007 Date of last inspection Brief Description of the Service: Wisteria House is a two-storey Hamstone building situated in the centre of the village of Tintinhull, local amenities are nearby. The home has been registered as a service for older people since 1985. Wisteria House is registered to provide care and accommodation for thirteen people. Due to the physical environment, Wisteria House is best suited to meet the needs of those with low to medium dependency. All rooms are for single occupancy. Mr and Mrs Wortley, have been the registered providers since March 2004. Mrs Wortley also shares the registered manager post with Maria Goodland. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The overall quality rating for this home is 2 stars - Good. This inspection took place over a one day period by one inspector. During this time we, The Commission, were able to talk with people living and working at the home, observe care practices, tour the building and view records. We were given unrestricted access to all areas of the home and all records requested were made available. Before the inspection the provider completed an Annual Quality Assurance Assessment (AQAA) This was completed to a good standard and gave evidence of a commitment to ongoing improvement. At the time of this inspection there were 12 people living at the home. What the service does well: Wisteria House provides a small homely atmosphere for the people who live there. People are able to make choices about their day to day lives and their opinions are sought and acted upon where appropriate. Everyone has access to an independent advocate. There is a complaints policy in place and people living at the home said that they would be comfortable to raise any worries or concerns with a member of staff. One person said “they always listen to you” another person said “you just tell the staff if something isn’t right and they put it right.” People felt that they were always treated with respect and dignity. People asked said that all the staff were polite and friendly. The home has good relationships with local healthcare professionals and everyone asked was happy with the support they received with physical healthcare difficulties. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 6 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. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 7 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 Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 8 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): 1, 3, 4 & 5. 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. Anyone wishing to move into the home has their needs assessed and is able to visit, to make sure that it is the right place for them. Intermediate care is not provided. EVIDENCE: Anyone wishing to move into Wisteria House has their needs fully assessed by a senior member of staff before being offered a place. Some bedrooms in the home are only accessible by steps and therefore people need to be physically mobile to access these rooms. The home takes into account the existing people living at the home and the layout of the building when making an assessment. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 9 People living at the home said that they, or their representative, had been able to visit Wisteria House before deciding to move in. A service user guide is given to everyone. This gives details about the care and facilities offered and states that the first month of any stay is a trial period to ensure that both parties are happy that needs and expectations are being met. We saw copies of the homes pre admission assessments, and assessments carried out by professionals outside the home, in personal files. These cover all areas of physical need and personal wishes. The assessment and admission process ensures that the home is confident that they are able to meet the new persons’ needs and expectations. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9 & 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. People living at the home have access to healthcare professionals according to their individual needs. Care plans give good information about the likes and dislikes of people but would benefit from further development to ensure they give clear guidelines for staff. People living at the home are treated with respect. EVIDENCE: Everyone living at the home has a care plan that is personal to them. People were aware of their care plans and had had some input into their creation. Three care plans were looked at in detail during this inspection. All contained Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 11 good information about people likes and dislikes and information about how needs would be met by the home. In two care plans instructions for staff were not clear, for example one person was diabetic and the care plan did not give full guidance for staff. It stated what to do if the persons’ blood sugar level was too high or too low but did not indicate what their normal range was. Another person had had a number of falls but there was no care plan in respect of this. Due to the size and nature of the home staff working at the home appeared to have a good knowledge of each person but this was not clearly reflected in care plans. There were no care plans in respect of the care that each person needed during the night. There was no indication about peoples’ night time routines or how often they should be checked. The home has good relationships with local healthcare professionals. People living at the home stated that the home assisted them to make appointments. All appointments are recorded and these records demonstrate that physical health is monitored and referrals are made to specialists where appropriate. Everyone asked felt that they were always treated with respect. People spoken with said that staff were kind and sensitive when they assisted with personal care. People are free to spend time in the communal areas or in the privacy of their rooms. Everyone asked said that they were able to see visitors in private. The home uses a Monitored Dosage System for medication. Medication Administration Records were seen and found to be correctly signed when entering the home and when administered or refused, this gives a clear audit trail. Controlled drugs were seen and records kept correlated with stocks held. We observed people being asked if they required medication that is prescribed on an ‘as required’ basis. Staff spoken with stated that they received training in the safe administration of medication and carry out this task with a more experienced member of staff until they feel competent to take on the role. One of the registered managers regularly audits medication practices. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 & 15. 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 living at the home have opportunities to continue to pursue their interests and hobbies. The home offers a good range of nutritionally balanced meals. EVIDENCE: Since the last inspection the home has employed a second activity worker to enable people to have more opportunity for social stimulation. Everyone has an ‘interest checklist’ in their care plan, this gives details about peoples interests and hobbies to ensure that people are able to continue with these whilst living at the home. The introduction of a second activities worker has meant that people now have more one to one time to pursue personal interests. During the inspection one person went out to the gym with a staff member, someone was doing arts and crafts and another person said that they were planning to do some gardening with the activity worker. People said that they regularly Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 13 went out for walks in the village and some people enjoy going to the local pub for lunch. A hairdresser visits the home on a regular basis and a member of the local church holds a monthly service. The provider stated that they are hoping to make an extra member of staff available on a Sunday to support people who wish to go to church. People living at the home said that they were happy with the activities available to them. Everyone said that they were able to have visitors at anytime and many said that they enjoyed trips out with family and friends. The main meal is at mid-day. The manager or deputy sees everyone each day to ask what they would like to eat that day. Since the last inspection one member of staff has completed a training course in nutrition and the menus have been altered in line with good practice guidelines. There is a small dining room but people are able to choose where they eat their meals. On the day of the inspection some people ate in their rooms, some in the dining room and some in the lounge. People spoken with were generally happy with the quality of the food and said that there was a good variety of meals. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 14 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): 16, 17 & 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 living at the home feel comfortable to raise concerns with a member of staff. People have access to the services of an independent advocate. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The complaints procedure is available in the statement of purpose and service user guide. No complaints have been received by the home or the Commission in the last 12 months. Since the last inspection the statement of purpose has been updated to include signs and symptoms of abuse. Everyone asked said that they would be comfortable to raise any worries or concerns with a member of staff. There are regular meetings for people at the home and minutes show that people who do not attend meetings are seen on an individual basis. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 15 All staff spoken with said that they had received training in the protection of vulnerable adults and were aware of the whistle blowing policy. Everyone has access to an independent advocate who visits the home on an annual basis and is available more frequently if required. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 16 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): 19, 20, 21, 24 & 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. Many areas of the home require redecoration and refurbishment to improve accommodation for the people who live there. EVIDENCE: Wisteria House is a large older style listed building. Accommodation is set over two floors but within the main floors there are several levels with steps making some areas of the home unsuitable for people with mobility difficulties. There is a passenger lift, and stair lifts are in place on short flights of steps. All areas of the home are fitted with a call bell and fire detection system. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 17 Communal areas are located on the ground floor and are accessible to all. There is a lounge and dining room. To the front of the house there is a pleasant garden with summer house. All bedrooms are for single occupancy. People are able to bring personal possessions when they move in which gives rooms an individual and homely feel. Many areas of the home require refurbishment to ensure that décor and furnishings are a good standard. Some rooms require decoration and recarpeting and some furniture, particularly in bedrooms, would benefit from replacement. This was discussed with the provider who has plans to redecorate and replace soft furnishings. The laundry flooring has been removed and the home is currently waiting for contractors to replace this. All areas seen were reasonably clean and odour free. The lounge carpet requires deep cleaning or replacement. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 & 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. Staff receive adequate training to carry out their roles. Staffing levels in the home are monitored and adjusted to meet the needs of the people living there. EVIDENCE: The home employs 14 care staff, 11 (78 ) have a National Vocational Qualification in care at level 2 or above. (Figures taken from Annual Quality Assurance Assessment) Staff spoken with felt that there were good opportunities for training and that they were well supported. The home employs an outside trainer to facilitate training at the home. The home also uses some on-line training programmes. Staff stated that they received statutory training in health and safety matters and training appropriate to the needs of people living at the home. Recruitment records of 4 people employed since the last inspection were seen and these gave evidence of a robust recruitment procedure. This includes Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 19 obtaining written references and undertaking checks against the Protection Of Vulnerable Adults (POVA) register and Criminal Records Bureau (CRB). One new member of staff was spoken with. They confirmed that they had not begun work till checks had been carried out. They stated that they were initially shadowing other staff members and currently always worked with supervision. New members of staff undertake an induction programme and work alongside more experienced members of staff. People living at the home said that there was always adequate staff on duty and that they received assistance promptly when they requested it. Staff felt that they had ample time to support people with physical care and social activities. During the day there are two members of staff and overnight there is one person with a second person on call. The management and activity hours are in addition to this. Since the last inspection the home has adjusted staffing hours to provide an additional person between 7am and 9am. This was as a result of an accident analysis that showed this to be the time when most accidents in the home occurred. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35 & 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. The home is effectively managed. There are systems in place to minimise risks to people living and working at the home. EVIDENCE: The registered manager position is jointly held by Siobhan Wortley and Maria Goodland. Both have the experience and qualifications to effectively manage the home. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 21 In addition to the managers there is a deputy and three senior carers. This ensures that there is always a senior member of staff on duty through the day and on call overnight. The home is currently assessing its management arrangements to ensure that they are appropriate to the home. The home has various quality assurance systems in place, these include regular audits, meetings with people living and working at the home, daily meetings with people living at the home and annual appraisals for all staff. The home draws up a development plan each year to ensure that standards are maintained and ongoing improvements are made. We were given a copy of this year’s development plan. Findings at this inspection show that the development plan is being put into action although some environmental improvements have not been carried out within the dates set. The home does not act as a power of attorney or financial appointee for anyone living at the home. Steps have been taken to ensure the health and safety of people living and working at the home. Staff have received training in health and safety matters. A fire detection system is fitted and regularly tested in house and by outside contractors. All equipment is regularly serviced. Accidents are recorded and analysed to ensure action is taken where necessary to minimise risks. The manager gave assurances that hot water temperatures are regularly checked but actual temperatures are not recorded. Up to date certificates of insurance and registration are displayed in the home. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 4 18 3 2 2 2 x x 2 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 (2) Requirement Timescale for action 30/09/09 2 OP19 23 (2) Care plans must give clear guidance for staff. To ensure that people receive care in a consistent manner in line with their wishes and preferences. The registered person must 31/12/09 ensure that all areas of the home are decorated and furnished to a good standard. 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 Refer to Standard OP38 Good Practice Recommendations Actual temperatures of hot water should be recorded. Wisteria House DS0000058877.V376281.R01.S.doc Version 5.2 Page 24 Care Quality Commission South West 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. 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. 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