Care Home: Wordsworth House Care Centre

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What the care home does well People admitted to the home found the information they had received very useful, and they had enough information to help them make a choice. Before being admitted people had their needs assessed to establish if the service could provide the right care and support, before a placement in the home was offered. Records showed there was consultation with relevant people about the level and type of care required. Residents living in the home benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident`s also benefited from additional specialist support where needed, suchas healthcare needs. Visiting medical professionals considered the staff worked well with them for the benefit of the residents. Relatives considered the care provided to be very good. Written comments included, ` I have never had a problem with the care given to my mum at Wordsworth House.` The expert by experience reported, `One gentleman`s relatives were happy with his level of care and the resident himself says he is being looked after well`. Staff were instructed how to care for people safely and avoid unnecessary risks being taken. Risk assessments were completed, and all care reviewed regularly. The development of activities made available was good. The activity coordinator was innovative, and residents enjoyed a varied programme to suit their needs. These included for example, luncheon clubs for relatives to enjoy special time with family or friends, pet therapy, and outings in the community. Visiting arrangements were very good and the meals provided met with resident`s tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. People using the service had confidence to raise any issue of concern they may have. The home is commended for the improved response time to any concern they may receive and records show any complaint or concern received is dealt with professionally. The expert by experience looked at the accommodation provided and reported, `One lady was pleased to show me her room, which had a display of family photographs in frames and on the walls. Most rooms had a lovely view. The furniture in each room was very similar and reasonably modern. Separate bathrooms were clean and well equipped to enable all residents to bathe`. The laundry facilities were exceptionally clean and organised. Recruitment of staff was thorough and met with regulatory requirements. Staff interviewed said they enjoyed their work and felt supported by management. Written comments included, `Thoroughly enjoy working at Wordsworth House. It is a happy environment for staff, residents and families to work together for the objective of providing the best care we can.` A quality assurance report from the Institute of Quality Assurance (IQA) read, `Staff have a positive approach to caring for older people, offering discreet encouragement and support to enable residents to conduct their lives as fully and independently as possible.` Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home. Residents had meetings and Quality Assurance was carried out. There are clear lines of management and staff accountability within the home, and the entire service is audited on a Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 7monthly basis. The home holds a four star rating from the Institute Of Quality Assurance. (IQA). This was awarded in November 2007. What has improved since the last inspection? Care plans are reviewed regularly therefore residents changing needs can be monitored, and support given as and when needed. A record is kept of all medication received at the home. This will help to ensure sufficient and correct medication is received. Medication such as eye drops with a use by date once opened, have the date of opening recorded, and therefore staff can know when to replace them. People requiring a liquidised meal can enjoy different tastes and textures as meal contents were blended separately. There is a cleaning schedule in place for the kitchen. This will help to make sure all areas where food is prepared and stored are kept clean. To make sure residents are kept safe in the event of a fire automatic door closures have been fitted on bedroom doors for those residents wishing to keep their bedroom door open. Recruitment of staff has improved by thorough checks being made to make sure staff employed at the home are suitable for working with vulnerable people. Southern Cross has monitored the service very well and therefore ensured the home is managed properly. What the care home could do better: Resident`s should be asked how they want their medication to be managed and a formal consent to medication administration by staff should be obtained. This will show that they have been consulted as to the best option for them. Medication prescribed to be administered when necessary should be detailed better as to the circumstances it would be given. To improve residents intake of fluids, drinks should be more readily available and offered between meals. Residents dignity must be respected at all times by making sure gender issues are considered for residents requesting or requiring this provision. Residents should have a daily living plan linked to their assessed needs and full care plan to support them to exercise choice and control over their lives.The missing fencing to the back of the garden must be replaced to ensure residents safety. The skill mix of staff must be balanced so that at all times suitably qualified, competent, and experienced staff are on duty. To support this all staff must be given essential training that is appropriate for their work. This must include safeguarding vulnerable adults, and therefore support staff to act in residents best interests and know what to do. Staff must be given regular formal supervision that will allow them to develop professionally and work towards Southern Cross vision for excellence in meeting standards. Staff training must be maintained to ensure the health, welfare, and safety of residents and staff. Individual risk assessments of residents should be completed for evacuation of the building to ensure staff will know who is at risk. CARE HOMES FOR OLDER PEOPLE Wordsworth House Care Centre Wordsworth Street Hapton Burnley Lancashire BB12 7JX Lead Inspector Mrs Marie Dickinson Unannounced Inspection 10:00 5 & 6 August 2008 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wordsworth House Care Centre Address Wordsworth Street Hapton Burnley Lancashire BB12 7JX 01282 778940 01282 770311 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) www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Mrs Linda Heyes Care Home 40 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (22) Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the overall registration of 40, a maximum of 17 service users who fall into the category Dementia Elderly, 1 named service user who falls into the category of mental disorder, 22 service users who fall into the category of Older People. Staffing levels are to be in accordance with the Notice issued 17 October 2002 This service should, at all times, employ a suitably qualified manager who is registered with the CSCI Should any of the service users referred to in 2 above be no longer resident in the home, registration must be altered to reflect this. 17th August 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Wordsworth House is registered with the Commission for Social Care Inspection to provide personal care and accommodation for forty older people. The home is a purpose built establishment situated in the village of Hapton Burnley. There are shops and public houses close by and it is near to public transport, rail, and bus. Accommodation is in single en suite bedrooms on two floors with access to the upper floors via a passenger lift. There is a residential and dementia care unit in the home that are staffed separately. Information about the service is available from the home for potential residents in a Statement of purpose and Service User Guide. Information about the service is available from the home. Weekly charges range from £366 minimum to £412; privately funded £482. Dementia care £433 Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. A key unannounced inspection was conducted in respect of Wordsworth House on the 5th & 6th August 2008. The inspection involved getting information from the service history held at the Commission, an Annual Quality Assurance Assessment completed by the manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the operations manager, visitors, and an inspection of the premises. Written comments from five relatives and six residents was received giving their view of the service provided. An expert by experience was used in this inspection. She observed daily life and social activities in the home and provided a written report to support the inspection findings. The home was assessed against the National Minimum Standards for Older People. What the service does well: People admitted to the home found the information they had received very useful, and they had enough information to help them make a choice. Before being admitted people had their needs assessed to establish if the service could provide the right care and support, before a placement in the home was offered. Records showed there was consultation with relevant people about the level and type of care required. Residents living in the home benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Resident’s also benefited from additional specialist support where needed, such Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 6 as healthcare needs. Visiting medical professionals considered the staff worked well with them for the benefit of the residents. Relatives considered the care provided to be very good. Written comments included, ‘ I have never had a problem with the care given to my mum at Wordsworth House.’ The expert by experience reported, ‘One gentleman’s relatives were happy with his level of care and the resident himself says he is being looked after well’. Staff were instructed how to care for people safely and avoid unnecessary risks being taken. Risk assessments were completed, and all care reviewed regularly. The development of activities made available was good. The activity coordinator was innovative, and residents enjoyed a varied programme to suit their needs. These included for example, luncheon clubs for relatives to enjoy special time with family or friends, pet therapy, and outings in the community. Visiting arrangements were very good and the meals provided met with resident’s tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. People using the service had confidence to raise any issue of concern they may have. The home is commended for the improved response time to any concern they may receive and records show any complaint or concern received is dealt with professionally. The expert by experience looked at the accommodation provided and reported, ‘One lady was pleased to show me her room, which had a display of family photographs in frames and on the walls. Most rooms had a lovely view. The furniture in each room was very similar and reasonably modern. Separate bathrooms were clean and well equipped to enable all residents to bathe’. The laundry facilities were exceptionally clean and organised. Recruitment of staff was thorough and met with regulatory requirements. Staff interviewed said they enjoyed their work and felt supported by management. Written comments included, ‘Thoroughly enjoy working at Wordsworth House. It is a happy environment for staff, residents and families to work together for the objective of providing the best care we can.’ A quality assurance report from the Institute of Quality Assurance (IQA) read, ‘Staff have a positive approach to caring for older people, offering discreet encouragement and support to enable residents to conduct their lives as fully and independently as possible.’ Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home. Residents had meetings and Quality Assurance was carried out. There are clear lines of management and staff accountability within the home, and the entire service is audited on a Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 7 monthly basis. The home holds a four star rating from the Institute Of Quality Assurance. (IQA). This was awarded in November 2007. What has improved since the last inspection? What they could do better: Resident’s should be asked how they want their medication to be managed and a formal consent to medication administration by staff should be obtained. This will show that they have been consulted as to the best option for them. Medication prescribed to be administered when necessary should be detailed better as to the circumstances it would be given. To improve residents intake of fluids, drinks should be more readily available and offered between meals. Residents dignity must be respected at all times by making sure gender issues are considered for residents requesting or requiring this provision. Residents should have a daily living plan linked to their assessed needs and full care plan to support them to exercise choice and control over their lives. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 8 The missing fencing to the back of the garden must be replaced to ensure residents safety. The skill mix of staff must be balanced so that at all times suitably qualified, competent, and experienced staff are on duty. To support this all staff must be given essential training that is appropriate for their work. This must include safeguarding vulnerable adults, and therefore support staff to act in residents best interests and know what to do. Staff must be given regular formal supervision that will allow them to develop professionally and work towards Southern Cross vision for excellence in meeting standards. Staff training must be maintained to ensure the health, welfare, and safety of residents and staff. Individual risk assessments of residents should be completed for evacuation of the building to ensure staff will know who is at risk. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 9 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 Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People were consulted and had their needs assessed. This meant a decision could be made if the home was suitable to meet those needs. Contracts issued, informed people of the terms and conditions of living at the home, and protected their legal rights. EVIDENCE: Information received from the home informed the Commission they did well as, ‘Wordsworth House Care Centre has a vigourous pre- assessment protocol to follow prior to any Service User entering Wordsworth Care Centre’. This Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 11 meant either the homes manager or deputy visited people in their own home or place of residence prior to admission. Written comments from residents and relatives showed most people considered they had enough information to help them make a choice. Several people had been admitted since the last inspection. Records seen showed they had a completed assessment of their needs that helped make a decision by considering if the home had the right facilities, and staff expertise to meet those needs. The pre-admission assessment record identified personal, health, and social care needs. The information recorded in the records was however brief. Whilst the use of tick boxes to indicate level of dependency and needs was informative, this could be improved on, with better written notes to use as the basis for writing a person centred care plan. Information recorded on the Annual Quality Assessment completed by the manager showed all residents had been issued with a contract. Copies of contracts were kept on resident files. Residents placed in the home by the local authority were given a contract for financial arrangements for payment. This was in addition to the service user guide, that outlined the terms and conditions of residency in the home. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents had care plans, risk assessments, and a named key worker, which supported them to ensure their health and personal care needs being met in a consistent way. Medication was managed safely. EVIDENCE: Information received at the Commission indicated a plan of care is prepared within 48hrs of admission of a new resident. This is based on assessments to ensure that residents personal and healthcare needs are considered. Potential risks were considered for example, risk of developing pressure sores, nutrition, moving and handling, continence, and risk of falling. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 13 Three care plans were looked at. A brief record was made of residents past history. Needs identified such as personal care, mobility, communication, personal safety, medication, medical, and social were listed. How identified needs are to be supported was generally clear. For example, ‘is chair bound. Needs 2 carers to assist. Planned care, will weight bare and can be moved by 2 carers. Carers must tell him of their intentions step by step, ensure sat correctly in chair. Can eat by him self, but needs prompts. Aim to maintain weight. Planned care. Observe to ensure he is eating independently, to encourage when necessary. To offer snacks, smoothies, etc. if he has not eaten adequately. Monitor weight’. Identified care needs in care plans instructed staff to maintain privacy, dignity, and independence. For example, ‘Carers to respect his privacy.’ And ‘deal with all aspects of care with discretion’. This is clearly good practice, and observed during inspection. Gender issues were usually considered, however care records showed that on one occasion this had not been followed and difficulties had occurred. Residents were allocated a named carer and key worker to provide personalised care. This doubling up of carers meant residents benefitted a continuation of their care support by people they knew and trusted. This was particularly beneficial for residents with dementia care needs. Relatives visiting were familiar with the key workers and were happy with the standard of care given. They were invited to care reviews and kept up to date with important issues regarding relatives care. One relative said ‘the staff are very good and always polite and at hand should they need anything. Mum never complains about them’. The expert by experience reported, ‘One gentleman’s relatives were happy with his level of care and the resident himself says he is being looked after well’. The expert by experience also commented, ‘Overall, the staff appeared respectful to the residents, when they were in contact and within their limitations’. Staff working at the home who provided written comments of their views, said ‘Wordsworth House provides a friendly caring home for our clients. Each one has certain needs and we cater to that specific person.’ And ‘Not only provide excellent care catered for each individual needs, but the home has high levels of involvement with families, friends, professional bodies etc. to ensure the best level of care can be tailored to each individual’. The Institute Of Quality Assurance (IQA) Quality assurance report stated, ‘Care is person centred and individual residents all treated with respect and dignity’. Residents had access to health care services both within the home and in the local community. All residents were registered with a GP and accessed local services either in the community, or were supported by visits to the home by health care professionals. This included visits from the district nursing team for Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 14 nursing intervention required such as applying dressings and ensuring residents had appropriate aids provided such as air flow mattresses. Continence care was managed well. Comments made from the health professional visiting during inspection were very positive and she considered the staff worked well with them. Arrangements were being made to show staff how to monitor blood sugar levels for diabetics as records show this was not always done at regular intervals. Pressure care was promoted and pressure-relieving aids were used where need was identified. Risk assessments had been completed for moving and handling and were used as guidance for staff to help care for residents safely. For example, ‘walks with a frame, however he could fall if not watched’. Measures to minimise the risk of a fall. ‘Staff will ensure he has correct footwear on; ensure he is wearing clean glasses; has his frame with him, and pathway is clear’. Observations were made of the hoist and wheelchairs being used safely. The home operated a monitored dosage system for the administration of medication, which was dispensed into blister packs by the supplying pharmacist. An appropriate recording system was in place to record the receipt, administration and disposal of medication. Consent for medication should be recorded better, and demonstrate peoples wishes and capabilities to self medicate. Medication given as when necessary requires more detail as to when this would be given, particularly where it involves administering medication to control aggression, and residents unable to verbally tell someone if they were not well. A clear audit of medication received was kept. The record of medication adminstration was signed and storage of medication was secure. Staff have been trained. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Social, recreational activities, and lifestyle, generally met with resident’s needs and expectations. Catering arrangements were satisfactory in providing for individual taste, and choice. Visiting arrangements were good. EVIDENCE: Information received at the Commission told us the home did well as ‘residents are consulted regarding trips, in house entertainment, and menus’. Residents benefitted a pet therapist who brings trained pet dogs to visit, hairdressing weekly, visiting clergy, regular concerts and outings, and they provided one to one activities.’ An activity coordinator was employed to support residents in pursuing their interests, and the home was currently looking to employ a second person to Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 16 ensure provision is every day. One staff who gave written comments for this inspection wrote, ‘Home feels very much like home from home environment with plenty of social activities and community involvement and is not seen as an ‘institution’. The expert by experience spent some time consulting with residents and staff about activities in general. Her conclusions were, ‘Records were kept of the activities provided on each resident’s “Recreational Activities Record”. Activities were recorded by an A-Z system i.e. family visit was recorded by one letter of the alphabet; therefore there was no record of who called and what the resident’s reaction was. There would be no indication of which relative the letter referred to. Similarly for other outings and activities. It was impossible to identify whether the resident went out on their own with a carer or relative or out in a group and where to, so therefore reactions could not be identified’. The expert by experience reported however, the co-ordinator ‘had actually managed to take at least two residents out on their own and become involved in the community. One lady loved her walks along the canal bank and had met local people whilst admiring their gardens. Therefore a rapport has been established. A gentleman had visited Burnley Football Club only on the outside, but after chatting with Burnley FC staff, it is on the agenda for him to visit and see the inside of the Ground’. And, ‘some residents attend Coffee mornings at the local church. Local religious representatives make regular visits to the House’. Other observations made during inspection included for example, a luncheon club held on a monthly basis where families and friends are encouraged to attend. A pet dog therapist visited with a trained dog that benefited people with little cognitive functioning, and movement to music was held in the afternoon. The notice board showed what events were planned. Within the company, a calender competition has been set up and residents are encouraged to enter the competition to win prizes and to have their work published in next years calender. Whilst residents’ care plans included details of their social and recreational needs and interests, residents’ choice for daily living had not been recorded sufficiently. Basic comfort needs such as getting up and going to bed, when they preferred to bathe, and what they would like staff to consider when supporting them. Comments from residents and relatives visiting showed visiting arrangements to be good. They could visit when they wanted and were offered refreshments. Privacy was respected during visits. The expert by experience report on meals indicated ‘some residents were happy with the meals they had. Others were unhappy with the actual meals not meeting the specific description. There was no menu available. One Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 17 resident said that they were given a choice of two after they were sat down at the table’. Observations on the dementia unit showed residents responded well to visual choices of meal offered. The cook had not been in post very long, and was currently reviewing the menus. Special diets were catered for. Food served were generous in portion with ample foods left for second helpings. Supervision of residents in the dementia unit was satisfactory. Those who wished to eat later had meals saved for them. To improve residents intake of fluids, drinks should be more readily available and offered between meals. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a complaints procedure, and relatives and residents were confident that their concerns are listened to, taken seriously, and acted upon. The homes vulnerable adults policies and procedures, and membership to Care Aware, supported people living at the home being protected from abuse. EVIDENCE: The complaints procedure was displayed in the home. Information received at the Commission stated, they had improved the procedure to investigate and respond to any complaint made within ‘14 days, rather than 28 days. The decrease in response time for any complaints eases any animostity within the Care Centre’. No complaints were referred to the commission and records showed any complaint made at the home were dealt with properly. Three complaints have been made in house, and the manager and Operation Manager has investigated all three complaints in a thorough manner with action being taken promptly. Residents and relatives spoken to said they could raise any issue they wanted in confidence the matter would be dealt with. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 19 Wordsworth House is also a member of Care Aware, which provides a confidential hotline that could be used to report any concerns. Training for staff in Protection of Vulnerable Adults continues to be rolled out. However the training record for staff employed in the home showed a significant number of staff have as yet to receive this. The last training session was in February 2008. Staff working at the home said they were familiar with the abuse policies and procedures in the home, which included whistle blowing. Those interviewed were aware of their duty of care and responsibility to protect residents. Staff contracts precluded them from financial reward or assisting in or benefiting from the service users’ wills. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,24,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents were provided with a warm, comfortable, clean, safe, environment that suited their needs. EVIDENCE: The home is a purpose built establishment situated in the village of Hapton, Burnley. There are shops and public houses close by and it is near to public transport, rail, and bus. There are parking facilities at the front of the home. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 21 The home is set in it’s own grounds with garden areas for residents to sit out, weather permitting. Accommodation is in single en suite bedrooms on two floors with access to the upper floor via a passenger lift. The home is divided into two units, residential and dementia. Entrance to the home and dementia unit is by security keypad access. The expert by experience looked at the accommodation provided and made the following observations. ‘There was an easy access into the building, but safety keypads were used to come out of the building’. ‘The two dining room floors, were both covered in a non-slip cleanable floor, which appeared ideal for residents safety. Each private room had an en-suite toilet and washbasin. One lady was pleased to show me her room, which had a display of family photographs in frames and on the walls. Most rooms had a lovely view. The furniture in each room was very similar and reasonably modern. Separate bathrooms were clean and well equipped to enable all residents to bathe’. ‘The first floor of the building was occupied by the residents who suffered from varying forms of dementia, and was secured by keypads to open and close doors. There was a furnished garden, which was to enable residents to enjoy the warm sunshine, when it appeared, but I noticed that there were two fence panels on the ground, and this allowed access on to the canal at the rear of the building’. This was discussed with the operations manager who reported this was being looked into, as a more permanent barrier was needed to resolve the problem. Information received at the Commission said the garden areas of the home continue to have input from residents. The main garden area is dedicated to attracting wildlife, used as visual stimuli for talking points amongst residents. The home continues to use pictorial stimuli on areas such as toilets, bathrooms, and bedroom doors to help those who have lost the ability to read. The laundry facilities were exceptionally clean and organised. Resident’s clothes were on hangers and each resident had a laundry basket. All resident’s clothes were ironed, however they reported it was not always possible to iron front creases in trousers due to the high temperature sometimes required for soiled clothing. The handyman had a maintenance book he used. This showed carpets’ requiring cleaning such as the lounge carpet was planned for one evening when residents were not using the room. The carpet shampooer had been out of action but was now repaired. He was also being supported to decorate a number of bedrooms. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Sufficient staff were employed to meet with residents needs, however lack of essential training meant the skill mix of staff was not always satisfactory. Recruitment practices were thorough in ensuring the right staff were employed. EVIDENCE: Written comments from staff included, ‘Thoroughly enjoy working at Wordsworth House. It is a happy environment for staff, residents and families to work together for the objective of providing the best care we can.’ Staff interviewed said they enjoyed their work and felt supported by management. Staff who provided written comments for the inspection indicated good recruitment practice had been carried out. Records showed Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. On appointment members of staff were Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 23 issued with a contract of terms and conditions of employment. All staff were given a job description/specification outlining duties and expectations. Staff induction included philosophy in care, principles of care, protection, diversity, role of the worker, health, and safety at work, communication, and personal development. Both units were staffed seperately and consisted of a unit manager and senior carers. The skill mix of staff was not always balanced, as night duty was covered at times by staff who had not been fully trained in essential topics such as first aid. A training matrix was kept up to date. Information recorded showed gaps in training, although arrangements were made for some training to be provided. Better training opportunities must be provided for fire safety, food hygiene, health and safety, abuse and POVA, infection control, nutrition, safe handling of medication, and dementia care awareness. A quality assurance report from the Institute Of Quality Assurance (IQA) read, ‘Staff have a positive approach to caring for older people, offering discreet encouragement and support to enable residents to conduct their lives as fully and independently as possible.’ ‘Staff are clear about what is expected of them in their role and demonstrate good self management skills.’ Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is managed to ensure residents and staff are generally protected, and the home is run in the best interest of residents, the staff, and the organisation. EVIDENCE: The registered providers Southern Cross have an active role in the management of the home. Interim arrangements have been made for an Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 25 operations manager and project manager to oversee the management of the home on a daily basis until the registered manager has returned from special leave. The roles of the management team as a whole includes seniors, unit managers and deputy, who take responsibility for a number of residents and staff employed. There are clear lines of accountability, and the entire service is audited on a monthly basis. Information received at the Commission indicated there is a workshop day for senior care staff once a month covering various topics of health and social care. The home promotes an open door policy, and the manager holds a managers surgery once a week for two hours for staff to come and speak in confidence. There is a commitment to meet with good practice standards and meet with regulatory requirements. Minutes of the different meetings for all parties showed for example, heads of department meetings, care staff meeting, and residents/relatives meetings. The last care staff meeting was well attended and was an opportunity for the project manager to introduce herself. Residents also had meetings. The home had received a four star rating from the Institute Of Quality Assurance. (IQA). This was awarded in November 2007. Outcome was as follows: standard of care, four stars, with four crowns for excellent standard of facilities. The quality assessment report included admission, assessment, and daily care, daily living, responding to change, meals and meal times and nutrition. Staff behaviour, and attitude, and additional needs relating to mental health. Written comments in the report included. ‘An open and involving management style enables all members of the staff team to deliver services to ensure the homes Statement Of Purpose and quality agenda can be fulfilled’. Quality assurance is also carried out in the home and relatives, residents, and staff are given the opportunity to have their say. Records showed staff supervision was not as regular as it should be. This meant there was no effective means for staff to express themselves, their concerns, and their plans for the future or to receive feedback on their performance. Staff received six monthly appraisals. Staff meetings are held regular to give staff news on new polices and procedures and gives staff the opportunity to air concerns and share information. Records maintained showed regular auditing of fire, water temperatures; wheelchairs and hoists etc. Fire risk assessment for the building had been completed. Individual risk assessments for resident response to the need to evacuate the building had not been done. Records kept were of a good standard and regularly completed. General risk assessments were completed and taken into account in planning the care and routines of the home. The home had access to professional business, legal, and financial advice and had Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 26 all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 27 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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 2 3 2 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES 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 OP10 Regulation 12(4)(a) Requirement Residents dignity must be respected at all times by making sure gender issues are considered for residents requesting or requiring this provision. The missing fencing to the back of the garden must be replaced to ensure residents safety. Previous timescale of 22/09/06 not met. The skill mix of staff must be balanced to ensure that at all times suitably qualified, competent , and experienced staff are on duty day and night All staff must be given essential training that is appropriate for their work. Staff must be given regular formal supervision. Staff training must be maintained to ensure the health, welfare, and safety of residents and staff. Timescale for action 31/08/08 2 OP19 23(o) 30/09/08 3 OP28 18(1)(a) 31/08/08 4 5 6 OP30 OP36 OP38 18(1)(c) 18(2) 12(1) 13(4) 30/09/08 31/08/08 30/09/08 Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 29 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 3 4 5 Refer to Standard OP9 OP9 OP14 OP18 OP38 Good Practice Recommendations Formal consent to administration of medication should be sought. It is recommended medication prescribed to be administered when necessary be detailed as to the circumstances it would be given. Residents should have a daily living plan to support them exercise choice and control over their lives. Staff should be given training in adult protection within six months of starting work. Individual risk assessments of residents should be completed for evacuation of the building to ensure staff will know who is at risk. Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wordsworth House Care Centre DS0000009590.V367164.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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