Care Home: Wythall Residential Home

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What the care home does well The manager has worked in the home for over ten years and is experienced in this care field. Policies and procedures in place are good and efficiently managed. Residents and their relatives generally speak positively about the care provided and the attitude of the staff. Prior to admission to the home, every resident has their needs assessed to ensure that the home is a suitable environment, and their wishes wherever possible are taken into consideration. Comments received about the home included: `The home is warm and comfortable and I have everything I need`. `I have a very good relationship with the staff`. `It`s like living at the Mayfair`. The home is clean and well maintained, making it a safe and pleasant place to live. Private rooms are very personal to each individual. Food provision is good. Residents spoken with said that they enjoyed their food, and confirmed that there was always plenty of it. Special diets are taken into consideration. `The food here is very nice, very good` `I have a low fat diet and the cook always gives me an alternative`. What has improved since the last inspection? Systems to support and supervise staff have been improved, and are now recorded. Training for staff in mandatory safety courses for example Health and Safety and Moving and Handling are recorded and updated regularly and systems are now in place to demonstrate this. Some improvements have been made to the quality assurance systems in the home, although this could be further improved to demonstrate what actions the home is taking in a response to comments made. Suggestions made to improve medication administration have been undertaken. What the care home could do better: Some care plans require more detail to adequately guide staff on how each individual, based on a skills assessment, requires their care to be delivered, and how each resident is supported to retain strengths and abilities. The home usually advertises an entertainment and activity programme of events, which shows how the home endeavours to ensure that residents lead a lifestyle that satisfies their social and recreational needs. At the time of the inspection a number of residents spent much of the day on their own, or asleep in the lounge and no information was available to support what was taking place and some information was out of date. A Dementia Care Training programme for staff needs to be introduced, supported by up to date literature, to ensure that all the staff working in the home have the required skills to effectively manage the care of people with a dementia, and can support retained strengths and abilities as well as consistently manage behaviours that may be challenging to others. The further development of the quality assurance system, to include the auditing and publishing of the results of the surveys and questionnaires, would help ensure the best possible outcomes for service users, and also to measure how far the aims and objectives of the home are being met. A more detailed record could be maintained of comments made about the service, specifically any compliments received, which would give a more balanced view of what people think about the home. Staff leaving the home and then returning following a period of absence must have all police and safety checks re done to ensure safety and protection to service users. CARE HOMES FOR OLDER PEOPLE Wythall Residential Home 241 Station Road Wythall Birmingham West Midlands B47 6ET Lead Inspector Jackie Howe Key Unannounced Inspection 5th February 2008 09:40 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 Wythall Residential Home DS0000018491.V358823.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. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wythall Residential Home Address 241 Station Road Wythall Birmingham West Midlands B47 6ET 01564 823478 01564 829834 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) Wythall Residential Home Limited Mrs Linda Ann McIntyre Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (22), of places Physical disability over 65 years of age (22) Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The room is registered for service users who do not have a mobility difficulty or any dementia type of illness. 2nd February 2007 Date of last inspection Brief Description of the Service: Wythall Residential Home is registered to provide residential care for up to twenty-two older people, over the age of sixty-five, who are frail, who may have a physical disability, and who may experience mental health problems. The house is a large, detached property, which has been upgraded and extended, to provide a pleasant environment for the people who live there. The building is well maintained and there is garden area to the rear, which is accessible to service users. Situated in a residential area of Wythall there is easy access to public transport and the local shops. Adequate parking facilities are provided at the front of the home. The home is owned by Wythall Residential Home Limited, and is one of four homes within the group. Mr A Barwell and Mrs S Barwell are both directors of the company and visit the home regularly. The General Manager, Mrs Vanessa Nuttall provides overall supervision of the home, and support for the manager. The registered manager, Mrs Linda McIntyre, has responsibility for the day-today management of the home. The philosophy of the home is to offer highly professional care with a personal touch, in a secure, relaxed and homely environment. The stated aim of the management and staff is to provide a home where individuality is emphasised, with staff who have the time to give attention to detail, and where residents can choose how they wish to live their lives. The fees are not currently displayed, but this information is available from the manager of the home. Wythall Residential Home DS0000018491.V358823.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 stars. This means the people who use this service experience good quality outcomes. This is the first inspection of the inspection year 2007/08. The visit was unannounced and was undertaken for seven and a half hours between 09:40am and 17:10pm. The inspection process reviews the home’s ability to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision where improvements may be required. During the inspection, the care of two residents who live in the home was examined. This included reading care plans and documentation, observing care offered to them and that staff have the necessary skills to care for them. The Medication Administration Records were also seen. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. The inspector ate lunch with the residents in the dining room and spent some time talking with residents, discussing with them what it is like living at the home, and observing their interactions with the staff. The inspector also spoke to relatives and staff. During conversations with staff, comments were made about what it is like to work at the home. Discussions were held with the Registered Care Manager, Ms Linda McIntyre, about her role, and the day-to-day management of the home. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also read. A tour of the premises was undertaken with the manager and the inspector was able to see communal rooms and bathrooms, as well as residents’ personal rooms. The inspector also looked at the laundry and kitchen to assess hygiene standards. The inspector would like to thank staff and residents for their co-operation and hospitality. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Systems to support and supervise staff have been improved, and are now recorded. Training for staff in mandatory safety courses for example Health and Safety and Moving and Handling are recorded and updated regularly and systems are now in place to demonstrate this. Some improvements have been made to the quality assurance systems in the home, although this could be further improved to demonstrate what actions the home is taking in a response to comments made. Suggestions made to improve medication administration have been undertaken. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 7 What they could do better: 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. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6. Quality in this outcome area is good. The pre-admission procedures and assessment, provides relevant information to ensure that the home is able to meet the identified needs of residents as well as offer an appropriate introduction to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a ‘Statement of Purpose’, which together with the ‘Service Users Guide’ provides prospective residents and their relatives, with the relevant information to enable them to make a decision with regard to their future care needs. These documents are on display in the entrance hall of the home, and the manager said a copy was placed in each resident’s room. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 10 The manager said that these documents were reviewed regularly, and the information read, appeared to be relevant and up to date, but the date on the front of the copy seen was March 2004. The fees payable in the home were also not included, and charges that are additional and therefore not included in the fees, were not itemised. The manager said that a statement of the Terms and Conditions of Residence is provided to each resident on admission, and contains relevant information about their occupancy, including their individual fees. The manager undertakes a pre admission assessment for all prospective residents, either at home or in hospital, following the initial referral. Two assessments and subsequent care plans were read during the inspection. One assessment was for a resident who was only recently been admitted to the home and the resident was spoken with, to assess how the admission to the home had been experienced. Areas required for assessment in the National Minimum Care Standards are covered in the documentation and those read showed that a thorough assessment had taken place in aspects of personal and health care needs. The residents’ hobbies and social life history is recorded to allow staff to have a good knowledge of personal requirements. It was commendable to note that gender preferences for staff were also recorded, as the home has a male carer. The documents seen in the files of service users were detailed and informative, and contained relevant information to assist staff in deciding if their needs could be met at the home. One resident spoken with said that her move to the home was well managed: ‘ They came and visited me in hospital and then when I moved in she was there to great me’. Prospective residents are encouraged to visit the home, and to spend time with the resident group, and also stay for a day or period of time. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10. Quality in this outcome area is good. Residents’ health and social needs are well documented, although there are some areas, which require more detail and clarification. Procedures for safe administration of medication are good. Residents are treated respectfully. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were requested for the purposes of case tracking, one for a resident recently admitted to the home and one with dementia care needs, and some challenging behavioural issues where continuity in care from staff is required. Generally care plans seen were well completed showing a good level of understanding of health care and personal care needs, and language used was sensitive. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 12 One care plan read showed that an area of concern was that of low weight. A nutritional screening had been undertaken and a weight chart started with directions to staff to monitor food intake and weigh on a monthly basis. This could have been improved, by recording how long the resident had been of low weight, as weight was recorded as low but stable. Other assessments where there could be issues of high risk, for example in moving and handling and tissue viability, had been completed. One care plan showed that the resident had seen by the GP on admission to the home and medications recorded and ordered. The staff had also started a chart to record blood pressure monitoring. Another care plan showed that staff had completed details of social and life history with a family tree. The care plan had also been signed by the resident, which shows that they had been involved and understood the contents of it. There was evidence that regular reviews of the care plan had taken place and that daily records were made, with a separate daily report kept for the psychiatrist to make sure that all areas of concern were well documented and easily accessible. Care plans included records from health professionals for example chiropodist, community psychiatric nurse and the psychiatrist. Family members spoken with said that residents attended hospital appointments and that they felt involved in resident’s care by being given updates on their day-to-day welfare. Care plans could be further improved, by including more detail of how care for those residents who require a consistent approach, should be given; for example high levels of agitation, or where behaviour may disturb others. More detail could also be included to make each care plan more ‘person centred’ in its content; for example to identify what a resident is still able to do for themselves, like choosing clothing or wearing make up and how a resident likes their care to be given. This was discussed with the manager and one of the senior carers during the inspection, and both demonstrated a good understanding of how this information would improve their current care planning systems. During the inspection residents were noted to be dressed appropriately and look clean, and well cared for. The senior carer was observed administering the lunchtime medications in the dining room. The medication trolley was neat, clean and tidy and items were labelled appropriately. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 13 Drugs are supplied to the home in a dossette box, where all the medications for a time of day are put together. Descriptions of each tablet are recorded on the reverse of the box, which are supplied by the chemist with a 28-day prescription. This system of drug administration is popular with number of chemists, but the manager and staff need to be aware of tablets where descriptions are similar i.e. ‘small white round tablet’. The senior carer said that the care manager was responsible for the medication ordering. Medication Administration Records (MAR) sheets were checked and found to be correct, although on one chart 2 omissions were noted, where no record had been made of a resident refusing medication. No one in the home is currently receiving a Controlled Drug (CD), but the home has a CD cupboard available, and drugs dispensed are recorded in a CD register as per recognised good practice. Eye drops are kept in locked box in fridge and the date of opening was recorded on the box to ensure that drops are not used after the recommended use by date. During the inspection it was noted that the staff treated residents respectfully. Doors were knocked before entering, and appropriate terms of address used. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 14 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): All of the above standards were assessed during this inspection. Quality in this outcome area is adequate. Residents in this home enjoy opportunities for recreational activity, but this is limited in regard to choice to fully suit their individual needs. The menu is varied and well balanced and is served in a way that residents enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection, the majority of residents were sitting in the lounge area, where they spent much of the day. Some residents were watching the television, but a number were asleep. One resident was sitting next to the television, which was quite loud in her ears, but she was not placed in a position where she would have been able to watch it. There was no obvious activity taking place or available and there was no activity programme displayed for February. The home does not employ anyone specifically to undertake activities for residents, so this is the responsibility of the care staff. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 15 The inspector was shown copies of previous programmes, with a number of social events having taken place around Christmas time. Previously monthly activity programme information included: Bingo, manicures, card games, ‘Fashion Fayre’ and a ‘Christmas Fayre’. The care manager said that four residents recently went to the local pub for a meal. The church services available for 2007 were still displayed on notice board, with none identified for 2008. The manager admitted that she was a little behind in getting this all typed up and made available. Family members spoken with, made comments that they would like to see more outings available, including small outings to local shops or cafes. The care manager said that the home has access to 2 minibuses, but these are not easily accessible by residents, as there is no tail lift for people who are not too ambulant or need a wheel chair. Residents, who are more able to undertake activities independently, said that they preferred to read or knit in their own rooms away from the main lounge. Care staff spoken with said that they tried to offer activities, based on individual likes and dislikes, and that there were games and puzzles for example available. The home should give consideration to developing the availability for residents, for whom it would be appropriate, to be involved in activities of daily living for example assisting in table setting, and preparing vegetables. On the day of the inspection, the cook was on annual leave, and a senior carer was cooking the main meal of the day. The menu on day of inspection was: Lunch: Corned Beef Hash with gravy or Cheese and potato pie Carrots or salad Bread and Butter pudding, with custard or fruit flan and cream. Tea: Soup/ smoked haddock or sandwich selection. Home made cake. The menus for 4 weeks are all displayed together in the dining room, but there is no indication of which is the current week, so it is difficult for residents and their relatives to know what meal is available for that day. Residents are given a menu choice on a day to day basis, and pre order with the kitchen staff. The manager said that there were 2 diabetic residents in the Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 16 home. Puddings are offered the same as for other residents wherever possible, but made with sweetener rather than sugar, or yoghurt is also available. The inspector ate lunch, with residents in the dining room and was able to observe how residents enjoyed their meal, and how it was served to them. The meal was served courteously, and although the main meal was pre plated, the gravy was served separately allowing residents personal choice, and there was a visual choice of pudding offered which is good practice. Some residents had a cup of tea, others had a choice of cold drink. The dining room is a nice bright place to eat with good quality furniture and chairs have arms and sliders underneath to aid movement. The tables were well presented, with flowers on the table and cloth napkins. Music was playing on CD player, which residents said they enjoyed. Comments made to the inspector during lunch included: ‘The food is ‘very good, very nice’ ‘I have a low fat diet and the cook always supplies an alternative’ ‘There is always plenty’. One resident said that she did not like corned beef hash, but was not aware that there was an alternative. Her daughter said she had already notified the staff about this, but staff on duty did not appear to be aware of this. There was evidence however that staff do make note of residents’ comments and what meals they eat and enjoy. One resident was rather restless during lunch and stood up and walked around and at one point sat at another resident’s place. Staff handled this situation quietly, but they should have considered moving her to a more comfortable environment whilst restless, rather than keep encouraging the resident to sit down. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 17 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): Standards 16 and 18. Quality in this outcome area is good. Residents and their representatives feel that complaints raised would be listened and responded to appropriately. Residents in this home are protected by policies and procedures in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure for receiving and investigating complaints, which is in the ‘Service Users Guide’ and is available in the entrance hall of the home. The manager keeps a complaints log of complaints received. One formal complaint has been received since the last inspection. Letters and the written reply from the area manager were available to show that the home responded appropriately to this complaint. The manager said that she does not formally record all complaints, but a record is made of concerns raised in the residents’ file or in the communications book, so that all staff are aware. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 18 The manager said that she made herself available and talks to relatives and visitors on a daily basis. On the day of the inspection it was noted that the manager had a good rapport with the residents and visitors to the home, and has a very ‘hands on’ approach. Currently little is recorded to demonstrate what she does in response to comments made and if people are satisfied with the outcomes. A relative spoken with said that she was happy to talk to staff if there were any issues and had in the past spoken with the area manager on views about the home. Residents spoken with, said that they had no complaints about the home, and if they did, that they would speak to Linda the manager. Staff spoken with said that they would feel confident to go to the manager if they had any concerns. Since the last inspection, the manager has not had reason to report any staff using the Protection of Vulnerable Adults procedures. The Home has in house procedures and manager said she would always involve her line manager. Some information from Worcester County Council is displayed in the office but manager was not aware of the local documents for multi agency procedures for responding to allegations of abuse, or of the Department of Health ‘No Secrets’ document. Staff have attended training in the Protection of Vulnerable Adults (POVA) so that they are aware of the different ways vulnerable people are at risk of abuse, and would know how to respond. Staff spoken with appeared to be aware of these issues. Residents are assisted to access any services that may be required according to individual need. The home is not currently using any form of restraint for residents, and no one is currently using bedrails, lap straps or recliner chairs. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 19 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): Standards 19, 20, 23 and 26. Quality in this outcome area is good. People who live in the home are offered an environment that is appropriate to their needs, is safe, clean and comfortable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken with the manager and with some residents who showed the inspector their personal rooms. Personal rooms seen were very clean warm and bright and were nicely decorated and appropriately furnished. Residents are encouraged to bring their own belongings, personal items, and small pieces of furniture into the home. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 20 The home provides a wardrobe, chest of draws, and bedside cabinet with a lockable drawer. Some of the rooms have en-suite facilities with aids and adaptations, for example grab rails and a raised toilet seat. The home has 18 bedrooms, 2 are shared rooms, one is currently shared by a married couple and the other by 2 residents who the manager said are happy to share. Screening is provided to allow for privacy. All the bedrooms are on ground level. The home has 2 bathrooms, 1 with a parker bath. Both bathrooms are clean and hoists available are regularly serviced. One bathroom is a little cold feeling, as it is only partially tiled and could be made more ‘homely’ with a few pictures or ornaments. The entrance hall to the home has the required certificates regarding the home’s registration displayed and some poems written about elderly care and feelings of older people displayed on the wall. The home employs maintenance and gardening personnel. The home is well maintained, and the gardens are well kempt and provide good additional outside space for residents to use. A tour of the kitchen and laundry found these to be tidy and clean. Washing machines are provided with sluicing programmes, and separate hand washing facilities are provided in both areas for staff, to minimise the risk of cross infection. An Environmental Health inspection was undertaken last year, and the manager said that there was no outstanding work required. The home could improve its environment in respect of people with a dementia, by including a form of signage, so that residents can make their way around the home independently, for example pictures and appropriate photographs. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 and 30. Quality in this outcome area is adequate. Training available to staff to meet the needs of residents is generally satisfactory although a lack of regular dementia care training means that not all staff are sufficiently skilled to meet these needs. Recruitment procedures are generally well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Rotas seen show that staffing numbers are being maintained as per the workforce model as described by the manager. Staff work a total of three shifts, the early shift being from 7am – 2pm, the evening shift from 2 – 9pm and the night shift from 9pm – 7am. Two staff are on duty during the night and on the day of the inspection, a senior carer was on duty supported by two carers on the early and late shifts. The homes duty rota should accurately show the hours actually worked by staff in the home if those hours are different to the normal shift pattern. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 22 The manager said that currently house keeping staff each work three hours per day from 9am – 12md and this is also available on a Saturday, but not on a Sunday. On the day of the inspection two members of house keeping staff were on duty. Care staff are expected to undertake laundry duties. Staff spoken with, confirmed that they enjoyed working at the home and had received an induction on starting at the home, as well as some subsequent training, and supervision from senior staff in their role. The manager has started a new training file to record training sessions attended by staff. Mandatory training for the home is: Health and Safety, Manual Handling, First Aid, Fire Safety, Basic Food Hygiene, Infection Control and Protection of Vulnerable Adults (POVA). The manager arranges updates on training as suggested by the certificate. Records seen show that a high percentage of staff have attended mandatory training, but that dementia care training, which would give the staff the specialist skills to offer care to people with a dementia, has been limited. Some staff have attended a dementia care course, and some a challenging behaviour training some time in the past, but the manager said that nothing had been organised recently and that she had identified this as an area for improvement with the area manager. The manager said that the home used the Community Mental Health Nurse for support, and that the area manager circulated interesting articles, but the home had limited resources available to ensure that staff are kept up to date with new dementia care methods. The manager informed the inspector that currently 15 of the 22 residents in the home have a level of dementia and that a few residents, are developing challenging behavioural needs. It is essential therefore that staff are suitably trained to equip them with the skills to care for these residents effectively. One member of staff confirmed that she had attended training in Health and Safety, First aid, Food Hygiene, POVA, and Moving and Handling and was due to attend infection control training. She had not attended any dementia care training. Recruitment records checked were generally found to be good with evidence of written references, and work history being obtained. One staff member is currently working with a POVA first confirmation as clear, but the CRB has not yet been returned. The manager checked this during the inspection, and was informed that this should be returned within the next few days. The manager said that this member of staff was currently working under supervision. The manager told the inspector, that a staff member had left employment of the home for a few weeks, but subsequently returned. This staff member had Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 23 not had a new criminal records bureau check undertaken, although one had been undertaken for the previous period of employment. The home does not currently have a procedure in place to describe what will be done in response to a disclosure on the Criminal Records check (CRB). Residents spoken with were very complimentary about the staff group: ‘The staff are excellent, nothing is too much trouble and everything is done to make your life better’. Wythall Residential Home DS0000018491.V358823.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): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is good. The manager is able to fulfil her responsibilities as manager of the Home, within an organised management system of policies and procedures. Staff are appropriately supervised and residents’ best interests are considered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has worked in the home for over ten years. She is experienced in this field of work, and has completed the Registered Managers Award and is currently working towards achieving an NVQ level 4 in care. Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 25 The manager said that there were four homes in the group and that she has an opportunity to get together with other managers informally, but also meets regularly with her line manager and with the owners of the home. The manager does not manage the budget, but she said that she is provided with everything she asks for as required. Areas for improvement identified at the last inspection were discussed with the manager, who was able to explain where she felt that improvements had been made and where improvements may still be needed. The manager said that the home holds residents meetings, normally in a small group. She keeps a folder with the minutes of the meetings, and puts issues into the care plan and into communications book for staff to see. There is no formal system for relatives, and although the manager meets relatives regularly, as previously mentioned, does not always record comments made. This was discussed with the manager at the inspection, who felt that this was something she could include in the quality assurance practices for the home. A recent questionnaire had been sent to users of the service and health care professionals to find out their opinions, but the manager has not produced a report on this for people to see, nor is she able to demonstrate what the home has done if required, in response to comments made. One area for improvement was for supervision of staff and a new senior carer has started a new system for supervision. The Manager now supervises senior staff and the senior carer supervises the carers. These sessions are now recorded and weighted towards staff who need to receive more supervision i.e. a new starter in the home. A member of staff, who is new to the home, confirmed that she saw the manager every day and that the senior carer is her supervisor and supports her work. Staff said that staff meetings are held regularly and repeated over a period of 3 days and different times, so that everyone can attend. One staff member said ‘If you are unable to attend Linda will go through things, she is a nice person to work for’. Systems are in place to ensure that the home is well maintained and safe for people to live and work in the home. Training records show that staff are given training in Moving and Handling, Health and Safety, Risk Assessment, Basic Food Hygiene, Control of Substances Hazardous to Health – COSHH, Fire safety, Infection Control and Protection of Vulnerable adults against abuse (POVA). Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 26 Information provided by the manager shows that safety tests and checks have been completed and regular fire drills are undertaken. The manager said that there was no money kept for Residents in the home, and any invoices were put on the fees payable. The Annual Quality Assurance Assessment (AQAA) was due to be returned to the commission by 6th February 2008, and therefore was not used to formulate evidence for this inspection. Wythall Residential Home DS0000018491.V358823.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 2 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x 3 x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 3 Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 12 Requirement Training in dementia care to ensure that there are sufficient staff with the skills required to meet the needs of these residents in the home, must be made available. Staff leaving the home and then returning following a period of absence, must have police and safety checks re done to ensure the safety and protection of residents. Timescale for action 30/04/08 2. OP29 19 31/03/08 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 OP1 Good Practice Recommendations The Service Users Guide should include the up to date fees DS0000018491.V358823.R01.S.doc Version 5.2 Page 29 Wythall Residential Home 2. OP12 3. OP15 payable, and details of any additional charges that may be made. The home should develop the availability of activities to reflect the different needs and abilities of residents in the home, and include more opportunities to attend external events and places. The home should display menus one week at a time and use pictorial prompts, to allow residents to be able to access them more independantly. The manager should access specialist dementia care literature and training materials, to ensure staff are up to date in modern dementia care methods and have the skills required. The manager should review the recruitment procedure to show how disclosures on CRB checks will be responded to and what actions will be taken to protect residents. A system of recording any comments made about the service, and demonstrate what actions are taken in response to those comments, should be developed to improve the quality assurance systems in the home. 4. OP27 5. OP29 6. OP33 Wythall Residential Home DS0000018491.V358823.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection 3rd Floor 77 Paradise Circus Queensway Birmingham B1 2DT 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 Wythall Residential Home DS0000018491.V358823.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. 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