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Inspection on 02/08/05 for County Homes Nursing Home

Also see our care home review for County Homes Nursing Home for more information

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

NHS and other health professionals are actively involved in the care of service users as needed. The service users spoken to told the inspector that the staff are kind and caring, and it was observed that the staff respect their privacy and dignity. An increasing range of activities is offered by the new designated activities co-ordinator who works for 40 hours per week; with both individual and some group activities, including outings, being available. Ongoing training and development was seen for most staff.

What has improved since the last inspection?

Staff supervision records and training has improved since the previous inspection, with the records seen being more concise and detailed. Staff personnel files evidence a significant improvement, with all files seen having the required records and documents, including induction records. Activities and the opportunity for social interactions with staff and the local community has also been an area of improvement. Environmentally, the home has undergone a transformation in terms of the standard of decoration, personalization, furnishings and bedrooms. Most areas are now homely, safe and clean; with the areas identified in the main body of this report planned to be refurbished and redecorated very soon.

What the care home could do better:

Continue with the refurbishment and redecorating programme, including additional personalization of rooms and corridors (as far as practicable). The medication management was not quite as good as on the previous inspection on all units, and the overall standard of record keeping by the qualified staff needs improvement with regard to attention to detail.

CARE HOMES FOR OLDER PEOPLE County Homes Nursing Home 40 New Hey Road Woodchurch Birkenhead, Wirral CH49 5LE Lead Inspector Miss Julie E King Unannounced 2 August 2005 nd 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 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. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service County Homes Nursing Home Address 40 New Hey Road Woodchurch Birkenhead Wirral CH49 5LE 0151 604 0022 0151 604 0066 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Modelfuture Ltd Paula McCabe Care Home (N) 90 Category(ies) of DE (E) Dementia - over 65 registration, with number MD (E) Mental Disorder - over 65 of places County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Five named adults under 65 years of age within the maximum number of 90 Two named adults in the category MD(E) within the maximum number of 90 Date of last inspection 30 November 2004 Brief Description of the Service: The Home is a purpose built two-storey building. The Home is registered to provide ninety beds for the care of older people with dementia. The Home is divided into three separate units, which are named after northern cities, Chester, York and Lancaster. A First level registered nurse is in charge of each unit, day and night. All three units have access to a secure garden area. The home is situated on the Woodchurch estate close to all amenities such as shops, libraries. The M53 motorway is close to the home, which affords motorway access to Liverpool and the North Wales coast. There are six double bedrooms and eighty-four single bedrooms that have a shared en-suite toilet. There is a service lift on each unit to access the first floor. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over seven hours. A full tour of the premises took place. A range of records such as care plans, staff personnel files, policies & procedures and medication charts were examined. A selection of staff on duty, and a number of service users were spoken to during the course of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Continue with the refurbishment and redecorating programme, including additional personalization of rooms and corridors (as far as practicable). The medication management was not quite as good as on the previous inspection on all units, and the overall standard of record keeping by the qualified staff needs improvement with regard to attention to detail. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 6 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. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 The service users assessed needs are being met, and the home is able to provide assurances to service users and their representatives that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: Service users are only admitted into the home on the basis of a full assessment is carried out prior to they move in. All pre-admission assessments are carried out by either the acting manager or senior nurse, and include direct input from the prospective service users’ family / representative as agreed. Multidisciplinary healthcare team members such as the service users’ social worker, physiotherapist or NHS ward nurse, are part of this process. Specialist healthcare professionals continue to be involved in the care of service users after they are admitted into County Homes. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 &10 There is a consistent care planning system in place for most service users. This provides staff with the information they need to satisfactorily meet the service user’s needs. EVIDENCE: Individual care plans had been documented for each service user, and all seen were in the process of being updated and reviewed with the involvement of the individual service user as far as possible. Some improvements were seen in the care plan detail and in the way they are recorded on a daily basis, however more improvements are needed regarding the recording of observations following falls by service users. Systems are in place to ensure good communication between the care home, the NHS and other professionals involved in the care of all the service users. Medications, the medication room and related records and documents were examined as part of this unannounced inspection. Some gaps were seen on the medication administration records (MARs), and some transcriptions were not double signed, which is not in accordance with current good practice guidelines. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Links with the local community are good, and support and enrich service user’s social lives. The meals in County Homes are good, offering both choice and variety, and catering for special dietary needs. EVIDENCE: The daily routines provided were flexible as far as possible, and service users are encouraged to exercise choice and control over their lives. Friends and family are actively encouraged to participate in the service user’s lives. A varied and nutritious diet was provided with specialist service user’s medical needs (such as diabetes) being catered for. The registered manager told the inspector that a new, revised programme of daily activities is being devised, and this was seen in action during this unannounced inspection, with a group of service users going out for the day to Southport. Much more involvement of family, local community groups and resources was evident. The staff spoken to during this inspection were observed to have a good rapport with the service users, and were seen engaging the service users in meaningful activities and conversation as far as possible. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 An efficient complaint and adult protection policy and procedure was in place to help ensure the safety and welfare of service users. EVIDENCE: County Homes has an efficient complaint and adult protection policy and procedure in place to help ensure the safety and welfare of service users that they, their relatives and staff can access when necessary. This procedure includes information on ‘whistle-blowing’, in accordance with the Department of Health ‘No Secrets’ guidelines. Most of the staff have, or are in process of completing training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. Some advocacy information was available if required by service users or their relatives. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The overall fabric of the building is of a good standard, with most service users’ rooms being highly personalized. However the ongoing programme of redecoration and refurbishment must address the issues identified during this inspection. EVIDENCE: A full tour of the home was undertaken, during which a sample bedrooms were inspected, all food preparation areas and communal areas. In general the home is now satisfactorily maintained with evidence of decorative and maintenance work having taken place in most areas. The majority of furnishings seen were of a good quality, and numerous items of furniture had been replaced on all units since the previous inspection. Curtains need to be replaced as a matter of urgency, as these were seen to be hanging off in a lot of rooms. Lids on waste bins are also needed as a priority throughout the building. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 13 The outside of the building has been improved since the previous inspection, and some service users and their families were seen enjoying the good weather in the enclosed courtyard. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 There are sufficient numbers of staff with complementary skills to meet the needs of service users. EVIDENCE: The home is staffed with adequate numbers required to meet the needs of the service users, with a qualified nurse and four or five care staff on duty in the daytime on each unit. Additional staff are brought in to accompany service users to hospital appointments, etc. The staff rota evidenced a much lower use of agency than in previous inspections; with the homes own staff covering the majority of hours. Staff spoken to during the inspection confirmed that a range of mandatory and specialist training was now available, with the majority of the cost being paid for by the care home. This approach to training is a positive aspect of County Homes, as it helps ensure that service users are being cared for properly and their needs are being met in accordance with current good practice guidelines. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 & 38 The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of service users, relatives and staff. EVIDENCE: Some quality assurance is in place, with feedback and minutes of staff meetings kept. The staff made positive comments and suggestions by all spoken to. Patient’s monies are kept in separate, secure facilities, and records of all transactions were seen. The registered manager completes a monthly accident audit of all falls that service users have, and Regulation 26 & 37 forms are sent into the Commission on a regular basis. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 16 Certificates of worthiness for gas, electric and public (employee’s) liability were up to date and valid. It was recommended that all service users accidents are clearly crossreferenced with their respective care plans, and all observations are clearly recorded. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x x 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 3 County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? 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 19 Regulation 23 Requirement The registered person must ensure that the ongoing decoration plan is continued, and the areas identified during the inspection, such as wall and floor coverings are replaced. The registered person must keep the care home clean and free from malodour at all times. Timescale for action 30 October 2005 2. 26 16 30 August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 7 7 Good Practice Recommendations It is recommended that the qualified staff do not use abbreviations in their daily reports. It is recommended that the terms no conditional change, and all care given are NOT used, but a more detailed explanation and record of the actual care delivered is recorded. All clinical observations following a service users fall should be recorded in full either on the accident report, or the care plan (preferably both). When bloods are obtained from service users, a record of exactly which tests are being undertaken ought to be recorded. F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 19 3. 4. 7 7 County Homes Nursing Home 5. 6. 7. 8. 9. 10. 9 19 22 All transcriptions should have a counter-signature of the checking nurse Additional pictures are obtained for the corridors and communal areas. It is strongly recommended that a set of weighing scales, suitable to the physical and mental health needs of the current service users, are obtained as soon as practicable. County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 3rd Floor, Campbell Square Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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 County Homes Nursing Home F52 F02 S20949 County Homes N.H V242216 020805 Stage 4.doc Version 1.40 Page 21 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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