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Inspection on 25/10/06 for Old Rectory Nursing Home - Capenhurst

Also see our care home review for Old Rectory Nursing Home - Capenhurst for more information

This inspection was carried out on 25th October 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The Old Rectory provides facilities for residents diagnosed with dementia. Each resident`s bedroom is personalised with photographs and ornaments. Prospective residents have a full assessment prior to admission. Residents are helped and encouraged to maintain contact with friends and family and visitors are welcome at any reasonable time. The staff are friendly and approachable. Care is generally of a good standard and relatives` comments support this. Comments made by relatives are " the home is lovely, I feel my mum is well cared for." " I feel like part of an extended family" " nothing is too much trouble" " the food is good and plentiful" The atmosphere in the home is warm and welcoming. Medication is stored and managed safely.

What has improved since the last inspection?

Care plan recording and documentation is being completed to a satisfactory standard to enable all staff working at the home to understand the residents` needs. New dining room furniture has been purchased and more bedrooms have been decorated and refurbished. New windows have been installed throughout the home.

What the care home could do better:

Regular staff need to be employed to ensure continuity of care for the residents. Social activities are not taking place and residents are frequently left to sit in small groups without any distraction or stimulation from staff. This was a requirement at the last two inspections and has not been met. An activities programme should be based on residents` preferences and expectations. Staff need to have training in dementia care, challenging behaviour and adult protection to enable them to care for the residents more competently. All new staff members should have induction training to ensure that they are aware of the needs of the residents, the routine of the home, and be aware of health and safety. All washbowls in residents` rooms must be labelled correctly to avoid cross infection.

CARE HOMES FOR OLDER PEOPLE Old Rectory Nursing Home - Capenhurst Rectory Lane Capenhurst Chester Cheshire CH3 6HN Lead Inspector Joan Adam Unannounced Inspection 25th October 2006 09:30 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 Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.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. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Rectory Nursing Home - Capenhurst Address Rectory Lane Capenhurst Chester Cheshire CH3 6HN 0151 339 4810 0151 339 7231 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) The Old Rectory Limited Robert McConnell Care Home 35 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (35) of places Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Maximum of 35 persons accommodated aged 65 years and above Maximum of 1 named service user D.O.B 01/03/42 be accommodated in the category DE 14th February 2006 Date of last inspection Brief Description of the Service: The Old Rectory is registered to accommodate 35 service users aged over 65 years of age with a diagnosis of dementia. The home is a detached house which has been extended and converted. Accommodation consists of twenty three single bedrooms and six double bedrooms on two levels. Access between floors is via a passenger lift or stairs. None of the bedrooms at the home have en-suite facilities, wash-hand basins are fitted in all rooms. The home is situated in the village of Capenhurst with easy motorway access. Long and short -term placements are offered and the home employs a team of 1st level registered nurses and support workers for the provision of nursing and personal care. The current charges for the service are from £417 to £440. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on the 25th October 2006 and lasted 7 hours. The visit was carried out by one inspector This visit was just one part of the inspection. Other information received was also looked at. Before the visit the manager was also asked to complete a questionnaire to provide up to date information about services provided. Questionnaires were provided for residents, families, health and social care professionals to find out their views. During the visit various records and the premises were looked at. A number of residents and relatives were also spoken with and they gave their views about the service. What the service does well: The Old Rectory provides facilities for residents diagnosed with dementia. Each resident’s bedroom is personalised with photographs and ornaments. Prospective residents have a full assessment prior to admission. Residents are helped and encouraged to maintain contact with friends and family and visitors are welcome at any reasonable time. The staff are friendly and approachable. Care is generally of a good standard and relatives’ comments support this. Comments made by relatives are “ the home is lovely, I feel my mum is well cared for.” “ I feel like part of an extended family” “ nothing is too much trouble” “ the food is good and plentiful” The atmosphere in the home is warm and welcoming. Medication is stored and managed safely. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments of people’s care needs are carried out before they move into the home so there is information to show that their needs can be met. EVIDENCE: The pre-admission documentation of three residents who had moved into the home in recent months was looked at. It contained assessments of dependency levels and likes and dislikes of the resident. The pre-admission assessments had been carried out by the manager. Pre admission documents were in place from Social services and for one resident there was supporting information from the mental health team. The home is not registered to take residents with intermediate care needs. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ health, personal and social care needs are met by staff who enable them to maintain their privacy and dignity. EVIDENCE: Five care plans were seen. Care plans identified areas of need such as pressure area care, mobility, continence, nutrition, mental health needs and general dependency. They contained sufficient information to provide staff members with the necessary information for them to look after a person’s needs. Visits from other health care professionals had been recorded. The care plans seen showed that there had been consultation with residents or their families/advocates. Information from relatives regarding residents’ likes and dislikes had been incorporated in to the plan of care. Care plans to manage aggressive or challenging behaviour were in place and details were recorded on how staff should manage the behaviour and how to identify triggers to aggressive behaviour. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 10 Evidence was seen of relevant daily records being maintained on the health and welfare of the residents, and of the plans of care being evaluated on a regular basis. Staff were heard to address the residents appropriately explaining to them what they were going to do when using hoists and to maintain their dignity and privacy when providing personal care to them. Relatives spoken with were positive about the care their relative received. “ the staff are lovely”” cannot praise them highly enough” “ my wife is well looked after” Medication management and storage arrangements were satisfactory. The home used a monitored dosage system. Medication Administration Record Sheets were completed appropriately. Audits were carried out for medicines liable to abuse and were found to be in accordance with the records. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 12,13,14,15. The quality rating for this outcome area is poor. This judgement has been made using available evidence including a visit to the service. An appropriate range of activities is not provided for all of the residents to keep them active and stimulated. EVIDENCE: The home does not employ an activities co-ordinator and there is little evidence of any stimulating activity other than the normal routines of the day. Residents are frequently left to sit in small groups without any distraction or stimulation from staff. This was a requirement on the last two inspections and must be addressed. Relatives and staff spoken with said that there were no activities taking place. Residents do not go out in to the community. Visiting at the home is open and relatives and friends of residents are an important aspect of the home. Choice is recorded in the care plan such as food preferences and the likes and dislikes of residents, these are discussed with the relatives. The home has a menu in place and the food provided looked appetising and wholesome. Residents and relatives said that the food on offer was good. Not all residents spoken to with could respond coherently but were relaxed and at ease. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 16,18 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a complaints procedure in place and residents are protected from abuse. EVIDENCE: The home has an established complaints procedure and this was on display at the home. The home has improved the way in which complaints are recorded. Two complaints have been received by the home since the last inspection. A record was seen of the investigation and a response being made to the complainants. The home has an up dated Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the Department of Health Guidance “No Secrets”. Staff training records were seen in relation to adult protection. identified that staff had attended training in 2005. The records Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 19,26 The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The environment has been improved but some infection control measures need to be improved to ensure the safety of residents. EVIDENCE: The home was clean and free from odours. A partial tour of the home was undertaken. All the shared areas and a selection of bedrooms were seen. Bedrooms were seen to be well personalised with the residents own pictures and ornaments. Further decoration has taken place in some of the bedrooms. The requirement regarding the replacement of the windows at the home has now been met. Washing up bowls were observed in some bedrooms that did not have the name of the resident for whose use they are intended. These bowls should be labelled appropriately to minimise the risk of cross infection occurring. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Training needs to be given to ensure the diverse needs of the residents can be met. EVIDENCE: Information provided by the manager and reading of staff rosters indicates that there are an insufficient number of staff within the staff team to ensure the protection of residents and continuity of care. Staff rosters confirm that the manager needs to find cover for four to five shifts each week. These staff are sourced from agencies who are unfamiliar with the home, residents and staff. There were a number of agency care staff on duty on the day of the visit. Few had worked at the home before. Comments about staffing levels not being adequate were made by several relatives. The manager said that he has advertised for new staff. According to the pre-inspection questionnaire completed by the manager prior to the visit there are 75 of staff members qualified to NVQ level 2 in care, a recognised qualification for staff involved in delivering care. A number of other staff members are currently undertaking this. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 15 The staff have received training for moving and handling, infection control and some staff have had first aid training. Staff members have not received up dated training regarding the protection of vulnerable adults. Staff have not received training on dementia care or challenging behaviour. One staff member who had been at the home for several months had not received any induction training and the manager appeared unaware of this. The staff files seen of newly appointed staff contained all of the required information and a robust recruitment procedure was in place for the protection of residents Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A system for resident and staff consultation is not in place to ensure that the health safety and welfare of residents is protected. EVIDENCE: The manager of the home is an experienced Registered Mental Nurse and a Community Psychiatric Nurse cert. and is registered with the Commission for Social Care Inspection. He is an experienced manager and has managed the home for a number of years. He is currently undertaking NVQ level 4 in management. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 17 It was stated by the manager that formal supervision takes place, however, records were not seen at this visit. Staff are informally supervised on a daily basis. Interviews have taken place for a new care co-ordinator and a start date was to be arranged with the successful candidate. The Old Rectory does not have a quality assurance system in place at present to enable residents’ /relatives views to be recorded and to make sure that residents are receiving the care they need and are not placed at risk. The proprietor or his designated representative must visit the home on a monthly basis, unannounced, to check on all health and safety, property and equipment and staffing issues. Training needs to be put in to place to enable staff to meet the diverse needs of all residents living at the home. The home does not have any responsibility for any resident’s finances. The pre-inspection questionnaire provided information to confirm that equipment and installations at the home are serviced on a regular basis. The home employs a handyman who attends to maintenance issues such as checking fire equipment, water temperatures and other health and safety matters, providing a safe environment for staff and residents. The handyman is trained to give prevention of fire training to staff. Two sessions have been recorded as taking place this year. The manager has sent a list of which staff had attended the training to CSCI. Two staff members spoken with said that they had attended the training session. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 18 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 X 3 X X N/A 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 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 19 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 OP12 Regulation 16(2)(m) Requirement The registered person must ensure that activities are provided, having regard to the needs of service users.( timescale of 15/06/05 and 31/03/06 not met) The registered person must ensure that suitable arrangements are made at the home to prevent infection and the spread of infection. The registered person must ensure that all staff receive training in dementia care and challenging behaviour. The registered person must ensure that all new staff working at the home receive structured induction training. The registered person must ensure that a quality assurance system in place for evaluating the quality of the services provided and to gain the views of service users and their relatives. Timescale for action 16/12/06 2 OP26 13(3) 16/12/06 3 OP30 18(1)c 31/12/06 4 OP30 18(1)c (i) 16/12/06 5 OP33 24(1) 31/12/06 Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 20 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 OP31 Good Practice Recommendations The manager should have NVQ level 4 or equivalent. Old Rectory Nursing Home - Capenhurst DS0000018750.V308528.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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. 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