Inspection on 13/02/07 for Redwalls Nursing Home

This inspection was carried out on 13th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Redwalls Nursing Home 09/10/08

Redwalls Nursing Home 27/09/07

Redwalls Nursing Home 16/02/06

Redwalls Nursing Home 13/09/05

Redwalls Nursing Home 14/02/05

Redwalls Nursing Home 12/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Redwalls Nursing Home Weaverham Road Sandiway Northwich Cheshire CW8 2ND Lead Inspector Helena Dennett 13 th Unannounced Inspection February 2007 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 Redwalls Nursing Home DS0000018791.V322387.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. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Redwalls Nursing Home Address Weaverham Road Sandiway Northwich Cheshire CW8 2ND 01606 889339 01606 883287 www.redwalls.net www.redwalls.net Redwalls Care Services Ltd 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) *** Post Vacant *** Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43), Physical disability (1) of places Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 43 service users to include: * Up to 43 service users in the category of OP (old age, not falling within any other category) * Within the maximum of 43, one named service user may be accommodated in the category PD (physical disability). Room 24 must not be used for any service user who requires nursing care. 16th February 2006 2. Date of last inspection Brief Description of the Service: Redwalls is a care home providing accommodation with nursing and personal care for up to 43 older people. Redwalls is a large converted property, the original being a grade II listed building, standing in its own grounds of 1.5 acres. It is close to the local amenities and the village of Sandiway, which is approximately five miles from Northwich town centre. The home is a three-storey building. Residents’ accommodation is on the ground and first floors. There are 39 single and 2 double bedrooms. Thirty six of the single rooms and one of the double rooms have en-suite facilities. The rest of the bedrooms have hand-wash basins. There are two lounges and a conservatory on the ground floor and another lounge on the first floor. The dining room is on the ground floor next to the kitchen. There are separate toilets and a variety of bathrooms throughout the home. There is a hairdressing salon on the ground floor. A nurse call system is provided in all areas used by residents. The residents’ primary care needs are due to a physical frailty and infirmity or chronic physical disability in old age. The home is staffed with registered nurses, carers, and ancillary staff at all times. The scale of charges range from £470 - £650 per week. This information was provided by the manager before the visit to the home that took place on 13 February 2007. A copy of the latest inspection report is available from the manager. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit, part of the key unannounced inspection of the home, took place over 7.5 hours. It was carried out on 13th February the findings were discussed with the manager and the owners. Before the site visit the manager was asked to provide information as part of the inspection. The views of residents and relatives about the home were also sought; their comments are incorporated into this report. During the site visit the inspector spoke to the manager, some staff members and residents. Three residents’ records were looked at to check the care they receive. Policies and procedures and records of medication, care plans, staffing rotas and training records were also examined. What the service does well: Residents spoken with were very happy about the care and services that are provided by the home. Comments such as ‘I like living here’ and ‘ staff are good’ were made. Residents are visited before they move into the home so that they know staff can meet their needs. Relatives were also very positive about the care provided at the home. They felt their relatives’ health had improved since they had moved in and that staff were ‘very good’. The following comment was received by CSCI before the site visit: ‘I am very satisfied with Redwalls – the staff are all extremely kind and caring. I feel her needs e.g. manual handling, toileting etc are catered for very well.’ There is plenty of specialised equipment for staff to use to ensure that residents’ needs can be met at all times. The owners are very involved in the social activities of the home. All of the residents knew the owners and were very appreciative of their efforts. The owners help residents to take part in activities both inside and outside of the home, to keep them active and stimulated. The meals provided were of a good standard, with choice, so that residents receive a healthy well-balanced diet. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 6 There were plenty of staff available during the site visit to make sure that residents needs were met. There are good management systems operating within the home to ensure that it is run in the best interests of the residents. 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. The summary of this inspection report can be made available in other formats on request. Redwalls Nursing Home DS0000018791.V322387.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 Redwalls Nursing Home DS0000018791.V322387.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of people’s care needs are carried out before they move into the home so there is information to show that staff at the home can meet their needs. EVIDENCE: The inspector spoke with a resident who had recently come to live at the home. She said that she had been given all the information she needed to make a decision about moving in. The manager visited her in hospital and discussed her needs. She was made feel welcome by staff and had met and spoken with the manager. The resident’s relatives said that they were well informed about all aspects of the home. They were made aware of the costs and the fees involved. They were very positive about the move from the hospital to the home. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 9 Three residents’ records were looked at. Two of the residents had recently moved into the home. In one of those residents’ records the assessment document completed before the resident moved in was in place. In the other record the manager was not able to find the completed assessment but she confirmed that she had visited the resident in hospital. A care assessment was in place as well as a psychiatric assessment so there was evidence that the manager had obtained all the necessary information about the resident to ensure that their needs could be met at the home. Intermediate care is not provided at Redwalls Care Home. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the health and personal care of residents is generally met, there were some problems with care plans, documentation, risk assessments and medicines that could leave residents at risk of their needs not being met. EVIDENCE: Residents and relatives were positive about the care provided in the home. Comments such as ‘ I like it here’ and ‘the staff are good’ were made. Two relatives said that the health of their parents had improved since they had moved into Redwalls Care Home. One relative was very pleased and said he felt that staff looked after his relative very well. One comment received back to CSCI stated: ‘I am very satisfied with Redwalls – the staff are all extremely kind and caring. I feel her needs e.g. manual handling, toileting etc are catered for very well.’ Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 11 Three care records were looked at during the site visi, as these should detail the care to be delivered for that person. The care plans were looked at to determine whether appropriate care is delivered to the individual resident. In two of the records looked at there were care plans in place. However these did not provide enough detail on the care to be delivered to the resident. In one of the care records there were no care plans in place. This resident had moved into the home four days before the inspection. There should have been an initial plan of care to identify the resident’s main needs and the care that was to be provided until a more detailed assessment of needs could be made. Risk assessments were in place. In one resident’s care records, staff had noted that the resident could be at risk of injury from the bedside rails. However, these were still being used and the risk assessment for bedside rails had not been reviewed following the change in the resident’s condition. This means the resident was at risk of injury or harm. The manager agreed to deal with this immediately. The recording of wound care also needs to be improved as in one person’s care plan it was difficult to track the progress of the wound over a set period of time. The care plan in place was dated 18/2/06; this should have been updated to reflect any changes in his care. There was plenty of evidence that the home provides suitable specialised equipment to meet the needs of the residents. Hoists and moving and handling aids were available and were used by the staff during the day. However, staff were seen transporting one resident from the lounge to the bathroom in the hoist. This is considered bad practice as it could compromise the safety of the resident and looked undignified. There was evidence that specialised mattresses are used for residents who have difficulty moving in bed so that they are not at risk of pressure sores forming. The general practitioner, dentist, dietician, chiropodists and other professionals visit the home regularly as required by individual residents. A sample of residents’ medication records were looked at during the site visit. There were some problems with the recording of some of the residents’ medicines so it was difficult to find out whether residents had received their medicines as prescribed. Some of the residents’ eye drops did not have a date of opening. This should be recorded as these particular eye drops should be discarded after 28 days of opening. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough activities available to meet the needs of the residents, to keep them stimulated and active and residents are able to exercise choice and control over their lives. EVIDENCE: Residents and relatives were very positive about daily life and social activities that are provided at the home. One resident told the inspector that there is plenty going on at the home. She said ‘I try to duck them and have managed so far’. She went on to say that she had a ‘date’ with the owner every Thursday for a game of bridge and dominoes and that she enjoyed this. The following comment was made on one of the homes questionnaires: ‘the efforts put into special social events are much appreciated’. On the day of the inspection several residents were going out for tea in the local Methodist Church. This is a regular occurrence. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 13 A programme of activities is displayed on the notice board. In addition members of staff will engage residents in conversation and activities during the day. Local clergy visit regularly in accordance with residents preferences. Residents were very positive about the meals provided at the home. One resident said ‘food is very good here’, another resident said ‘I only like small amounts, the quality of the food is very good, especially the meat’. Most of the residents chose to take their meals in the dining room. The tables were nicely set out with tablecloths and napkins, giving a welcoming and homely appearance so residents could feel relaxed and enjoy their food. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 19 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the complaints process for the home is readily available so residents and their relatives know how to make complaints and who to make them to. EVIDENCE: Information on how to make a complaint is given to each resident and their relative when they move into the home. One resident told the inspector that she had spoken to the manager on the morning of the site visit as she had some concerns. She felt confident that the manager would investigate the issue and sort it out. The pre inspection questionnaire states that the home has not received any complaints in the last twelve months. The manager confirmed that this was correct. The home has a procedure on adult protection. This identifies the action to be taken by staff should an allegation of abuse be made. Two care staff were spoken with during the course of the visit. One member of staff showed a good awareness of adult protection issues and the action to be taken should an allegation be made. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 15 The second member of staff did not know the correct action to take should an allegation of abuse or neglect be made. The manager confirmed that training on adult protection had been organised later in the week for staff that have not had training, so that they will then have the necessary skills and knowledge to ensure that residents are not placed at risk of harm or injury. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well maintained, clean and tidy and so provides a safe and comfortable place for residents to live in. EVIDENCE: Residents said they enjoyed going out in the gardens on warmer days. The home was clean and tidy on the day of the site visit. Residents’ rooms appeared homely with several containing residents’ own possessions. The lounge and dining areas were clean and tidy. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 17 A maintenance man is employed to make any repairs or do ther work that might be needed. A laundry assistant is employed to care for all the residents’ laundry and residents said their clothes were well cared for. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there was plenty of trained staff working at the home to meet the needs of the residents, there were some problems with staff practice that could put residents at risk of injury or harm. EVIDENCE: There were plenty of staff working at the home on the day of the site visit. Registered nurses are employed to meet the nursing needs of the residents. Approximately 75 of care staff have a NVQ level 2 qualification in care or an equivalent qualification. This means that staff should have the skills and knowledge to care for the residents. Recruitment records were looked at. These were satisfactory in the main with one exception. In May 2006 a member of staff had been employed for four days before the POVAfirst check had been received back. The owners agreed that this is not acceptable practice and said they would investigate how this occurred. More recent employees did have a POVAfirst in place before they began working. There is a staff training and development programme in place. Although most of the staff have had training in moving and handling some poor practice was witnessed during the site visit. The manager agreed to deal with this. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety of the residents is promoted and protected in the main and the home is run in the best interests of residents EVIDENCE: A new manager has come into post since the last inspection. She is a registered general nurse and has had previous management experience. The manager confirmed that she is in the process of gathering all of the information needed in order to submit an application for registration. On the morning of the site visit the home was extremely busy with some unexpected events. The manager dealt with these in a professional and timely manner. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 20 Residents and staff were positive about the management style. They felt that the manager was approachable. Residents were also positive about the owners and appreciated the effort they put into the social events in particular. A quality assurance system is in place. The manager holds regular resident/relative meetings. Staff meetings are also held. Resident questionnaires are sent out yearly and action taken to address any problems or concerns that arise. The following comments were made on the home’s questionnaires: ‘Approachable staff, friendly atmosphere’; ‘the effort put into special social events are much appreciated’. The owners complete a monthly report on the conduct of the home. A copy of this report is given to the manager and available for the inspector to look at during the inspection. Residents and/or their relatives or representatives handle personal allowances. The home does not manage any residents’ money. Health and safety systems are satisfactory. The owners confirmed that all essential equipment is serviced regularly and all fire tests are completed. A sample of the records on these checks was looked at. These were found to be satisfactory. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 21 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 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 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 Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(1)(2) Requirement A written plan must be drawn up for all residents that identifies how all of their needs with respect to their health and welfare are going to be met. (Timescale 16/03/06 not met) Bed rail risk assessments must be reviewed when residents’ needs change so that residents are not placed at risk. Medicine Administration Records sheets must be signed by staff after they have given medicines or indicate why medicines have not been given. Eye drops must be dated when they are opened so that all staff know that residents have received their medicines as prescribed and that their medicines are safe to use. Correct moving and handling techniques must be used in accordance with current guidelines to make sure that residents are not placed at risk of injury or harm. Timescale for action 30/04/07 2. OP7 13(4)(c) 28/02/07 3 OP9 13(2) 28/02/07 3 OP30 13(4)(c) 28/02/07 Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 23 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 OP8 OP18 Good Practice Recommendations The care of residents’ wounds should be recorded clearly with information about the size of the wounds so that healing can be assessed. All staff should receive training on adult protection so they have the necessary skills and knowledge to deal with any allegations of abuse. Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Redwalls Nursing Home DS0000018791.V322387.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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