Inspection on 29/01/09 for Wardington House Nursing Home

This inspection was carried out on 29th January 2009.

CSCI found this care home to be providing an Excellent service.

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.

Other inspections for this house

Wardington House Nursing Home 15/03/07

Wardington House Nursing Home 05/12/05

Wardington House Nursing Home 04/05/05

Wardington House Nursing Home 18/11/04

Wardington House Nursing Home 08/07/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wardington House Nursing Home Wardington House Nursing Home Wardington, Banbury Oxfordshire OX17 1SD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kate Harrison     Date: 2 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Wardington House Nursing Home Wardington House Nursing Home Wardington, Banbury Oxfordshire OX17 1SD 01295750622 01295750036 george.tuthill@wardington.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wardington House Partnership care home 60 Number of places (if applicable): Under 65 Over 65 0 0 60 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 60 60 0 60 The maximum number of service users to be accommodated is 60 The registered person may provide the following category of service; Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category(OP) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Physical disability (PD) Date of last inspection Brief description of the care home Wardington House lies on the edge of Wardington village close to the town of Banbury. The home has been providing care for individuals with dementia and other mental disorders since 1965. The home aims to provide a relaxed, stress-free environment so that individuals can retain their freedom of choice and individuality. The homes Care Homes for Older People Page 4 of 26 Brief description of the care home minibus provides safe transport for trips out of the home. The accommodation is provided on three floors and is accessed by a passenger lift. There is a mix of single and larger rooms, and a top floor special unit with up to 7 sharing. Within the complex there is also a unit for people who want more independence. The 3 large communal lounge/dining rooms offer choice and space for individuals to walk around in safety. Large picture windows provide an open aspect to the extensive attractive grounds, and the grounds are accessible to the people living there. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was an unannounced Key inspection and was conducted by one inspector over 6 hours during one day. It was a thorough look at how well the home is doing, and took into account detailed information provided by the home through the Annual Quality Assurance Assessment (the AQAA) and any other information we received about the service since the last inspection. We asked the views of people close to those living in the home through our survey, and other people we met during our visit. We saw documents and records about the care provided and discussed the running of the home with the managers. We saw all areas of the home used by the people living there, we looked at how the home manages peoples medication, and we observed lunchtime in the dining room. We spoke to several people living in the home, and observed how the staff team interact with them. We looked at how the home is Care Homes for Older People Page 6 of 26 meeting the standards set by the government, and in this report we make judgements about the standards of the service. The date of our last inspection visit was 15 March 2007, and the homes fees currently range from GBP 820 to GBP 885. What the care home does well: What has improved since the last inspection? What they could do better: The home has identified in the AQAA how it intends to continue the improvements, through continuing staff development and through applying new and developing technologies. The home has planning permission to build more single rooms with specially designed bathrooms, and this will help to provide more accommodation choice in the home. Care Homes for Older People Page 8 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The preadmission process includes an assessment of need, and all the information about the person to be admitted is available so that the home knows that their needs can be met. Evidence: The home has a strong philosophy of how to care for people who are living with dementia, based on their right to live freely in the home. The managers understand the importance of having enough information about the individual from admission, so that the staff team can understand how to respond to the individuals dementia behaviour after admission. People who responded to our survey said that they were told about the philosophy at their first meeting, and families are asked to provide as much information about the individual before admission as possible. The homes matron carries out a full assessment of need before an individual is admitted to the home, and takes into account any information from family members or other Care Homes for Older People Page 11 of 26 Evidence: representatives showing how the individual would like to be cared for. The information is carefully considered to see if the home is suitable to meet the needs of the individual, and focusses on how positive outcomes for the individual can be achieved at the home. Information is also requested from key care professionals when appropriate, such as general practitioners (GPs) and discharging hospitals, so that all the important information about the individual is known and recorded. People who responded to our survey said that the admission process centred on the needs of the individual, that they were able to visit the home as often as they wanted before deciding, and that they were provided with a very personalised service. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of individuals are known and met, in a way that shows respect for their privacy and dignity. Evidence: The health and personal care needs of individuals admitted to the home are recognised from information obtained during the admission process, and from detailed recorded observation during the first 72 hours the individual spends in the home. We saw the care records for four individuals, and saw that risk assessments are carried out for care topics such as nutrition, mobility and skin care. Care plans are developed when necessary, so that the care staff have all the information they need to look after the individuals in the way they prefer. The home gives a statement for staff to new care staff about the philosophy of the home, and regularly discusses the homes aims and objectives about how people with dementia should be cared for in the home. Staff are taught to observe reactions to their interventions, so that they can better understand the wishes of the individual, when the individual cannot communicate verbally with them. The focus is on the need of individuals to feel and be free within the home, and Care Homes for Older People Page 13 of 26 Evidence: on the staff members duty to respect their privacy and dignity. Nobody in the home manages their own medication, and the home has a good system in place for those whose GPs prescribe some medication. Medication is provided by a large high street retailer, delivered monthly and kept securely in the home. There were no controlled drugs prescribed or kept at the home at the time of our visit. The medicine administration record is used to record the receipt and administration of medication, and we noted that one record had not been completed for medication recently received. This issue was investigated and the receipt of the medication recorded, so that an accurate audit of the homes medication is available. One relative commented staff are particularly receptive to any expression or sign of discomfort or pain, and another said that matron rings for permission or to discuss an alternative when there are changes to be made. All the people who responded to our survey said that their relative receives the medical support they need. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a sustained track record in supporting people living in the home to live as they want to, and provides them with personal, social and cultural opportunities to do so. Evidence: The home strives to meet its statement of purpose in providing care in such a way that people living in the home are free from restrictions, from instructions and orders, and are free to be happy and enjoy their lives. The focus is on learning as much as possible about the individual, and using the knowledge to provide the type of lifestyle appreciated by the individual. We saw that care records are kept to show that there is a team effort to understand the individuals needs, and that daily life is organised around the individuals liking. People who responsed to our survey said At Wardington there does not seem to be a regimented routine, the atmosphere is one of tolerance and understanding. There are design features outside so that individuals can safely use the garden and inside so that individuals privacy is protected in their bedrooms. We saw that the range and frequency of the activities provided meets the needs of all the people living in the home, and that the activities are appropriate for the individuals, as they help people living in the home to remember past times. The Care Homes for Older People Page 15 of 26 Evidence: activities include visits to local pubs and museums, library, fetes and cricket and football matches, and indoor activites of film shows, exercise groups, singing, dancing and music. People who responded to our survey gave positive comments about the activities provided, such as X enjoys a range of activities far superior to anything we could provide, a great deal of imagination and ingenuity goes into devising activities and entertainment which are stimulating and appropriate, animals such as cats and rabbits to stroke, and staff often chat to X and read extracts from newspapers or magazines. The home supports people to fulfill their individual wishes for themselves, and is responsive to the needs of individuals to have personal relationships. Families are very welcome at the home, and are encouraged from the individuals admission to work in partnership with the home in the care of their relative. Other people are welcomed into the home, such as ministers of religion, and people are supported to practice their religion in whatever way they want. The home recognises the importance of nutrition in caring for people with dementia, and has found ways of improving food intake when necessary. A Meals Review Group meets regularly to discuss food issues and regularly comes up with new ideas to improve meals and mealtimes. There is a lunch and supper club, where individuals with more independence are able to eat together. Menus are developed with the preferences of the people living in the home in mind. Mealtimes are unhurried and one carer acts as the waitress, so that other carers can concentrate on helping people to eat. Carers have training in helping individuals to eat, and we saw that they are able help in a sensitive manner. People who responded to our survey said that the food was good, commenting: I particularly like how they cater to individual needs at breakfast time, X has gained quite a bit of weight since arriving. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives have a high level of trust in the staff team, and are supported by the homes philosophy and procedures. Evidence: The home includes its complaints procedure in the statement of purpose and every person living in the home is provided with a copy. The procedure is also available in the home and on the homes website. Complaints and concerns are recorded, and no complaints have been received since the last inspection. We have not received information about any complaints made to the home. The homes management has regular contact with families and welcomes comments about the quality of the service. Responses to our survey showed that people knew how to complain if they wanted to. Examples are It is our view that X is sufficiently comfortable and trusting of staff that she would tell them if there was anything wrong, I know if I had a problem that any of the staff would deal with it, and if it was serious I would speak to Matron or Mr Tuthill. Training is provided for all new staff about protecting people living in the home from abuse, and regular update training is provided. We saw that the home has a copy of the local safeguarding guidance, and staff are provided with information about how to respond to suspicions or allegations of abuse. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The best interests of the individuals are regularly reviewed so that the environment continually meets their needs. Evidence: The homes management is aware of the needs of the people living in the home, and continues to develop the environment to meet their needs and to meet the statement of purpose regarding freedom of movement. Creative solutions have been found to issues arising, such as individuals going into other peoples rooms, and the homes staff and management continually reflects on how changes to the environment can improve life for those living in the home. There is a dedicated department to manage maintenance issues, and updating and refurbishment of the home continues on a rolling programme. Decorators were working in the home during our visit, and we saw that they took the needs of the people living in the home into account during the decoration. There were no issues identified by the environmental health officer for addressing at the recent visit. We saw the homes laundry and saw that infection control measures are in place. The home continues to seek out innovative technological solutions to make life easier for the people living in the home. People who responded to our survey said that the home is always fresh and clean, and one person commented: Over 3 years I have never seen the sitting rooms or bedrooms anything other than sparkling. Another comment was that the low level windows in all Care Homes for Older People Page 18 of 26 Evidence: the rooms giving a view of the countryside not only makes the rooms light and bright they also give a feeling of expansiveness. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The best interests of the people living in the home are met by the homes policies and procedures about recruitment, staffing numbers and staff training. Evidence: The home has considered how best to provide a reliable motivated trained staff team, and has developed innovative ways to bring it about. There is a staffing rota showing multiple shift patterns, allowing shift overlap times for nurses and a good supply of staff. This innovative way of managing staff benefits people living in the home, for example it allows the nursing staff to have regular time away from clinical duties to update records. People who replied to our survey gave positive comments about the staff team, one commenting at the different times and days when we have visited the staff are available and engaged with residents, talking with them, walking with them, feeding them or seeing to a whole host of needs, physical and emotional. Other responses confirmed that there are always staff available when needed, and that staff listed and act on what people say. The home has a training centre where much of the staff training is carried out, and specialises in dementia training. All staff in the home complete dementia training, and all the care staff have mandatory health and safety training, such as moving and handling and fire safety training, and other training such as how to help people to eat, and equal opportunities. Some nurses have specialist training, for instance in wound management, and act as the homes resource for the Care Homes for Older People Page 20 of 26 Evidence: staff team. We saw the staff training matrix and noted that the numbers of care staff with National Vocational Qualification (NVQ) Level 2 in Care has increased to 33 , and the home encourages the staff to enroll on the training. Several staff members have difficulty because of the few hours they work, and there are restrictions about using the homes own NVQ assessors. The home compensates for this by providing in house training on relevant topics for all staff members, and having short discussions about care practice during shift handover. The homes matron and deputy marton are completing a mentoring qualification, to better support the staff team in their work. We saw the recruitment records for three members of staff, and noted that all the necessary information was available. The staff rota has a colour code system to show the supervision arrangements for those awaiting their Criminal Records Bureau clearance. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The best interests of the people living in the home are met through the way the home is managed. Evidence: The homes management has remained stable for the past nineteen years, and has a sustained track record of managing improvements to the home. The management has a clear vision about excellence in the provision of care for people with dementia, and aims to provide the environment, staffing and management to enable the individuals living in the home to live happily. The home aims to understand the needs of individuals from the pre-admission procedures, and works to meet their needs through providing good staff training and a supportive environment. The matron and her deputy provide good role models for the staff team, and have an open and supportive approach to meeting the needs of the people living in the home. The homes AQAA was completed by the responsible individual, giving detail of improvements and barriers, and he is supported by the homes matron and her deputy Care Homes for Older People Page 22 of 26 Evidence: who are responsible for the clinical care of people living in the home. People told us through our survey that the home is well managed, and one relative commented Whenever we call at any time of night and day X is well cared for and her needs have been met. Along with the care staff the homes team includes housekeeping, maintenance, kitchen staff and an administration team. The home regularly carries out a quality survey and discusses the results with relatives at meetings. The home does not manage any petty cash for individuals. We looked at how the home manages health and safety issues and found that it has a health and safety policy statement and provides training for staff so that they work safely. There is a fire risk assessment in place, and staff receive fire training so that they know how to behave in case of fire. The home has a sprinkler system in place and uses a fire consultant to make sure that all necessary precautions to protect against fire are in place. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!