Inspection on 20/08/08 for Warrens Hall Nursing Home

This inspection was carried out on 20th August 2008.

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

Warrens Hall Nursing Home 23/05/09

Warrens Hall Nursing Home 11/06/07

Warrens Hall Nursing Home 05/06/06

Warrens Hall Nursing Home 07/11/05

Warrens Hall Nursing Home 09/05/05

Warrens Hall Nursing Home 10/01/05

Warrens Hall Nursing Home 14/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Warrens Hall Nursing Home 218 Oakham Road Tividale West Midlands B69 1PY Lead Inspector Sara Gibson Key Unannounced Inspection 10:00 20th August 2008 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 Warrens Hall Nursing Home DS0000004853.V371920.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. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warrens Hall Nursing Home Address 218 Oakham Road Tividale West Midlands B69 1PY 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) 01384 455202 01384 240068 starrs.p@bupa.com www.bupa.co.uk BUPA Care Homes (ANS) Ltd Brenda Essom Care Home 56 Category(ies) of Old age, not falling within any other category registration, with number (56) of places Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user identified in the variation report dated 29.7.04 may be accommodated in the category PD(E). This will remain until such time that the service users placement is terminated. 11th June 2007 Date of last inspection Brief Description of the Service: Warrens Hall Nursing home is partly purpose built. The part of the home that served as the original home is a converted farmhouse, this has been added to and converted to provide a 56 bedded home registered to provide nursing care to older people. The home is owned and managed by BUPA who have a number of other homes in the area. There are pleasant views from the back of the home over open fields, and the home has generous garden space with a courtyard patio area to the rear. There is car parking space at the front of the home. Resident accommodation is spread over three floors and has three distinct units known as Rowley, Malvern and Clent. The home offers 40 single en-suite bedrooms, 4 single without en-suite facilities and 6 double rooms. There are three lounges and two dining rooms and two passenger lifts enabling resident access to all floors. Weekly fee rates for Warrens Hall range from £439 to £630, these are subject to change and only correct at the time of this report. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 3 star. This means that the people who use this service experience excellent quality outcomes. The focus of our inspection is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The home did not know we were visiting on that day. There were thirty people living at the home on the day of the visit. Information was gathered from speaking to and observing the care people who lived at the home received, three people were “case tracked”, this involves discovering their experiences of living at the home by meeting and observing them, looking at medication and care files, and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Fifteen random questionnaires were sent out to people who live at the home in order to gain their views about the service, twelve were returned. During our visit we spoke to six people who live at the home, three staff members and two relatives. Comments received about the home were generally positive. These will be included throughout the report. Prior to the inspection the home had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements made, and plan for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. What the service does well: Warrens Hall provides a warm, friendly, welcoming atmosphere. The Manager is experienced and proactive, and leads an experienced staff team providing good standards of care for the people who live there. Standards of care practice are very good, and the staff team interact well with the residents, and understand their individual needs very well. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 6 Well-planned menus and the introduction of the 24-hour snack menu has led to improved nutrition and well presented appetising meals. The assessment carried out before admission to the home is good and the person entering this service can be sure that their needs will be met. The information about the home is clear and tells us what the service can offer and is available in different formats. There are a variety of activities that suit the people who live there and the manager ensures that all individuals are consulted and their wishes are considered in the running of this home. There is a variety of food available at all meals and a 24 hour snack menu, we were told by those people spoken with that they enjoyed the meals, and staff told us that for those who had poor appetites the kitchen staff and care staff worked together to create appetising meals. All concerns and complaints are taken seriously and dealt with quickly. All staff employed are given training in safeguarding people and how to recognise abuse. Staff spoken with were confident and knowledgeable about how to report any abuse and their responsibility in reducing the risks. The employment procedures are good and staff are given training to enable them to meet the needs of those they care for. The home is clean, comfortable and individual rooms are personalised. Each person can chose where they spend their days. What has improved since the last inspection? All the requirements made at the last inspection have been met. This is due to good leadership from the Manager, and teamwork from the staff at Warrens Hall. Care plans are much improved, enabling staff to have clear guidelines to meet individual’s specific needs. Pressure area care and wound assessment training has led to the reduction in acquired pressure sores, and prevention of further sores developing. The home has also bought pressure relieving equipment, so that each bed in the home has a Pentaflex mattress in place to further reduce the occurrence of pressure sores developing. Activities have improved with the appointment of a second activity organiser enabling all residents to have a chance of taking part in an activity of their choice. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 7 The staff training and development programme has been planned for the year, giving all staff mandatory and specialist training to enable them to increase their knowledge and ability to meet specific needs. Infection control procedures are much improved particularly in the laundry area, thereby reducing the risk of cross-infection. 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. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who may wish to use the service have detailed information about the home to enable them to make an informed decision as to whether the home can meet their needs. EVIDENCE: Warrens Hall provides comprehensive information to prospective users of the service. The information includes a statement of purpose that is specific to the home and the resident group they care for. It sets out the objectives and philosophy of the service supported by a service user’s guide. The service user guide details what the prospective residents can expect and gives an account of the services provided, the quality of the accommodation, the qualifications and experience of the staff team, how to make a complaint and inspection reports. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 10 All people living in the home had a copy of the guide to refer to if needed. The Manager said that when requested the service can provide a copy of the statement of purpose and service user guide in a format which will meet the capacity of the resident, such as large print, other languages or Braille. Trial visits are offered to prospective residents to enable them to get a feel for the home and decide if the home is suitable for their needs. Residents spoken to said they had visited before moving into the home. “I came for a day to visit before I moved in, I liked it, the staff were very nice”. Admissions are not made to the home until either the manager or social services have undertaken a pre-admission assessment. For people who are self-funding and without a care management assessment, the Manager always undertakes an assessment. The assessment involves the individual and their family or representative, and other professionals where appropriate. Three completed assessments were looked at during the inspection. All the assessments were very detailed and thorough, and covered area’s such as Communication, Lifestyle, Maintaining a Safe Environment, Mobility, Mental State, Memory, Cognition, Eating & Drinking, Elimination, Personal Cleansing, Sleeping, Medication, End of Life arrangements and Relatives expectations. In one assessment for example, under sleeping it states: “Has difficulty in sleeping due to poor pain control and symptoms of nausea. To monitor pain levels and nausea. Ensure adequate pain relief is given and symptoms of nausea are relieved”. We spoke to the person who was referred to in this assessment and they confirmed that before coming to stay at the home, the Manager had visited her, and asked a lot of detailed questions about her specific needs. She said that the care she receives is very good and she is very comfortable. The assessment also states the persons reason for admission to the home, and their past medical history, preferred name, date of birth, GP and next of kin. All the assessments seen were signed and dated, and had been reviewed in the last 6 months. From case tracking three of the people living at the home, we were able to see that the pre-admission assessments had been completed in detail, were specific to the individual and allowed a detailed care plan to be developed to meet their individual needs. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs and promotes their well-being. EVIDENCE: People living in the home receive personal and healthcare support using an individual approach. Personal healthcare needs including specialist health, nursing and dietary requirements are recorded in each person’s plan. They give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Staff said: “We get good information on new residents from the nurses, from reading the care plans and assessments, and from asking the residents what they like”. Three care plans were examined during the inspection, and these were comprehensive, detailed and contained clear guidelines for staff to follow to meet the individual needs of the person. The plans identify the assessed need, Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 12 the aim of the care to be given, and is reviewed monthly, or when needs change. The care plans are clear and inform the staff what is required to meet each person’s needs, it also gives guidance on symptoms to be looked for and what actions to take if these occur. There are risk assessments available to assist the staff in recognising where there are risk to health and well-being. From these care plans are developed to reduce the risks. One person who is nursed in bed told us “The staff are very friendly and pleasant, I am well looked after. All my needs are met, including pain control, they try very hard to make sure I don’t have any pain and that I am comfortable”. Another person told us ‘how pleased she is with the staff, that they are very friendly and helpful, nothing is too much trouble for them’ Staff work to clear guidelines when caring for individuals with palliative care needs. Care plans contain information about the individual’s wishes, choices and decisions as their health deteriorates. Staff monitor pain, distress and other symptoms to ensure individuals receive the care they need. End of life arrangements are noted and staff respect the individual’s final wishes. There is information that tells us that professionals in community are used to assist the home in meeting the needs of the people who live there. One person admitted to Warrens Hall from hospital with a large pressure sore, had a full assessment of the sore including photographs and measurements that are reviewed monthly; advice has been sought from the Community Tissue Viability nurse. A wound care assessment chart is completed at each dressing change approximately every three days. A care plan is in place to promote healing of the pressure sore and to prevent further deterioration. The delivery of personal care and support is responsive to the varied and individual needs and preferences, and is flexible, consistent and reliable. Staff respect privacy and dignity and are sensitive to changing needs. Staff said: “We always offer choice and try to do things the way the resident prefers”. The home listens and responds to individual’s choices and decisions about who delivers their personal care. It is recorded in the individuals care plan as to whether they prefer male or female care staff and we saw that it was taking place when people were receiving personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 13 Residents have access to healthcare services. Staff make sure that those who are able, are encouraged to be independent and visit local healthcare services. The health care needs of people unable to leave the home are managed by visits from health care services. The people living in the home have the aids and equipment they need, and these are well maintained to support them and the staff in daily living. From the surveys received from people living at the home prior to the inspection a theme emerged of people having to wait to be taken to the toilet, these were all people who used the hoist. They were told they had to wait as the hoist was in use. Staff confirmed that most people used the same maxi hoist and there was only one per unit, so residents had to wait. After a discussion with the Manager and staff it was realised that the staff are hoisting a resident onto the toilet, then keeping the hoist in the room until the person was ready to return to their chair, this could sometimes take twenty minutes. The Manager has now instructed the staff to hoist a resident to the toilet, then take the hoist to the next person and hoist them onto toilet, etc. There are enough slings for each resident for this system to work, and the Manager is going to monitor this procedure and ensure that people no longer have to wait. Following the last inspection the home has taken action to improve the medication administration, recording and storage. These actions include: improving the induction process for new nurses, regular competency assessments for all nurses, and medication rounds where the nurses are protected from interruptions. The recording of the receipt and administration of medicines has significantly improved since the last inspection. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home are able to make choices about their life style, and are supported to take part in social and recreational activities to allow them to maintain an active lifestyle. EVIDENCE: People using the service take part in activities within the home and in the community. The home has two part-time activity co-ordinators and they work well together to provide a full programme of activities to involve everyone living at the home. One relative said: “The atmosphere in Warrens Hall is really good now with the appointment of a new entertainments organiser. Everyone who wants to has a chance to do something every day. Some of the carers have joined in which helps relationships between everyone in the home”. Activities range from bingo and board games to art & crafts, sing-a-longs and exercises. The home is currently running a cruise ship theme visiting different countries around the world. The lounge and dining rooms are decorated to Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 15 reflect the cruise ship theme, and food, drink and entertainment are provided to enhance the theme of the country the cruise is visiting. The Manager has kept the cruise theme running to include the places where staff and residents are from including Jamaica, Poland, Russia and Thailand. Residents enjoy the cruise, and the staff really get into the theme. Staff said: “Activities have really improved for the residents” “We have good fun”. The home is also running an activity project looking at the period of history during the 1940’s. One of the lounges in the home has been themed as a 1940’s lounge would be, original items from that period have been sourced to reflect this including an iron, a gas mask, kettle, fireplace, curtains, chairs, an ironing board, and clothing including a 1940’s wedding dress. Pictures and posters adorn the walls and there is also a 1940’s history of events book. The people living at the home use the room regularly, and reminiscence activities have been developed using the 1940’s theme. Residents spoken to said they found the reminiscence sessions very interesting as it brought back a lot of fond memories of their childhood. During the inspection a number of activities were seen taking place, including individual board game playing, magazine reading, and residents chatting in small groups. A number of residents like to stay in their rooms during the day watching television or listening to music. One person said: “I like my room, it’s very comfortable and I have a lot of my own things with me to make it feel like home”. Relatives were seen visiting and were made to feel welcome by the staff. The home has an open visiting policy, and relatives visit regularly. A resident said: “My family visit me all the time and they are always made to feel very welcome”. Relatives and residents meetings are held three monthly. Letters are sent inviting the relatives to the meetings, and as a result meetings are usually well attended. Minutes of the meetings are held on file for the Manager to refer to, and they enable updates to be given on actions taken. The food available at Warrens Hall offers lots of choice, caters for varied diets including diabetic, gluten-free and vegetarian, is well presented, and enjoyed by the residents. Comments included: “The food is very good, always lots of choice” “You can have other things that aren’t on the menu that day” “They try very hard to give you what you want”. The daily menu is displayed in reception and on each table in the dining room. Cooked breakfasts, various hot and cold meal choices for lunch and tea, and a twenty-four hour snack menu ensures that residents have a diet that meets their individual needs. Staff said: “X has a very poor appetite but the catering staff speak to her daily to try and tempt her with some food, they will try any alternatives”. “Residents get good food, the menus have improved and there is lots of choice” “Where residents are having problems eating or their appetite is low due to their Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 16 health conditions, we work with the kitchen staff to offer alternatives that will appeal to the resident. Those residents have food charts to monitor what they are eating and we keep a close eye on them”. Cold drinks are available in each lounge and there is a small kitchenette where staff and visitors can make hot drinks at any time of day. Staff assist people with feeding and drinking in the dining room and in their own bedrooms. Staff were taking their time, sitting down and chatting with the person whilst helping them to eat. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People, who live in the home are able to express their concerns, have access to a complaints procedure and are confident that their concerns will be listened to and acted upon. Staff have had training to ensure people living in the home are protected from harm in the event of an allegation of abuse. EVIDENCE: The complaints procedure at the home is robust. There is a clear complaints policy on display in the home and in the service user guide, which each resident has a copy of to refer to if needed. All complaints are taken seriously, and documented in the complaints log. Since January 2008 the home has received seven complaints, all of which have been investigated and resolved. An audit of the complaints is sent to the head office each month to allow for trends to be identified and to ensure complaints are being investigated thoroughly. No complaints about the home have been received by us. People living at the home said: “I’ve got no complaints at all. I’ve never had to complain but if I did I would talk to the manager” “I’ve not had to complain at all but I would talk to the manager, she’s very nice and always has time for a chat”. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 18 The staff spoken to had a good understanding of the complaints procedure, and would report any concerns raised to the senior staff. The home has also received eleven compliment letters in the last few months praising the standard of care given to individuals at the home. One letter said that the family were very pleased with the care given to their mother during her stay at Warrens Hall. The home has a robust Adult Protection policy, and would refer any concerns to the Vulnerable Persons team for further investigation. No adult protection referrals have been made since the last inspection. All staff including the kitchen and housekeeping staff have received training in adult protection, and were aware of what to do if a potentially abusive situation arose. We put different scenarios to the staff, in relation to abuse. They were all aware that external bodies would investigate any allegations. Staff commented: “We have had lots of training on adult protection and abuse” “If we had any concerns about abuse we would go to the Manager”. Staff recruitment procedures are robust and the appropriate checks are carried out prior to the person commencing employment, safeguarding the people living at the home. People living at the home have access to their personal monies, and there is a system in place to monitor and record financial transactions for each resident, thereby ensuring an accurate account is kept and enabling an audit trail to be maintained. Residents spoken to said they could access their money at any time. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The layout of the home enables people who use the service to live in a safe and comfortable environment that meets their needs. EVIDENCE: People living at the home were happy with their environment and said they were very comfortable. One resident said: “I am very well looked after here, couldn’t ask for more”. During a partial tour of the home all the areas seen were clean and smelt fresh. Toilets and assisted bathrooms were clean and odour free, with wash hand basins complete with paper towels and liquid soap to safely manage infection control. The bedrooms are spacious, light, comfortable and had been personalised with the individuals own photos and ornaments, and in some cases items of their own furniture to reflect their personal taste, gender and culture. Bedrooms Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 20 were very well decorated with matching curtains and bed linen, and modern bedroom furniture. En-suite facilities consisting of wash hand basins and toilets were present in each bedroom, and bathroom and toilet facilities were also close to the bedrooms. All the beds in the home have special Pentaflex mattresses on them to help prevent pressure areas occurring, and where individuals have been assessed as at high risk of developing pressure sores, airflow mattresses are in place to fully support and cushion the body. Staff undertake mattress checks throughout the day to check mattresses are working properly, that they are fully inflated and that the person is comfortable on the mattress. There are three lifting hoists on each floor to enable individuals with poor mobility to be moved safely, and the main bathrooms have assisted baths to enable safer bathing. Residents were seen spending a lot of time in their rooms. Residents spoken to said: “I like being in my room with the door open, I can see people going past, I have a comfy chair to sit in and can watch television or read the paper” “ My room is very nice, I have my own things round me and can watch what I want on the television or listen to the radio” “The staff pop in to make sure I am ok and have everything I need” “I like my room, its very comfortable and I have a lot of my own things with me to make it feel like home”. Communal lounge and dining areas are spaced around the home, allowing people living at the home to socialise with each other, or have some quiet time if they prefer. The communal area’s are very comfortable and homely, and are decorated and furnished to a good standard. Dining room tables are nicely laid with matching tablecloths, napkins and condiments, and the daily menu is displayed on tables. All the homes maintenance checks are carried out as scheduled. There is a maintenance book on each unit, where staff record when repairs are needed, the homes maintenance man then completes the repairs as quickly as possible. The home has a well-tended garden area with disabled access, and is regularly used by the people living at the home and their visitors. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is sufficient staffing in the home to support the people living there. Training and supervision for staff ensures the specific individual needs of people using the service are met. EVIDENCE: Staffing levels at the home are maintained to meet the needs of the people living there. The rota was seen for the month and shows that seven care assistants plus two Registered Nurses, the Administrator and the Manager are on duty during the day. Since the last key inspection the staff group has changed, and there is now an experienced team in place. We observed staff interacting very well with the residents, giving choice, and asking questions in a friendly relaxed atmosphere. All the staff are very helpful and knowledgeable about residents individual needs, this has lead to high standards of care being given to all. Comments from people living at the home included: “Very pleased with the care received, staff are very friendly and pleasant” “I really like it here, the staff are lovely and look after us very well” “The care is very good, I have everything I need” “I am very well looked after here, couldn’t ask for more”. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 22 Robust recruitment procedures safeguard the people living at the home. Two care assistants and a nurse’s recruitment files were sampled and all the relevant checks had been carried out prior to the staff member starting work at the home. New staff undergo an induction programme based on the “Skills for Care” modules to ensure that all areas of care practice are covered, they then work with a more experienced member of staff to improve their knowledge. The culture and gender mix of the staff team reflected the culture and gender mix of the people living at the home so that care is provided in an understanding way. From talking to staff and observing them during the day it was evident that staff morale was good, and the interaction with the people living at the home was excellent. Staff spoken to said that there was a good staff team at the home and they all worked well together to achieve the best outcomes for people living at the home. Comments included: “It’s a good staff team, we all work well together” “Good support from the nurses and the manager” “We get good information on new residents from nurses, the care plan and assessments, and from asking the residents what they like” “We always offer choice and try to do things the way the resident prefers”. The staff training programme has been developed to provide ongoing training for all the staff working at the home including management, nursing staff, care assistants, kitchen staff and housekeeping. Training for all staff in the last year has included: Fire Safety, Health & Safety, Manual Handling, Food Hygiene, Infection Control, Safe Cleaning, Adult Protection, Nutrition and COSHH (Care of Substances Hazardous to Health). Other training has included: Safe Use of Bedrails, Wound Care, Drug Administration, Dementia Care, the Mental Capacity Act, Pressure Area Care, Customer Care and Activities. The Manager has introduced the Personal Best Training Programme, this is given to all staff in the home to ensure that residents receive person-centred care and that all staff aim for high standards of customer care. Staff who have participated in the first two sessions have found it very good. Comments included: “It has made me more aware of how the resident feels when they live here” “I wasn’t sure about this before I started but I am finding it really useful, it makes me more aware of the residents and their needs” “We have enough training, it helps us to do our job better, keeps us up to date on the latest techniques” “I really enjoy working here, I like caring for the residents” “Am happy to come to work, its like a family here”. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 23 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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager is experienced and possesses the skills and knowledge to oversee the day-to-day management of the home, and ensures that resident’s needs and views are responded to. EVIDENCE: The Manager has been in post for the last eighteen months, and has made a number of improvements to the service, such as, introducing new care plans and developing the staff training programme. The Manager is capable, efficient, and proactive and has a number of years experience in care. She is very knowledgeable about the residents, knows them all very well, and is open with the staff and has respect from the staff. Staff feel very well supported and managed and are very appreciative of the Manager. Comments from staff Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 24 included: “Manager is very supportive.” “Approachable manager, able to talk to her” “The Manager is excellent, very positive and encouraging.” Resident and relative meetings are held regularly and minutes are documented. Resident and relative satisfaction questionnaires are sent out and a full report on the responses has been compiled and is available in reception. The overall results show that people living at the home are very satisfied with their care. Staff meetings for the nurses, carers, catering, housekeeping, health & safety team, and the infection control team take place regularly. The Manager is very open and takes note of what the staff are saying, e.g. catering meeting suggested change in residents requesting meals, was the day before but residents then forgot what they had ordered and food was being wasted, changed to requesting on the day. Fruit and home made cakes offered with tea in the afternoon. Staff said: “We have regular staff meetings, again able to discuss anything” “Manager supportive and will listen to staff and try to put things right”. People living at the home have access to their personal monies. Finances are secure, with receipts and transactions listed. A robust audit trail is maintained. There is a well-planned staff supervision programme in place, with monthly supervisions taking place. The supervision sessions are well documented, and staff have the chance to discuss care issues, air any concerns they may have, gain feedback from their mentor and residents, and identify any training needs they may have. This further safeguards the people living at the home by ensuring that staff have the skills, knowledge and support they need to meet people’s needs. Staff said: “Our supervisions take place monthly, we feel able to discuss any issues, give opinions and suggestions to improve things for the residents”. Weekly tests of the fire alarm take place, and staff had recently undertaken a fire drill and were familiar with the procedure to follow in the event of a fire. Reports of accidents involving residents are completed, and appropriate actions are taken following accidents to ensure good outcomes for the individual. A falls report and accident audit is undertaken each month in order to reduce the risk of similar accidents occurring again. General arrangements for health and safety are good. Maintenance checks are carried out on schedule to ensure equipment is safe to use, and maintenance issues and repairs are responded to promptly. Monthly audits take place on all areas of the home from care plans to equipment checks to medication to activities. Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 25 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 3 3 3 X 3 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 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Warrens Hall Nursing Home DS0000004853.V371920.R01.S.doc Version 5.2 Page 28 - 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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