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Inspection on 13/03/07 for Weir Nursing Home The

Also see our care home review for Weir Nursing Home The for more information

This inspection was carried out on 13th March 2007.

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

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

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

What the care home does well

The Management team and staff team have embraced the failings identified in the last inspection report and have worked hard to rectify them. All of the 26 requirements outstanding at the time of the last inspection (some of which were not assessed on that occasion) have been addressed. Findings made during this visit indicate that improvement within the home will be sustained.

What has improved since the last inspection?

The provider is working towards introducing systems, to address shortfalls to meet the national minimum standards at previous inspections, so that the outcomes for service users in all areas of care are improved. In particular, the management team have delivered significant change in care planning, staff recruitment, training and induction. They have liaised closely with service users and their families to discuss change and the effect it will have on the service the home provides. These areas have been managed sensitively with due regard to service user involvement. Records required by regulation for the protection of service users and for the efficient running of the business are now well maintained, stored securely, up to date and accurate.

What the care home could do better:

It is considered that this home is currently improving its performance in all areas of care. It is setting its own objectives for continual improvement which the CSCI are confident the management will sustain.

CARE HOMES FOR OLDER PEOPLE Weir Nursing Home The Swainshill Hereford Herefordshire HR4 7QF Lead Inspector Lorraine Briggs Unannounced Inspection 13th March 2007 10:00 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 Weir Nursing Home The DS0000027692.V326982.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. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Weir Nursing Home The Address Swainshill Hereford Herefordshire HR4 7QF 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) 01981 590229 01981 590445 The Weir Nursing Home Ltd Mr David Anthony Kingham *** Post Vacant *** Care Home 35 Category(ies) of Dementia (35), Dementia - over 65 years of age registration, with number (35), Old age, not falling within any other of places category (35), Physical disability (35), Physical disability over 65 years of age (35) Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. This Home provides care for residents aged 60 years and over. This Home provides specialist care for Parkinsons Disease sufferers. The home may continue to admit service users with the categories DE and DE(E) provided that dementia is not of such severity as to render such service users either, as a danger to themselves or others. 15th August 2006 Date of last inspection Brief Description of the Service: The Weir care home is situated in the village of Swainshill 4 miles from Hereford. The Georgian property is leased from the National Trust and managed by The Weir Nursing Home Ltd. It is set in attractive gardens adjacent to the Weir National Trust gardens with extensive views over the River Wye and surrounding countryside. It is a care home with nursing currently registered for a maximum of 35 service users of both sexes over the age of 60 years. Categories of care offered are physical disability; dementia and specialist care for Parkinson’s Disease sufferers. The Home was registered in 1995 and consists of a two and three-storey building. The Home has 22 single bedrooms, 15 have en-suite facilities. 5 double bedrooms of which one has an en-suite facility. There is a passenger lift to all floors of the Home. The home has a range of equipment available for moving and handling residents with physical disabilities. The current range of fees are £455.20 - £700 per week. Additional charges are made for hairdressing, chiropody, newspapers & periodicals & taxi fares. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: The Management team and staff team have embraced the failings identified in the last inspection report and have worked hard to rectify them. All of the 26 requirements outstanding at the time of the last inspection (some of which were not assessed on that occasion) have been addressed. Findings made during this visit indicate that improvement within the home will be sustained. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Weir Nursing Home The DS0000027692.V326982.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 Weir Nursing Home The DS0000027692.V326982.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 Quality in this outcome area is good. Service users have their needs assessed so that they can be assured that the service will try and provide the necessary care. This judgement has been made using available evidence including a visit to this service. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 9 EVIDENCE: Records seen and discussion with the Care Manager at the time of the inspection indicated that significant time and effort is spent making admissions to the home personal and well managed. There is a high value on responding to individual needs for information, reassurance and support. The service considers carefully the needs assessment for each prospective service user before agreeing admission to the home. Examples of assessments were within care plans viewed. The Clinical Manager ensures that a summary of any assessment undertaken through the care management arrangements is obtained and insists on receiving a copy of the care plan. Prospective service users and their family, always have the opportunity to visit and spend time in the home prior to agreeing admission. This was substantiated with discussion with service users during the inspection. Staff are prepared to visit the prospective service user and their family to get to know them and answer questions. Weir Nursing Home The DS0000027692.V326982.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 and 10 Quality in this outcome area is good. The health and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 11 EVIDENCE: Four care plans were examined. The plan in most all includes the basic information necessary to plan the individual’s care and includes a risk assessment element. The management team has worked to make the new system provide a more informed indication of care provided and progress made by individual service users. The practice of involving residents in the development and review of the plan was seen to be in with recorded evidence of service user consultation. There was recorded evidence of updating information and changing actions in the care plans. This aspect has improved with the input of staff training. Service users have access to health care services that meet their assessed needs both within the home and in the local community. Service users have access to dentists, opticians and other community services. The service users’ health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and generally is able to provide the aids and equipment recommended. There is written evidence in the care plan of health care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. Wound care is very well recorded. Waterlow risk assessments, were seen in place alongside Prideaux nutritional risk assessment tools. These were seen to be well recorded. The home has a medication policy which is accessible to staff, medication records are up to date for each service user and medicines received, administered and disposed of are recorded. Regular audits take place to monitor that practice meets policies and procedures. The management team has been working towards improvement in this area. Staff were seen to be aware of the need to treat service users with respect and to consider dignity when delivering personal care. Service users spoken to stated they were happy with the way that most staff deliver their care and respect their dignity. Weir Nursing Home The DS0000027692.V326982.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 and 15 Quality in this outcome area is excellent. Residents are able to choose their life style, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. This judgement has been made using available evidence including a visit to this service. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 13 EVIDENCE: From information seen and results of residents surveys, the home is able to enable a full and stimulating life style with a variety of options to choose from. The home seeks the views of residents through meetings and quality assurance surveys and considers their varied interests and abilities when planning the routines of daily living and arranging activities. Routines are very flexible and residents can make choices in all areas of their life. The routines, activities and plans are resident focussed, regularly reviewed, and can be quickly changed to meet individual residents’ needs. Policies, procedures and practice guidance focus on residents being in control of their life. The home employs an activities coordinator who is responsible for creating meaningful activities and experiences both in the home and the wider community. She meets with new residents and individual activity care plans are produced which review the effectiveness of activities engaged in by each person. Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them to have a drink or a meal with the resident. Residents can choose to entertain visitors in their own rooms or perhaps a lounge or garden area. The home clearly records and actions any restrictions, which the resident may make on who they wish to visit them. The food in the home is of good quality, well presented and meets the dietary needs of service users. The cook has basic food hygiene training, consults with service users and tries to meet the preferences and suggested dishes when preparing the menu. Service users are able to choose to eat in their own room if they wish. Regular drinks and snacks are available. Service users stated that the meal provision had greatly improved and a visitor was also very complimentary about this aspect of care. Weir Nursing Home The DS0000027692.V326982.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 and 18 Quality in this outcome area is good. Residents have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. This judgement has been made using available evidence including a visit to this service. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 15 EVIDENCE: The service has a complaints procedure that is up to date, very clearly written, and is easy to understand. The complaints procedure is visible within the home. Service users stated they would know who to talk to if they were concerned about any aspect of the service. There have been no recent complaints made to the home. The policies and procedures regarding protection of service users are of a high quality and have been reviewed and updated. The service is clear when incidents need external input and who to refer the incident to. Training of staff in the area of protection is regularly arranged by the home. Service users and others associated with the service state that they are very satisfied with the service provision, feel very safe and well supported by staff that have their protection and safety as a priority. Through discussion staff enable service users to understand documentation, to be aware of their rights, and to also ensure that they can access places of worship or community facilities of their choice. Staff are skilled and understand the importance of actively promoting individuals rights. Weir Nursing Home The DS0000027692.V326982.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 and 26 Quality in this outcome area is good. Residents have bedrooms that suit their needs and offer enough space for them to arrange them in a way that they prefer. The furniture and fittings supplied by the Provider are of good quality so that service users enjoy their surroundings. This judgement has been made using available evidence including a visit to this service. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 17 EVIDENCE: The home has a well-maintained environment, which provides aids and equipment to meet the care needs of the service users. It is a very pleasant, safe place to live with rooms that are personalised and individual. Many of the Service Users commented that the rural location of the home and the views of the Herefordshire countryside and river Wye were particularly important as they had always enjoyed living in the countryside. Service users can personalise their rooms. Choice of communal areas is satisfactory with lounges and separate dining rooms. There are quiet areas where service users can sit and/or entertain relatives/friends in private. There is a choice of bathing facilities, both assisted and unassisted, showers and baths and toilets strategically placed around the home. The home is well lit, clean and tidy and smells fresh. The management has an infection control policy. They seek advice from external specialists, e.g. infection control, and encourage their own staff to work to the homes’ policy to reduce the risk of infection. Weir Nursing Home The DS0000027692.V326982.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 and 30 Quality in this outcome area is good. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of service users. This judgement has been made using available evidence including a visit to this service. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 19 EVIDENCE: Service users stated that they are satisfied with that the care they receive and that staff meet their needs, but there are some times when no one is available to immediately help them. They feel that staff are receiving more training and able to deliver their care needs. Staffing rotas try to take into account the times of high and low activity. Induction programmes are in place and starting to be used with new staff, examples of which were seen. Plans for supervision and appraisals to monitor the performance of staff are in place. The service is now recognising the importance of training, and is planning to deliver a programme that meets statutory requirements. The Care Manager has identified priorities for training which has previously been lacking. Staff are more clear regarding their role and what is expected of them. The service’s recruitment procedure has improved and now meets the regulations and the national minimum standards. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by the Management team. This judgement has been made using available evidence including a visit to this service. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 21 EVIDENCE: Findings throughout this inspection indicate that the current management structure is effective. The home has policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. Systems are in place to monitor staff adherence to policies and procedures during their practice. Management processes ensure that staff receive feedback on their successes and failures through supervision and examples of this were seen recorded. The provider has improved its record of meeting relevant health and safety requirements and legislation and has introduced systems to conduct its own audit to ensure compliance with policies. Staff have been given specific areas of responsibilities. Records are of a good standard and are routinely completed. Fire records were sampled and were in order. Business planning provides a quality assurance and monitoring process through service users satisfaction questionnaires and service user meetings. The home has all the necessary insurance cover in place to enable it to fulfil any loss or legal liabilities. There is strong evidence that the ethos of the home has improved significantly and is now open and transparent with the views of both staff and residents listened to, and valued. If they wish and are able to, service users are helped to take responsibility for managing their own money. Where the home is responsible for service user’s money it works to a rigorous system. It maintains very clear records that are routinely kept up to date and can be used to track individual service users finances. Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 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 4 3 X 3 X X 3 Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 Weir Nursing Home The DS0000027692.V326982.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Weir Nursing Home The DS0000027692.V326982.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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