Inspection on 12/08/09 for Whitchurch Christian Nursing Home

This inspection was carried out on 12th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whitchurch Christian Nursing Home 29/05/08

Whitchurch Christian Nursing Home 27/06/07

Whitchurch Christian Nursing Home 08/02/07

Whitchurch Christian Nursing Home 15/03/06

Whitchurch Christian Nursing Home 28/09/05

Whitchurch Christian Nursing Home 08/02/05

Whitchurch Christian Nursing Home 18/10/04

Whitchurch Christian Nursing Home 16/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Whitchurch Christian Nursing Home 95 Bristol Road Whitchurch Bath & NE Somerset BS14 0PS     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vanessa Carter     Date: 1 3 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Whitchurch Christian Nursing Home 95 Bristol Road Whitchurch Bath & NE Somerset BS14 0PS 01275892600 01275832675 whitchurch@trinitycare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trinity Care (Whitchurch) Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 50 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Whitchurch Christian Care Home provides nursing care for up to 50 residents over the age of 50. The home was purpose built in 1997, and is now owned by Trinity Care (Whitchurch) Ltd, part of the Southern Cross Healthcare group. Mrs Daveda Evans is the registered manager. The home is situated in a suburban position, and is easily reached by car and bus. There are 46 single and 2 double rooms. All are fitted with ensuite facilities. The accommodation is arranged over two floors. A passenger lift provides easy access to all areas of the home. There is a pleasant enclosed garden to the rear of the building. Care Homes for Older People Page 4 of 33 Over 65 50 0 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: one star adequate 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: The last inspection of this service was undertaken on 29 May 2008 and our overall judgement about the quality of the service provided for the people who live in the Whitchurch Christian Nursing Home was that people received a good service. After that inspection we planned to visit the service again within two years. In the meantime, we completed an annual service review on 19 May 2009, based on information we had in the annual quality assurance assessment (AQAA), completed by the home manager, a small number of our survey forms that were completed by people who live in the home, and an event that had occurred in the home and how this was dealt with. The AQAA is a self assessment document that focuses on how well outcomes are being met. The assessment had not been completed with much detail. The home manager was not present for the first day - the main part of the inspection. During the inspection we looked at records kept by the home, including care records Care Homes for Older People Page 5 of 33 and those that are kept in respect of the running of the home. We spoke to those staff on duty, the registered home manager and we observed the interactions between the staff and the people who live in the home. We spoke to people and asked them what it was like to live in the home. We spoke to visitors and asked for their views on the home. At the time of this report the fees for placement in the home range between 536 and 700 pounds per week. Additonal charges may be made for other services and these are detailed in the homes brochure. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 33 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 33 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 9 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information that is produced about the home and the pre-admission assessment process will ensure that placement is only offered to people whose needs can be met. Evidence: The Statement of Purpose sets out the aims and objectives of the service , the facilities available in the home, details about the manager and the staff team, the arrangements in place for ensuring that the quality of the service is maintained and the admission criteria. This statement will be referred to throughout this inspection report. A copy of the statement of purpose is kept in the main reception area of the home and is readily available for people who live in the home and any visitors. A copy of the service users guide is also kept in the main reception. This is given to people on admission and contains details about home life, what extra services are available for which there are various charges, and meal time arrangements. Each person who is admitted in to the home will be provided with a statement of Care Homes for Older People Page 10 of 33 Evidence: terms and condition. If the person is purchasing their care privately a contract for payment of fees will be set up. For those people who are funded by the local authority or the primary care trust, a schedule of payments will be set up with Southern Cross. A pre-admission assessment of need will always be completed before an offer of placement is made. The person will be visited by the home manager or another representative from the home to see whether the home is able to meet the persons specific care needs. This visit could be made to a hospital ward or the persons own home. We saw the assessment completed for one person who had recently been admitted to the home. Information is asked about personal care needs, physical well being, mental state and cognition, mobility and dexterity, diet and weight, sight hearing and communication, continence, safety and medications. We saw that specific information was recorded about the individuals needs. In addition, supporting documentation from health and social care colleagues are gathered where appropriate. These measures will ensure that the home has the necessary equipment and the staff have the necessary skills to be able to meet the individual needs of each person. The home provides placement for up to 50 people, one of the beds is used as a respite bed, providing short term care for people who then return to live in their own home. We were told that some people have used this facility and then chosen to remain living in the home on a long term basis. The home looks after people who have nursing care needs - they may be older people or young people with physical disabilities. They also look after people who have palliative care needs and are at the end of their life. Where possible, people who want to live in the Whitchurch Nursing Home are invited to visit the home and have a look around. One visitor who was visiting their relative said our daughter had a look at a lot of homes and chose this one. She made a very good choice. Another visitor said we chose the home because it is just around the corner from where we live and we can call in regularly. Care Homes for Older People Page 11 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may not get the individual care they need because care planning documentation is not always clear or up to date, but people who have end of life care needs are well looked after. There is evidence that not all people are treated respectfully. Medication systems are safe and well managed. Evidence: We looked at the care planning documentation for five people, including one person who had not lived in the home for very long, and four people who each had a range of different needs, and had lived in Whitchurch Nursing Home for a long time. Each of the plans was based upon the assessment of needs however all five had significant shortfalls that could potentially mean that the person would not receive the care and support that they required. One persons eating and drinking plan made no reference to the fact that they had very specific dietary requirements, and that their ability to feed themselves had altered. A review of the care plan had recorded this latter fact however the care plan still inferred the person could feed themselves with supervision. For another person changes in their mobility status had not been reflected in the care plan. Whilst all the plans we looked at had been consistently reviewed on a monthly Care Homes for Older People Page 12 of 33 Evidence: basis, information about changes had not been updated in the care plan. This provides a very confusing picture and has the potential to mean that people may not get their care needs met in the way that they should. Care plans for one person who had lived in the home for a number of years, had not been rewritten since their admission. It would be good practice if the needs of long term residents were reassessed on a regular basis (at least annually) and new care plans prepared. This would ensure that care plans remain a true reflection of peoples individuals needs. The plans are supported by a number of risk assessments in respect of the likelihood of developing pressure sores, nutrition, manual handling tasks, continence and falls. A dependency assessment is completed for each person however the information captured in this is not used to determine the level of assistance the person needs. No falls management plans are prepared when a person is at high risk of falls -a record of falls is not maintained for each relevant person which means that trends are not then identified. Where nutritional assessments are completed a MUST assessment tool is used - this measures body weight against height to determine the level of risk. It was not always evident what actions the nursing staff have taken when there has been a continual steady weight loss. The records for some people who were to be weighed on a monthly basis, were not complete. The manager had previously identified this shortfall in an audit completed in June, however there appears to have been no action taken. Manual handling risk assessments are undertaken which result in the level of risk being determined. Specific information regarding how a person should be moved or transferred from one place to another is recorded on a mobility care plan - these needed to contain more specific information that meets each individuals needs. One person told us that they should be hoisted from bed to chair but that sometimes the staff would move them manually. This is not good enough and places the individual and the staff at risk of injury. The registered manager must ensure that the staff team follow agreed safe systems of work, devised following robust risk assessments of manual handling tasks, at all times. We looked at how wound care is managed. The care plans for one person had been prepared two days before the first mention of the wound in the daily information records, so it was unclear when the wound had first been noticed. There was also a record made 10 days later that mattress now changed to aid healing of the pressure sore. It was recorded that this person had previously had a pressure sore on admission and needed an air mattress so it would appear that the appropriate preventative measures had not been put in place. The plans for a second person stated that the wound needed dressing every 3-5 days but on one occasion an evaluation had not been recorded for six days. We saw that the advice of specialist tissue viability nurses had been sought in some cases. Care Homes for Older People Page 13 of 33 Evidence: Daily information records are maintained for each person and in general the entries were detailed and informative. There was a record of care given and how significant medical events had been handled. A professional vistors record is kept when the GP, chiropodist, speech and language therapist and physiotherapists for example visit. We were told that most of the people who are living in Whitchurch Nursing Home are registered with the doctors at the Whitchurch Health Centre and that a GP will visit the home on a weekly basis (Mondays) and do a ward round. GPs will be asked to visit people on an individual basis as and when necessary. People and relatives we spoke with during the inspection said that they received the medical support that they needed. Those staff spoken with were knowledgeable about the health status of the people they were looking after. The home has well managed systems in place for the ordering, receipt, storage and disposal of medications. The majority of medications are supplied in a multidispensary system, and when supplies in packets or bottles are started, the date of opening is recorded. This ensures that medications are not used beyond their bestby date. Where oxygen therapy is in progress, or cylinders are being stored appropriate hazard warning signage is in place. We were told that all trained staff will be completing a medication competency assessment training pack in the near future. People spoken with during the inspection said that they were well looked after and that they generally received the support they need. Observations of the interaction between staff and people living in the home evidenced that they are well thought of and treated in a respectful, polite and courteous manner, however one person told us that some staff refer to them in a derogatory manner. This was confirmed as fact by the registered manager, and she has been asked to discuss this with the staff team. Visitors we spoke with said they were always welcomed and kept informed of what was happening. Mum is well looked after, I am happy with the help my relative gets and my wife is kept clean and always look nice. The home will continue to look after people when they are in the terminal stages of their illness and are dying, and the staff team have received training in palliative care. The home has links with the local hospice and the registered nurses are competent to administer adequate pain relief medication when required. The home has equipment to aid peoples comfort when they are confined to bed, however the instances when this equipment is required has significantly increased and the amount of equipment should be reviewed, in order for the home to be able to be able to continue providing this valuable service. Care Homes for Older People Page 14 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are arrangements for the people who live in the home to have their social care needs met in a variety of meaningful ways. People are encouraged to make choices. They will be provided with a well-balanced and nutritious diet. Evidence: The home has two designated Activities Organiser and time was spent with both of them. Information about the activities that are organised are advertised upon the activities board along with photographs of previous events. During the course of the inspection we observed a flower arranging session and a craft session. Examples of other activities that are arranged include sing-a-longs, music and relaxation, quizzes, the hairdresser, and a visit by ladies from the church who hold a friday fellowship meeting. We were aslo told that communion is arranged once a month but individual visits by church members can be arranged as necessary. Although Whitchurch Nursing Home is Chritian based, in line with their ethos they would welcome people from other faiths and would provide services that would meet with the persons expectations. The activities organisers told us they often ask people what they would like to do and will spend time with people on an individual basis in the afternoons. Coffee mornings, cream teas, fetes and festivals are celebrated throughout the year along with birthdays. Trips out have recently been arranged to Clevedon, Weston super Mare and Care Homes for Older People Page 15 of 33 Evidence: a garden centre. One person said during the inspection I look forward to the flower arranging because we also have a real good chat. People are able to choose whether to participate in activities or not and we heard people being asked what they wanted to do. People are asked what time they like to get up, go to bed and where they want to have their meals served. The manager and two senior nurses have recently attended mental capacity act (MCA), and deprivation of liberty safeguards (DOLS) training and will be cascading this information to the rest of the staff team. There are no plans to date as to when this will happen. This must be done in a timely manner so that the whole staff team are aware of when they may have to make best interest decisions for the people they are looking after. The home has a four-week rolling menu plan, offering a choice of two main midday meals. Alternatives can be provided upon request. We looked at the menus - a range of different meals are served, including red meat dishes, fish, chicken, vegetarian dishes and roast meals twice a week. People in general were complimentary about the food and felt they were offered a good choice. On the day of inspection roast pork was served - The roast dinners are the best. I look forward to wednesdays. Those people who completed our survey forms had the following comments to make - there is always a choice of dinner except on Sunday when everybody has the roast meal, the meals are usually very good and I am satisfied and sometimes the meals could do with being served hot instead of just warm. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Correct safeguarding procedures may not always be followed meaning people may not be protected from harm. The management of any concerns or complaints is haphazard and may mean that people will not have their issues addressed adequately. Evidence: The homes complaints procedure is displayed in the main reception area and is included in the service users guide. We looked at the complaints log maintained by the home manager and saw that three formal complaints have been dealt with since the last inspection. One person told us during the inspection that they had raised many complaints (there was no record of these), and that they were left feeling a nuisance. This person does not feel that the issues that have been raised have been addressed properly and that now the staff do not like me. We were told that the home manager holds weekly evening surgeries, and that in general any complaints, concerns or niggles are dealt with in an informal manner. The manager will meet with people who live in the home, relatives and other visitors and staff. Whilst this is good practice, it will not identify any trends in the issues being raised as no records are kept of the surgery meetings. The Care Quality Commission have been contacted on two occasions since the last inspection and concerns have been raised about individual staff conduct, standards of care, the manner in which the home is being run and the lack of reporting to the appropriate authorities when safeguarding issues were raised by staff in the home. In May 2009 we completed an annual service review and sent our survey forms to some of the people who live in the home. We received negative Care Homes for Older People Page 17 of 33 Evidence: comments from those who returned completed survey forms, in respect of the standards of cleaning and the food provided. Because of this we decided to bring the inspection forward so that we could check the quality of the care in the home and ensure that people were safe. Other people spoken with during the course of the inspection, felt that they could raise concerns - the girls are so hard working and always do their very best and the staff are generally very good, some are better than others and I am perfectly satisfied with things. In our opinion the home does not always view complaints seriously or take the appropriate actions to ensure that similar complaints do not reoccur. The home has a Safeguarding of Vulnerable Adults (SOVA) policy and guidance for the staff to follow if abuse is suspected, alleged or witnessed. Howevere we were told that the up to date policy is currently only available on the computer, and the policy and procedures manual contains the previous policy that has now been superceded. This is not good enough, as staff said they did not have access to the computer system. Those staff we spoke with during the inspection confirmed they had received SOVA training, were aware of their responsibilities in safeguarding people in their care and would report any concerns to the home manager. Since the last inspection a number of staff used the whistleblowing policy to raise concerns about some bad practice that they had witnessed. In this instance the manager failed to report this event following agreed No Secrets procedures and the matter was dealt with in-house. Information leaflets saying how concerns could be reported to Bath and North East Somerset Council, were now displayed in the main reception area as a result of this incident. Care Homes for Older People Page 18 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whitchurch Nursing Home is a safe and well maintained environment but it would benefit from replacement carpets and furniture. More specialist nursing beds would ensure the continued comfort of very poorly people. Evidence: The home is a purpose built two storey building with level access from the large car parking area at the front of the home. The inner front door is secured and the door bell in linked into the call bell system. Visitors to the home are able to shelter in a vestibule until the door is opened. During office hours the receptionist/administrator is on hand to open the door promptly. The administrators office, the home managers office and the main dining room lead off from the main reception area. There are stair ways and a shaft lift up to the first floor making the home fully accessible to people with impaired mobility. The corridors are wide allowing easy wheelchair access. There are several communal areas throughout the home. One large lounge room and two smaller quiet rooms, the dining room and the activity room provide sufficient space for the people who live there. One of the lounges is referred to as the church lounge and is used for the fellowship gathering each week. There are also a number of seating areas at the ends of corridors. At the rear of the home there is a very pleasant secluded garden area - there is covered seating area where people can sit outside in the sunshine.The hanging baskets and tubs have been planted out by the Care Homes for Older People Page 19 of 33 Evidence: some of the people and the activity staff. There are four bathrooms with assisted baths, two shower rooms and seven toilets located throughout the home. The carpetting in the corridors in the upstairs floor is marked, in parts heavily stained and showing signs of age - it needs to be replaced. Some of the paintwork throughout the home is in need of attention. We were told that the condition of each bedroom is assessed when it becomes vacant, and if necessary will be redecorated and/or recarpetted. Rooms will be deep cleaned after they become vacant and before new people are admitted. There are 46 single bedrooms with ensuite facitilies,and two shared rooms (one on each floor) with an ensuite and screening fitted between the beds. A tour of the home included seeing all rooms - bedrooms had been personalised and contained family photographs, pictures and small items of furniture. Some of the beds in the home are specialist profiling beds but this only accounts for about 15. These types of beds are required for people who are confined to bed or who have multiple or complex health problems. We were told that on some occasions nursing staff have to move people into different rooms so that they are able to be nursed in a suitable bed. One person commented on our survey form I really need a better bed and pillows. There needs to be a review of the number of specialist beds available, as most placements these days are for very poorly people who need a specialist nursing beds. There were no unpleasant odours noted during the inspection and the home appeared to be clean and tidy throughout. We observed the housekeeping staff working hard in the home and were told that most days there are two part time staff on duty. We were told that most of the housekeeping staff have worked at the home for many years and we found them totally committed to their role, which they achieved to the best of their ability, during the time allowed. Once a week a third member of staff will cover six hours to complete any extra tasks. There is an expectation that each persons room will be cleaned each day but this may not alway be possible if extra deep cleans are needed because of infections. Comments that we received on survey forms and during the inspection include the home is always fresh and clean, sometimes only my bin is emptied and my toilet cleaned, cleaning is daily but it is only a quick wipe round. In addition to the housekeeping staff , there is six hours of support in the laundry each day. The laundry was not visited on this inspection. A requirement was issued following the last inspection regarding the cleanliness of the kitchen area and strict cleaning schedules are now in place. The environmental health officer last visited in April 2009 and reported a well run kitchen with comprehensive records, good structure and hygiene practices. A number of recommendations were made in respect of the kitchen bin the food mixer, stained trays, and a de-staining agent for the beakers, cups and tea-pots. We were told that all but the food mixer has been Care Homes for Older People Page 20 of 33 Evidence: attended to - the food mixer is still awaiting replacement. Care Homes for Older People Page 21 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff on duty are not arranged according to the collective needs of the people who live in the home and therefore there is the potential that people will not receive the full level of care that they need. Recruitment procedures for new staff are safe but induction training is not always adequate. Training opportunities are satisfactory meaning that people will be looked after by trained carers. Evidence: The home has a number of staff in both the care and ancillary teams who have worked at the home for many many years and those spoken with were very committed to their role at Whitchurch Nursing Home. We were told that there are a number of staff vacancies but in general agency staff are not used - existing staff will cover extra shifts and agency would only be arranged as a last resort. This means that people will be cared for by staff with whom they are familiar, however this does put pressure on the staff, some of whom were very tired. The recruitment process for new staff is already in place. Staff will work on both floors and therefore will get to know all of the people who live there. One visitor said some of the staff must live here as they are always on duty. All shifts are covered by registered nurses and care assistants. The staffing rotas for four weeks were looked at and these showed that during the day there are two registered nurses plus eight care assistants on duty. Over night there is only one Care Homes for Older People Page 22 of 33 Evidence: registered nurse and four carers. We noted that some evenings there were only seven carers on shifts and staff confirmed that they do sometimes work short because of last minute staff sickness. Staffing levels are not arranged to take into account the dependency levels and care needs of the people who live in the home, rather they are arranged with a resident to staff ratio. We were told that this ratio has not been reviewed for many years and does not take in to account the fact that the people who are now living in the home, are older, or frailer, or have multiple and complex health needs. There is a process in place to determine the dependency level of each individual and this is reviewed on a monthly basis. This task is however meaningless unless it is used to calculate the number of staffing hours required to meet the collective needs of the people who live in the home. Staff we spoke with during the inspection said that peoples needs were met but we often have to work over. The following comments were made on our surveys forms - there is a shortage of carers to cope with the work, one has to wait for anything up to 30 minutes on occasions for a carer to be free to answer the bell and there needs to be an adequate staffing ratio. We were told that registered nurse rarely have the opportunity to work alongside the carers due to the tasks they have to undertake. One member of staff said she had never worked with a registered nurse since they had been employed at the home. Care staff are supported in meeting peoples daily living needs by a team of administrative, housekeeping, catering, laundry and maintenance staff. The numbers of housekeeping staff needs to be reviewed as previously referred to. We were told that approximately 62 of the care staff have either already achieved at least an NVQ Level 2 qualification (17) or are working towards the award (9). The home operates a thorough recruitment procedure and expects written application and attendance for an interview. Two written references are obtained that verify any previous experience and CRB and POVA1st are always completed prior to employment commencing. Six staff files were checked and verified these arrangements. The home provides an induction programme of training for all new recruits. We were told that the Southern Cross induction-training programme is in line with the Skills for Care guidelines. The programme includes a two day corporate induction that covers values, confidentiality, person centred approach, role as a worker, health and safety, first aid, manual handling and fire awareness. We spoke to one care assistant who had been working in the home for a while and this was their first care job - their programme had not been signed off as completed, and large sections of the programme appeared to have not been covered. This was discussed with the home Care Homes for Older People Page 23 of 33 Evidence: manager, who must ensure that all new recruits complete the induction training programme. A computer database is maintained that shows what training each member of staff has received and shows when update training is required in the mandatory courses such as manual handling, safeguarding of vulnerable adults, health and safety and fire awareness. Much of the training is provided in-house or via distance learning courses. Other examples of training attended by the staff team include wound care, palliative care, infection control and risk assessment. Those staff spoken with during the inspection said that the training opportunities were good. Care Homes for Older People Page 24 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Monitoring of standards in the home is not sufficently robust and may mean that the home is not run to the expected standards, and people may not always receive a quality service. Evidence: The Home Manager Mrs Daveda Evans has been the registered manager since 2002, having previously been the deputy manager at the home. She is a Registered Nurse, has experience in general and orthopaedic nursing, and has completed relevant management qualifications. Mrs Evans was only present for day two of the inspection. There is currently no deputy manager however she is supported by two senior nurses. The statement of purpose for the home states that Southern Cross will monitor the standards of this service by a variety of quality assurance mechanisms - these will include visits by a senior manager on a regular basis (referred to as regulation 26 visits), home assessment monitoring and customer survey. We looked at some of the monitoring audit sheets - namely care file audits and medications. According to the Care Homes for Older People Page 25 of 33 Evidence: records we saw only three care files had so far been auditted in 2009, a number of shortfalls had been highlighted during the process however there were no records to indicate that any corrective action had taken place. The shortfalls in care planning documentation were in line with what we found on this inspection. We were told that other audits had been completed but that these records were not available for inspection. We saw a medication audit that had been completed in January and one action was for all trained staff to complete the Southern Cross medication competency assessment pack by February 2009 - we were told that none of the registered nurses have achieved this to date. Monthly maintenance audits are completed but these do not get signed off by the home manager. Regulation 26 visits have not been undertaken for three months. We found sufficient evidence to prove that the quality of this care service is not being rigourously monitored and action plans are not being devised to improve outcomes. The home will be asked to prepare an improvement plan as there are many shortfalls in meeting the national minimum standards and regulations of the Care Standards Act. Southern Cross will also be asked to submit to the Care Quality Commission, on a monthly basis, a full quality assurance assessment and action plan. We will expect this action to be reviewed the following month. People can deposit personal monies with the administrator to pay for extra services such as chiropody, hairdressing and outings. Computer records are kept for each person who uses this services and all transactions in and out of the account are recorded. We were told that these accounts are regularly auditted by Southern Cross, and a statement of account is issued every month by the home administrator. All staff spoken to during the inspection said that they do not have individual supervision sessions with a senior person. One member of staff who had previosuly worked in another care home said that they were disappointed that they did not have the opportunity to talk about training or staff issues. The general view was that there was no time for staff supervision. Group staff meetings are held infrequently - there were no records available to check on the regularity of these. Notes in respects of relative and resident meetings were not available either. During the inspection safe moving and handling procedures were observed, using a variety of different aids, and with the care staff informing the person about what they were doing. However, one person told us that they were not always moved properly and that unsafe moving techniques were used . This was discussed with registered nurses and the manager during the inspection. The home manager must ensure that staff always work to the safe system of work, that has been devised following a manual handling risk assessment. Care Homes for Older People Page 26 of 33 Evidence: Where bed rails are used to maintain a persons safety whilst they are in bed, a risk assessment is not being completed prior to their use. This means that the likelihood of any additional risks being posed as a result of bed rail use has not been considered. Consent by the person themselves, or their representative, is not recorded either. This was discussed with the home manager. The home manager must ensure that a risk assessment is completed before bed rails are used and that consent for their use is gained. Monthly environmental audits are completed in respect of water temperatures, the staff call system system, hoists and the profiling beds and all wheelchairs. A new system of Check IT technology is just starting a trial in the home and all equipment is barcoded - as the checks are completed this information is recorded in a computer log. The system appeared to be working well and is also used by the night staff when they are completing their regular night time checks of people in their bedrooms. The fire log was up to date and evidenced that all the necessary checks had been completed. No other health and safety issues were raised as a result of this inspection. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15(1)(2) The care plans must be 30/07/2008 developed to reflect the need of identified resident. 2 36 18(2) The registered person must 31/08/2008 ensure that formal supervision sessions must be undertaken more regularly to include assessing training needs. This is a repeated requirement. Care Homes for Older People Page 28 of 33 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 1 7 15 Each person must have a plan of care covering all their care needs and setting out the specific action required by the care staff. Repeated requirement. This is so that care staff know how the person wants to be looked after. 13/10/2009 2 8 12 The registered person must ensure the prevention of, and management of wounds is improved. This is so that peoples welfare and comfort is promoted. 13/10/2009 3 8 12 Risk assessments and 13/10/2009 management strategies must be in place to deal with falls, manual handling tasks, and nutritional needs. Care Homes for Older People Page 29 of 33 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 This is so that staff are provided with specific information on what actions to take. 4 16 22 You must ensure that all 13/10/2009 complaints about the service are managed as stated in your complaints procedure. This is so that people can be assured that complaints are dealt with appropriately and that any trends are highlighted and corrective action taken 5 19 23 The carpet in the upstairs corridor must be replaced. This is so that the physical environment for people is pleasant. 6 27 18 There must be a review of 13/10/2009 staffing numbers on duty for each shift and this must be based upon the assessed needs of all the people who live in the home. This is so that there are adequate numbers of staff on duty to meet everybodys needs. This must be reviewed as often as is necessary. 13/11/2009 Care Homes for Older People Page 30 of 33 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 7 30 18 All new recruits must complete the induction training programme. This is so that they know the policies and procedures and what is expected of their role. 13/11/2009 8 33 26 You are required to submit regualtion 26 reports to the Commission on a monthly basis This is so we can be assured Southern Cross are monitoring the quality of this service 13/10/2009 9 33 24 You are required to submit an improvement plan to the Commission detailing how you intend to improve the service This is so we can see the measures you are taking to improve the service and the timescales that are set. 13/10/2009 10 36 18 The registered person must ensure that staff receive appropriate supervision. Repeated requirement. This is so that staff performance and training needs are monitored. 13/11/2009 Care Homes for Older People Page 31 of 33 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 11 38 13 You must ensure that staff 13/10/2009 follow agreed safe systems of work in respect of manual handling tasks. This is so that the risk of injury to people being moved and staff, is removed or reduced. 12 38 38 You must ensure that bed 13/10/2009 rails are not used unless risk assessed and consent obtained. This is so that you know that the bed rails do not pose additional risk and are an agreed part of the persons care needs. 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 1 7 The care needs of long term people should be re-assessed on a regular basis (at least yearly), and new documentation prepared. This will ensure that clear information about peoples care needs are provided. review the numbers of specialist beds available so that the home can provide adequate care for people who are confined to bed. 2 11 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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