CARE HOMES FOR OLDER PEOPLE
Whitchurch Christian Nursing Home 95 Bristol Road Whitchurch Bath & NE Somerset BS14 0PS Lead Inspector
Kathy Marshalsea Unannounced Inspection 15th March 2006 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 Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 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. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Whitchurch Christian Nursing Home Address 95 Bristol Road Whitchurch Bath & NE Somerset BS14 0PS 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) 01275 892600 01275 832675 whitchurch@trinitycare.co.uk Trinity Care (Whitchurch) Ltd Mrs Daveda Joan Evans Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (50) of places Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 50 Patients over 50 years of age sickness, injury and infirmity Staffing Notice dated 06/05/1998 applies Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 28th September 2005 Brief Description of the Service: 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 en-suite 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. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and commenced at 07.30am. This was in order to observe the routines of the home and how care is delivered and organised. The staff and Manager were very helpful during the inspection. The evidence was gathered in a variety of ways including case tracking 4 residents (service users), reading documents and talking with residents and staff. Time was also spent having lunch with the residents. The inspection concluded with the Manager having feedback. What the service does well:
Residents who talked with the inspector made the following comments: “ I’m allowed to do anything”. “I’ ve made lots of friends here and the staff are kind”. “I like the ladies who do the activities, they are fun”. This inspection focused mainly on the way the care is delivered. This visit needed to be outside of normal inspection hours to observe the way the early shift was organised. It was obvious that there is a real sense of teamwork as the trained staff also assist with care delivery. They also work as a team to support each other during the shift. The routine is flexible enough to cater for individual choices while maintaining some sort of flexible routine. There is no pressure for the night staff to get some residents up to ease the morning routine. Despite this there was a calm and relaxed atmosphere throughout the morning. Some residents attended a communion service and some the art and craft class. Both were well attended. Health care needs are reported promptly and attended to in the same way by the trained staff. Mealtimes are a pleasant social occasion with most residents attending the dining room. Choices of meals are offered. Assitance with meals is given discreetly and in an unhurried manner. A recent outbreak of an infection was dealt with competently and the Environmental Health Officer commended their swift actions. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 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. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 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 Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed this time. When case tracking it was noted that comprehensive pre-admission assessments had been completed and a draft care plan available. This is commended. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,10 Care plans need to set out in detail all aspects of care needs such as emotional, social and psychological. They must be draw up with the service user themselves. The comprehensive assessment must include life profiles to enhance the holistic picture of each person admitted to the home. Service users confirmed that they are treated with dignity and respect. EVIDENCE: Four care plans were viewed in detail. Three were of good quality giving useful information about health care needs. These had been developed from excellent pre-admission assessments conducted by the Manager. They contained good quality detail of how to meet the needs, and an evaluation had taken place to gauge the action’s effectiveness. This is commended. One plan was very sensitively written with comments such as “handle with dignity and respect” and need to be patient and use tender loving care”. Two plans were of people recently admitted to the home and their plans need to be developed now and should be more holistic. This development should
Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 10 include a social, emotional and psychological plan. This ensures that holistic needs are assessed and considered. Care plans must show evidence of the resident themselves and/or their representative being involved so that the plan is personalised and meaningful to them. Life profiles should enhance the knowledge of each person admitted to the home so that all staff are ware of individuals previous lifestyle and interests. Psychological needs need to show clear strategies for dealing with those problems so that staff are consistent in their approach. Health care needs are recorded effectively with changing needs clearly described and re-evaluated within the plan and daily notes. This included the plans for pressure sores. Only one file did not have any health assessments completed. Continence assessments were also evident which is commended. Risks were assessed and realistic actions needed to minimise those risks recorded. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Most residents have meaningful occupation meeting their leisure expectations. The same expectation must be met for those residents who do or cannot join in group activities. EVIDENCE: 12.The inspector joined the activities arts and craft session. There was also a communion service being held that morning. The craft session was well attended and those service users who commented stated that they enjoy the activities. Thought must be given to those residents who cannot or do not want to join in the group activities. The inspector suggested that key worker time is used regularly to provide this quality time and continue their interests. This is particularly important for those residents who are in their rooms. The inspector met a relative who visits the home often. They stated that they are welcome at any time and that staff greet them warmly. There was also evidence that the change in their relative’s condition is reported to them promptly. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 12 The inspector joined the service users for lunch. The dining room is very spacious allowing for all who want to eat there to be able to. It was a very pleasant social occasion with many service users chatting to each other. It was noted that assistance was given on a one to one basis. This was done discreetly and sensitively, for example using long handled teaspoons. Service users spoken with confirmed that they are treated with respect and that they are able to exercise choice about their life in the home. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not inspected. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not inspected however the following were noted: The dining room has been decorated since the last inspection. It is disappointing that the organisation has not decorated the corridor despite this being a requirement at the last inspection. The action plan received had indicated that this was to be done. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Staff are mostly trained and competent to do their job. However, due to the number of residents who are suffering from dementia this training and awareness must be given to all staff. EVIDENCE: 30.Training needs were discussed with the Manager and trained nurses. The manager is using a pack from Age concern for regular informal sessions. These also include a training plan and handouts for the staff. These sessions include Pressure area care, constipation, strokes, continence, care of the dying, communication and nutrition. The manager stated that there has been very positive feedback from staff following these sessions. Staff have thought about ways for example that they could help ensure that their residents receive a balanced diet. Two of the staff have been trained to train others in Manual Handling. Both trained nurses had recently attended study days relevant to their residents. They are able to pass on aspects of these courses to the care staff as part of the handovers and as they work with them. One nurse had recently been reading about techniques, which could be used when talking to someone with dementia when they were distressed. This technique had been very successful. The inspector advised that this should be passed on to all staff and incorporated into the care plan. The staff need to be trained in the subject of dementia due t the number of residents who are suffering from this condition.
Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,36 Residents are able to influence the way the home is run. Residents benefit from staff that are supported but need to have structured one to one supervision. EVIDENCE: 33. Residents spoken with made positive comments about their care and the way the home is managed. Residents meetings are held. After the last inspection a meeting was held for them to discuss whether they wished to have personalised name pates on their door. This had been a recommendation at the inspection. The residents decided they did not. The manager also has a weekly surgery so that she can talk to residents and/or their families. The routines of the home are flexible and allow individual choices to be observed. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 17 36.The manager has not been conducting formal supervision sessions. Trained staff said that they work as a team and are able to support each other professionally during their shifts. They therefore do feel supported by their peers. Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x X X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 2 X x Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23(2)(b) Requirement Timescale for action 2. OP7 15(1)(2) 3. OP36 18(2) The downstairs corridor must be re-decorated. 30/04/06 This is a repeated requirement Service users and/or their representatives must be involved 31/03/06 in the drawing up of the care plan. These should also include social and psychological needs. Formal supervision sessions must be commenced which 31/05/06 should include assessing training needs. 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 Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 20 Whitchurch Christian Nursing Home DS0000020325.V286675.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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