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Inspection on 27/06/07 for Whitchurch Christian Nursing Home

Also see our care home review for Whitchurch Christian Nursing Home for more information

This inspection was carried out on 27th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Generally the home was found clean, warm, well lit and free from unpleasant odours. The atmosphere of the home was noted to be relaxed. Residents looked well cared for in their homely environment. Staff were noted to be interacting with residents in an informal, respectful, personalised and dignified manner. Prospective residents are assessed before admission to the Home and the Home ensures that a Service Users Guide is given to them to enable them to make an informed choice about moving to the Home. Residents and relatives are informed on admission about the one- month trial period to enable them to make a decision whether to stay. In order to ensure adequate nutrition for residents, good meals are provided and are not hurried. The inspector observed the residents at lunchtime and noted that those who have difficulty with feeding themselves are assisted by staff as required without compromising their independence.The Home provides varied meaningful and stimulating activities and outings for the residents and ensures that individual interaction is provided as a routine and as necessary. The home has a well-established team of trained nurses and generally a stable work force that treat the residents with respect. One comment card received from a relative states "We are pleased the home is taking care of my mother. More importantly, my mother is very satisfied with the quality of care she receives."

What has improved since the last inspection?

It was pleasing to note that most of the requirement made at the last inspection had been met. The manager stated that the home has developed new ways of working that enables care staff to concentrate on providing care and do less of the jobs that take them away from the residents. To ensure equality and diversity the home has improved in the staff training to include dementia awareness training and inclusion of equality and diversity in the induction of new staff members for better understanding of this very important topic and ensure that no individual is treated differently. The home has introduced regular deep cleaning of different places in order to improve the home`s standard of hygiene.

What the care home could do better:

To ensure that a resident`s need is adequately met, care plans must be developed after assessment and in agreement with individual concerned in a way that the individual feels that they are being listened to and confident that the home is able to meet their needs. Whilst the home provides good care to residents it was disappointing to note that one resident`s care did not reflect respect and dignity to the individual as is expected within a care setting. The home must demonstrate that other health professionals are involved in developing strategies to meet the challenging needs of an identified individual. Residents handling equipment noted with unstable wheels and a loose handle must be repaired/replaced to prevent potential injury to the residents and staff. Staff members would be enabled to perform the duties effectively if regular formal documented supervision is provided. To ensure that resident, staff and visitors are adequately protected fire doors must not be wedged.Staff must receive appropriate training that reflects the needs of residents to ensure that they have the skills and knowledge to provide care for residents with behaviour that challenges.

CARE HOMES FOR OLDER PEOPLE Whitchurch Christian Nursing Home 95 Bristol Road Whitchurch Bath & NE Somerset BS14 0PS Lead Inspector Grace Agu Key Unannounced Inspection 26th June 2007 09:30 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.V336048.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. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 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.V336048.R01.S.doc Version 5.2 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 8th February 2007 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.V336048.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit which was undertaken as a part of key inspection over ten hours to review the requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. At the last inspection ten requirements were made in relation to care planning staff supervision, training and ensuring that good standard of hygiene is maintained at the home. Other requirement notice issued included ensuring that medication practices are in line with the home’s medication policy. It was pleasing to note that the home has made efforts to ensure that most of the requirements were met. The manager stated that the home is working towards meeting the remaining requirements. At this inspection seven requirements were made in relation to various aspects of service provision. I met with Mrs Evans, the home manager, and the administrator. Whilst touring the building. I spoke with a number of residents, staff and two relatives and a number of records were viewed. What the service does well: Generally the home was found clean, warm, well lit and free from unpleasant odours. The atmosphere of the home was noted to be relaxed. Residents looked well cared for in their homely environment. Staff were noted to be interacting with residents in an informal, respectful, personalised and dignified manner. Prospective residents are assessed before admission to the Home and the Home ensures that a Service Users Guide is given to them to enable them to make an informed choice about moving to the Home. Residents and relatives are informed on admission about the one- month trial period to enable them to make a decision whether to stay. In order to ensure adequate nutrition for residents, good meals are provided and are not hurried. The inspector observed the residents at lunchtime and noted that those who have difficulty with feeding themselves are assisted by staff as required without compromising their independence. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 6 The Home provides varied meaningful and stimulating activities and outings for the residents and ensures that individual interaction is provided as a routine and as necessary. The home has a well-established team of trained nurses and generally a stable work force that treat the residents with respect. One comment card received from a relative states “We are pleased the home is taking care of my mother. More importantly, my mother is very satisfied with the quality of care she receives.” What has improved since the last inspection? What they could do better: To ensure that a resident’s need is adequately met, care plans must be developed after assessment and in agreement with individual concerned in a way that the individual feels that they are being listened to and confident that the home is able to meet their needs. Whilst the home provides good care to residents it was disappointing to note that one resident’s care did not reflect respect and dignity to the individual as is expected within a care setting. The home must demonstrate that other health professionals are involved in developing strategies to meet the challenging needs of an identified individual. Residents handling equipment noted with unstable wheels and a loose handle must be repaired/replaced to prevent potential injury to the residents and staff. Staff members would be enabled to perform the duties effectively if regular formal documented supervision is provided. To ensure that resident, staff and visitors are adequately protected fire doors must not be wedged. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 7 Staff must receive appropriate training that reflects the needs of residents to ensure that they have the skills and knowledge to provide care for residents with behaviour that challenges. 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. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The process of admission of prospective residents is, detailed and well planned to enable the residents to make an informed choice of moving to the home with the assurance that their needs will be met. EVIDENCE: A copy of the Statement of purpose was on display in the entrance hall of the home. This document contains all the required information. There is also a copy of the Service Users Guide that is clearly written in an accessible format. The staff members spoken with stated that this document is given to prospective residents and/or their relatives to enable them to make an informed choice about moving to the home. One relative spoken with during the visit confirmed that they were provided this information when they came to look round and were also informed of the four weeks trial period after admission of the individual. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 10 One care file of resident admitted recently contained pre-assessment information in relation to activities of daily living, social activities, likes and dislikes, medical history and medication. The above information is evaluated and care plans are provided on how the assessed needs are to be met. The care file reviewed contained information detailing the terms and conditions of stay at the Home. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9.10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home offers care and support to residents throughout their lives and towards the end however, it fails to protect residents by reviewing their health needs and appropriate care planning. The home ensures that residents are protected through safe medication administration and storage practices EVIDENCE: Care files kept in relation to five residents were looked at. In each case there were care plans, which reflected the assessed needs of the resident. A risk assessment had been carried out for each resident The records seen were able to give staff clear information on how individuals at the home are supported in areas of personal care as well as individual’s social, emotional and physical support requirements. These are followed up by monthly reviews and intervention as needs change. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 12 Examination of care documentation evidenced that residents are well supported with their health care requirements in order to access services. There were records of when individuals have been visited by dentist, optician’s district nurses and general practitioners. Residents spoken with confirmed this. All care is undertaken in the resident’s rooms and treatments may be carried out in the spacious treatment room. Professional visitors also meet residents in their rooms or another room if preferred. All rooms have a telephone point and there is a pay phone available. Residents are able to entertain friends and family in one of the smaller sitting rooms. Staff were noted knocking at the door and asking resident for permission to enter the residents room to assist them with personal care. All the care records seen contained pressure area risk assessment and when the residents were visited in their room’s pressure relief equipment noted in the risk assessment was provided. One resident met in the room states “ they listen to me, they answer the bell when we call. Sometimes when they are busy they come when they can. I have a choice of when I get up and when I go to bed. They respect my choice.” Another resident said, “ The girls look after me I always get the help I need, the girls are very respectful”. One comment card received from a relative states, “Since my mother has been in Whitchurch I have been pleased with the care she has received” The comment card received from the local surgery states “ A well run nursing home, run with compassion and efficiency. The staff are client centred. As their local GP practice we feel we have an excellent relationship with the qualified staff”. Whilst touring the building the inspector met a resident who was admitted four weeks ago with mental health needs with challenging behaviour and other specialist medical condition The pre-admission assessment identified clearly the needs of the individual to include anxiety pain and low mood. However no care plan was seen in the care file to enable staff to support the person in meeting the identified needs. In relation the challenging behaviour, a specialist doctor had visited to review medication; there was no involvement of Community Psychiatric Nurse (CPN) to support the home with developing strategies to meet the challenging needs of this individual. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 13 The manager stated that the person’s needs have increased since admission and would be discussing with the social worker and the individual about a more appropriate care setting where the needs will be better managed. The inspector discussed a high dependency resident met in the room whilst walking about. This person was noted with very dry mouth and tongue and unaware of their surrounding. The person’s care file evidenced a care plan relating to action to be taken to ensure adequate mouth care, however this was not happening as planned. A requirement notice has been issued for action to be taken to met the above identified needs of both individuals. A local pharmacy supplies drugs to the home in a monitored dose system. These are stored in and administered from two drug trolleys. Both trolleys were inspected and evidence of good practice was noted. Both trolleys were tidy and well organised; all the medicines were appropriately labelled for each individual resident. The Medicine Administration Records Sheets (MARS) were signed by registered nurses to confirm the receipt, administration and disposal of drugs. Control drugs were stored in an appropriate cupboard in the treatment room and required records were kept. All care is undertaken in resident’s own rooms and treatments may be carried out in the specious treatment rooms on both floors. Professional visitors may meet the residents in their rooms or another preferred room. All rooms have a telephone point and there is also a pay phone available. Staff were observed knocking at doors and asking permission to enter residents’ room to assist them with personal care. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home enables the residents to maintain contact with families, friends and the local community. It provides meaningful activities and choice in respect of meals and meal times EVIDENCE: The manager stated that the home employs to part time activities organisers. The inspector noted that residents profile and interest are recorded in their care file. There is a weekly planned activities that is varied and a record of attendance if kept individual files and used to plan future activities. A group of residents were noted in the large dining area on the day making cards with one of the activities person. One resident that participated in the activity told the inspector that they always enjoyed the activities. “It keeps us busy and entertained. Other activities noted in the book include table skittles, gardening. Quizzes and crosswords. The manager stated that there is a fellowship on Fridays and Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 15 that the local church assists with transporting residents to and from church on Sundays Discussion with the manager, staff members and evidence from the visitors’ book showed that the residents maintain good contact with families and representatives. The level of contact varies for each resident living at the home, some receive regular visitors and go out with family, and others do not. The home would contact individual’s next of kin should they need to be informed of issues, which affect the well being of an individual living at the home. Two relatives were met on the day were very complimentary about the home, both confirmed that they were always welcomed at the home during their visits and that they are satisfied with the care given to their relatives. Whilst walking around the building residents were seen spending time in their bedrooms and the communal lounges. Daily records of care and discussion with residents met in their rooms showed that residents are able to choose when to get up and retire, what to eat/drink and how they wish to be assisted with aspects of their life. The residents told the inspector that the food provided at the home is good. Lunch on the day of visit looked nutritious and smelt tasty. The cook showed the inspector the new menu provided by Southern Cross Health Care that showed a choice of two meals at lunchtime. The meal was relaxed and residents were given the meals based on the choices they made after consultation on the meals available to them. Staff provided assistance in a discrete and sensitive way. Residents who chose to have their meals in their rooms were served the food on covered dishes on a tray. One resident stated on the comment card that ‘catering is excellent particularly on special occasions for example birthdays/Christmas. The inspector was unable to inspect the kitchen on this visit however; the cook stated that the fridge and freezer temperatures were up to date. There is a cleaning schedule that is followed by kitchen staff. All kitchen staff have Basic food hygiene certificate. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 16 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): 16,17,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to complain and are confident that their complaint will be listened to. Practices at the Home ensure protection of residents from harm and abuse. EVIDENCE: The Southern Cross procedure for making and handling complaints is clearly stated in the Statement of Purpose and Service User’s Guide. Review of the Complaints book showed that no formal complaints have made since the last inspection. The Registered Manager Mrs Evans stated that she holds a weekly evening ‘surgery’ on Wednesdays to enable residents, relatives and staff to come and speak to her without formal appointment. Staff members spoken with confirmed this. Residents responses noted on the comment card evidenced that residents are aware of whom to complain to. One resident stated, “I have no reason to complain”. Staff are aware of the Whistle Blowing policy and would report any bad practices to the Manager without fear of reprisal. There is evidence of staff Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 17 training in relation to Protection of Vulnerable Adults from Abuse. More training days have been booked in July and August. Records of recently employed staff members were viewed and contained personal information and record of identity. Other statutory information to seen include two satisfactory references, record of previous employment, and satisfactory Criminal Record Bureau disclosures. Manager stated that all registered nurses working at the home had Personal Identification Number verified by the Nursing and Midwifery Council (NMC) before commencement and periodically. This information was noted on the notice board in the manager’s office. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 18 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): 19,22,25,26. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has a safe and well -maintained environment, comfortable bedrooms suitable for service users needs, however if fails to ensure that specialist equipment is safe to use. EVIDENCE: The home is purpose built and provides good all round accommodation. The single rooms are well designed and have easy access to the en-suite areas. There is room for personal items to be added without causing problems for movement in the room. The colour schemes in the home are attractive the manager stated that the organisation is in the process of reviewing the colours to enable the residents to identify their own room and orientate themselves easily within the building. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 19 The communal dining rooms and lounges were all attractively furnished and seem well used by the residents. The home was found clean, tidy and free from offensive odours. All the corridors have handrails fitted on both sides. The toilets and bathrooms had grab rails and various manual handling equipment and aids to assist the staff with meeting service users needs. However the inspector noted that one handling equipment being used by care staff to assist a resident could potentially cause injury to the resident and staff. This was discussed with the manager and the equipment was put out of use to protect the residents and staff. The manager stated that an order had been placed for purchase of a new one. It was agreed that the home must inform the Commission as soon as the new equipment is purchased. A requirement was issued for this to happen. The laundry person stated that residents and their families are encouraged to label their clothing to enable staff to identify it if it was missing. The home has infection control policy. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment process demonstrates safeguards are in place, and also ensures staff competency, adequate numbers and skill mix. However staff training do not reflect the needs of the residents. EVIDENCE: The rota was reviewed with the Home Manager Mrs Evans and it was noted that there are two registered nurses on duty during the day and one at night. In addition a ‘twighlight’ nurse works three hours between 7pm and 10 pm. There were eight care assistants from 8pm to 8am. Mrs Evans stated that the present staffing level meets the needs of the present category of residents. The rotas for the last three weekend was reviewed and it was noted that there were no occasions when the home fell short of staff. The manager stated that she would continue to make efforts to ensure that the staffing level is appropriate to the assessed needs of the residents. One resident spoken with stated that staff always attended her when she rang the bell and that they gave her as much tie as needed. The home employs separate staff to work in the kitchen and laundry and for domestic duties. There is also a maintenance person and an administrator. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 21 Review of the staff training record evidenced that have attended training in relation to fire safety, food hygiene, moving and handling dementia awareness and Protection of Vulnerable Adults from abuse. Other trainings booked include infection control in August, health and safety and POVA in July. All staff spoken with at this inspection confirmed that they have attended various training to include, Manual Handling, Control of Substances Hazardous to Health, Food hygiene and dementia. Awareness. The home must ensure that nursing and care staff attend specific training on challenging behaviour to equip them with the necessary knowledge and skills required to provide care for residents with behaviour that challenges. Records kept in relation to two recently employed staff members one registered nurse and one care staff were reviewed. In each case there was a completed application form, a confirmation of the personal identification number from the Nursing and Midwifery Council (NMC) for the registered nurse, two satisfactory references and an enhanced Criminal Record Bureau (CRB) disclosures. These were obtained before the staff members were appointed. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 22 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): 31,32,33,36,37,38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home benefits from good leadership and management however; its practices do not fully protect the health and safety of residents. EVIDENCE: Mrs Daveda Evans has been the registered manager of Whitchurch Care Home since it opened. The residents and staff spoken with on the day of inspection stated that Mrs Evans is a good manager. For example one staff member stated during a discussion “ the manager is flexible, very approachable and fair.” Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 23 Mrs Evans is the registered manager has a dual qualification as a Registered General Nurse Mrs Evans has attended various courses to assist her in training her staff to provide good care to the residents These include Palliative care training Advanced Management for Care and Yesterday Today and Tomorrow (YTT) dementia training linked with Alzheimer’s disease Society. One service user stated ‘I will go to Mrs Evans if I have any complaints’ Individual residents’ records were noted securely locked at the home along with other service information. In relation to Quality Assurance the manager stated that care plans are reviewed monthly and other monthly audits include medication audit, accident audit operations manager’s bi-monthly audit, Regulation 26 visits from the organisation, residents’ meetings and satisfaction surveys. The above information is collated and analysed to identify areas for improvement. The manager also stated that the home has an open door policy and residents, relatives, friends and other visitors approach the management at any time to talk about any issues, confidential or otherwise. Review of the accident book showed a high accident rate at the home however the manager is aware of the rate through the monthly accident audit and stated that this is regularly reviewed and measures are through the risk assessments to reduce the rate to protect and residents from injuries. Whilst it was noted that staff are receiving supervision and staff spoken with stated that they receive supervision to enable them to perform their duties effectively and deal with any areas that impacts on the care of residents. However discussion with registered nurses evidenced that they have not received supervision regularly to afford them the opportunity to voice their opinion on matters of concern in relation to the residents care. It was agreed that this need to happen more regularly to ensure that they are aware of the needs of the residents and are given the opportunity through supervision to express any areas of concern relating to their practice. The manager stated that a system has been put in place for the commencement of regular supervision of all staff. A requirement has been made to ensure that this is implemented. Home maintenance book showed that fire detection and alarms system were serviced, accidents were accurately recorded. There was evidence of health and safety checks to include water, food, fridge and freezer temperatures. There was a certificate of gas inspection certificate. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 24 While walking round the home some of the fire doors were noted wedged and some doors had door guards that could be released in the event of fire emergency. At a discussion with some staff members concern was raised in relation to fire doors without door guards. The inspector was informed that the relatives bought the door guards to enable the resident to keep the door open. This was discussed with the manager and it was agreed that she would this discuss this with the provider to ensure uniformity and adequate protection of all the residents. A concern raised by a relative in relation to the security of the front door was discussed with the manager. The inspector was informed that there is an ongoing discussion about the issue at present. The home aims to implement the best option that offers greater protection to the residents without compromising the choice of mobile and independent residents. Furthermore, one residents’ handling equipment noted with unstable wheels and loose handle that had made it potentially hazardous to the residents and staff. To ensure that the residents and staff are protected, the equipment was put out of use until repaired or replaced. The manager stated that the equipment had been serviced and there is an evidence of this, however it is still unsafe to use and the service contractors were due to come back and repair it in a few days time. A requirement notice was issued for this to be implemented. There were policies and procedures in place to include Abuse and Medication, in addition to Health and Safety. Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X 2 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 2 Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) Requirement The registered person must ensure that service users and/or their representatives must be involved in the drawing up of the care plan. These should also include social and psychological needs. Furthermore care plans must be developed to reflect the need of identified resident. 2. OP36 18(2) The registered person must ensure that formal supervision sessions must be undertaken more regularly to include assessing training needs. The registered person must ensure that other health professionals are involved in the care of identified individual. The registered person must ensure that the mouth care is given to an identified resident in a dignified manner and as written in the care plan. 31/08/07 Timescale for action 31/07/07 3. OP8 13(4)(c) 26/08/07 4. OP10 12(4)(a) 27/06/07 Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 27 5. 6 OP30 OP38 18 23(4)(d)( e) 23(2)(c) 7 OP22 The registered person must 26/09/07 ensure that staff receive training on challenging behaviour The registered person must 26/08/07 ensure that fire doors are not wedged to protect the resident in fire emergencies. The registered person must 26/07/07 ensure that the piece of equipment (Stand aid) is repaired or replaced. 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.V336048.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Whitchurch Christian Nursing Home DS0000020325.V336048.R01.S.doc Version 5.2 Page 29 - 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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