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Inspection on 28/09/05 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 28th September 2005.

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

Residents spoken with during the inspection were satisfied with their life in the home. While acknowledging that nowhere could be home, the staff work very hard to provide a personal and caring service. Residents have very regular contact with the manager who they said was approachable and would do what she could to help them. One resident said it felt like being part of a large family. Satisfaction was also evident about the meals provided. Another said that they loved the activities and that the ladies who ran that were great fun and how much they looked forward to them coming. Prospective residents have their holistic needs fully assessed so that an informed decision is made about the suitability of the admission. Health care needs are fully met and specialist advice sought where necessary. Residents` privacy and dignity is upheld. The home employs full time activities organisers who provide a lively and stimulating programme. Meals are served in the spacious dining room and choices offered. Assistance is given at an unhurried pace. The manager holds a weekly evening surgery enabling relatives to bring any concerns to her. Regular testing, drills and training for staff maintain fire safety. There is an informal and friendly atmosphere throughout the home.

What has improved since the last inspection?

This was not assessed, as it was this inspector`s first visit to the home.

What the care home could do better:

Re-decorate the downstairs corridor and dining room. Replace the carpet in the reception area. Ensure that staff start their employment only once they have a clear POVA First check.

CARE HOMES FOR OLDER PEOPLE Whitchurch Christian Nursing Home 95 Bristol Road Whitchurch Bath & N E Somerset BS14 0PS Lead Inspector Kathy Marshalsea Unannounced 28 September 2005,10.00am th 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 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 D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Whitchurch Christian Nursing Home Address 95 Bristol Road Whitchurch Bath & N E Somerset BS14 0PS 01275 892600 01275 832675 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Trinity Care (Whitchurch) Ltd Mrs Daveda Joan Evans Care home with nursing 50 Category(ies) of OP Old age (50) registration, with number of places Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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 8-Feb-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 D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted as part of the annual inspection process. The evidence was gathered by a tour of the building, observation of staff interactions, document reading, discussions with staff, some residents and the manager. The staff were very helpful with the inspection process. An activities session was also observed. What the service does well: What has improved since the last inspection? This was not assessed, as it was this inspector’s first visit to the home. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 6 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 D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 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 standard(s) 3 People wishing to move into the home have their holistic needs assessed. The home confirms whether those needs can be met. EVIDENCE: It was noted that there was a Statement of Purpose, recent inspection report and a compliments folder in the entrance area of the home. A pre-admission assessment just completed by the manager was examined. This assessment forms part of the new documentation the home is transferring to. The assessment had been completed comprehensively, giving an excellent baseline for future care planning. It also ensures that all needs have been assessed so that an informed decision can be made about the suitability of the admission. This should also ensure for the prospective resident that their needs could be met by the home. The home confirms either way to the person assessed whether the home can meet their needs. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9,10 Health and personal needs are set out clearly in the care plans. Social needs are as yet not as well documented. Health care needs are fully met and regularly reviewed. Medication systems conform to best practice, making errors unlikely. It was evident from observation and discussions with residents that they are treated with dignity and respect and choices are promoted. EVIDENCE: At the moment care plans are stored on computers and password protected. All staff have access to the records but only the trained staff can enter data. They are in the process of changing to corporate paper care plans and assessments. This new system was examined and contained detailed questions on all assessments, for example the social needs assessment, encouraging the holistic picture of each person. This includes vital information about the person and their lifestyle before they entered the care home. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 10 Meanwhile the care plans viewed for 3 residents contained very up to date and realistic plans with achievable goals. Short term problems were also recorded and reviewed appropriately. Care intervention was written in plain English and gave good detail about how to meet assessed needs. In order to meet health care needs information is gathered after admission to fully assess each person. This includes a detailed medical history, an initial assessment of the activities of daily living, pressure area risk assessment, nutritional assessment, risk assessment and manual handling assessment. This information is then updated regularly and used to form the care plan. Within the daily notes were details of changing conditions and interventions to deal with those changes. Risks were identified and steps taken to reduce these risks, and also identify when a risk could not be reduced - balancing the duty of care with promoting independence. Weights also are recorded regularly alongside the nutritional assessments for nutritional screening. Access to other health care professionals was also clearly recorded, such as chiropody visits. The manager undertakes monthly audits of accidents, wound care and dependency levels. The medication system on the upstairs floor was checked. The home uses a monitored dosage system supplied by Pharmacy Plus. The administration records provided evidence of good practice. Medication cupboards were well ordered and there was no evidence of excessive storage. Controlled drugs are stored correctly. A check of one resident’s medication confirmed that the amount held tallied with the records. These amounts are checked at each handover of staff. The home has a contract with Pharmacy Plus to dispose of their medication. There is a homely remedies policy. Checks are made of the fridge and room temperatures to ensure optimum temperatures are maintained. It is recommended that guidance is sought from the GPs, and recorded on the MAR chart, about the parameters required for any restrictions on the giving of medication, for example, the pulse rate when administering Digoxin. Staff were observed to knock and wait at residents’ doors before entering; this is good practice. Interactions observed were respectful and warm. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 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 standard(s) 12, 15 The lively activities programme satisfies most residents’ social needs. There are also arrangements for meeting religious needs. There is a choice of meals served in a pleasant and relaxing setting. EVIDENCE: The inspector watched a wonderfully lively sing-a-long session during the inspection. 21 residents were in attendance and all were actively engaged in the session. Some were using percussion instruments and most were singing. The organisers ensured that all participating were included and encouraged. They were able to offer a thoroughly enjoyable experience, offering all sorts of beneficial stimulation. There is an activities timetable posted in the entrance hall and throughout the home. There is 40 hours per week of time employed for the two activities organisers. For those unable or not wanting to join in the group sessions one to one time is spent. This is possible due to the time staff have when the activities are taking place. This is not always fully recorded. The home is to be highly commended for this commitment to providing a stimulating and interesting full time activity programme. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 12 There is a large and homely dining room. Since the last inspection the flooring has been replaced with a wooden floor which looks very attractive and is also practical. Attention to details such as tablecloths, condiments, and drinks were evident. An appetising meal was served. This was curry and rice or sausages with onion gravy. Those who needed assistance were helped discreetly and at the resident’s own pace. Teaspoons were used for this, which made the process more dignified. Soft diets were served with the ingredients served separately making it look more appetising. Residents are asked the day before which meal they would prefer, but can change their mind on the day. It was noted that there was pleasant conversation taking place between residents themselves but also between staff and the residents they were assisting. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 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 standard(s) 16, 18 Concerns/complaints are listened to and acted upon. Staff are trained in adult protection and are aware of the need to protect residents from abuse. EVIDENCE: The manager holds a weekly “surgery” enabling visitors, relatives and sometimes staff to discuss their concerns with her. The manager stated that this is very productive and facilitates an open culture for raising concerns. She is often able to sort out any problems at the time. Since the last inspection the home has received two complaints. One was from a respite resident and the other from a social worker. The social worker had contacted the Commission who had asked for the home to respond to these concerns. They did. The social worker’s manager accompanied the inspector on this inspection to follow up this case. They were satisfied with the care and response to the concerns raised. There has been training for staff in the prevention of abuse. The manager stated that this training led to informal discussion about subtle forms of abusive practice. It has led to a greater awareness of how to approach residents as individuals. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 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 standard(s) 19, 22, 26 Most of the home is well maintained. Some areas are in need of redecoration. Specialist equipment is provided where necessary. The home was clean and hygienic on the day of the inspection. EVIDENCE: The home is purpose built. The bedrooms are well designed, allowing space for furniture without any restriction on moving about. Some rooms contained personal items and looked very homely and individual. Doors to bedrooms are painted in different colours making the corridors more homely. The nameplates are quite small. It may be more appropriate for the resident to put their own picture or design on their door. The carpet in the main entrance hall needs to be replaced. Although clean, it is stained and is a disappointing initial impression. There is plenty of information for visitors to the home including a fire procedure for them. This is commended. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 15 During a tour of the building it was noted that the downstairs corridor also needs to be re-decorated to bring it to a satisfactory standard. There is a choice of lounges which are comfortably furnished. There are also informal seating areas at the ends of corridors offering choice and privacy. There are a range of aids available. These facilitate the independence of residents. Specialist equipment is also acquired for the prevention of pressure sores by pressure relieving mattresses and cushions. There are also profile and hospital beds for safe manual handling. During the inspection the domestic staff were present and all areas viewed looked clean. There were no unpleasant odours. Aromatherapy diffusers are used rather than artificial fresheners. This is commended. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 The staff team have the skills to meet the needs of the residents. There are sufficient staff on duty, including ancillary staff. Training is provided and staff are encouraged to do their NVQ training. Recruitment practices are generally robust. One staff member started their induction before having a POVA First check done. This should not happen. EVIDENCE: It was evident during the inspection that there were sufficient staff on duty to meet the residents’ holistic needs, not just their physical needs. There are sufficient ancillary staff to provide a safe and clean environment. There are skills of specialism within the trained nurse team to facilitate best practice; these staff have a particular interest in each area, such as wound care, and are encouraged to attend study days to keep their skills up to date. Currently 9 care staff have achieved their NVQ 2 training in care. The home has just arranged for 7 staff to register for this course. The recruitment records were checked for 3 staff, one very recently recruited. The records showed a robust and systematic approach to recruitment following equal opportunities guidelines. However, the most recently recruited member of staff started work before their POVA First clearance had been received. This is not acceptable practice. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 17 They had had two days of induction shadowing another member of staff before the POVA First was returned as satisfactory. Other records for this person showed that the proper procedures had been followed. The manager stated that it is not the home’s normal practice to start any member of staff before receiving this clearance. The two other staff files were satisfactory. It was noted that checks are made for trained nurses to ensure that they have an up to date PIN number enabling them to practice as a trained nurse. It was evident that the staff team work well together and have sufficient time to offer a friendly, efficient, warm and professional service. Training records were not looked at during this inspection. It was noted that there were posters for staff advertising future training events which they could subscribe to. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 38 The home benefits from the experience and qualities of its manager. There is a clear sense of leadership and direction communicated by the manager. Staff and residents are empowered to influence the way the home is run. Fire safety records are kept up to date, promoting a safe environment for the residents and staff. EVIDENCE: Mrs Evans continues as the registered manager of the home. She has been in post for three years. She is a level one registered nurse and holds a qualification in care management. Evidence gathered confirmed that there is an open and consultative approach to Mrs Evans’ management style. She makes herself available for staff and residents by walking the floors and holding her weekly surgeries. This is commended. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 19 Meetings are held and minuted for residents and staff. There was an informal and very friendly atmosphere despite the inspection being unannounced. Mrs Evans was open to suggestions and was well informed about the responsibilities of a manager. The fire log was held in the main lobby with clear signs posted with instructions for staff in case of a fire. The log was well ordered and fire safety tests recorded as being consistently tested at recommended intervals. There was also evidence of regular drills and staff training. This is done three monthly for night staff and six monthly for day staff, fulfilling the criteria for training updates. Included in the log was a recently updated residents evacuation list in case of fire for both day and night time. This is commended. It was noted that there is a visitors and relatives request book for maintenance issues by the front door. On examination it was shown that requests are met promptly. This is commended. Mrs Evans conducts informal and formal supervision sessions but stated that she does not always record these sessions. It will be necessary for this to be done as evidence that the sessions take place and are productive. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 4 COMPLAINTS AND PROTECTION 2 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 4 4 x x x x x 4 Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 29 Regulation 19(1)(4) Requirement Staff must not start employment until a satisfactory POVA First check has been received. The carpet in the reception area must be replaced. The downstairs corridor and dining room must be redecorated. Timescale for action From 28/9/05 No later than 31/1/06 No later than 28/2/06 2. 3. 4. 19 19 16 2 c 23(2)(b) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 9 36 12 23 Good Practice Recommendations To record the parameters requested by the GP for medication administration. To ensure that supervision sessions are recorded. To record one to one time spent with residents. To use personalised door signs for residents own rooms using whatever is meaningful for each resident. Whitchurch Christian Nursing Home D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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 © 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 D05 D56 S20325 WhitchurchNH V238764 280905 Stage 4.doc Version 1.40 Page 23 - 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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