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Inspection on 29/05/08 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 29th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Evidence from the visitors book shows that families, friends, relatives and other visitors are encouraged to visit the home to ensure that regular contact is maintained. Service users we spoke with stated that they were satisfied with the care provided for them, staff are kind and that their relatives are able to visit the home at any time without restrictions. 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. Care plans are developed for individual residents and are reviewed monthly and when changes in need occur. The Home provides meaningful and stimulating activities for its residents and ensures that individual interaction is provided as a routine and as necessary. In order to ensure adequate nutrition for residents, good meals are provided and are not hurried; those who are unable to feed themselves are fed in a respectful manner. The Home provides varied meaningful and stimulating activities and outings for the service users and ensures that individual interaction is provided as a routine and as necessary. The home provides a warm, clean and comfortable environment free from unpleasant odours for the residents and ensures that adequate aids and equipment are in place to promote independence, mobility and to assist staff with meeting the needs of residents. The residents were found to be relaxed and looked well cared for in their homely environment. The Manager and staff were noted interacting with the residents in a dignified and sensitive manner. In addition, to ensure that residents are adequately protected, on-going training courses are provided for staff and stringent recruitment procedures are followed for all persons that are employed at the Home.

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 in the Annual Quality Assurance Assessment (AQAA) that home has provided a sheltered area in the garden to provide the service users with more fresh air.

What the care home could do better:

Whilst some of the standards we reviewed at this visit had positive outcomes for the individuals living in the home, there were areas of concern and these were discussed with the Home manager. We agreed that there must the kitchen must be deep cleaned to remove the stains noted under the cookers, the work tops and the dry food areas to ensure that the areas remain clean at all times in order to protect, service users staff and visitors. Whilst touring the building we noted that two toilets on the ground and top floor were used for wheelchair storage. This practice prevents access the toilets and reduces the number of registered toilet facilities to the residents. The manager told us that the home is looking into providing extra facilities for storage however residents are not using the identified toilets at present. To ensure that service users, need are adequately met, care plans must be developed after assessment and in agreement with the 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.Providing domestic staff with training on the Protection of Vulnerable Adults from Abuse would make them aware of how abuse may occur and empower them to report suspected abuse without fear of reprisal. Furthermore in order to minimise hazards and to prevent falls generic risk assessments must be undertaken to include service users bedrooms and other areas that service users have access to. Deep clean or replace the flooring noted in a service user`s bedroom to provide the individual with a comfortable environment to eliminate offensive odour. To enable registered nurses raise any issues of concerns about the care of the people living in the registered manager must ensure that adequate systems are in place for regular supervision.

CARE HOMES FOR OLDER PEOPLE Whitchurch Christian Nursing Home 95 Bristol Road Whitchurch Bath & NE Somerset BS14 0PS Lead Inspector Grace Agu Unannounced Inspection 29th May 2008 09:15 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.V361145.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.V361145.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.V361145.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 27th June 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.V361145.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes 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 seven 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 fire protection in relation to fire doors is satisfactory. 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. I met with Mrs Evans, the home manager, and the administrator. Whilst touring the building. We spoke with nineteen residents, seven staff and four relatives and a number of records were viewed. What the service does well: Evidence from the visitors book shows that families, friends, relatives and other visitors are encouraged to visit the home to ensure that regular contact is maintained. Service users we spoke with stated that they were satisfied with the care provided for them, staff are kind and that their relatives are able to visit the home at any time without restrictions. 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. Care plans are developed for individual residents and are reviewed monthly and when changes in need occur. The Home provides meaningful and stimulating activities for its residents and ensures that individual interaction is provided as a routine and as necessary. In order to ensure adequate nutrition for residents, good meals are provided and are not hurried; those who are unable to feed themselves are fed in a respectful manner. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 6 The Home provides varied meaningful and stimulating activities and outings for the service users and ensures that individual interaction is provided as a routine and as necessary. The home provides a warm, clean and comfortable environment free from unpleasant odours for the residents and ensures that adequate aids and equipment are in place to promote independence, mobility and to assist staff with meeting the needs of residents. The residents were found to be relaxed and looked well cared for in their homely environment. The Manager and staff were noted interacting with the residents in a dignified and sensitive manner. In addition, to ensure that residents are adequately protected, on-going training courses are provided for staff and stringent recruitment procedures are followed for all persons that are employed at the Home. What has improved since the last inspection? What they could do better: Whilst some of the standards we reviewed at this visit had positive outcomes for the individuals living in the home, there were areas of concern and these were discussed with the Home manager. We agreed that there must the kitchen must be deep cleaned to remove the stains noted under the cookers, the work tops and the dry food areas to ensure that the areas remain clean at all times in order to protect, service users staff and visitors. Whilst touring the building we noted that two toilets on the ground and top floor were used for wheelchair storage. This practice prevents access the toilets and reduces the number of registered toilet facilities to the residents. The manager told us that the home is looking into providing extra facilities for storage however residents are not using the identified toilets at present. To ensure that service users, need are adequately met, care plans must be developed after assessment and in agreement with the 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. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 7 Providing domestic staff with training on the Protection of Vulnerable Adults from Abuse would make them aware of how abuse may occur and empower them to report suspected abuse without fear of reprisal. Furthermore in order to minimise hazards and to prevent falls generic risk assessments must be undertaken to include service users bedrooms and other areas that service users have access to. Deep clean or replace the flooring noted in a service user’s bedroom to provide the individual with a comfortable environment to eliminate offensive odour. To enable registered nurses raise any issues of concerns about the care of the people living in the registered manager must ensure that adequate systems are in place for regular supervision. 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.V361145.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.V361145.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 home ensures that the admission processes provide safe guards to meet the assessed needs of the residents. EVIDENCE: The Home’s Statement of Purpose has detailed information about services and facilities provided at the Home. The Home also has a Service Users’ Guide, which is given to the prospective resident or their representative when they visit the Home to enable them to make an informed choice of moving to the Home. During a discussion, the Manager stated that the prospective resident and/ or their relatives is encouraged to visit the Home and interact with existing residents and receive more information about the services provided at the Home. Residents/or their relatives are informed on the day of initial visit or on Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 10 admission of the one-month trial period during which she/he can change their mind. One care file of one 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 drawn up 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. There is evidence that the home confirms in writing to the prospective service users of its ability to meet their needs. This is so that the people moving to the home are confident that care and services they will receive are what was expected. Whitchurch Christian Nursing Home DS0000020325.V361145.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): Quality in this outcome area is good. 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 it also protects residents by reviewing their health needs and good care planning. The home ensures that residents are protected through appropriate medication administration and storage. EVIDENCE: At the inspection, five care files were reviewed. There was evidence of preassessment before admission of a resident to the Home. This assessment was to enable the Home to determine whether the Home is suitable and that they are able to meet the resident’s needs. The care plans are drawn up initially from the assessed needs. Thereafter, regular reviews are undertaken and the plans updated should there be the need to do so. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 12 Evidence from the care plans seen show that residents and their relatives have been consulted whilst developing the care plans to ensure that the needs are adequately met. Thorough 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, opticians and general practitioners. Staff members spoken with had full understanding of the needs of the residents living at the home. Staff clearly identified the values that the home promotes and to be afforded to the individuals living at the home. These include Dignity, Rights and Privacy. All the care documentation and related information seen promoted good care based on the above values. 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. 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 were provided. All of the residents are allocated a key worker; staff spoken with had a clear understanding of their role and responsibilities. We sent out a document called ‘Have your say’ to the relatives of the people living at the home to tell us how they feel about the services provided for their loved ones. An example of what they told us includes “The care my mother receives is excellent. They treat her with respect and kindness. She is always clean and personal hygiene is again excellent. The home is also good in keeping me informed on how my mother is”. People living at the home told us at a discussion that they were treated with respect and were enabled to maintain their right to privacy. Staff were noted knocking on the doors and waiting for a response before going in to attend to the resident. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 13 However the inspector met one resident in the bedroom that had unpleasant odours due to their medical condition. We believe that this compromises their dignity and right to good personal hygiene. The manager stated that care plans of this individual would be reviewed and that adequate monitoring would be put in place to ensure that the person is clean and comfortable at all times. This will be the focus of next the inspection. We also discussed the care file of a person with weight loss. While the monthly weight measuring clearly identified that this person had lost weight there was no care plan noted to support staff in meeting this persons needs. The manager stated that this would be put in place and evidence that this had been implemented was received at the Commission before the report was completed. Furthermore we noted on one individuals care file that the person was complaining of pains on both legs on 11/05 /08 and was seen by the general Practitioner (GP) on 12/05/08. There was also an entry on 13/05/08 that this individual had low mood and had poor lunch. We have made a requirement for these care plans to be put in place. There was no evidence of care plan on how the pain was being managed and how staff were to support the service user in relation to the low mood that could be the reason for poor lunch. A requirement have been made Procedures for medication administration, handling, records and storage were assessed. The home had policy and guidelines on medication. A local pharmacy provides medication using a monthly monitored dosage system. A check of the blister packs indicated that medication had been administered as recorded. All medication seen was stored securely. A Medicines trolley is used to transport medication around the home. The home has a medicine fridge and temperatures are recorded daily. Controlled drugs were stored correctly and recorded in a register. A policy is available to enable residents to look after their own medicines. All medication is ordered and received by staff. The pharmacy supplies printed medicines administration record sheets each month. Records of administration of medicines were clear. Records are kept of medicines received into the home. Waste medication is recorded and disposed of via the supplying pharmacy. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 14 Staff demonstrated awareness of their responsibilities in terms of meeting the needs of a dying resident and at time of death and ensuring confidentiality of service users information. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 15 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. People who use the service’ are provided with meaningful activities and are enabled to maintain contact with families and friends. People are provided choice of nutritious meals at prefered times. EVIDENCE: Discussions with residents and staff and entries in the visitors’ book showed that the home actively supports the residents to maintain contact with families and representatives. 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. Staff said that the home had no restrictions and families’ visit whenever they like. One relative stated that they visited “every day to see my relative staff are always welcoming and cheerful. I always have a meal here everyday”. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 16 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. However some of the residents stated that the vegetables were undercooked. This was discussed with the manager to ensure that this is rectified. The manager showed the inspector the new menu provided by Southern Cross Health Care that showed a choice of two meals at lunchtime including chicken curry in order to demonstrate diversity. 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. 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 are weekly planned activities that are varied and a record of attendance is kept in individual files and used to plan future activities. A group of residents were noted in the large lounge on the first floor area on the day doing exercise and reminiscence with one of the activities person. Residents who participated in the activity stated that they always enjoyed the activities. We noted that that there are sensory lights to stimulate service users with communication problems. Other activities noted in the book include external entertainment, table skittles, gardening, Quizzes, Crosswords and one to one to include individuals who prefer to stay in their bedrooms. There is a fellowship on Fridays and the local church continues to assists with transporting residents to and from church on Sundays. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 17 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): 16,18. 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 and also displayed at the entrance of the home. Review of the Complaints book showed that no formal complaints have made since the last inspection. The Registered Manager Mrs Evans stated that she continues to hold 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 relatives responses noted on the comment card evidenced that residents are aware of whom to complain to. One relative stated, “The manager is always available to listen and clarify things when concerns have been raised”. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 18 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 training in relation to Protection of Vulnerable Adults from Abuse. We noted a copy of the South Bath and North East Somerset Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidents of abuse occur. 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. Information noted on the notice board in the manager’s office evidenced that all registered nurses working at the home had Personal Identification Number verified by the Nursing and Midwifery Council (NMC) before commencement and periodically. We looked at records of service users money with the home administrator. The is evidence of money received from service users representatives and how the money was being spent and the balance. We noted that the money in the safe was more that the amount recorded, however the administration was able to give us a satisfactory explanation why this was the case. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 19 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 an odour free room for identified service user and that the kitchen is satisfactorily clean 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. The communal dining rooms and lounges were all attractively furnished and seem well used by the residents. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 20 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 some areas in the kitchen were found unsatisfactorily unclean. For example floor areas underneath the worktops were heavily stained also the underneath the shelves in the dry food store and require deep cleaning. Furthermore we noted whilst touring the building that one service users bedroom had offensive odour. We believe that this compromises the individual’s dignity and comfort and must be addressed. We discussed these concerns with the manager and have issued requirements to ensure that the identified issues are addressed. We noted that one handling equipment being used by care staff to assist residents that could potentially cause injury to the resident and staff had been repaired. We further discussed our observation in relation to two toilets on the ground and top floor being used for wheelchair storage. This practice prevents access the toilets for service users and reduces the number of registered toilet facilities to the home. The manager told us that the home is looking into providing extra facilities for storage however residents are not using the identified toilets at present. 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. Whilst the home has an infection control policy the home must ensure that people working in the laundry receive training on the subject to ensure that service users staff and visitor are adequately protected. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 21 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 good. 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. Skill mix. Residents are provided with sufficient numbers of staff skill mix to meet their needs, adequate training is also provided to its staff to protect the residents. EVIDENCE: Evidence from staff rota and discussion with the manager showed that the home has a satisfactory staffing level to meet the needs of the residents. Residents spoken with stated that staff attended them when they rang the bell. The home operates a key working system to enhance the resident/staff relationship. However we spoke to staff and relatives whilst touring the building and. comments we received from these sources led us to believe that the home should review the staffing notice to ensure that residents’ needs are appropriately met. The Home manager reassures us that an extra care staff usually comes in 8am-2pm when the dependency of the service users is highly. Agency staff are also used when absolutely necessary to ensure continuity. The manager also Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 22 informs us that the home is advertising for new staff. There was evidence that two new staff members were recruited the day before this visit. We are satisfied with this arrangement and would be monitoring the staffing level and issue a requirement as necessary. The home operates a key working system to enhance the resident/staff relationship. The manager has developed a training matrix to enable the home to identify what courses each staff member has attended and to ensure that relevant courses are provided. The manager stated and it was evidenced that 36 staff have attended fire safety training on 18/03/08 11 staff have attended training on basic food hygiene on 23.04/08, 46 staff have attended Manual Handling training update on 7/2/08 and 12/04/08. Other training undertaking includes Protection of Vulnerable Adults from abuse, Infection Control nutrition Challenging behaviour and dementia awareness. The manager stated that future training have been planed to accommodate staff that have not attended the above training updates. Some staff members spoken with stated that they have achieved National Vocational Qualification (NVQ) at level 2 and 3. Review of records of recently employed staff members showed that statutory required documentation were in place. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 23 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): 31,32,33,25,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home benefits from good leadership, and management its practices fully protect the health and safety of service users. However regular staff supervision need to improve to provide higher standard of care for service users. 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 approachable and would listen to their concerns if any. For example one staff member stated during a discussion “ We try our best to communicate with the manager to enable her to understand the need for more staff.” Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 24 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. One service user told us on the day of the visit that the manager is nice and that they would let her know if they have any complaints. The manager told us that she is well supported by new director however she would welcome the opportunity for a one to one supervision to enable her to discuss issues that would enhance her performance in her role and responsibilities in other to meet the needs of the people who live in the home. The manager described the different ways of monitoring the quality of the services at Whitchurch Nursing Home. These include review of care plans monthly and more regular if there were increase in pressure sores at the home. Six monthly questionnaire, general audits every other month. There were also kitchen audits, three monthly drug audits, questionnaire for residents, monthly visits by the provider, staff meetings Social Services reviews, medication audits, monthly accident audit and communication book for relatives and visitors to inform the management of any concerns that they may have. There was evidence of the statutory monthly visit by the provider. The fire logbook was viewed and is well maintained. The home employs the services of a maintenance person who has a schedule for work that needs doing and when it has been completed. Staff have attended fire lectures, evidence also showed that fire alarm systems, servicing of hoists, lifts and electrical appliances were all in date. There was also a Gas inspection certificate as well as the 5 yearly Electrical Installation Safety certificate to ensure that the service users are adequately protected. We looked at accident record and we noted accident rate at the home remains high. For example there were thirteen accidents to service users in May and twelve in April. The manager told us that she is aware of the rate through the monthly accident audits and stated that this is regularly reviewed and would ensure measures are implemented in terms of risk assessments to reduce the rate in order to protect and residents from injuries. This will be the focus of our next visit. Whilst there was evidence of generic risk assessment, it was agreed that this should include the bedrooms lounges, dinning areas and other areas that service users have access to in order to minimise falls/accidents. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 25 Evidence from staff records show that staff are receiving supervision however not regularly to enable them to perform their duties effectively and deal with any areas that impacts on the care of residents. Furthermore we noted that registered nurses have not received supervision regularly to afford them the opportunity to voice their opinion on matters of concern in relation to the residents care. We discussed this with the registered manager and it was agreed that this must happen to ensure that trained nurses receive regular supervision to also enable staff to discuss any areas/issues that may be a barrier to their professional development and improving their skills to meet the needs of the people that they look after. A requirement has been made to ensure that this is implemented. This is a repeated requirement and the registered manager is reminded that failure to meet requirement may lead to enforcement action being taken. Policies and procedures at the home include, confidentiality, manual handling, health and safety, Missing persons, Protection of Vulnerable Adults from Abuse and Death and Dying. The home administrator stated that residents’ relatives deposit monies weekly or monthly for chiropody, hairdressing and outings. All documentation in relation to the monies deposited was and securely locked away. Details of findings in relation to monies deposited had been previously discussed under Standard 16. Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 26 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 3 8 3 9 3 10 3 11 3 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 X 18 3 3 3 3 3 2 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Whitchurch Christian Nursing Home DS0000020325.V361145.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(1)(2) Requirement The care plans must be developed to reflect the need of identified resident. The registered person must ensure that formal supervision sessions must be undertaken more regularly to include assessing training needs. This is a repeated requirement. Timescale for action 30/07/08 2. OP36 18(2) 31/08/08 5. OP24 13 Furthermore in order to minimise 27/10/08 hazards and to prevent falls generic risk assessments must be undertaken to include service users bedrooms and other areas that service users have access to The registered person must ensure that identified staff member receive training on infection control to enable the individual to perform their job effectively. The registered person must ensure that the flooring in identified service users room is replaced in order to eliminate DS0000020325.V361145.R01.S.doc 6. OP30 18 26/10/08 7. OP22 23(2)(c) 26/10/08 Whitchurch Christian Nursing Home Version 5.2 Page 28 unpleasant odour. 8 OP26 23 The registered person must ensure that the kitchen is be deep cleaned to remove the stains noted under the cookers, the work tops and the dry food areas to ensure that the areas remain clean at all times in order to protect, service users staff and visitors. 26/09/08 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.V361145.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V361145.R01.S.doc Version 5.2 Page 30 - 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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