Inspection on 08/02/07 for Whitchurch Christian Nursing Home

This inspection was carried out on 8th February 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Whitchurch Christian Nursing Home 12/08/09

Whitchurch Christian Nursing Home 29/05/08

Whitchurch Christian Nursing Home 27/06/07

Whitchurch Christian Nursing Home 15/03/06

Whitchurch Christian Nursing Home 28/09/05

Whitchurch Christian Nursing Home 08/02/05

Whitchurch Christian Nursing Home 18/10/04

Whitchurch Christian Nursing Home 16/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Whitchurch Christian Nursing Home 95 Bristol Road Whitchurch Bath & NE Somerset BS14 0PS Lead Inspector Kathy Marshalsea Key Unannounced Inspection 8th February 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whitchurch Christian Nursing Home DS0000020325.V309802.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.V309802.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.V309802.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 15th March 2006 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.V309802.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and conducted over two days. The Manager was present for both days and received the feedback at the completion of the inspection. Survey forms had been sent to the home for service users (residents) and relatives to complete giving their views of what the home do well and areas they could improve upon. These were also for visiting health care professionals. Information on these informed areas for the inspector to focus upon. What the service does well: Survey forms, which valued the quality of the service provided, included the following comments; “A well run Nursing Home – I have no concerns about the care provided”. “At the moment I am very happy here” “I was well pleased with the home from what I’d heard and what I found on moving in”. “All staff are willing at all times to listen to our complaints”. “I have been very happy here, staff are very good and helpful”. “I was given the opportunity to visit the home and have my lunch there. I am very happy here”. “Staff are always polite and answer questions I may ask regarding what myself and my relative ask. The staff are very friendly and helpful – the level of care is excellent”. “I would just like to say that I find all the members of staff in the home very caring and friendly”. “I couldn’t wish for a better place for my relative”. Survey forms and evidence gathered during the inspection confirm that prospective residents are given enough information before moving into the home. The home gain a comprehensive assessment about the person before they are admitted to the home, ensuring that the admission is appropriate. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 6 Healthcare needs are recorded effectively, with changing needs clearly described and re-evaluated in most instances. There is a lead nurse for care of the dying and also for nutritional needs. This ensures that up to date practices are upheld and that careful consideration is given to these important areas. For those that are able to join in there is an activities programme. There are various regular sessions of interest to the residents. Residents spoken with at lunchtime confirmed that meal times are an enjoyable social occasion. Those residents that need assistance with their meals are helped discretely and at the residents own pace. Relatives and residents can be assured that any complaints made will be taken seriously and acted upon. This is confirmed in survey forms returned to the Commission. Residents are protected from abuse by staff being trained in the area. The Manager is aware of the local policies and procedures and is clear about how to initiate them in the event of an allegation being made. The home itself is generally well maintained and many bedrooms are personalised. The beds are suitable for elderly people and able to be raised or lowered according to need. Residents benefit from continuity of care by the fact that many of the staff have been working at the home for several years, particularly the trained nurses. They are very committed to providing a high standard of care and keep themselves up to date clinically. There is also a commitment to care staff having their NVQ qualification in care, the home has achieved 70 of care staff having that qualification or equivalent. This is commended. Recruitment procedures are robust and should protect residents from unsuitable staff being employed. What has improved since the last inspection? What they could do better: Some negative comments about the home from survey forms included: “I sometimes have to wait too long to be put into a comfortable chair”. “The care assistants do not always listen and act upon what I say”. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 7 “Sometimes I have to wait a long time before someone comes in to sort me out”. “I can’t join in the activities because of my poor sight”. “The standard of meals varies, sometimes I enjoy the meals”. “Might it be possible for the bedrooms to be cleaned more often?” “More care could be taken by the laundry staff as despite garments being labelled items disappear”. “The standards of care depend upon which staff are on duty and some things are overlooked such as the cleaning and cutting of fingernails.” “I feel that the room could be cleaner, especially the bed table and the chair I sit in”. There were several answers of ‘usually’ and ‘sometimes’ to survey form questions about whether the residents receive the care and support they need and whether staff are available when they are needed. The inspector’s findings were as follows: The home’s Statement of Purpose and Service user guide need to be amended so that they give accurate information about the services the home provides and meet revised Regulations. Care plans need to be developed so that they give a holistic picture of each resident and tell staff how those needs should be met. They need to be completed with the resident and/or relatives so that they reflect their preferences and goals. The review of the plans need to occur when changes happen so that they are up to date. Wording should be positive and concentrate on promoting the resident’s remaining abilities. The risk of falls/accidents needs to be better managed. If a resident suffers a fall then the risk that poses should be re-assessed to show evidence that the risk is minimised. This was to happen from the date of the inspection. Medication practices need to improve to reduce the risk of any errors occurring. All staff need to practice the principles of care which are offering respect to all residents at all times and preserving their dignity. Staff must ask permission to enter a resident’s bedroom and not talk over them with other members of staff. Those residents who don’t join in the group activities must have social time with their key worker and this time recorded. The standard of cleanliness needs to be maintained at all times. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 8 The staffing levels for care assistants needs to increase to meet the resident’s needs. The dependency levels need to be monitored so that the levels meet these needs and admissions to the home are considered using this information. Supervision of staff needs to be regular and structured covering performance issues where necessary. Regulation 26 visits will need to show progress with the Requirements made at this inspection. Any fire training given to staff needs to be recorded to evidence that staff are regularly updated according to Avon Fire Brigade’s recommendations which are 3-monthly for night staff and 6-monthly for day staff. 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.V309802.R01.S.doc Version 5.2 Page 9 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.V309802.R01.S.doc Version 5.2 Page 10 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, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User guide need to be amended to reflect the changes in regulation. This will then give accurate and up to date information for prospective service users. The home gain a comprehensive assessment about the person before they are admitted to the home, ensuring that the admission is appropriate. EVIDENCE: Standard 1 Each prospective service user has a full assessment done by the home. They are given enough information about the home before moving in. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 11 It was noted that the Statement of Purpose was still displayed in the home. This was read by the inspector, who then discussed the contents with the manager. This document is a corporate document, therefore the home are not able to make the changes they may wish to. The Regulations about what these documents need to contain have been revised. The manager was informed of these changes. The Service User guide also needs some amendments to meet this revised regulation. This includes the qualification of staff employed. There also needs to be clarification of the area in this document stating the negative and positive points about the home. This states that this is from inspection reports, whereas actually this is from the homes’ own perspective. Prices of additional services- how much service users will have to pay needs to be clarified, as although this is mentioned in the document the actually prices are not included. There needs to be clarification regarding the registered nurse contribution to the fees and a copy of the standard contract (once amended) should be included in this document. Survey forms completed by relative and residents confirm that people are given enough information about the home before they move into the home. Standard 3 The manager continues to assess prospective service users for the home and a pre-admission assessment form is completed. Once this is done, a draft preadmission care plan is also produced. The inspector care tracked two residents who had come in for respite care, one of whom had been coming to the home for some time, the other who had only been admitted to the home 2 days previous to the inspection. It was noted in the file that social services assessments and care plans were present. This enables the home to gain a comprehensive assessment of the person before they are admitted to the home. The manager stated that she was clear about the admission criteria to the home and considers the dependency levels of the current service users in the home. The inspector met the two service users who had come in to the home for respite care. Both were satisfied with the amount of information they had about moving to the home. Both stated that they found the staff helpful and welcoming and that they settled quickly into the routine of the home. The documents of the pre-admission draft care plans and pre-admission assessment form are limited in space, this has meant that the emphasis is on peoples inabilities rather than emphasising their skills and abilities. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 12 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, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans read did not give an accurate description of service user needs and how those should be met. The plans were not holistic or accurately reviewed. Health care needs are well met and well documented. Service users need to have any risk assessed following a fall to evidence the risk is reduced. Medical practices need to be increased to promote safe practice. All staff must knock on a service user’s door before they enter their room to offer them respect and preserve their privacy. There is good awareness of end of life care and support needs. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 13 EVIDENCE: Standard 7. Five care plans were looked at in detail as part of the inspector’s case tracking process. These included, as previously mentioned, 2 residents who had come in for respite care, 2 residents who had been at the home for some time, and 1 resident who was a fairly recent admission. One resident who had come in for respite care had a pre-admission assessment and a draft care plan. There was limited information about this resident’s skills and abilities. It therefore concentrated on the help that was needed for staff to assist the person. Information about this person before they came to the home indicated that there was a risk of falls for this person. No risk assessment was present to evidence that the home were reducing the risk of falling during their stay at the home. The other resident who had come in for respite care had been coming to the home for some time, making some of the documentation a little unclear due to some documents not holding dates. Some important information like planning for this person’s medical condition of diabetes, and the fact that they had chosen the home particularly so that their religious beliefs could be met, had not been mentioned in their care plan. A care plan for a resident who had been at the home for some time had no social profile. This was particularly important for this resident who was now bed bound due to increased frailty and at risk of social isolation. There was also no plan for the fact that this resident had been put on medication for their depression recently. There was confusing information in the plan about whether this resident needed to have bed rails fitted to the bed for their safety. There had also been very irregular reviews of the care plan and associated health care assessments. Another care plan looked at was for a resident who had been at the home for some time. There was no care plan for a medical condition which was a primary need for this person, and also for their dementia care. There were also no social interests noted in the care plan or indeed in the review of that care plan. There were some unrealistic actions needed to try and minimise the risk of falls for this resident. This included ‘constant surveillance’ which was not achievable, as one-to-one nursing had not been offered. Negative and inappropriate wording had been used for the fact that this resident was very active in the home. Staff had used the expression Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 14 ‘wandering’ as a negative problem rather than an expression of need. There were not dates on risk assessments for this resident being very active, one of which included them trying to leave the home. Staff spoken with were using different tactics to those actually mentioned in the risk assessment. There were also similar negative connotations of this resident being active in the daily notes. On a positive side, there were lots of entries in the daily notes and the activities record for the amount of social activities that this resident had been included in. The final care plan was more detailed and more holistic. Mention had been made of this residents social preferences and previous interests. It would be useful for this now to be reassessed and add more details to it and also for an end of life care plan to be included. There was evidence that 6 monthly reviews are held with a resident where appropriate and also their family or representative and the care plan discussed. This was confirmed by some relatives met during the inspection and from the survey forms returned to CSCI. Life profiles are still not present in care files so that the holistic picture of each person is not gained. Any psychological needs need to show clear strategies for dealing with those problems so that all staff are consistent in their approach. Standard 8. Healthcare needs are recorded effectively with changing needs clearly described and re-evaluated in most instances. Various healthcare assessments are obtained for example, pressure area risk assessments, manual handling assessments and general risk assessments including the likelihood of falls. The daily notes for each service user gave a lot of information about the current medical status of each person. The inspector talked with the lead nurse for nutrition within the home. After the nutritional assessment is done on admission, this is regularly reassessed and weights are recorded either weekly or monthly depending on the need of the service user. Nutritional supplements are used regularly and there are a variety of these for each person. The incidents of pressure sores, their treatment and the outcome of this treatment, are recorded in the service users care plan, and are reviewed on a regular basis. There is equipment present in the home for the promotion of healthy skin and the prevention of pressure sores. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 15 Continence assessment were also in place in each service users folder. Service users are able to register with a GP of their choice within the vicinity. The home has a regular weekly surgery from a GP who is paid a retainer to do this. Records are kept within each service users file of these visits. There was also evidence within the file of service users being able to have access to specialist medical treatment such as psychologists, psychiatrists, dental services, chiropody and ophthalmic services. The inspector met an acupuncturist who had been employed by a service users family to come in to the home. The accident records were checked for the previous month. Two residents had more than one fall in January 2007. The inspector checked the records for these 2 residents. Despite the fact that they had more than one fall recently, there had been no re-assessment of their risk of falling again or any instructions for staff regarding different strategies for reducing the risk. Both care plans had been reviewed for January 2007, but no further information was given in the care plan about the type of falls, what the risk might be and how that risk could be minimised. The inspector left an immediate requirement notice that from the first day of the inspection, the 8th of February 2007, any service user suffering a fall / accident, had to have this reassessed and evaluated to minimise any potential risk to the resident. Standard 9. Medication records were checked for the downstairs floor. The medication administration charts showed some errors, these were omissions of signatures of staff administering medication, and also come confusing information about when dosages had been changed and that not being clarified. One of the registered nurses was able to explain these discrepancies to the inspector and agreed that these needed to be clarified on the charts. The nurse and the inspector agreed that in one instance this needed to be referred to the GP so that the changes could to be made by him. There was some evidence of good practice, for example there were photographs of each resident on their drug administration chart, and examples of the RGNs signatures held so that any discrepancies could be matched to the RGN. Standard 10. While the inspector was talking with two residents in their room staff entered without knocking, or asking the residents permission, to give out returned laundry. The inspector also observed doing this happening in other residents rooms. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 16 One resident told the inspector that the staff were often disrespectful when giving them care or taking them from one place to another. The disrespect showed itself in the staff talking about their personal lives with each other and not talking to the resident themselves. This resident felt a little fearful talking about this to anyone for fear of any consequences for them in doing so. With their permission this information was passed on to the manager. Other interactions observed during the inspection were respectful and warm. This was particularly so in the dining room while staff were assisting those residents that needed it, with their meal. Standard 11. The home cares for people who come into the home for palliative care. The inspector talked to the lead nurse for this subject. They receive regular training from one of the local hospices to keep themselves up to date with current practice and are then able to teach the staff. This particularly includes pain relief, the staff are experienced at the different methods of administering this and monitor the effectiveness of analgesia used. The home offers good support for the families during this difficult time. Families are encouraged to participate where they can and spend as much time with the resident as is possible. The nurse also recognised the need to offer some support to the staff, particularly when a long term resident has passed away. Individual religious needs are recognised and met. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 17 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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The activities co-ordinator offers a varied activities programme. For those residents who can’t or don’t join in, one to one time must be spent with them and recorded. There is an open culture of visiting in the home. Some improvements to how food is served are needed. EVIDENCE: Standard 12. The home employs two activities co-ordinators who job share. This means that from Monday to Friday from 8.30am to 3pm there are various activities being held within the home. These sessions include religious fellowship and communion, exercise classes and relaxation classes, doing puzzles and board games, table skittles, popular bingo sessions, word games, musical entertainment, artwork, flower arranging Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 18 and there have been visits to local garden centres, shops, horseworld and some residents attend local churches. Two residents spoken with said how much they enjoyed the activities and how much they liked the activities ladies. A record of activities participated in is kept in each residents file. For those who choose not to join in or can not join in these sessions, the activities ladies go round daily to speak to each person individually. The inspector spoke to one activities person who said that in the afternoon they try and spend time with people who are in their rooms, and therefore at risk of being socially isolated. It was agreed that this needed to be enhanced by care staff too and include weekends when the activities organisers don’t work. Due to the size of the home the giving of pleasurable social time needs to be embraced by all staff to ensure that all residents receive the time they would like. The inspector asked about trips provided, as a couple of residents had stated that there are less than there used to be. The inspector was told that there was no driver for these activities at the moment, and also that some residents had become increasingly frail and more dependant, making it more difficult to go out. They are hoping that when the weather is better and another driver is found that they will start going out on trips again. There have been some one to one trips in the activities co-ordinator’s car and also sometimes during the better weather, there are walks over to Asda. Unfortunately there has not been formal time for key workers to spend with their residents at the moment, this was discussed with the manager. It was agreed that this was important to formalise and record to provide evidence that this happens. Standard 13. Visitors to the home confirm that they are able to visit at any reasonable time. The inspector noted that the visitors book that she herself completed, was filled during the day with lots of entries. The inspector met and talked to some relatives who visited the home quite frequently. Standard 15. Comments about the meals provided in the survey forms completed were not entirely positive. Most commented that they usually or sometimes liked the meals provided. Residents spoken with confirmed that they are able to choose the meals provided and this is asked for the day before. There is a spacious dining room enabling all residents who are able to eat there, although some choose to eat in their rooms. Despite the fact that there Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 19 are a large number of residents who needs assistance with their meal, residents were helped discreetly and still at the residents own pace. The process was made more dignified by the use of teaspoons and long-handled small spoons. Those residents who need to have a soft diet had this served with the ingredients pureed separately making it look more colourful and appetising. There was a lively buzz of chatter in the dining room during the meal. Staff spoken with stated that the reason they are able to deliver meals in a timely way is due to them being organised and working as a team. One resident did comment to the inspector that “I am left when they are feeding me sometimes” and felt fed up about that as when the member of staff returned the meal was cold. This information was passed on with the resident’s permission to the manager. Comments and survey forms about the meals needing to be hotter had already been noted by the home during their own surveys and this had already been remedied. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 20 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. Complaints are taken seriously and investigated. Staff are trained in the subject of abuse and have policies and procedures to support them. EVIDENCE: Standard 16. Complaints were discussed with the manager. She still holds a weekly evening surgery enabling visitors, relatives and sometimes staff to discuss any concerns with her. She stated that this is always a busy surgery and hopes that this facilitates an open culture for raising concerns, and feels that she is always able to sort out minor problems before they become a major problem. There had been two major complaints since the last inspection, one of which the inspector had been informed about by another agency. The inspector had been sent a copy of the manager’s investigation, which was comprehensive and identified some training issues for some staff. However, the major concerns noted had been from a member of staff who had left the homes employ recently. This member of staff’s file was checked and it was noted that there had been some concerns about this persons conduct, disciplinary meetings had already been held and arranged. Unfortunately due to the staff Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 21 member delaying some of these meetings, this has not happened as promptly as the manager would have liked. The manager stated that she encourages staff to advocate for the residents in their care. This is particularly so for those residents who may not have many visitors or relatives and also whose communication is limited. It was noted that in the entrance area of the home there are various leaflets, one of which includes and advocacy service which could be used. The complaints procedure is displayed in the entrance area of the home and is also in the Statement of Purpose and Service User guide. Standard 18. The manager stated that although there had been no allegations of abuse since the last inspection. Staff had received training in this area last year. The manager was able to give an example of where staff had initiated the Whistle Blowing policy for another member of staff who was not performing as per the home’s policies and procedures. The manager is aware of the local adult protection policies and procedures and would initiate them if the need arose. Restraint is not used commonly throughout the home and in fact the home has an open door policy. However visitors to the home are not able to walk in freely. Bedrails are used in some instances and this is subject to consent being gained and a risk assessment being completed. This should be reviewed regularly. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 22 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 - 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained. Domestic staff need to be supervised more effectively to maintain standards of hygiene. EVIDENCE: Standards 19-26. There were two areas of concern eg the cleanliness of rooms and problems with the laundry that had been mentioned in survey forms. These had been discussed with the manager. The manager stated that she needs to meet with the domestic staff every 3 months or so to remind them that standards need to be improved and then maintained. The inspector suggested that she Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 23 needed then to meet with them 2 monthly and include supervision of these staff if there are still problems. The manager agreed that this might be a good idea. One relative and one resident stated that they weren’t happy always with the cleanliness of the room particularly the chairs and bed tables which weren’t cleaned properly. Other comments and survey forms remarked on laundry not being well organised and some labelled clothing being put in the wrong wardrobes, this information was also passed on to the manager. The home is a purpose built building and contains 46 single rooms with ensuite facilities and 2 double rooms with en suite facilities. As mentioned previously there is a large airy and homely dining room with three day rooms. There are 4 bathrooms and 2 showers and plenty of assisted toilets. The corridors are wide allowing easy wheelchair access. The home is generally well maintained, and it was noted that the previous requirement at the last two inspections for the downstairs corridor to be repainted, had now been met. It was noted on a tour of the building that many bedrooms are personalised and contain lots of mementos. All of the beds in the home are suitable for elderly people and are able to be raised or lowered according to need. Thee beds also have integral bed rails. It was noted that still the name plates on bedroom doors are small and may be difficult for some residents to read and recognise their own room. The inspector sat with one resident upstairs at the end of a corridor. This resident said that she found it very confusing to find their way around the building. Thought needs to be given for those residents that suffer from Dementia, and how they can recognise where they are, and importantly recognise their own bedroom. There were no unpleasant odours noted during the inspection and the home still uses aromatherapy diffusers throughout the home. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 24 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. Staffing levels were not meeting the levels of dependency in the home. Service users are supported and protected by the home’s recruitment policy and procedures. Staff receive sufficient training so that they should be competent to do their job. This is supported by a high level of NVQ achievement: however, the induction process is basic and does not include the National Training Organisation’s recommendations. EVIDENCE: Standard 27. Survey forms commented that in some instances there does not appear to be enough staff on duty and also they have to wait a long tome for the buzzers to be answered. It was noted during the inspection that call bells did take a long time to be answered. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 25 On the second day of the inspection, the inspector rang a call bell for a resident she was talking to. It took quite some time for this buzzer to be answered despite the fact that this was a quiet time in the afternoon. As the inspector went to go and get a member of staff, one came up from downstairs. When the inspector went downstairs, there was 3 staff in the office looking at off duty rotas and not attending to 3 other call bells which had now been ringing for some time. The staff were prompted to answer the bells, and the manager informed about this. The trained nurses spoken with, all stated how much the dependency of the home had increased since the last inspection and this had been fairly acute about 2 weeks before the inspection. This has impacted on the time that they, and the care staff, are able to spend with residents. They also stated that this has affected staff morale. This was discussed with the manager in some detail. Two registered nurses are on duty from 7am to 7pm. There is then an additional twilight registered nurse who is on duty until 11pm, and one between 11pm and 7am. Rotas indicated and staff confirmed that there are 8 care assistants on duty between the hours of 7am and 7pm. However the 8th care assistant is deployed to do tasks such as giving out drinks, dealing with the teas and coffees and ensuring that all residents have plenty of fluids, not only offered to them, but actually ensuring that these drinks are completed. This was discussed with the manager. It was agreed and indeed the manager had said that this had been discussed at a recent meeting, that the deployment of a carer for dealing with fluids, although worthwhile, could actually be performed by a kitchen assistant. It was agreed with the manager that this needed to be altered as soon as was possible in order to give another pair of hands out on the floor delivering care. This will be monitored at future inspections. The registered nurses who work at the home are named nurses which means they are responsible for doing the care plans for their designated residents, in this instance the full time nurses are responsible for roughly 8 residents each. All the trained nurses spoken with stated how difficult it is to keep the care plans and associated assessments up to a high standard, while actually delivering care on the floor for some very dependant residents. At the moment they are trying to take themselves off the floor in turn so that they can actually update their care plans. All of them agreed that it would only take approximately 2 hours per week per registered nurse to actually keep their paperwork up to a good standard, and provide evidence of a good practice that is evident throughout the home. Standard 28. The manager stated that 70 of care staff have their NVQ certificate or equivalent. Some staff are now going to go on to completed their Level 3 certificate. This is commended. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 26 Standard 29. The inspector checked the recruitment records for the three most recently recruited members of staff. These were for 1 trained nurse and 2 care assistants. The 2 care assistants started their employment in January 2007. These records show that there is a thorough recruitment in place, which ensures the protection of service users. Application forms seen were completed in full. Two written references are obtained, and new staff only start after a satisfactory police check is returned, and there is also sufficient proof of identity. There are also health questionnaires, a job description and an interview checklist which confirms equal opportunities. For the registered nurse there is also confirmation of their registration with the Nursing, Midwifery Council. Standard 30. The inspector looked at the induction records that each new member of staff complete. This is a fairly basic document which does not meet the National Training Organisation workforce training target, and will not ensure that staff trained on the principles of care, safe working practices, and the experience and particular needs of the resident group. It also does not show evidence of questions put to the new member of staff, and whether their answers fulfilled a common standard. This was discussed with the manager who is intending to complement this by using the Pathways to care, Common Induction Standards. These standards can be photocopied and will give the detail missing in the Southern Cross programme. They contain principles of care related standards. The manager remains committed to providing training for her staff, and also for keeping herself updated. Training records for 3 members of staff plus the manager were checked by the inspector. These records confirmed that staff are provided with mandatory training. The records for one registered nurse showed that this nurse had also in 2006, been able to update themselves in various topics related to the client group. These included palliative care, medicines, end of life care, and dementia. 2 of the registered nurses are the lead nurses for end of life care and attend a local hospice and update themselves 4 times per year with current practice for care of the dying. Some of the care staff had received training in dementia care. Trained nurses spoken with said that they thought this had had a positive outcome, and had noticed that staff seem to be more aware of the needs of people with dementia, and how the condition effected their behaviour. This has enabled the staff to act more appropriately and according to best practice. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 27 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, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has enough experience to run the home. The views of the service users are sought so the home should run in their best interests. The results of the quality assurance surveys need to be published. Service users’ financial interests are safeguarded. The health, safety and welfare of service users and staff are promoted and protected, but there must be written evidence of fire training given to staff. EVIDENCE: Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 28 Standard 31. Mrs Evans continues to be the registered manager of the home and has been in this post for over 4 years. She is a registered nurse and holds a qualification in care management. The manager undertakes periodic training to update her knowledge, skills and competence, while managing the home. She is also familiar with the conditions and diseases associated with old age. There are clear lines of accountability within the home which staff were familiar with. Mrs Evans has line management support from Southern Cross in respect of having monthly visits from a regional manager. Standard 33. As well as conducting regular weekly surgeries for relatives, the manager holds regular residents meetings. The minutes of this were seen from October 2006. Information was given to relatives such as the fact that the home were no longer using bed rails and were trialling the use of wedges to prevent the residents from falling out of bed. Annual Quality assurance monitoring is done via survey forms which are distributed to residents. This was last done in July 2006. It was unclear whether an action plan had been published as a result of the survey forms, which would inform residents and relatives of any areas in which the home were first of all doing well and secondly needed to improve. Survey forms returned to the Commission from relatives and residents confirmed that they feel able to consult with any member of staff in the home on the whole, in order to deal with any concerns that they have or to talk about issues of importance to them. The home is also monitored via visits from the home’s line manager, these reports need to be more detailed so that the organisation are seen to be taking seriously requirements made at inspections and indicate when these are discharged. A report was received after the inspection –27/02/07 and did not mention the immediate requirement notice left for the after care of accidents.. Standard 35. The records and amounts for residents monies were checked by the inspector. The home does not hold personal allowances for any residents within the home. The only money held is money needed for purchasing items from the shop or from hairdressing and chiropody appointments. The inspector checked the amounts for 3 residents, the amount held in cash tallied with the amounts recorded as being held. There is also an amenities fund which is a separate account in which money is accumulated and a decision made about how to Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 29 spend it by the residents themselves. There is a plan to build a pagoda in the garden using this money this year. Standard 38. The fire log was checked for compliance with safety tests being completed in the times recommended by Avon Fire Brigade. These included weekly checks of the alarm system, monthly checks of the emergency lighting and visual checks of fire extinguishers. These were all complied with. It was seen that fire drills had been completed in 2006 ion different zones of the building. It was noted that there was also a fire risk assessment of the building although this was not read by the inspector. It was not possible to verify from either the fire log or fire training records whether staff actually had the updates for fire safety training in the timescales recommended by Avon Fire Brigade, eg night staff 3 monthly and day staff 6 monthly. The manager stated that she herself had instructed the night staff in fire safety but had not recorded this. It was therefore not possible to evidence that this regular training takes place. It was noted from the Pre Inspection Questionnaire information that some visits have taken place for other areas in health and safety such an Environmental Health Officer in July 2006. Temperature checks for hot water appliances and also for checks for compliance with legionella safety have been done in August 2006. Maintenance and servicing of the lifts and hoists and adaptations needed for safe lifting and transferring had also been done in 2006. There are assessments completed for any substances that may be hazardous to health and staff made aware of these assessments. Testing of portable appliances was also done in 2006. Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 30 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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Whitchurch Christian Nursing Home DS0000020325.V309802.R01.S.doc Version 5.2 Page 31 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 OP8 Regulation 13(4)(c) Requirement Timescale for action 08/02/07 2. OP7 15(1)(2) The registered person must ensure that any service user who has a fall or accident has this reassessed so that any potential new or increased risk is minimised wherever possible. The registered person must 31/05/07 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. This is a repeated requirement 3. OP36 18(2) The registered person must ensure that formal supervision sessions must be commenced which should include assessing training needs. This is a repeated requirement 31/05/07 4 OP1 4&5 The registered person must ensure that the statement of Purpose and Service User guide DS0000020325.V309802.R01.S.doc 30/04/07 Whitchurch Christian Nursing Home Version 5.2 Page 32 are nded to reflect the service available and to meet the revised Regulation. 5 OP9 13(2) The registered person must ensure that Medication practices follow their own policies and procedures. The registered person must ensure that staffing levels are increased so that the service users have their personal and social needs met. This must be kept under review. The registered person must ensure that the cleanliness of the home is of a high standard and maintained. The registered person must ensure that any fire training given to staff is recorded. The reports completed for the Regulation 26 visits must show the monitoring of the quality of care and progress with the requirements form this inspection. The registered person must ensure that all service users are treated with respect at all times. 28/02/07 6 OP27 18(1)(a) 30/03/07 7 OP19 23(2)(d) 28/02/07 8 9 OP38 OP33 23(4)(d)( e) 26 28/02/07 30/04/07 10 OP10 12(14)(a) 28/02/07 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.V309802.R01.S.doc Version 5.2 Page 33 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. 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