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Inspection on 12/06/07 for Wombwell Hall Nursing Home

Also see our care home review for Wombwell Hall Nursing Home for more information

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Visitors are welcome at the home at any time and are invited to be involved in the care of their relatives if that is their wish. It is the view of healthcare professionals that specialist advice sought and provided is followed through appropriately for the benefit of residents. One respondent added the home also does well in providing the appropriate atmosphere for patients and there are good staff/patient relationships. The design of the home promotes independence for all residents. Good interaction was seen between residents, staff and visitors. Satisfaction surveys received from or on behalf of residents included additional comments such as "I am generally satisfied with the standard of care I receive; the staff are polite and friendly and carry out their duties diligently"; "I have always had help when I asked for it, I think we are their [staff] priority"; and "staff are well organised and motivated, they work as a team to cater for the needs of the residents". The new manager was receptive to advice given and demonstrated an eagerness to improve the service where shortfalls have been identified.

What has improved since the last inspection?

Action has been taken to meet the requirements and most of the recommendations made at the last visit. The level of cleanliness on Micawber has much improved since the last visit and staff should be complimented on this. The recently introduced new Quest care documentation encourages more information to be sought and recorded on all aspects of residents` care and support. The provider continues to demonstrate commitment to staff training with 56% of unregistered care staff now trained to NVQ II care. This exceeds the National Minimum Standards recommendation. More attention to employment histories is now given to information provided by new applicants in support of their job applications. This should ensure better protection for residents. To assist the home manager in monitoring trends on each house, senior nurses are now required to submit weekly management returns. This includes details of incidents and complaints. Continuing care nurses from the local primary care trust now carry out weekly reviews of their patients so that any potential problems can be easily identified and acted upon. Better arrangements are in hand for bedrooms to be redecorated when vacancies arise, improving the environment for the next resident.

What the care home could do better:

To ensure equality, all residents should be provided with a contract or terms and conditions of staying at the home. A planned programme of refurbishment should be devised so that all residents living at Wombwell Hall are provided with the same environmental standards. All care staff should continue to improve their record keeping skills to clearly demonstrate the care assessed and that actually being delivered to residents. In consultation with residents and their advocates, the home needs to expand and improve the current range of activities to ensure there is an equitable distribution across the site to meet the diverse preferences, needs, abilities and wishes of individual residents. The current system of monitoring and logging all types of complaints and niggles should be reviewed. This should assist the home manager in rectifying matters identified as not being quite right. Systems should be in place to ensure residents can summon help from wherever they may be sitting. Staff should ensure that residents and or their property are not placed at risk. Equipment used to monitor residents` condition, including chair scales, must be kept in good working order, for accuracy purposes.

CARE HOMES FOR OLDER PEOPLE Wombwell Hall Nursing Home Wombwell Gardens Northfleet Gravesend Kent DA11 8BL Lead Inspector Elizabeth Baker Key Unannounced Inspection 12th June 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 Wombwell Hall Nursing Home DS0000026216.V339274.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. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wombwell Hall Nursing Home Address Wombwell Gardens Northfleet Gravesend Kent DA11 8BL 01474 569699 01474 569267 rosente@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Limited 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) Post Vacant Care Home 120 Category(ies) of Old age, not falling within any other category registration, with number (120) of places Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2006 Brief Description of the Service: The home is divided into four houses providing general nursing care Copperfield, Weller, Pickwick and Micawber. Micawber house is contracted directly to the Primary Care Trust and accommodates highly dependent residents. Each house is staffed and equipped to care for up to 30 residents. All bedrooms are at ground floor level and are for single occupancy. Each house is connected by sheltered walkways. The administration building houses the registered manager’s office, reception, hairdressing salon, kitchen, laundry and training rooms. Each house is under the direction of a senior sister; supported by registered nurses, care staff and ancillary staff. There are good car parking facilities. Gardens surround all houses and external communal areas. The nearest shops, church, bank and post office are approximately half a mile away. Buses to Gravesend stop nearby. Current fee charges range from £512.82 to £856.56 per week. Additional charges are payable for hairdressing, chiropody and newspapers. A copy of the latest inspection report is kept in the main reception of the administration building. Activities include bingo, games, quizzes and music and movement. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key unannounced visit to the home for the inspection period 2007/08. Link inspector Elizabeth Baker carried out the visit over two days on the 12 and 13 June 2007. In total the visit lasted just over 16 hours. As well as touring each house, the visit consisted of talking with some residents, staff and visitors and inspecting some records for case tracking purposes. A number of residents, visitors and members of staff were interviewed. Feedback of the visit was provided to the Senior Sisters of each house. Feedback was also provided to the Home Manager at the conclusion of the 13 June 2007 visit. At the time of compiling the report, in support of the visit, the Commission received survey forms about the service from 14 residents, three relatives/advocates, one care manager and three healthcare professionals. At the Commission’s request the Home Manager completed and returned an Annual Quality Assurance Assessment (AQAA). Some of the information gathered from these sources has been incorporated into the report. The report is a composite of the findings from visits to all four houses. At the time of the visit, 109 residents requiring nurse care were residing at the home. Since the last visit, the Commission has not received any formal complaints about the service. What the service does well: Visitors are welcome at the home at any time and are invited to be involved in the care of their relatives if that is their wish. It is the view of healthcare professionals that specialist advice sought and provided is followed through appropriately for the benefit of residents. One respondent added the home also does well in providing the appropriate atmosphere for patients and there are good staff/patient relationships. The design of the home promotes independence for all residents. Good interaction was seen between residents, staff and visitors. Satisfaction surveys received from or on behalf of residents included additional comments such as “I am generally satisfied with the standard of care I receive; the staff are polite and friendly and carry out their duties diligently”; “I have always had help when I asked for it, I think we are their [staff] priority”; and “staff are well organised and motivated, they work as a team to cater for the needs of the residents”. The new manager was receptive to advice given and demonstrated an eagerness to improve the service where shortfalls have been identified. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence, including a visit to this service. Prospective residents move into the home knowing their needs can be met. Not all residents are treated equitably in that only privately funded residents receive a contract. EVIDENCE: To assist prospective residents and relatives in choosing a care home, the organisation and home have produced and published a number of documents including Service User Guide and Statement of Purpose. These are quite informative. However not all the information is completely up to date. At this visit it was identified that only privately funded residents are provided with a contract setting the terms and conditions of admission. There is currently no equivalent document for residents whose care is paid fully or partly by other agencies, such as local authorities or primary care trusts. This situation prevents all residents being adequately informed of current rules, rights and responsibilities of staying at this home. Indeed of the 14 returned Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 9 survey forms so far received, nine respondents indicated they had not been provided with a contract. Where practicably possible, prospective residents are assessed in their current environment to determine their suitability for admission into Wombwell Hall. Registered nurses carry out the assessments. Information gathered at these visits is recorded and used to inform the resultant programme of care. Because of the high dependencies of the majority of residents now admitted into the home, prospective residents are rarely able to visit the home before making any decisions themselves. However their relatives/advocates normally undertake these visits. During conversations with some residents and visitors it was said that friends and or neighbours had recommended the home to them. The home is not registered for intermediate care. Standard 6 is not applicable. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 10 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 and 11. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence, including a visit to this service. The health needs of residents are generally met with evidence of good multidisciplinary working taking place on a regular basis. However documentation in support of this is sometimes lacking. EVIDENCE: Since the last visit new care documentation has been introduced. A review of a sample of care records from each house was undertaken. The new documents provide for more detail to be obtained on each resident. There is now more evidence of resident and or advocate input with the composition and review of care records, if that is the wish of residents. However not all records were complete of residents’ current situation. Where there had been a change in the residents’ condition this had not always generated a review of the care plan or accompanying risk assessment. Some registered nurses still continue to use abbreviations and Latin terms. The Nursing and Midwifery Council discourage this practice. Not all the prompts on the new assessment document had been completed as required by the form. Some houses are Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 11 keeping separate records of details of residents’ observations including weights. The current information is not always transferred to the main care records, which prevents the reader obtaining a coherent picture of the residents’ condition. Care records contained a range of clinical and health and safety risk assessments, including nutrition, falls, continence, pain and skin integrity. These are used to monitor treatment plans. The home has a range of pressure relief and preventative equipment. However where a pressure mattress had been identified as a need for a particular resident, this had not been provided on admission. The resident had subsequently acquired a pressure sore at the home. The resident’s records also required them to sit on a special seat cushion. The resident was initially seen sitting in an armchair without this provision. The resident’s records identified an unexplained weight loss. There was no accompanying nutritional assessment. Where a particular resident had now been “discharged” from specialist input, this information had not been cross-referenced to the care plan. Where the resident had been referred to other specialists for pain management, there was no recorded evidence a pain assessment had been carried out. Specialist input is obtained from GPs, dietitians, speech therapists, tissue viability nurses, palliative care nurses and opticians, where there is an assessed need. Daily records are maintained for each resident. The content of these varied from house to house. Although some care staff write good information providing a holistic picture of the residents’ day and condition, other staff do not. Meaningless phrases included “all care and safety maintained”, “due care given to [residents] needs”, “no problems” and “toileted regularly”. The handwriting on some daily records was difficult to decipher. Each house has a clinical room in which medicines, nursing aids and equipment are securely and hygienically stored. Room and drug fridge temperatures are recorded on a daily basis to ensure medicines are stored in accordance with manufacturers’ instructions. However the temperature in one of the rooms exceeded the current recommendations. And a drug fridge in another clinical room also exceeded the recommendations. There is still confusion in some of the houses about the correct method of recording drug fridge temperatures. To ensure efficacy of medicines is not compromised all registered nurses should be trained on how to do this. The home has just introduced a new medication administration system and registered nurses have received training for this. The maintenance of medication administration record (MAR) charts on one house identified some unexplained gaps. On another house there were no witness countersignatures to handwritten entries on MAR charts. Where there had been a change in the dose and or frequency of some medicines it was difficult to establish the person who authorised this or indeed the date. Not all “administer when required medicines” (PRN) had specific administration Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 12 instructions in the corresponding care plans. Permission to administer homely remedies was seen on each house. However some of these were seen last recorded as having been reviewed by a GP in 2004. Residents said care staff support them with their personal hygiene needs in a way, which protects their privacy and dignity. However a situation noted on one particular house actually compromised the resident’s dignity. Whilst acknowledging the problems associated with the resident’s behaviour, the matter had not been assessed to see whether it could be better managed. During the visit to all houses it was also identified that charts are maintained in bath/shower rooms recording residents initials and water temperatures relating to baths/showers taken. Displaying this information compromises residents’ confidentiality. The new care documents provide for more spiritual and cultural wishes and preferences in respect of death and dying to be recorded. Where the resident and or advocates have declined to provide this information, a note is made of this. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 13 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 and 15. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence, including a visit to this service. Generally meals at the home are good offering both choice and variety. The current range and availability of activities and stimulation does not wholly satisfy all residents. EVIDENCE: Biographical details of residents is obtained and recorded in their respective care records. However a review of these identified that some of the information is brief and not wholly reflective of information obtained during the visit. The home currently employs three hobby therapists for the four houses. An activities programme is displayed at the entrance of each house. However not all residents are able to access the area. The home’s residents and relatives information publication informs the reader that the Welcome Pack in each bedroom contains details of specific activity programmes for the home. This is not currently the case. Indeed residents indicated during the visit that “nothing goes on much in the house at the moment – used to have quizzes, skittles and ball games”; “not a lot goes on during the day for occupation”; “can get boring” and “time can drag”. A survey respondent added they couldn’t always take part in activities, as they are not always told what they are “because notices are not available with dates/events”. Eight of the 14 Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 14 satisfaction surveys returned from residents indicated there are always or usually activities that they can take part in. Visitors are welcome at any time and many were seen coming and going during the two-day visit. Each house has a private room in which residents can meet with their visitors or use for private contemplation. Bedrooms visited had been individualised with personal affects. However a review of some residents’ care records identified they had not all been provided with a property list. Where these had been provided, they were not up to date. Generally residents were complimentary about their meals, which they indicated have improved. Full English breakfasts are available. Appetising meals were seen during the visit. Each house has a dining area, which residents can use to have their meals. New menus are about to be introduced which will include a “Nite Bites” menu. This should enable residents to have a snack outside normal kitchen hours if that is their wish. Eleven of the 14 satisfaction surveys returned indicated they always or usually like their meals. Residents spoken with indicated drinks are always available. Special diets are catered for where there is an assessed need, including soft diets. A survey respondent added “My [relative] has a pureed diet. The portions are always separated to look as appetising as possible. She always enjoys her food and seconds are available. The food smells good”. The majority of meals currently available are a mix of traditional and European. A review of the current four-week menu plan identified curry dishes appears twice, and that is on the same day. The home has a number of residents who because of their background may prefer curries. Whilst acknowledging this may not be a problem at the moment, because of the home’s location consideration should be given to increasing the variety of meals for the future. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 15 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 and 18. Residents who use the service experience adequate quality outcomes. This judgement has been made using a range of evidence, including a visit to this service. Not all residents and or their representatives can be sure their complaints and niggles are listened to and acted upon. EVIDENCE: Residents and visitors spoken with indicated they knew what to do if they had a complaint. The home’s complaints procedure is displayed throughout the site. Complaint records are maintained. For auditing and monitoring purposes the home manager reviews the complaints log of each house on a weekly basis. However, the numbers recorded in the individual houses did not wholly correspond with that provided on the returned AQAA document. All 14 survey forms returned from residents indicated they or their advocates know how to make a complaint. Additional comments included “but nothing to complain about” and “I have never needed to [complain]”. Adult protection training is provided. Staff described appropriately what they would do if they suspected abuse had occurred. Although the Commission has not received any formal complaints about the home, the Commission is aware of a number of concerns, which have been investigated under the respective sponsoring authority’s own statutory powers. In one case this has resulted in a number of new practices and arrangements being introduced at the home, including weekly reviews of health sponsored residents by continuing care nurses. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 16 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, 20, 21, 22, 23, 24, 25 and 26. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence, including a visit to this service. Continued refurbishment of the home will enhance the quality of life for all residents. EVIDENCE: Since the home was built and registered in 1991 the bedrooms in one house have been totally refurbished. A number of bedrooms in two other houses have also been refurbished. However no bedrooms in the remaining house have been refurbished. Corridor carpets in all houses are the original ones. Although domestic staff do their best to keep the carpets looking clean, due to passage of time and continuous wear and tear, these are now stained and worn. Sadly the work to replace the new corridor and communal carpets for one particular house has been postponed. The monies intended for this project are to be used to rectify a sluice problem. Numerous bedrooms throughout the site have been redecorated. On one house there is now an arrangement between the home and sponsoring authority to ensure all bedrooms are at Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 17 least re-decorated between vacancies. Sadly some of the bedrooms on this home still look stark and institutional. All houses visited were clean, tidy and odour free. During the visit it was established that the organisation has applied for planning permission to build an additional 30-bedded unit. The beds would be used for residents with dementia. The home is purpose built and has many adaptations to promote independence to residents who may require some assistance and support. Corridors are wide and allow self-propelling residents to move freely around the home. Indeed several residents were seen doing this during the visit. However in one case it was noted that the wheelchair did not belong to the resident. Indeed a survey respondent added the additional comment, “been asking for find my wheelchair as own one went missing about four months ago and said they can’t find it (they have given me another one but it is too small)”. Each house has a variety of armchairs for residents and visitors to use. However some of them have ground-in stains and others had sagging seats. Some equipment used to assist residents has to be stored in bathrooms when not in use. However this practice may restrict residents’ immediate access to some communal toilets. Bedrooms do not have ensuite toilet facilities. Grounds are easily accessible and are kept in good order. Indeed on the day of the visit some residents were seen sitting out in a patio area enjoying drinks and the good weather. Some other residents were seen in the grounds with their visitors. Each house has its own nurse call system installed. This should enable residents to obtain assistance when needed. However during a conversation with some residents on a particular house it was identified that the system does not extended to the conservatory area of the day room, causing them some anxieties in the past. In addition to assisted bathrooms, each house now has a shower room increasing residents’ choice. The home continues to increase its stock of adjustable type beds, and these are provided on an assessed needs basis. Facilities are available for residents to securely keep some items of importance in their rooms. Bedroom doors are lockable. However this does not guarantee residents’ property is secured when the room is unoccupied for a period of time. Standard 38 also refers. Radiators are of the low surface type and hot water temperatures are controlled. This should ensure residents are protected from burns and scalds. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 18 The home has a suitably equipped laundry. Residents indicated the service works well with clothes taken away one day and returned the next. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 19 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 and 30. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence, including a visit to this service. Residents are cared for by appropriate numbers of trained staff. The home’s recruitment and appointment of staff procedures ensure residents are protected. EVIDENCE: In addition to care staff, staff are employed for catering, activities, cleaning, laundry, administration and maintenance. Off duties rotas are maintained and demonstrate the home is suitably staffed 24 hours a day as is required of a care home providing nursing. Staff were seen carrying out their duties in an unhurried manner. Thirteen of the fourteen surveys returned from residents indicated staff are always or usually available when they need them. The returned AQAA indicates that 56 of unregistered care staff are now trained in NVQ level II care. Having qualified staff should provide better care for residents. Since the last visit various members of staff have received training in subjects including nutrition, bedrail safety, infection control, Mental Capacity Act (train the trainers course), moving and handling and fire safety awareness. Staff files inspected demonstrated procedures had been followed for the recruitment and appointment of staff. This includes obtaining relevant Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 20 references, recording full employment histories and obtaining relevant clearance. New staff are required to undertake an in-depth induction programme. This includes an initial three-day course, which covers mandatory training. The initial induction leads into a foundation course, which follows the Skills for care training requirements. Registered nurses are supported in keeping their skills are up to date. An arrangement is currently in place for registered nurses/carers to be seconded to the local hospice so their palliative care knowledge and skills can be enhanced and updated. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 21 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, 35, 36, 37 and 38. Residents who use the service experience good quality outcomes. This judgement has been made using a range of evidence, including a visit to this service. The new home manager has a good understanding of what needs to be done to improve the home. The home reviews aspects of its performance through a programme of self-review and consultations, which include the views of residents, staff and relatives. EVIDENCE: A new home manager was appointed in April 2007. The home manager is a registered nurse and has experience of working in both hospital and care home settings. The new home manager does not have a requisite management qualification. To rectify this she has commenced on the Registered Manager Award course. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 22 Residents, visitors and staff spoke openly throughout the visit. A number of staff commented on the management changes at the home and were complimentary of the new manager’s approach. As part of the organisation’s quality assurance programme, annual resident customer satisfaction surveys are carried out. The results of the latest survey report dated December 2006 are available on request at the home. Regular staff meetings take place and staff indicated these are very useful. Currently residents/relatives site meetings take place. It is the new manager’s intention to facilitate these differently so that each house has its own meeting to reflect its individuality. Each house has been provided with a copy of the organisation’s revised policies and procedures. These are available in the nurses’ office and accessible to staff at all times. Safe systems are in place for maintaining monies held on residents’ behalf. A separate interest bearing account has been opened and interest is proportionately distributed. Receipts are obtained for items and or services purchased or provided on residents’ behalf. Where the home keeps small items of importance for safe keeping on behalf of residents, appropriate facilities and records are maintained. As stated previously, not all records relating to residents were available or indeed kept up to date. Some records where difficult to read because of poor handwriting. Registered nurses must ensure they maintain care records in accordance with their professional body’s requirements. Staff receive mandatory training including fire, moving and handling and health and safety. The returned AQAA indicates the home’s equipment is maintained regularly. However on this visit it was identified that chair scales in a particular house may not be accurate. As stated previously bath water temperatures are maintained. This is good practice. However the current system of recording this information with that of residents’ details, compromises their confidentiality. Accident records are maintained. These are reviewed and monitored by the home manager on a weekly basis so that trends can be identified and appropriate action taken if there is a need. The organisation has issued new and comprehensive bedrail risk assessments. These are just about to be introduced at Wombwell Hall. During the visit it was noted that although the resident of a particular room had been admitted to hospital, their bedroom door was unlocked and the patio Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 23 door was left open. The room contained many personal items. The home is not situated within a secure site. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 24 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 3 2 3 3 3 3 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 2 3 3 X 3 3 2 2 Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 26 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 2 Standard OP2 OP8 Regulation 5 16 Requirement All residents must be provided with a contract setting out terms and conditions of residence. Appropriate pressure relief equipment must be provided to residents at the time the assessed need is identified. Where handwritten changes have been made to the prescriber’s instructions on medication administration record charts, these must be signed and dated, including a witness when this is possible. Medicine administration record charts must not contain unexplained gaps for regular prescribed medicines. The range and availability of activities, occupation and stimulation must be reviewed to meet the needs and expectations of current and future residents. The home’s central complaints records must reflect the information maintained on the individual houses, in order that a complete picture is obtained. A programme for the refurbishment of the remaining houses must be devised. The programme should also include communal carpet replacement timescales for all houses. DS0000026216.V339274.R01.S.doc Timescale for action 31/10/07 30/06/07 3 OP9 13(2) 30/06/07 4 OP12 16 30/09/07 5 OP16 17 31/07/07 6 OP19 23 and 16 30/09/07 Wombwell Hall Nursing Home Version 5.2 Page 27 7 OP37 17 8 OP38 13(4) All records relating to residents must be kept up to date and maintained with due regard to privacy and confidentiality. Residents and or their property must not be put at risk. 30/06/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 10 Refer to Standard OP1 OP7 OP8 OP8 OP9 OP9 OP10 OP15 OP22 OP22 Good Practice Recommendations All information and documents published for prospective residents must be kept up to date. Care plans must reflect the current assessed needs of all residents. All clinical risk assessments must be used and kept up to date so as to monitor the effectiveness of residents’ individual treatment plans. Daily statements should contain meaningful information on residents’ quality of day and experiences. Staff should receive training on the use of minimum maximum fridge thermometers and what action to take when the temperature is outside the correct range. Homely remedies authorisation letters should be regularly reviewed. Residents should have the right of having their privacy and dignity maintained, particularly where their condition prevents them doing this themselves. Menus should reflect the needs and preferences of all current and future residents. The nurse call system must be extended to all areas used by residents. Excess nursing aids and equipment should be appropriately stored, so not to impinge on residents’ facilities. Wombwell Hall Nursing Home DS0000026216.V339274.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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