Inspection on 02/02/06 for Wombwell Hall Nursing Home

This inspection was carried out on 2nd February 2006.

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

Other inspections for this house

Wombwell Hall Nursing Home 04/06/08

Wombwell Hall Nursing Home 12/06/07

Wombwell Hall Nursing Home 24/08/05

Wombwell Hall Nursing Home 21/01/05

Wombwell Hall Nursing Home 21/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Wombwell Hall Nursing Home Wombwell Gardens Northfleet Gravesend Kent DA11 8BL Lead Inspector Wendy Jones Announced Inspection 2nd February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 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.V272823.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wombwell Hall Nursing Home Address Wombwell Gardens Northfleet Gravesend Kent DA11 8BL 01474 569699 01474 569267 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) BUPA Care Homes Limited Miss Mary Margaret Bazeley Care Home 120 Category(ies) of Old age, not falling within any other category registration, with number (120), Terminally ill (5) of places Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Care of Service User whose date of birth is 07/05/1951 Care of Service User whose date of birth is 07/01/1941 Care of Service User whose date of birth is 01/02/1945 Care of Service User whose date of birth is 07/01/1947 Care of Service User whose date of birth is 03/08/1944 Care of Service User whose date of birth is 22/07/1956 Date of last inspection 24th August 2005 Brief Description of the Service: Wombwell Hall is a care home that provides nursing care to 120 residents in four houses on a site in Northfleet on the outskirts of Gravesend. General nursing is provided in three of these houses, Copperfield, Weller and Pickwick. The fourth house, Micawber is contracted directly to the Primary Care Trust. Each house is staffed and equipped to care for up to 30 residents and has a senior sister, registered nurses, care and support staff. All residents have single rooms that are at ground level and each house is connected by sheltered walkways. A separate management/administration building also houses the hairdressing salon, kitchen and laundry. Attractive gardens surround the houses and there is ample car parking facilities on the site. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by Wendy Jones, Regulatory Inspector between 9:30am and 2:40pm. Judgements are based on conversations with management, staff, residents and their relatives, reading of care plans, other documentation and records, comments received prior to the inspection from residents, their relatives/visitors, doctors and health and social care professionals and a tour of parts of the home. What the service does well: What has improved since the last inspection? All residents now have sufficient access to healthcare facilities outside the home. Some improvement has been made to improve the nutritional element of the meals that are served to residents. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 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.V272823.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 4 and 5 Prospective residents and their relatives have the opportunity to visit and receive all the information they need to decide whether the home can meet their needs. EVIDENCE: The regional support manager, is managing the home whilst the registered manager is on sick leave. She explained that a complaint had been received from the relative of a new resident that they had not received appropriate information when their relative first moved into the home. From the investigation of this complaint, it has been decided that an additional booklet about what to expect when first moving into the home is to be produced and given to residents and their relatives when they first move in. Relatives said that they had all the information they needed when they moved in. Both relatives and residents spoken with on the day, said they were happy in the home and could not fault the care they received. Care plans seen showed that residents’ needs are fully assessed in conjunction with assessments received from other healthcare professionals. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 11 Residents’ health, personal and social care needs are fully met and they are treated with respect. Medication procedures and storage arrangements protect the residents. Residents can be assured that at the time of their death both they and their families will be treated sensitively and respectfully. EVIDENCE: Care plans seen, contained detailed information about residents’ personal and health care needs. They contained detail of when doctors and other healthcare professionals are asked to visit and the outcomes of these visits. Daily recording is comprehensive and contains meaningful information about the residents. Detailed, individual risk assessments that ensure the safety of residents, are in place. Staff said that they have a handover at the beginning of their shifts so that they are aware of any changes to residents’ needs. They were also knowledgeable and clearly very aware of residents’ needs. From discussion with the relative of a resident who had recently moved into the home, it was identified that they had not been involved in the preparation of their relative’s care plan. A nursing sister and the regional support manager confirmed that this was an oversight and was not the usual practice. Care Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 10 plans seen, had been signed by relatives, which supported this statement and indicated their involvement. The regional support manager said that they would speak to staff to ensure that this does not happen in future. Each of the four houses on the site has a medication room. On this occasion the medication room in Copperfields House was inspected. Medication was stored securely and records accurately reflected what residents had taken and confirmed that medication is being administered safely. Some residents take controlled drugs and these were stored securely in a cabinet which was bolted to the wall and complies with the Misuse of Drugs Regulations. This medication is accurately recorded and signed for by two members of staff. There is a contract for unused medication to be removed from the home at least quarterly each year. Individual records of the medication disposed off for each resident, are kept with the medication administration records. Residents said that their needs are being met, they are “very happy” and “cannot fault” the help and support they get. One resident said they would recommend the home to others. They said the “staff are very good and treat them well”. Comments received from a small number of the relatives surveyed prior to the inspection, indicated that they were concerned that the carers are too busy at times and feel they should be able to respond more quickly to residents’ needs, i.e. when they need to go to the toilet. They did however feel that although “rushing as if under pressure” “care appears excellent”. Other comments received included “very approachable and friendly staff”, feel relative “cared for very well”, “very pleased with nursing care” and “never concerned” as they know their relative “is always well looked after”. Staff were clearly knowledgeable about what help and support the residents need, and treated them with respect. Residents clearly trusted and had a good relationship with them. Staff receive regular training in palliative care and talks are given by the local hospice, so that staff are able to provide appropriate care and support to residents who are dying. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 Residents enjoy a range of activities and have regular contact with their family and friends. There are still some shortfalls in the diet and choice of wholesome and appealing meals that residents can choose from. EVIDENCE: Residents are able to use the communal areas in the houses at all times. Some were sitting in the lounges and others were in their rooms on the day of the inspection. Details of activities planned for February and March were seen displayed on a notice board in Weller House. A relative of a resident spoke of a recent sponsored walk that had been carried out by staff, relatives and friends of residents. Photographs of the walk were displayed in the corridor. Relatives said they can visit at any time and can make themselves drinks in the kitchenette whenever they wish. All relatives who completed comment cards prior to the inspection stated that they are always made welcome and can visit in private. Improvements are being made to resolve the shortfalls in the meals provided by the home. The head chef is no longer employed and currently head chefs from other of the organisation’s homes are helping out until a new head chef is Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 12 appointed. A nutritionist from Darenth Valley hospital has visited and given advice on nutrition, and improvements have been made in the planning of the menu. More work is needed to ensure that the menu plan is wholesome and balanced. Currently residents have a choice of meat and vegetarian dishes and a range of desserts at lunch and a number of different choices for tea. However, thought needs to be put into these to ensure there is a balance i.e. not two pastry dishes on the same day. Residents choose from menus the day before and staff let the chef know of any special diets etc. that are needed. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents, their relatives and friends can be confident that any complaints are taken seriously and acted upon. EVIDENCE: The home’s complaints policy is displayed in the entrance area of the home. It contains appropriate information about how to complain and gives contact details for the Commission. Four complaints have been received in the last twelve months. Records were seen of the investigations that had been carried out and of feedback given. These showed that complainants are being kept informed and responded to within 28 days. The regional support manager explained that monthly returns of complaints investigated and the outcomes are sent to head office each month. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 25 Residents live in a clean, pleasant, safe, comfortable and well-maintained environment. EVIDENCE: The main entrance to the home is in a separate building which also includes the hairdressing and laundry rooms and main kitchen. There are four houses Weller, Pickwick, Micawber and Copperfields, which are linked by covered walkways. Each house is made up of communal living and dining areas, four bathrooms and communal toilets and 30 single rooms. None of the rooms have en suite facilities. Some bathrooms have recently had ‘Malibu’ baths fitted. Others are fitted with standard bath hoists. Raised toilet seats are provided in separate toilets. The lounge areas in each of the houses are comfortably furnished and include an attractively laid out dining area. Copperfields house was refurbished Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 15 approximately three years ago. The regional support manager advised that a maintenance programme was in place for the refurbishment of the remaining three houses. All bedrooms are on the ground floor and there are no stairs in any of the houses. Residents and relatives spoken with, all said they were happy with their rooms and were able to have their personal items with them. Bedrooms seen were colour co-ordinated, had matching curtains and bed linen and contained all the furniture and equipment the residents needed. There is ample car parking to the front of the houses and attractive, well maintained gardens with benches and areas for residents and their visitors to sit. Although it was a cold day the houses were warm and residents were clearly comfortable. Everywhere was extremely clean and there were no offensive odours. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Residents are protected by a robust recruitment process and an appropriate number of skilled and competent staff on duty at all times. EVIDENCE: There were 116 residents living in the home at this time. Registered nurses, care staff, a chef, kitchen, laundry and domestic staff were working at the home. In addition the regional support manager and administrative staff were on duty. A staff list and duty rosters seen, showed that there were enough trained and competent nurses and care staff employed to ensure that an appropriate number of staff are on duty at all times so that residents needs can be met. Staff were able to carry out their duties unhurriedly and efficiently and had time to speak with residents. Fifty per cent of the care staff have achieved at least NVQ 2 in care and a further six are due to complete this course shortly. Staff files and recruitment records seen, contained all relevant information, documentation and checks needed to ensure that residents are protected. The induction programme completed by a new member of the nursing staff was seen. This included manual handling, food hygiene, COSHH, fire awareness and abuse awareness training. This member of staff said they had attended a week’s induction training in the classroom before spending a week Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 17 working supernumerary to the rota to give them time to get to know the residents and the home. They felt they had received all the training and information they needed to bring themselves up to date and learn about the policies and procedures of the home. Records of the training staff have received was seen. Training courses provided in 2005 included fire safety, moving and handling, abuse awareness, infection control, care planning, the administration of medicines, nutrition and first aid. The home employs a training co-ordinator who organises training events locally and books staff onto courses provided centrally by the organisation. Due to the size, diversity of services and the line management arrangements for the home, for all senior nurses will undertake the Registered Manager’s Award as recommended at the last inspection. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 The Residents benefit from living in a home that is well managed, safeguards their best interests and promotes and protects their health, safety and welfare. EVIDENCE: The registered manager is currently on sick leave. In her absence the regional support manager is managing the home on a day-to-day basis. She is suitably qualified, very experienced and is running the home competently and in the best interests of the residents. There was a calm and welcoming atmosphere in each of the houses. Comment cards from 23 relatives or visitors of residents were received prior to the inspection. They stated that they can visit the home at any time and in private, are kept informed of important matters, are consulted and are satisfied with the overall care provided. Relatives spoken with said staff are always welcoming and are “very approachable and friendly”. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 19 Although financial records and accounts for the home were not seen on this occasion there was evidence that the home was financially viable. Resources were available for staff to meet the needs of the residents and the structure and contents of the home were in good condition. Appropriate insurance cover is provided for the home and a current insurance certificate is displayed. The home runs a “pocket money” account for the residents. The administrator keeps a “float” in the safe for residents to use on a day-to-day basis. Records of monies spent and paid into this account are recorded and signed for on separate sheets for each resident. This information is then transferred onto a computer spreadsheet. Manual records, spreadsheet details and bank statements inspected all tallied. Evidence was seen that any interest earned on the monies in the “pocket money” account are shared out and recorded against each resident in proportion to the amount they have in the account at that time. It was noted that a rather large sum was in the “pocket money” account for one resident and it was suggested that this was not the best place to keep this. The administrator advised that if monies begin to mount up they are transferred into residents’ personal saving accounts and would ensure that this was done. The manager, senior and junior sisters are responsible for carrying out appraisals and supervising staff. Records seen showed that appraisals are carried out yearly but that supervision is being carried out informally on an ad hoc basis. No formal supervision of care staff or clinical supervision of nursing staff is carried out at present. However, all staff were clearly competent and aware of the help and support that residents needed and received the training and support required to do their jobs. It is recommended that the current informal arrangements be formalised and supervision, including clinical supervision be carried out at least every two months with records kept. All records seen were stored securely and confidentially in locked cabinets in offices that are kept locked when not in use. Training records showed that staff received updates on manual handling to avoid injury to residents or themselves and regular fire training is also provided. Pre-inspection information received, showed that all maintenance contracts and checks had been carried out and residents live in a safe and wellmaintained home. Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 3 3 3 3 3 3 3 x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP6 OP38 Good Practice Recommendations Although these standards have been assessed as met, it is recommended that the home consider whether the registration conditions reflect the current admission trends. The current initiative to improve the meals for residents should continue and appropriate measures put in place to ensure residents receive a wholesome, appealing and balanced diet. It is recommended that the current informal arrangements be formalised and supervision, including clinical supervision be carried out at least every two months with records kept. 2. OP15 1. OP36.2 Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wombwell Hall Nursing Home DS0000026216.V272823.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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