Inspection on 24/08/05 for Wombwell Hall Nursing Home

This inspection was carried out on 24th August 2005.

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 02/02/06

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 Eamonn Kelly Unannounced 24 & 25 August 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 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 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 with Nursing 120 Category(ies) of Terminally ill (5) registration, with number Old age (120) of places Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) Care of Service User whose 2) Care of Service User whose 3) Care of Service User whose 4) Care of Service User whose 5) Care of Service User whose date date date date date of of of of of birth birth birth birth birth is is is is is 07/05/1951 07/01/1941 01/02/1945 07/01/1947 03/08/1944 Date of last inspection 21 January 2005 Brief Description of the Service: The home has 3 general nursing units (Copperfield, Weller and Pickwick). Another unit (Micawber) is contracted directly to the Primary Care Trust. Each unit is staffed and equipped to care for up to 30 service users. All patients (referred to as service users in this report) have single bedrooms. All bedrooms are at ground floor level and each unit in connected by sheltered walkways. The management/administration unit also houses the hairdressing salon, kitchen and laundry. Each of the 4 nursing units has a senior sister, registered nurses, care staff and support staff. There are good car parking facilities. Surrounding all the units are gardens and external communal areas. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit consisted of meeting with the manager (matron), members of staff, visitors and service users in several of the units. Some records relating to the care of service users were seen. Visits were also made to some of the home’s “support” facilities (hairdressing, kitchen and laundry). What the service does well: What has improved since the last inspection? There have been improvements to the premises and equipment at the home (new hoist, Malibu bath installed, conversion of a bathroom to a special shower unit, repainting of some corridors, new carpet in one lounge area, repair of lighting in car-park, use of bath plugs that change colour to warn of high temperatures, additional profiling beds purchased). Organisational reviews have also begun (review of catering standards, improvements to care plan content and presentation). Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 6 What they could do better: The continuous progress made by the home as outlined above is acknowledged. The maintenance schedule to keep the home functioning efficiently is acknowledged as is the partial delegation of management duties to the four senior nurses. The recommendations discussed with the manager were that • • The manager assesses whether registration categories could more accurately reflect current practices and admissions. Senior nurses complete suitable management training (eg. the BUPA management scheme or NVQ Level 4 in Management) because of the proportion of their time (minimum 30 ) required in their respective units for management and administration. The Commission appoints a nutritionist to carry out an assessment of food provision (after the current BUPA initiative has been completed) and A review is undertaken to assess if all service users receive sufficient access to external healthcare. • • 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 H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 6 Prospective service users have detailed pre-admission assessments to enable reasonable decisions to be made so that their care and accommodation needs can be met. EVIDENCE: New service users are admitted on the basis of an assessment undertaken by the matron and/senior nurses. Pre-admission information is recorded and placed in care plans that are begun at this point. Service users are sometimes admitted for short-term care: there are suitable facilities, equipment and staff to deliver respite care or longer term nursing and palliative care. Three units admit older people who are assessed as needing permanent residential and nursing care. One unit admits people for continuing and palliative care (admission is determined by PCT staff and BUPA senior nurse). Some care plan records were checked and the persons to whom they referred were seen. The records indicated that the home assessed in some detail how prospective service user’s needs could be met (generally in consultation with Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 9 care managers). There are a number of variations to the home’s registration to enable it to admit people under the normal age criteria. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 Service users have good access to health and social services. Recording of their care requirements (and how these are being met) suggests good access by service users to the levels of care needed. However, it is possible that some service users may not be gaining sufficient access to some healthcare support outside the home. EVIDENCE: Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 11 A service user plan of care is generated from an initial pre-admission assessment. New care plan presentation has recently been introduced to enable records to be more easily completed and read (and to be standardised in each of the units). As part of “case tracking”, some service user care plans were checked and the persons to whom they referred were met. There was reasonably close correlation between the information recorded and the service user’s condition. Each unit has a locked medication room. These were not visited on this occasion: during the previous inspection visit a CSCI pharmacist assessed the medication administration system in some detail and only minor alterations were recommended. In the meantime, some aspects of handling medication were the subject of complaint and a subsequent adult protection investigation indicated that systems were robust and kept under review by the matron and senior nurses. The evidence from care plan records, equipment and facilities, visitor feedback and observation of some service users indicated that the home does what is necessary and possible to promote service users’ health. A review of a service user’s health (and, in this case, the service user’s expressed concerns) was observed. The outcome was that a number of actions were recommended by the senior nurse to help alleviate some of the service user’s conditions. All service users have good access to GP services and other medical and social services. Each service user’s plan of care seen showed how this service was maintained. There was, however, an indication that service users may not always have suitable access to external healthcare services. Members of staff have relevant experience in providing care for very frail people, including those needing palliative care. All observations on this occasion evidenced a high standard of personal care provided in private and with dignity. There were a number of plaudits from visitors on the help and support they themselves received during visits when a relative was seriously ill or dying. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 Within the context of their serious and terminal illnesses, service users are helped to live a comfortable life where their preferences and capabilities are known and expectations met. The identification of significant shortfalls in the meal provision service and positive action to rectify these indicate a desire by the home to improve service user’s wellbeing. EVIDENCE: The routines of daily living and activities made available are flexible and varied to suit service users’ expectations and physical and mental capacities. An activities schedule is displayed in each unit (these were a little out of date and the manager indicated that they would be rectified). In Micawber unit, most service users are confined to bed: their access to staff and to visitors is a major part of their care and social interaction. There were examples of activities/past-times which service users were assisted with on a one-to-one basis. In all units, there were many visitors and some said they visit almost daily. There was much positive feedback from visitors. Apart from communal TV/DVD provision, service users have (or can have) similar facilities in their bedrooms. Church services are arranged at the home for service users. Large print books from the library are provided. There was evidence of occasional music and Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 13 movement sessions. The home has 2 activities organisers. There are good external facilities for service users and visitors (only a very few of those with patio doors opening to a garden area were making use of this benefit). Examples were discussed where service users received help and advice in obtaining independent legal or financial representation. A theme witnessed during the inspection was senior staff assuring some service users that their future was safe and secure. Members of staff were engaged in many instances talking to service users, helping them with queries or concerns, reading to them or helping with feeding. The assistance given with feeding is an important theme at the home where people in very poor health lose the will to eat (the procedures in these instances were recorded in care plans). The matron has reviewed the (recently falling) standard of meals provided to service users. Measures are underway to improve the organisation of the central kitchen (these include the provision of better food, more choice on the menu and acting on the consultancy advice of the chef manager from another BUPA nursing home). During the inspection, the matron checked the quality of the day’s main meal. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The home has suitable measures in place to protect service users. EVIDENCE: All members of staff have been checked under BUPA recruitment procedures (ie. references, application form, CRB/POVA check, probation, induction training, supervision). The home follows the Kent & Medway Policy for Adult Protection. In cases of complaint over the past 12 months, adult protection investigation has indicated that service users are protected from abuse and that care practices at the home underpin service user’s interests. Service users met expressed their views about the care they receive. Members of staff listen to service users and their visitors. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The premises are suitable for the care and accommodation of service users. EVIDENCE: The premises are purpose built, well maintained and suitable for the purpose of caring for older people including those with nursing needs and terminal care. Each unit comprises single bedrooms, lounge/dining room, visitor’s room and bathrooms. There are 33 WC’s, 16 bathrooms and 1 shower facility throughout the 4 Units. Services facilities (hairdressing, central kitchen and laundry) are in a separate unit with management and administration services. The laundry service recently achieved the best-run service award for BUPA homes. The premises were clean, hygienic and generally free from offensive odours. Domestic staff in each unit have the benefit of a cleaning unit specially designed to reduce the risk of infection and spread of cross contamination. Some of the domestic staff have achieved or are undertaking NVQ Level 1. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 16 Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) x These Standards were not assessed on this occasion. EVIDENCE: Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 38 Service users and visitors have the benefit of a well run home. The emphasis placed on improvements based on the outcomes of quality assurance measures contribute to the safety and comfort of service users. EVIDENCE: The manager (matron) is a registered nurse and has achieved the NVQ Level 4 in Management [for registered managers (services for adults)]. Each senior nurse in the 4 units has access to BUPA’s management development programme (“Managing Excellence”, the elements of which can be credited towards NVQ Level 4). With formal allocation on staff rotas of two thirds of their time as shift nurses (the remaining third is allocated to management and administration), it could be of benefit to the home for them to complete a relevant management qualification [eg. NVQ Level 4 in Management (in managing the care of adults)]. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 19 There is considerable emphasis in maintaining the home as an efficient and functional organisation to meet the needs of people with severe health problems. A significant proportion of senior nurse time is allocated to management and administration because of the size of the home and diversity of its services. A service manager visits monthly and, on the basis of examples of reports seen, carries out extensive quality assurance checks at the home. A précis of these inspections are submitted to the CSCI (as Regulation 26 reports). BUPA requires home managers to submit monthly statistics on a range of issues (eg. pressure sore occurrence, complaints/plaudits, vacancies, human resource issues, incidents). Home managers receive derivitive data that shows their place in a league table within the organisation: this could require them to make improvements or assess trends in some areas. The home follows a detailed regime of health and safety measures required by BUPA. An assessment of the safety of all bedsides has been completed. Lighting in external areas has been improved to help security and movement between units. The identification of the needs of each service user is accompanied by recorded risk assessments. The outcome of training policies and procedures will be assessed at a subsequent CSCI inspection. The manager has assessed the standard of meals provision and a determination has been made on how to improve this. Renewal and repair of the fabric of the premises is continuing (eg. bath panels have been removed to enable better cleaning methods, bath plugs have been replaced by ones which identify excessive water heat, some repainting has taken place, some bathrooms have been upgraded, the method of cleaning has been improved and new equipment (eg profiling beds) is purchased when possible). It was agreed with the matron that there would be further consultation to assess if the home’s registration conditions needed to be reviewed. Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 4 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 x x x x x x 3 Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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 6 & 38 Good Practice Recommendations Although these Standards have been assessed as met, it is recommended that the home considers discussion with the Commission as to whether the current registration conditions reflect the current admission trends. There should be some reflection by the home as to whether or not all service users have sufficient access to external heathcare facilities. The current initiative by the home to improve meals for service users is acknowledged. The CSCI may request a nutritionist to assess the effectiveness of improvements in due course. Although the home is well managed, it is recommended that, because of the size of the home and diversity of its services, senior nurses in the 4 units are encouraged to complete suitable management training [NVQ Level 4 in Management (for managing the care of adults)]. 2. 3. 8 15 4. 31 Wombwell Hall Nursing Home H56-H06 S26216 Wombwell V244758 240805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent 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. 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