Inspection on 04/06/08 for Wombwell Hall Nursing Home

This inspection was carried out on 4th June 2008.

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 12/06/07

Wombwell Hall Nursing Home 02/02/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Wombwell Hall Nursing Home Wombwell Gardens Northfleet Gravesend Kent DA11 8BL Lead Inspector Mrs Susan Hall Unannounced Inspection 4th June 2008 08:20 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.V363769.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.V363769.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 nevards@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd 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) Manager 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.V363769.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2007 Brief Description of the Service: Wombwell Hall Nursing Home is a multi site home, divided into four houses, which each have thirty beds. These are all set at ground level, and provide nursing care for older people. The houses are named after characters from Charles Dickens’ books – Copperfield House, Weller House, Pickwick House and Micawber House. Each house provides accommodation in thirty single bedrooms, and is equipped with communal areas, bathroom and toilet facilities, and their own garden and patio areas. They are staffed individually, with a senior nursing sister in charge of each house. There is an additional building for administration, and as well as offices and staff rooms, this houses the main kitchens and the laundry. The home is situated in the suburbs of Gravesend, and is easily accessible via the main A2 road. There are excellent car parking facilities. There is a good bus service into Gravesend, and local amenities such as post office, bank, shops and church are approximately half a mile away. The current fee levels range from £530.97 to £863.40 per week. These are arranged according to individual nursing and care needs. Additional charges are payable for items such as hairdressing, chiropody and newspapers. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The outcome of this inspection is a rating of good, 2 stars. This was a key inspection, which includes assessing all key national minimum standards, and takes into account all information obtained about the home since the previous inspection. The visit was carried out by one inspector over a day and a half, for a total of 12.5 hours. As well as visiting the home, we (i.e. CSCI) sent out survey forms to a number of residents, staff and health professionals, and received seven of these back, with helpful information. During the course of the visit, we talked with 18 staff (as well as the manager), 17 residents, 5 relatives and 3 friends of residents. Residents expressed their confidence in the staff with comments such as “they are all very kind and caring” and “I can’t fault them”. Conversations with staff included nursing and care staff, housekeeping, kitchen, and laundry staff, activities co-ordinators, maintenance, and administration. We met the senior sister in charge of each house, and viewed each building. In each house we spent time talking with the senior sister, reading care plans, and examining medication management, as well as talking with people and viewing the facilities. The home had a period of instability during 2007 after the previous manager left, and the home was overseen by different temporary managers for some months. A new manager was appointed in January 2008, and staff and residents spoke highly of the difference her appointment has made. They stated that she has brought about significant changes and improvements in the home already, and gives a good lead to other staff. Micawber house has had a history of providing continuing care beds for the NHS. This contract has now ceased, but the house continues to have a number of residents still in this category, and the senior staff work together with multidisciplinary health professionals to ensure that the assessed needs are being met for these residents. Planning permission has been obtained for a fifth building for accommodation, providing another thirty-two beds. The category of care has not yet been decided, but may include younger adults. The company will need to ensure that views of existing residents are taken into account when making this decision. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 7 Most points raised in this report which would improve the home still further, are in connection with the environment: • Each building is in need of refurbishment for communal areas. This includes new carpeting and some new soft furnishings and furniture. The estates management have already stated that the home is due for general refurbishment, and there is a requirement to send the details of this, with proposed dates, to CSCI. • The four houses for residents lack storage space, specifically for hoists. These are mostly kept in bathrooms or corridors at present. Clinical room temperatures in three of the houses were noted to be consistently high (at 25 degrees C or above). Action is needed to ensure that medicines are stored at the recommended temperatures to prevent deterioration. The writing of daily life records could be improved in some of the houses. Some are very good, but others have poor handwriting and /or poor content. Senior staff carrying out pre-admission assessments, must ensure that they do not arrange admission for residents with a diagnosis of dementia, as the home is not registered for this category of care. 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.V363769.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (standard 6 does not apply in this home). Quality in this outcome area is good. The home provides good information for prospective residents, enabling them to make a choice about moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose and service users’ guide are presented together in one folder for enquirers, together with a colour brochure about the home. The statement of purpose contains up to date information about the new manager, and includes all required details. The service users guide is produced in large, clear print, and includes relevant information about life in the home. Additional required documentation – such as a copy of the last inspection report, and views of service users – are retained in a folder in the reception area. All newly admitted residents are given a copy of the service users’ guide, which includes residents’ rights, and Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 10 details about items such as meal times and menus, arrangements for visiting, and arrangements for additional facilities such as hairdressing and chiropody. All privately funded residents have a contract signed by both parties. Residents who have local authority funding or NHS continuing care funding are given a copy of the terms and conditions of residency. Several residents stated on surveys that they were unaware as to whether they had a contract or not, as relatives had dealt with the details of the admission on their behalf. All residents have a pre-admission assessment carried out by the deputy manager (who takes a lead in clinical care) or a senior sister. This is the first part of the BUPA “Quest” documentation, which is a system in place for preadmission, admission process, and care planning. Eight pre-admission assessments were viewed (two from each house), and had been well completed, providing comprehensive information about the residents. Residents’ stay for a trial period of four weeks, after which there is a review to see if the placement is suitable. Residents may also be admitted for respite care. All care homes are required to send CSCI an Annual Quality Assurance Assessment (AQAA), and this was well completed by the new manager, and provided clear and detailed information. It showed that twelve residents in the home have a diagnosis of dementia, and this was discussed with the manager in so far as the home is not registered for providing dementia care. The manager showed a clear understanding that residents who have both nursing needs and a diagnosis of dementia should have placements in care homes registered for nursing and dementia (EMI). However, some of the residents have developed dementia whilst being in the home, and others have lived at the home for a number of years. It was evident that the manager, senior nursing staff, and some carers have dementia care training, and are working together to meet the mental health needs of these residents. However, the manager agreed that the staff who carry out pre-admission assessments would be particularly careful in future to ensure that they do not arrange placements for residents with a diagnosis of dementia, that the home is not registered to take. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 Quality in this outcome area is good. Health care needs are clearly identified in care plans, and residents’ benefit from good standards of personal and nursing care. Medication is well managed in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home uses the BUPA “Quest” documentation for all residents, for planning and recording their care needs. This system includes “prompts” to nursing staff, ensuring that all aspects of care are included. The care plans are based on the initial pre-admission and admission assessments, and developed as needed. They are evaluated on a monthly basis, and senior staff carry out random audits to check they are up to date. Each resident has a named nurse, and it is their responsibility to ensure that care plans are properly maintained. Cultural and religious needs are included, as well as health, personal and social needs. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 12 We (i.e. CSCI) viewed eight care plans – two from each of the four houses. Pre-admission and admission data are well completed, and care plans include comprehensive data and are kept up to date. They include risk assessments for maintaining safety (e.g. use of wheelchair or bed rails); moving and handling assessments – which document how all moves/transfers are to be carried out, and are sufficiently detailed with records of which hoist and type of sling to use; nutritional risk assessments, and skin care assessments. Pressure relieving equipment is provided for residents who have a risk of skin breakdown – e.g. pressure relieving mattresses and cushions. There have been times when it has been difficult for staff to obtain additional pressure-relieving mattresses to ensure there is one in place for new residents prior to admission. The home must ensure that the necessary equipment is in place prior to admission, regardless of who is funding the resident. Admissions should not be accepted if the equipment is not already in place. Wound care and management was assessed in each house. The home has a link nurse who oversees wound care and tissue viability, and who obtains advice from other health professionals and BUPA’s own tissue viability nurse as needed. Wound care is generally well managed, with clear directions for dressings, wound assessment charts, and photographs of wounds taken on a regular basis. Some houses had better written evaluation than others, and the wound progress can be most clearly seen when there is a written evaluation each time that the dressing is changed – as well as charted information. There is good evidence of input from other health professionals, including GPs, dietician, speech and language therapist, and local Hospice nurses. This is especially well documented in Micawber house, where there are residents who have been admitted from the NHS for continuing care. Many of these have complex nursing issues, including “PEG” feeds, and end of life care. Care plans show evidence of discussions about end of life preferences, and record individual wishes. This house has a small quiet room available, which is helpful for relatives and friends to have a place of privacy if a resident is dying. Care plans show evidence that staff are aware of the Mental Capacity Act, and that it is residents’ own choice, for example, in going into hospital or not, so long as they have the capacity to make a decision for themselves. Care staff write a daily life record for each shift, and nursing staff add other information to these as needed. Some are very good records, showing what activities the resident has been doing, what their mood has been like, and aspects of personal care given and if they have enjoyed their food. Other records were poorly written with comments like “no problems”, or “all care given”, and with poor quality handwriting. There has been recent teaching for staff about the correct way to complete these records, and training is ongoing, so we are confident that this is being addressed. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 13 Residents are encouraged to maintain independence and mobility, and can take part in exercise/music and movement classes. Staff were observed as treating residents with respect and a caring attitude. The most recent BUPA residents’ survey showed that 100 of residents who responded to the survey find staff to be respectful, maintain their privacy, and provide very good or excellent standards of care. Each bedroom has a “vacant/engaged” sign to hang on the door, which is a good way of ensuring residents are not disturbed if they do not want this. Medication management was inspected in each house. There is a small but functional clinical room in each house, with sufficient storage space and hand washing facilities. Each is fitted with a drugs fridge, and a Controlled Drugs cupboard that meets specifications. Room and fridge temperatures are recorded each day. Three of the houses have room temperatures which are consistently 25 degrees Celsius or above, and there is a requirement to address this issue, as medication must be stored within the temperature guidelines specified by the Royal Pharmaceutical Society (25 degrees is the maximum). One house uses two medication trolleys for administration, and the other three have one trolley. Some of these are full, although the houses are not fully occupied. Consideration must be given to supplying additional medication trolleys if needed. Medication storage is otherwise well managed, and there is evidence of good stock rotation. One out of date item was found for homely remedies. There is a signed letter from each GP specifying which homely remedies may be used. Residents may self medicate if assessed as safe and able to do so. There is a good assessment process for this. Residents who self medicate must have a clear understanding of the importance of keeping their medication in the lockable facility provided. Medication Administration Records (MAR charts) were viewed in all houses, and are well completed. They include a photograph of the resident, highlight any allergies, and include additional instructions for medication such as warfarin, and for blood sugar records for diabetics. The home uses a blister pack monitored dosage system for administration. Nurses carrying out medication rounds wear a red tabard, as a reminder to other staff/residents that they should not be disturbed when concentrating on medication. There are good procedures in place for storage of oxygen, ordering medication, and for waste disposal of medication. Suction equipment in one house did not show evidence for maintenance for over a year. There is a recommendation to check maintenance dates for all medical equipment. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 14 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): 12-15 Quality in this outcome area is good. The home has made significant improvements since the last inspection in meeting residents’ social needs, and in providing suitable activities. Residents’ benefit from a good variety of food, which is well prepared. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a marked change in the number and type of activities available in the past few months. This is due to the appointments of the new manager in January 2008, and the senior activities co-ordinator in April 2008. Each house now has it’s own activities co-ordinator, as well as the senior co-ordinator for the whole home. One person said that the activities have come on “in leaps and bounds” since the senior co-ordinator was appointed. She has instigated weekly planners for each house, but with flexible programmes to take into account how residents are feeling, and if the weather is suitable for group activities or outings. Each house now provides one to one care for residents in the mornings, (designed for residents who are unable to leave their rooms, or who do not Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 15 wish to); and group activities in the afternoons. One to one time includes chatting quietly with residents, hand massage, word games, crosswords etc. There are also joint activities and networking between houses, enabling residents to have a wider circle of friends. These include activities such as joint entertainment, quizzes, games, crafts, bingo, music and movement, singing afternoons, and church services. The home was currently preparing for a fete in July, and residents were clearly envisioned by this, and spoke enthusiastically about things they were involved in, such as making craft items, and potting up seedlings for plants. The senior activities co-ordinator is putting arrangements into place for regular trips out using local minibus transport services, and outings will include visiting places of interest, country drives, and shopping trips. Each house has a display notice board – set at a level suitable for wheelchair users to view; and pictures of past events and house items (“down memory lane”) to stimulate conversation and reminiscing. The activities co-ordinators write a diary in each resident’s care plan, showing activities in which they have taken part, or where they have been happy to observe others. Understanding the importance of stimulating activities and events is being developed with care and nursing staff, so that they will be increasingly aware of residents’ social needs, as well as personal care and health needs. This is being carried out through additional activities awareness training. Residents are encouraged to bring in their own personal items, so that their bedrooms reflect their own style and personalities. Residents said that the food is good, and there is plenty of choice. Comments included – “the food is always good and there is plenty to choose from”; and “sometimes I will ask for something different from the menu, and the chefs are very good about this”. Food is prepared in a large kitchen in the administration building, and taken by hot trolleys to each house. These have a small kitchenette area, adjacent to lounge/dining areas. They are stocked with everyday food items such as bread/milk/biscuits/tinned items/snacks/fruit, so that residents can have a snack at any time, as well as three meals per day. The kitchen and kitchenette areas were seen to be clean and well organised. Menus are on a four weekly cycle and are changed seasonally. These had just been changed to include Spring/Summer choices. Residents can have a cooked breakfast any day. There are two main choices and a third vegetarian option for lunch, and a choice of desserts. There is a hot choice at teatime, as well as sandwiches/soups etc. Residents can ask for different items than those on the menu, and will always be accommodated if the items are available. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. Residents are confident that concerns or complaints will be listened to, and that appropriate action will be taken. Staff are trained in the prevention of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: BUPA has a set complaints procedure, which is produced in a brochure, and clearly details the pathway to take in the event of a concern or a complaint. Survey forms indicated that some residents are still unaware of complaints procedures, but they stated that they would talk to care staff, nurses, or the senior sister if they were unhappy with anything. A complaints log is kept centrally, and showed ten concerns or complaints logged since January 2008. Good documentation showed that complaints are dealt with promptly and appropriately. One complaint was made directly to CSCI in Autumn 2007, and we asked the providers to investigate this matter. This was carried out thoroughly. Staff are trained on the first day of their induction in the recognition and prevention of adult abuse. They then receive regular (i.e. approximately six monthly) updates. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 17 A staff member said they would have no hesitation in raising concerns about other staff members if they suspected that a resident’s health or wellbeing was at risk. The manager is aware of the importance of liaising with other agencies such as the police or the Social Services Safeguarding Adults team if indicated, and has demonstrated this in practice. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-22, 24-26 Quality in this outcome area is adequate. Residents appreciate that the houses are kept clean and tidy, and that necessary repairs are carried out. All houses are in need of refurbishment in communal areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is pleasantly set out with four houses and an additional administration building. It provides a sense of space and of a well maintained environment. The grounds between houses are well managed, with clipped hedges, flower beds, bedding plants and attractive flower tubs. Each house has their own garden areas, and patio/courtyard areas in which residents can sit. These were all seen to be well maintained, and a credit to the gardener. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 19 Each house was viewed, and seen to be clean and tidy. There was evidence of recent re-decoration in a number of bedrooms. The maintenance man said that twenty-two bedrooms have been redecorated in the last year. These are redecorated when vacant, or as needed. Communal areas are bright and cheerful. Each house has a large lounge/dining room. Dining areas are attractively presented with lace tablecloths, flowers etc. Although all areas are kept clean and tidy, carpeting, woodwork, and soft furnishings in many areas look “tired” and in need of upgrading. All houses are due for refurbishment, and this was mentioned in the last inspection report. This work is due to commence at the end of the summer. There is a requirement to inform the Commission of the proposed dates for commencing this. The maintenance man carries out repairs to areas as needed on a day to day basis, as well as keeping a check of systems and equipment. These include fire alarm checks, water temperature checks, bed side rail checks, hoists, and call bell checks. A number of bedrooms were viewed in each house. These mostly have reasonable quality furniture, and nursing beds. Some have carpeted floors, and some have hard flooring. Bedrooms are fairly small, and do not include en-suite facilities. There are sufficient numbers of bathroom and showers in each house, and these include adapted baths with hoists for assisting residents with personal care. Bathrooms are clean and functional rather than homely. Micawber house has a shower trolley, for residents who cannot be comfortably bathed or showered in other facilities. There are sufficient numbers of assisted toilets, with some of these near to communal areas. Each house has two sluice facilities. There are sufficient numbers of hoists, but these are mostly stored in bathrooms. Consideration needs to be given to providing suitable storage areas, and there is a requirement for this. The laundry is included in the administration building, and is well managed by a dedicated team of laundry assistants. It has separate entrances for clean and dirty linen, and good systems are in place for ensuring clothing is returned to the right houses. Relatives/representatives are requested to name clothing items prior to admission. The laundry has three commercial washing machines and two dryers. These are working almost permanently. The laundry staff struggle to cope if a dryer is out of order, and the possibility of fitting in a third dryer may need to be considered - especially as numbers of residents increase. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 20 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): 27-30 Quality in this outcome area is good. The home has a team of competent and skilled staff to deliver all aspects of care. Staff training is well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each house is staffed separately, and with staffing levels maintained more or less equally for all houses. Micawber House currently has a higher ratio of staff, as this still has some residents in continuing care beds, with higher dependency levels. There are two nurses on duty for day shifts (usually one for each side of each house); five care staff in the mornings, and three care staff in the afternoons. There is one nurse and two care staff at nights. Senior sisters are included in the day duty nursing numbers, except for a few hours each week when they have supernumerary hours to enable them to carry out management tasks. Staff said that these numbers work satisfactorily in practice with the numbers and dependency levels of residents, and the lay out of the houses. Micawber only had twenty-one residents at the time of the inspection, and would need more staff if fully occupied. The manager said that this was recognised, and there are sufficient staff to increase numbers. The home has a system of “bank” staff, as well as a contract with an agency if needed. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 21 Each house has their own housekeeping staff and activities co-ordinator. The home has good systems in place for recruitment. Practices include completing an application form, an interview, and checks for ID, Criminal Record Bureau (CRB), Protection of Vulnerable Adults register (POVA first), two written references, and a health questionnaire. Nurses “PIN” numbers are checked. Copies of previous training records are taken to confirm training. Staff from other countries have police checks from their own countries as well as Britain, and work permits are checked. Three staff files were inspected and were well completed. BUPA is committed to providing care staff with NVQ training, and there are currently 60 care staff trained to NVQ level 2 or higher. Three care staff are going on to study for NVQ 3, and others are due to commence NVQ 2. The home has a training co-ordinator who used to be the deputy manager, and so knows the home well. She oversees every aspect of training, including the induction programme. BUPA has their own induction programme, which matches Skills for Care requirements. Each staff member is issued with an induction booklet, which incorporates all basic training, and includes written answers, which are checked by the training co-ordinator or a designated mentor. Staff are also issued with BUPA distance learning books for the relevant subjects for their job description, and these include health and safety, infection control, basic food hygiene, and nutrition. There is an exam at the end of these, which is sent to Head Office for marking and certification. The training matrix shows that fire training is carried out every six months, and that moving and handling training is done yearly. Most senior sisters have completed “Training the Trainer” courses, enabling them to follow up ongoing moving and handling management in each house. There is a backup DVD system in place, for subjects such as health and safety, use of bed rails, and COSHH. Nurses are enabled to keep their skills and competencies up to date, and are able to attend seminars and workshops for relevant training. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 22 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): 31-38 Quality in this outcome area is good. The appointment of a new home manager has already brought about significant management improvements. Staff have a clear understanding of the home’s policies and procedures, and work together to ensure these are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home went through a time of upheaval during 2007, when the existing manager left, and temporary managers were put in to oversee the home. A new permanent manager was appointed in January 2008, and staff stated that the home has settled down and made considerable progress since her appointment. She is a trained nurse who has completed the Registered Managers’ Award, and has experience of running care homes with nursing. She Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 23 is in the process of applying to CSCI for registration. She maintains a visible presence in the home, in all houses, and is highly spoken of by staff, relatives and residents. A new deputy manager has been recently appointed to assist her. There are regular monthly meetings for all heads of department, and for senior sisters. The manager also attends residents and relatives meetings held in individual houses, enabling her to get to know different people, and seeing if the same themes are raised in regards to care practices, activities, and any concerns. Senior sisters said that the BUPA monthly Early Warning Audit Tool (EWAT) (which is carried out by the manager/regional manager), is a helpful tool for providing them with insight and support into how the individual houses are running. These visits include talking with residents, reviewing care plans, and checking the maintenance etc. There is good networking between houses, and an appreciation of some nurses having specific skills, which others can access for additional advice. Within houses, nurses act as named nurses for a number of residents, and also carry out additional responsibilities in some houses e.g. for medication, tissue viability, or Quest care planning documentation. BUPA have their own yearly survey forms for all residents. The results are audited and compiled into a document which is kept with the welcome pack for prospective residents to view. The last surveys carried out in December 2007 showed that 100 of residents who responded classified the standards of care as “excellent” or “very good”. There was also 100 agreed that their privacy is respected, and their dignity maintained. Some common themes were raised for improvement, and included tastier food, more entertainment, and better TV reception. All of these have been addressed, or are in the process of being addressed, showing an excellent regard for responding to residents’ own views. BUPA has a “Provider Relationship Manager” within CSCI, and she stated that the CSCI finance department has carried out an Organisational Financial Viability Assessment. They are of the opinion that BUPA is financially viable. Residents are encouraged to manage their own financial affairs, (or via a representative), or are assisted with advocacy if needed. The home’s administrator oversees small amounts of pocket monies for some residents. Money is held in a bank account which pays out equal amounts of interest to residents, and is non-profit making for the company. Individual accounts are kept, and all receipts are retained. The administrator ensures that two people sign for money taken out of accounts, if residents are unable to sign for themselves. The manager said that a formal staff supervision programme is now up and running, but has not yet been brought up to date. However, the systems are now in place. Senior sisters have formal one to one supervision with the Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 24 deputy manager, and delegate supervision in the individual houses to named nurses, or heads of departments. Records in the home are generally well maintained and up to date. Maintenance records are well managed. We viewed the monthly bed rail checks, hoist and sling checks, water temperature checks, fire alarm checks, and monthly maintenance audits. “PAT” testing is done as an ongoing routine. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 2 X 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 3 3 2 3 3 Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13 (2) Requirement Timescale for action 18/07/08 2 OP19 23 (2) (b) 3 OP22 23 (2) (l) To take action to ensure that medication storage is within the temperatures set by the guidelines of the Royal Pharmaceutical Society. i.e. medication which does not need to be stored in a drugs fridge, must not be stored above 25 degrees Celsius. To inform CSCI of the details and 31/08/08 proposed dates for carrying out the planned refurbishment for the home. To ensure there is sufficient 30/09/08 storage space for equipment – including storage of hoisting facilities in all houses. 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 OP3 Good Practice Recommendations To ensure that all residents admitted in the future are DS0000026216.V363769.R01.S.doc Version 5.2 Page 27 Wombwell Hall Nursing Home within the stated category of care. 2 OP9 To ensure the maintenance of all medical equipment is kept up to date. Wombwell Hall Nursing Home DS0000026216.V363769.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone 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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