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Inspection on 21/06/06 for Wren Hall Care Home

Also see our care home review for Wren Hall Care Home for more information

This inspection was carried out on 21st June 2006.

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

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

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

What the care home does well

The outcome of the care received by residents at the home is considered excellent. The home has substantial strengths and a sustained track record of compliance with meeting the National Minimum Standards for the care of Older People. As areas of improvement emerge the service recognises and manages these well. The staff receive an excellent training provision, which ensures they know how to do their job and deliver up to date care for the residents. There is significant time and effort made by all staff to ensure that residents feel valued and that their wishes about how they are cared for are upheld. This is an extremely well managed service.

What has improved since the last inspection?

The manager has accessed training for staff in the care of the dying using the Liverpool Care Pathway, this is a recognised clinical practice that is research based and is being implemented nationally. The manager has introduced a Newsletter that is circulated to residents every three months; this is in addition to the home`s monthly magazine. The activities worker is now employed full time and has completed a training course in the use of Chair Based Exercise for the promotion of activity for residents. Day care co-ordinators are now provided with dedicated hours to ensure better practice. The communal day areas are now used more effectively, one room is a quiet room whilst people requiring more assistance are cared for in the main lounge. In February 2006 the care co-ordinators completed a management development programme, which they will now use to ensure the new skills improve resident care.

What the care home could do better:

No requirements or recommendations were made at this inspection.

CARE HOMES FOR OLDER PEOPLE Wren Hall Care Home 234 Nottingham Road Selston Nottinghamshire NG16 6AB Lead Inspector Mary O`Loughlin Unannounced Inspection 21st June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wren Hall Care Home DS0000024672.V294295.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. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wren Hall Care Home Address 234 Nottingham Road Selston Nottinghamshire NG16 6AB 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) 01773 581203 01773 860683 Wren Hall Nursing Home Limited Ms Anita Astle Care Home 41 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (41), Physical disability (3), of places Terminally ill (2) Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: Wren Hall is a 41-bed care home, providing nursing care for older people of both sexes, situated in the village of Selston. The two-storey building provides three lounges and two dining areas, one in a pleasant conservatory setting. There are 30 bedrooms, all comfortably furnished and decorated to a high standard. Externally there are extensive well-maintained gardens and, to the front of the building, a good-sized car park. All parts of the home are accessible to service users. The range of prices are: £353.00 to £435.00 (plus registered Nursing Care Contribution (RNCC)) Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted over 5.5hrs. All key standards were assessed. A range of information was used to inform this report; The main method of inspection used was case tracking three residents, this means their records were viewed and the arrangements around their care observed. The resident was then spoken with and their rooms were examined. Two relatives gave an account of the home during the inspection. The manager and one member of the care staff were spoken with. The records of staff recruitment and training were looked at. Responses to the Commission for Social Care Inspection pre-inspection surveys to residents were also received and the information used to inform the inspection and the report. All responses and feedback on the service from residents and relatives were positive and complimentary about the care provided at the home. Everyone felt happy with the care they were receiving. What the service does well: The outcome of the care received by residents at the home is considered excellent. The home has substantial strengths and a sustained track record of compliance with meeting the National Minimum Standards for the care of Older People. As areas of improvement emerge the service recognises and manages these well. The staff receive an excellent training provision, which ensures they know how to do their job and deliver up to date care for the residents. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 6 There is significant time and effort made by all staff to ensure that residents feel valued and that their wishes about how they are cared for are upheld. This is an extremely well managed service. What has improved since the last inspection? What they could do better: No requirements or recommendations were made at this inspection. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 7 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. Wren Hall Care Home DS0000024672.V294295.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 Wren Hall Care Home DS0000024672.V294295.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2-3-6 Quality in this outcome area is excellent. This Judgement is made using available evidence including a visit to this service. Residents have a comprehensive assessment of their needs before their admission to the home which assures them that the home is able to meet their needs. Intermediate care is not provided at the home. EVIDENCE: Significant time and effort is spent making admissions to the home personal and well managed. The service considers carefully the needs assessment for each prospective resident before agreeing admission to the home. Staff are prepared to visit the prospective resident and their family to get to know them and answer questions. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 10 Clear information is available within the contracts provided which explains the terms and conditions of the home. This inspection evidenced the last admission to the home had received an opportunity for a trial visit. The individual had a comprehensive assessment of their needs undertaken by a person trained to do so. The assessment exceeded the national minimum standard required. Intermediate care is not provided. Wren Hall Care Home DS0000024672.V294295.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-8-9-10 Quality in this outcome area is excellent. This Judgement is made using available evidence including a visit to this service. The Health and Personal care which the resident receives is based on their individual needs. The principles of respect dignity and privacy are put into practice. Medicines are safely managed. EVIDENCE: Three residents case tracked had a robust care plan. There were effective systems in place to ensure that each person has their plan reviewed monthly or as their conditions changed. The manager has developed a system of obtaining the views of the residents and relatives for their level of agreed involvement in care planning and each record contains evidence with signed documentation of the arrangements in place. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 12 The care plans are type written and provide an excellent record of instructions to staff on how the individual needs of the resident is supported, they are clear and in plain english and could be followed by people not familiar with its content. There are good risk assessments in place. The staff keep up to date with training on specific practices around the identified needs of the residents, this ensures that the care plans are reflective of relevant social and clinical guidance. There is substantial emphasis on the management of the residents health, routine checks are undertaken with good records of annual health checks such as Influenza vaccine requirements. Residents were seen to have good access to equipment necessary to manage their needs. Residents spoken with felt their privacy and dignity was upheld by a caring and respectful staff team. Staff were seen to knock on doors, each room has a privacy notice that is displayed during any personal care activity or if the resident wishes to be left in private. Residents know who their named nurse is and their key worker and these are also displayed within their room for reference. The Home has a sustained track record of managing medicines appropriately and safely. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-13-14-15 Quality in this outcome area is excellent. This Judgement is made using available evidence including a visit to this service. Residents are able to choose a lifestyle that suits them, are encouraged and supported to maintaincontact with family and friends. Activities are available that suit the residents needs. Residents receive a healthy and varied diet according to their assessed need and choice. EVIDENCE: The home has a sustained track record of meeting these standards. The Residents spoken with felt they had opportunities that suited them to take part in activities and social events. Residents said the staff supported them to see their visitors in private and also escorted them on visits home and to church. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 14 Residents are actively encouraged to keep in contact with their families and friends. Residents are encouraged to control their own finances wherever possible and there is appropriate referral to advocacy arrangement. Residents were participating in an art cleass during the inspection. The full time activities worker receives training in different techniques to ensure good practice. She has recently undertaken a course in chair based exercise that improves peoples level of activity and involvement regardless of their disabilities. Kitchen staff were seen to take around a menu to all residents that included suitable meal choices and they recorded the choices of the resident for that day. Meals were served in the dining area which was very well presented. The meal of the day was a traditional lunch with meat and vegetables. The meals were appetising and appealing. Staff were seen to assist residents with their meals and their approach was very sensitive and considerate. The main entrance has a snack dispenser and drinks are also available at any time. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16-18 Quality in this outcome area is excellent. This Judgement is made using available evidence including a visit to this service. Residents have access to a robust, effective complaints procedure, are protected from abuse by a trained staff team. EVIDENCE: The service has a highly developed, clear complaints procedure. The procedure is made available to all residents and their relatives. Outcomes of any complaints or concerns are managed well. Residents and relatives spoken with on this said they were extremely satisfied with the home and felt safe and well supported by a highly aware management. There are policies and procedures in place and refelect current guidance in adult protection issues. The staff team receive training on adult protection issues and this is evidenced within induction training records. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is excellent. This Judgement is made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well maintained environment that supports people with physical disabilities. EVIDENCE: The home is a clean and well maintained environment where residents are enabled to see it as their own. Residents receive a monthly magazine and an IN TOUCH newsletter that keeps them informed of all that is or has happened at the home and what actions are being taken to improve the service. The residents case tracked had individual rooms with good width doorways and low level windows to ensure people could see out from their chairs and have good space to enable access for those with disabilities. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 17 Residents had a range of excellent quality fixtures and fittings and had their own personal possessions too. The home is hygenic with safe infection control procedures in place to safeguard the residents. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 18 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): 27-28-29-30 Quality in this outcome area is excellent. This Judgement is made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet its stated objectives and the changing needs of the residents. EVIDENCE: The staffing numbers are well above the average and the minimum requirements. There is a highly developed recruitment procedure in place that has the needs of the residents at its core. The service is highly selective, with an excellent emphasis on providing good external induction before staff are expected to deliver direct care. Management prioritise training and facilitate staff members to undertake training monthly, which exceeds far beyond the basic requirements. Relatives and residents felt the staff team were able to carry out their jobs in a skilled way. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 19 New staff are supported by a mentor and are supervised throughout their employment. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 20 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): 31-33-35-38 Quality in this outcome area is excellent. This Judgement is made using available evidence including a visit to this service. The management and administration of the home is based on openess and respect, has an effective qaulity assurance system developed by a qaulified and extremely competent manager. EVIDENCE: The registered manager has the required qualification and experience, is highly competent to run the home and meet its stated aims and objectives. The manager has a sound knowledge of financial planning and review, and manages the service efficiently providing an extremely value for money service. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 21 The manager discussed how the present funding available is restrictive to further enhancement or improvement in services. The manager is seen by staff and relatives to be a strong leader, which leads to confident workers, providing an excellent role model. There is strong evidence that the ethos of the home is open and transparent with the views of both staff and residents listened to and valued. The manager is very committed to ensuring the health, welfare and safety of the residents and staff. There are strong quality assurance systems in place and residents receive feedback on their views. The residents manage their own money or have an advocate to help them. Residents can leave small sums of pocket money within the homes safe and good accounts are in place for these. The records of the fire safety training and management of the systems to control fire were viewed and compliant. Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 22 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 X 4 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 4 Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 23 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. 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. Refer to Standard Good Practice Recommendations Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Wren Hall Care Home DS0000024672.V294295.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!