Inspection on 21/11/08 for Wren Park Nursing And Residential Home

This inspection was carried out on 21st November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wren Park Nursing And... 07/12/06

Wren Park Nursing And... 12/01/06

Wren Park Nursing And... 25/08/05

Wren Park Nursing And... 17/02/05

Wren Park Nursing And... 11/06/04

Wren Park Nursing And... 27/01/04

Wren Park Nursing And... 22/12/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wren Park Nursing And Residential Home Hitchin Road Shefford Bedfordshire SG17 5JD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 2 1 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Wren Park Nursing And Residential Home Hitchin Road Shefford Bedfordshire SG17 5JD 01462851548 01462850667 gagroup@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): GA Projects Limited Name of registered manager (if applicable) Mrs Elizabeth Mazhar Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No one falling into the category of DE(E) may be admitted into the home where there are already 15 persons of category DE(E) accommodated in the home. No other person under the age of 65 years of age may be admitted to the home. The maximum number of service users must not exceed 46. To continue to accommodate the person aged 62 accommodated under category OP and who was named in the proposal to vary the conditions of registration. Date of last inspection Brief description of the care home Wren Park is a privately run care home for people over 65 years with nursing. There are forty six places, and fifteen of these can be for people with dementia. The home is situated at a short distance from the market town of Shefford. The Care Homes for Older People Page 4 of 27 care home 46 Over 65 15 46 0 0 Brief description of the care home premises comprise the original old house that has been adapted, and a large extension has been added to provide residential care. There is a garden with hard area and paths, and parking to the front of the building. Information about this home can be obtained by phoning or visiting the home, and there is also an email address. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out on the 28th November 2008. The care of three people was looked at in detail. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. Care Homes for Older People Page 6 of 27 During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in two of the sitting areas. Observations of care practise and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards. The current range of fees is from 485.00 to 560.00 approx with the home accepting both private and funded placements. In addition extra charges are made for hairdressing and chiropody services and newspapers. Any charges incurred for private dentistry or ophthalmic services are the responsibility of the individual. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have sufficient information needed for them to be able to make an informed choice about living at the home. Evidence: A colour brochure is available with a GA Projects index guide within it, this document is on display in the front reception. The information within this includes comments from people living at the home, activity information, hairdressing charges and how to complain. The use of photographs assists with introducing the staff and showing the grounds and building of the home. On questioning staff it was confirmed that they were aware of the purpose of this document and one member of staff described it as our brochure. People living at the home confirmed that they were aware of the statement of purpose and they or their relatives had been offered a copy prior to moving into the home. Care Homes for Older People Page 11 of 27 Evidence: The records of four people living at the home were examined. All four people had received an assessment of their needs prior to moving into the home. Information had been obtained by social services and/or staff at the home. This information described the history of why the person now required care, alongside their physical and social needs. People spoken to and their families all confirmed that they had been involved in their assessment and had been given the opportunity to offer their views and wishes. All people at the home had terms and conditions of their stay, in addition information had also been included within the statement of purpose and service user guide. This showed the additional charges that would be made above the standard weekly fee rate, and when such additional charges would be made. The home does not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not have sufficient information to ensure that staff have all the information that they need to ensure continuity of care. Evidence: The care plans seen within the individual records were standardised typed documents. The majority of assessed needs identified within the original assessment for each person did have a care plan in place, however for one person assessed as being at risk of weight loss had no plan in place for this. In using the standardised documents the exact individual needs of the person and how staff should meet them were not always fully explained. One example was a person had been described as having outbursts of verbal aggression and can be upsetting, there was no specific guidance to staff in how they should approach this or support the person when this happened. The use of the standardised plans can still be used however additional information needs to be added to ensure that they follow a person centred approach. In addition more specific information must be included an example of this was for one person who received insulin as part of the management of their diabetes. The actual level and frequency Care Homes for Older People Page 13 of 27 Evidence: had not been included within the care plan or at what level their blood sugar should be and if it wasnt what action staff should take. Records were seen within the individual folders that showed people had been receiving treatment from medical professionals, these included letters from the hospital to confirm appointments. Two people living at the home confirmed that if they ever needed to see a Doctor then the staff would always arrange for this to be done, this was supported by written entries seen. Staff through questioning demonstrated a sufficient level of knowledge in how to access additional health care or advice this included seeking guidance from a dietitian for one person. Medication stocks and records were examined. In the main these were satisfactory however there were some discrepancies found. One person living in the older part of the home had signatures missing from their medication record, in the current cycle there should have been 9 signatures but there were only 7. Another person living in the newer part of the home had not received one dose of their prescribed ferrous sulphate, one member of staff had signed to say that they had given it, when in fact they had not. The storage, stock balance and records for controlled medication was correct. Staff were observed throughout the inspection to assist people in a courteous manner. The term of address that they used was in response to the individual wishes of the person. It was observed that when anyone required support with personal care that staff would do this in a way to ensure the persons privacy was maintained. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home feel that the choice of meals available meets their individual preferences. Evidence: Management are developing their practise of delivering person centred care regarding the social needs of the people living at the home. Staff make daily routines as flexible as possible to enable them to provide Person Centred Care. During the course of the visit no restrictions were seen to be made to any activity that people choose to do. An activities coordinator has been working closely with individuals to ensure activities are available to meet their preferences. An extensive programme is advertised at the front of the home. The service in their written values within the statement of purpose state that they recognise how important it is to the individual to continue with personal and social relationships and there is no restriction on visitors and or residents going out to continue their involvement in community activities or to become involved with the community. On speaking with people living at the home everyone supported this view. People living at the home said that management encouraged the staff to speak with Care Homes for Older People Page 15 of 27 Evidence: them and spend time with them. Many relatives were seen to visit at this inspection, no restrictions were noted. People when they move into the home are encouraged to bring in their personal belongings to personalise their room. When rooms need decorating the manager advised that people could be given a choice as to the colour scheme they would like. With the exception of one person, all other people spoken to stated that they enjoyed their meals. A menu board detailed the choices available. The most recent environmental health inspection found that there were sufficient standards in this area being maintained. In addition nutritional risk assessments were seen to have been undertaken for the people living at the home. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place at this home for receiving and investigating complaints is positive and responsive to assure people that their concerns will be received, listened to and acted upon. Evidence: As described within the choice of home section information within the statement of purpose and service user guide was noted to be up to date. There was information on whom to contact if you wished to make a complaint. At the previous inspection records were seen at that time to show how complaints had been responded to and what action had been taken to remedy any shortfalls and this was assessed as meeting this standard. The inspector spoke with people living at the home. One person said I wouldnt mind complaining if I wanted to it doesnt matter what we say the staff are always so friendly. The management of complaints and concerns were seen to be important to the owners and management of the service as they felt it was another way that they could improve the service. The home had in place a policy on abuse and a copy of the most recent guidance for the Safeguarding of Vulnerable Adults that contained the correct reporting of any alleged abuse. Training records showed staff had received training in this area. During Care Homes for Older People Page 17 of 27 Evidence: the interviewing of staff they were able to demonstrate that they knew how to report any concerns. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All areas in the home provide a good standard of accommodation and provide a homely environment for people to live in. Evidence: Peoples rooms that were seen contained personal items for example photographs and pictures. Assisted bathrooms are in place and grab rails were also in place to assist people with their mobility. The large ground floor sitting areas to both sides of the home were decorated satisfactorily, people spoken with all said that they were satisfied with the accommodation and the views from the windows onto the grounds. Communal spaces provide a good amount of natural light and ventilation. People spoken to felt very satisfied with their individual rooms. Cleaning schedules were seen to be in place alongside clinical and domestic type waste contracts. Protective clothing such as gloves and aprons were seen to be used by staff and hand washing facilities were situated throughout the home. No odours were detected at this visit. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The training arrangements for staff needs to improve and the recruitment systems do not protect the people living at the home. Evidence: Training records and plans were examined. These showed that there was a deficit in some of the areas required. Information supplied by the service stated that the owners are going to be working on a rolling training programme to support learning and development, with the assistance of this programme training will be more readily available and accessible for staff. A training schedule given to the inspector showed that there were plans in place to ensure the remaining staff had up to date training in food hygiene, moving and handling and SOVA . The homes recruitment policy and procedures as previously assessed are clear and comprehensive. Examination of three staff files was undertaken to look at recruitment practises in the home. Evidence seen in all the folders showed that there was a deficit in the checks required in accordance to schedule 2, also staff were noted to not be directly employed by the service but under a self employed system. This related to the recruitment of staff from overseas and did not involve the manager. The records relating to staff employed who were living in Britain did meet the standard and included an application form and Criminal Records Bureau check alongside the relevant Care Homes for Older People Page 20 of 27 Evidence: references. Several people spoken to at this visit felt that in the main staff would respond to them when they needed assistance. Everyone spoken with described feeling confident in their abilities and felt the manager was especially friendly and courteous to them as they were always asking if they were alright. Observation over the visit showed that positive relationships had been established between the people living at the home and staff. Conversation flowed freely with engagement between them evidencing that this was a usual pattern. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety systems are sufficent to reduce the risks associated with this area for the people living at the home. Evidence: Information supplied by the home show that the Registered manager has many years managerial experience and holds the RMA certificate as well as being a Registered Nurse. The manager is supported by a Deputy. Both the Manager and the Deputy are supernumerary to staff numbers. The people living at the home and staff spoke positively about her approach and management style. It was observed during the inspection that she involved herself with the daily life of the home and was evident that she makes time to spend with the residents. The home has a Health and Safety policy. There was evidence within the training records that some staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments have been undertaken and were seen within the Care Homes for Older People Page 22 of 27 Evidence: individual records examined. The inspector observed during this visit safe moving of a person living at the home by two staff. Records of the testing of water temperatures, emergency lighting and fire equipment are maintained. Questionnaires to seek feedback had been sent out, feedback from this can be found within the service user guide. A quality assurance programme used by the service is carried out by senior staff where they audit specific areas in the home. This programme requires a monthly audit to be undertaken in specific areas. The balances of small amounts of monies held on behalf of people living at the home were checked, all were noted to be correct. Receipts are kept for any expenditure. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be in place for all assessed needs and contain the individual requirements of the person. This is to ensure all people living at the home receive continuity of care. 06/03/2009 2 9 13 Medication systems must be sufficient to ensure people receive medication when prescribed and records are accurate. This is to ensure people living at the home maintain optimum levels of health. 06/03/2009 3 29 19 A POVA First Check as a minimum must be secured alongside two references and all other matters listed in schedule 2, one reference from the most recent employer prior to commencement of employment of staff to verify their suitability to 06/03/2009 Care Homes for Older People Page 25 of 27 work with the people who use the service. This is to protect the people living at the home, from receiving care by someone who may not be suitable to work in a care home. 4 30 18 Staff must have received as a minimum specific training relating to the individual needs of a person before being allowed to provide care to them. To ensure their safety and the protection and safety of people using the service. 06/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!