CARE HOMES FOR OLDER PEOPLE
Wren Park Nursing and Residential Home Hitchin Road Shefford Beds SG1 2EE Lead Inspector
Andrea James Unannounced 25th August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Wren Park Nursing and Residential Home Address Hitchin Road Shefford Beds SG1 2EE 01462 851548 01462 850667 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) G A Projects Ltd Care Home with Nursing 46 Category(ies) of OP Old Age - 46 registration, with number DE(E) Dementia over 65 - 15 of places Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17.02.05 Brief Description of the Service: Wren Park was registered to provide for residential and nursing services to forty-six persons over the age of sixty-five years. Fifteen of the places were registered for those with dementia. The registration also included forty-six places for those with a physical disability.Satisfactory arrangements were in place to refer service user to health care specialists as need be and to provide a comfortable and supportive service. The service included the provision of meals, laundry services and in house activities provided by a delegated organiser.The home was managed by a registered nurse and sufficient other nursing staff were employed to provide a qualified person on duty at all times. Adequate care and ancilliary personnel were employed. The home was situated at a short distance from the market town of Shefford. The building comprised the original old house that had been suitably adapted and had a large extension, purpose built to provide residential care. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 25th of August 2005 over a period of 5 hours. The registered manager and the registered provider were present for the duration of the inspection. The inspection followed a case tracking methodology where samples of service users were selected from the residential and nursing sections in the home. The service users spoken to were selected at random and their documentations reviewed in detail. The inspection report also reflects the views of relatives, care staff and the management team. The home was registered for 46 service users, 25 of which had residential needs and the remaining 21 had nursing needs. The home had 3 (step-down) beds. There were 4 vacancies on the day of the inspection. What the service does well:
The home provided good standards of care to the service users and created an environment that the service users and relatives spoke positively about. The service users said the home was lovely and they were well taken care of. One service user said staff looked after her very well and they were always there for her. Care staff were observed having conversations with service users in a relaxed manner. Relatives spoken to said they were happy with the home and felt that the care staff were “ fantastic”. The care staff were described as professional and nice. One relative said the home seemed to ensure that enough care staff were on duty, as a result she could always find staff if she needed one. The home ensured that qualified nurses were always on shift to meet the needs of the service users. Care staff appeared to take active interest in service users and they were allowed to go out in the community on a regular basis during the summer months. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 6 Service users were encouraged to maintain their independence and some service users were encouraged to self-medicate. Care staff explained how certain service users ability to perform personal care had developed through encouragement from staff. What has improved since the last inspection? What they could do better:
There were areas in the home that needed further development in order to ensure satisfactory standards of care are being upheld. One being the lack of information recorded on service users’ care plans. This was only noted for those service users receiving nursing care. The home failed to demonstrate how they were able to meet the identified needs of the service users. One example was a service user who had a catheter whose records not have sufficient information about when it was to be replaced or what care staff should do to care for the service user. There was need for better risk assessments to ensure the safety of service users. The home had recruited 50 of their staff team from overseas and as a result there were some communication barriers between these carers and the service
Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 7 users. Staff commented that the overseas carers had limited caring experience. The health and safety aspects in the home needed further development to ensure all service users had access to call systems in all areas of the home. There was also a need for the home to ensure sufficient numbers of staff are available to meet the needs of the service users. The qualifications of the carers needed further development to ensure at least 50 of the care staff had an NVQ level 2 qualifications or equivalent. Arrangements for dealing with deceased service users needed to be implemented in the home to ensure service users wishes were upheld. It was also noted that one service user’s insulin was being drawn up 7 days in advance by the district nurse team, which was not good practice. The commission would like to thank the care staff, service users, relatives and the management team for their co-operation in the inspection process. 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 Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4and 5. The home provided sufficient information that enabled the service users and relatives to be able to make an informed choice of the suitability of the home. There were good admission processes in place and service users benefited from the information provided. Minor changes were needed to the contracts and service user’s guide to ensure service users are safeguarded and kept informed of the procedures of the home. EVIDENCE: All service users spoken to said they were given a statement of purpose and a service user guide. One service user said she was able to view the home before they moved in. She said she had a review meeting once she moved in. This was evidenced in her records. The service users guide needed further development to include the views of the service users, the fire procedures and the Commission’s inspection reports. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 10 The contractual agreements also needed further development to ensure both service users and the home’s representative signed the document to show consensual agreement to the conditions detailed in the contract. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 standard(s) 7,8,9,10 and 11 The home’s ability to identify and meet the health care needs of the service users were poor with the exception of the residential care. This resulted in the welfare of the service users being compromised and neglected. Arrangements for deceased service users were poor and as a result the wishes of the service users were not documented. EVIDENCE: The home had developed it’s ability to assess the needs of the service users to a satisfactory standard. The care plans and records inspected in the residential areas of the building were satisfactorily maintained with a few exceptions, however the records seen for those in the nursing section of the building were poor. The care plans had not identified how they were meeting the needs of the service users and in some cases service users had no care intervention recorded. One service user who had a catheter had no care intervention recorded for this need and no records were available to say when this should be changed. The records also failed to provide sufficient evidence that service users were consulted about their care package or that they were reviewed. There was a
Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 12 lack of risk assessments, resulting in the possibility that service users welfare was compromised. The home had satisfactory medication procedures; the storage and recording of medications were satisfactory. One service user who self-medicated had his insulin drawn up 7 days prior to administration by the district nurse. Service users spoken to said they were treated with respect and dignity. One service user who was blind also explained that service users were patient with her and she was able to say when she wanted to rise and who she wanted to care for her. This was also documented in her care plan. Service users said they were given choices on a daily basis. One example of this was all service users were able to choose what they wanted to eat on any one day. The home failed to demonstrate their ability to identify the wishes of service users once they are deceased. No records were seen that identified the wishes of service users after they were deceased. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 standard(s) 12,13,14 and 15. The home was able to meet the expectations of service users in their daily lives and social activities, these included regular family contact and varied dietary needs. This resulted in service users ability to maintain control over their lives. EVIDENCE: The home was able to meet the needs of the service users by providing various activities that met with their expectations. Service users spoken to said they had regular activities and were able to go out with staff. The home employed an additional two carers who were responsible for the activities of the service users. Care staff also said they tried to take all service users out using a rota system. Some service users were observed exercising to music on the day of the inspection. Relatives spoken to said the service users received several activities and were aware that the Hairdresser and Vicar made weekly visits to the home. Relatives said they were made to feel welcome when they went to the home. One relative commented that the home would benefit from having a visitor’s
Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 14 room where private conversations can be had. The manager said a visitor’s room was available for this purpose. The home had a weekly menu that was rotated to offer choice and variety. The meals offered were nutritious and tasty and had choices to meet the needs of the service users. Service users spoken to said they enjoyed the food and felt that they were always given large portions. One service user said sometimes the vegetables were too hard but enjoyed other aspects of the food and the presentation. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 The complaints procedures implemented in the home were satisfactory and ensured that complainants would receive a positive outcome should service users complain. The home had a policy for protecting service users but there was no evidence available to suggest care staff were aware of the procedures, as a result service users could be abused through ignorance. EVIDENCE: The home had not received any formal complaints since the last inspection. The service users spoken to said they were aware of the complaints procedures but did not feel they needed to use it. Relatives spoken to said they were aware of the complaints procedure and felt confident that they could approach the manager should they wish to complain. The complaints procedure was also available in the service user’s guide. Service users spoken to said they had a good relationship with the care staff and would tell them if they were not happy. The care staff spoken to had little knowledge about the protection of vulnerable adults policy and the training records showed that the home had not addressed this area of training for the care staff. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 standard(s) 19,20,22,23,24,25 and 26. The environmental standards of the home were good and this was also reflected in the service users’ bedrooms and the outdoor facilities. The condition of the environment ensured that service users were comfortable and safe. EVIDENCE: The home was decorated to a satisfactory standard. The maintenance person who had worked in the home for 14 years was repainting some communal areas on the day of the inspection. Some furniture was old and needed replacing but the overall feel of the communal areas were that they were comfortable and had a sense of character. The home was situated on a large area of land and as a result the garden areas were large and accommodated a swimming (area) that staff said they used in the summer. Relatives also spoke about this feature and felt that more
Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 17 service users could benefit from the view if the garden was more wheelchairs accessible. The service users’ bedrooms were individually decorated to meet their needs. The use of hoists and other lifting equipment were visible throughout the home. The home was not totally secured and as a result those service users with dementia needed to be risk assessed to ensure their safety should they go out into the gardens unattended. The home was clean and free from offensive odours. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30. The home’s ability to recruit, train and produce competent care staff were poor, as a result service users needs were not always met in a satisfactory manner. EVIDENCE: The home admitted that they found it difficult to recruit care staff and felt that this was because of the geographical location of the home. The home employed 21 care staff including qualified nurses to ensure the needs of the service users were met, however further development was needed to ensure service users needs are to be met. One area of the home had 18 service users but only had 2 care staff. The care staff spoken to said they felt this workload was very heavy and although they received help from other sections of the home there were no guarantee when this help would arrive. The care staff said they had several service users to bath and transfer resulting in 2 carers having to care for one service user, as a result the other service users needs are not being met at these times. The unit had a nurse but her role did not include performing personal care to service users. The home also had a large amount of carers that were recruited from overseas. This resulted in some communication difficulties between the service users and the carers. Care staff said that they did not have any experience in care and as a result required training. This is difficult to achieve due to their
Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 19 communication barrier. The home had ensured that a weekly English course was available to the carers but those spoken to said they did not get to attend very often because they regularly had to work 12-hour shifts. The home had addressed some aspects of training but further development was required to ensure the care staff were aware of the changing needs of the service users. 2 carers had achieved their NVQ level 2 in care but the manager said 5 care staff had embarked on the course and another 2 had expressed an interest. There was a need for further training in dementia awareness, abuse awareness and health and safety, as the staff team had not embarked on these areas of training. The recruitment procedures needed further development to ensure care staff were not allowed to work in the home unless they had sufficient clearances available. The staff files inspected showed that two carers were working in the home without satisfactory Criminal Record Bureau clearance. One staff had no records. The manager said she was transferred from the sister home and her records had not yet arrived. The staff files also failed to have contract of employment and job descriptions. There were no induction procedures seen. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32,33,34,36,37 and 38 The manager demonstrated effective leadership skills that ensured service users were able to feel confident in her approach. The manager had limited control over the budgetary aspects of the home and as a result could not readily make changes, to reflect service users wishes. The quality monitoring systems in the home were poor and as a result service users’ best interests could not be assessed. EVIDENCE: The manager had worked in the organisation for several years and had been managing the home for 5 years. She was a qualified nurse with several years of experience with the client group. She demonstrated a good knowledge and understanding of the service users needs.
Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 21 She said she received support from the registered providers, who visited the home on a regular basis. The manager had received no formal supervision. The manager had made some development to the quality assurance system by collecting questionnaires from the service users but these were not evaluated. Other aspects of a quality monitoring system needed to be developed by the home. The care staff said they received regular supervision and records were seen of staff supervision. The home had satisfactory health and safety policies and procedures available. The fire safety records checked were satisfactorily maintained and various notices were seen to demonstrate the home’s commitment to health and safety. There was a need for further risk assessments to ensure the safety of the service users when they left the building. The service users welfare could be compromised by the lack of call points in the communal areas of the home, which was evidenced on the day of the inspection. Service users said they would call for staff by shouting because they were always around. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 2 x 3 3 2 Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 (1) Requirement Timescale for action 30.10.05 2. 3. 4. 5. 6. 7 7 7 7 8 7. 9 8. 11 Arrangements must be made to develop the care plans for the service users with nursing needs. These must show the care interentions to be carried out by the care staff. 15 (2) (b) The care plans must be reviewed on a monthly basis. 15 (2) ( c) Service users must be consulted where possible about the care to be implemented. 13 (4) ( c) Adequate risk assessments must be developed to safeguard the welfare of the service users. 15 (1) The health care needs for the service users must be reviewed to incorporate good practise. 15 (1) All service users wearing catheters must have satisfactory guidelines for their usage and disposal. These must be documented. 13 (2) The advance dispensing of insulin medication must be reviewed and must only be dispensed on the day of administration. 17 (1) Arrangements must be made to ensure the service users wishes in accordance to their death are recorded and adhered to at all
I51 S17698 Wren Park V223728 250805 Stage 4.doc 30.10.05 30.10.05 30.10.05 30.10.05 30.10.05 30.10.05 30.10.05 Wren Park Nursing and Residential Home Version 1.30 Page 24 times. 9. 27 Arrangements must be made to ensure sufficient numbers of staff are available to meet the needs of the service users to a minimum ratio of 6 to 1. 19 (4) ( c) Arrangements must be made to ensure satisfactory recruitment procedures are in place to ensure clearances are sought for all employees prior to them commencing employment at the home. 24 (1) (a) Improvements must be made to (b) the quality assurance monitoring systems in the home to meet the requirements of the regulations. 12 (1) (a) (b) The manager must have better control over the budgetary forecasting of the home to include staffing and purchases within the home. Arrangements must be made to ensure all service users have access to a call system in the event they needed assistance. 18 (1) (a) 30.10.05 10. 29 30.10.05 11. 33 12. 34 13. 38 13 original date: 12/7/04. 31/3/05 New date: 30.10.05 original date: 12/2/05. 28/2/05. New date: 30.10.05 30.10.05 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. 2. 3. Refer to Standard 1 2 19 Good Practice Recommendations The service users guide should be developed to include the homes fire procedures. All contracts for the service users should have both the signature of the service user and the homes representative. Arrangements should be made to replace the furniture which are worn to ensure the comfort and appearance of the home.
I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 25 Wren Park Nursing and Residential Home 4. 5. Wren Park Nursing and Residential Home I51 S17698 Wren Park V223728 250805 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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