This inspection was carried out on 17th November 2009.
CQC found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Wrenbury Nursing Home Wrenbury Hall Drive Wrenbury Nantwich Cheshire CW5 8EJ two star good service 03/04/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: June Shimmin Date: 1 7 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Wrenbury Nursing Home Wrenbury Hall Drive Wrenbury Nantwich Cheshire CW5 8EJ 01270780114 F/P01270780114 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wrenbury Ltd care home 33 Number of places (if applicable): Under 65 Over 65 33 0 old age, not falling within any other category physical disability Conditions of registration: 0 3 The home is registered for a maximum of 33 service users to include: * Up to 33 service users in the category OP (old age, not falling within any other category). * Up to 3 service users in the category PD (physical disability). Date of last inspection Brief description of the care home Wrenbury Nursing Home is a two storey converted detached property situated in its own grounds in a rural area. It is close to the local amenities of Wrenbury village and near to Nantwich town centre. 0 3 0 4 2 0 0 9 Care Homes for Older People Page 2 of 9 What we found:
We looked at two care plans of two people who live at Wrenbury Hall and these were of a good standard overall. They identified each persons care needs and included appropriate risk assessments. They had been kept under review on a regular basis so that peoples changing needs were recorded and the care plan updated to reflect any changes. Although there was a risk assessment in place for people in relation to nutrition, there was no care plan for this need so care staff might not know what they should do to meet the persons nutritional needs. We noted that the number of accidents in the home was quite high and that four people in particular had sustained multiple falls, one of which had resulted in serious injury. There was little evidence on the care plans that advice had been sought from health professionals about techniques and approaches to reduce the incidence of these falls. One person living in the home had developed serious pressure ulcers over a period of time. We saw records that indicated that the home had obtained advice from the specialist nurse about this so that the staff were using best practice according to the specialist nurse. We looked at medication records and these were well managed so people living in the home received the medication they needed in a safe and timely manner. We observed interactions between staff and people living in the home and these showed that staff were kind and sensitive to the needs of the people they cared for. However, several incidents regarding the manner in which people were addressed and in relation to the protection of a persons privacy were brought to the attention of the manager at the end of the visit. We looked at the way in which complaints were managed at the home. A record of complaints was being kept but we received information that complaints were not always fully investigated so that people may be uncertain that their concerns were taken seriously. We also looked at how the home manages safeguarding issues. When an allegation is made under safeguarding procedures the home contacts social services, the lead agency in relation to safeguarding. The training records we saw showed that a number of staff had not undertaken training on safeguarding adults so may not be fully aware of their responsibilities and what action they needed to take to make sure that people living at Wrenbury Hall were protected from abuse. We noted that at least one radiator in the dining room was very hot to the touch and was not covered so that people may be harmed if they came into continuous contact with it. The issue of uncovered radiators was raised at previous inspections and has not been fully addressed. We looked at the way in which the home is managing infection control. One senior staff member was wearing jewellery and nail varnish, which are potential sources of infection and which is not good practice, particularly when delivering personal care. Staffing levels at the home seemed to be sufficient to meet the needs of people living
Care Homes for Older People Page 3 of 9 there. We looked at recruitment records. Full records were not initially made available to us so it was difficult to check if these were satisfactory. There was no initial security check for a new staff member although the enhanced disclosure [CRB] was later obtained. Records indicated that there was only one reference for this staff member and that he was asked to visit the home for orientation before the CRB was received. This means that full checks had not been obtained before he came to the home. Prior to the inspection we had requested that the registered person obtain an enhanced security check for a senior staff member who only had a basic disclosure but this had not happened by the time of our visit. We looked at records to see if staff were receiving supervision in relation to training and their practice. The management team for the home told us that they were aware that this is not happening but that this would start in the near future. Training records we saw showed that a number of staff had not done mandatory training in moving and handling or fire safety training so might be putting themselves and people living in the home at risk. The manager told us that the home had difficulty accessing this training but was hoping to arrange training. We raised concerns during our visit about the way in which the home is currently being managed. Communication between the provider and the manager appeared to be limited although the provider visited the home regularly. We also expressed concerns that notifications about events taking place in the home were not sent to us as required by law. We had concerns about the way in which complaints were being managed and that a number of staff had not received mandatory training in moving and handling and fire safety so may not have the knowledge and skills to protect themselves and people living at the home. What the care home does well: What they could do better:
There should be a care plan on nutrition for each person living at Wrenbury Hall so staff know what to do to make sure that peoples dietary and nutritional needs are being met. Professional advice should be sought for people who fall on a frequent basis so that staff have the necessary guidance to make sure that they are taking appropriate action to reduce the number of falls. Staff should undertake further training so they understand the importance of ensuring that the privacy and dignity of people living in the home is protected. The complaints records should clearly show that any complaints made about the home are thoroughly investigated. This is so that people living in the home and their relatives know that any concerns raised about the home are taken seriously and action are taken to put matters right. Care Homes for Older People Page 4 of 9 Those staff who have not already done so should undertake up to date safeguarding adults training so they know how to recognise abuse and what to do if they suspect someone is being abused. Action should be taken to make sure that people living at Wrenbury Hall are not at risk of suffering contact burns if they touch hot, uncovered radiators. Staff working in the home should not wear jewellery or nail varnish to help make sure that infection control at the home is effective. Recruitment practices should be more thorough so that people living in the home know that staff working in the home are suitable to work there. Staff should receive supervision about their practice and training needs so they are given guidance and feedback about their role and care practice. Staff must undertake up to date training in moving and handling procedures so they can help people who live at Wrenbury Hall to move safely. The Care Quality Commission should be notified of any events that might have an adverse effect on people living at Wrenbury Hall, as detailed in the Care Homes Regulations 2001. Staff must undertake training in fire safety and take part in regular fire drills so that people living and working in the home are protected in the event of fire. 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 2. Care Homes for Older People Page 5 of 9 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 6 of 9 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, 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 38 13 Staff involved in moving and 17/02/2010 handling people and objects must receive appropriate up to date training. This is to make sure that staff know up to date safe techniques for moving and handling to make sure they can do this safely without injury to people who live at the home and to themselves. 2 38 23 All staff must undertake fire 17/02/2010 safety training and take part in regular fire drills This is so that they know what to do in the event of fire to protect the people living at the home and themselves. Care Homes for Older People Page 7 of 9 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 1 7 Care plans should be drawn up for nutrition to make sure that staff know what they must do to make sure that the dietary and nutritional needs of the people living at the home are met. Professional advice should be sought about actions that could be taken to reduce the risk of and the number of falls that people living in the home experience. Staff should undertake further training to help them understand the importance of maintaining the privacy and dignity of people living in the home. The complaints records for the home should show that all complaints and concerns about the home have been thoroughly investigated and action taken to resolve them. This is so people who live at the home know that their concerns are taken seriously and acted upon. All staff working at the home should undertake training in safeguarding adults so they know how to recognise abuse and what actions to take if they suspect someone is being abused. Appropriate action should be taken, including risk assessments, to make sure that people living at the home do not suffer burns from hot radiators that are uncovered. Action should be taken to make sure that all appropriate steps have been taken to limit the spread of infection in the home so that people are protected from cross infection. All the necessary information and checks about people being recruited to work in the home should be obtained before they start work there. This is to make sure that new staff are suitable to work with vulnerable people. Staff should receive regular supervision so they have guidance about training and practice to help make sure they provide appropriate care for the people living at the home. The Care Quality Commission should be notified of any events that happen in the home which may have an adverse effect on people living there as detailed in the Care Homes Regulations 2001. 2 8 3 10 4 16 5 18 6 19 7 26 8 29 9 36 10 37 Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - 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!
