Inspection on 02/04/09 for Wrenbury Nursing Home

This inspection was carried out on 2nd April 2009.

CQC found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wrenbury Nursing Home 17/11/09

Wrenbury Nursing Home 05/04/07

Wrenbury Nursing Home 22/06/06

Wrenbury Nursing Home 27/09/05

Wrenbury Nursing Home 31/05/05

Wrenbury Nursing Home 04/01/05

Wrenbury Nursing Home 27/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wrenbury Nursing Home Wrenbury Hall Drive Wrenbury Nantwich Cheshire CW5 8EJ     The quality rating for this care home is:   two star good 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: Wendy Smith     Date: 0 3 0 4 2 0 0 9 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 25 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 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 Additional conditions: 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. Care Homes for Older People Page 4 of 25 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: two star good 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 2 stars. This means that the people who use the service experience good quality outcomes. We visited Wrenbury Nursing Home unannounced on 2 April 2009 as part of this inspection. Two inspectors carried out the visit. The manager had gone out with residents, so we made a second visit on 3 April to look at management records and complete the inspection. During the visit we spoke with residents and staff. We walked round the building to see all the communal areas and were able to visit some of the bedrooms. We checked some of the records kept at the home and spent time talking with the manager. Care Homes for Older People Page 5 of 25 We also looked at any information that we had received about Wrenbury since our last inspection there. Before the inspection the manager was asked to complete a questionnaire to give us information about the service. Some members of staff completed surveys to give us their views of the home. What the care home does well: What has improved since the last inspection? What they could do better: Radiator covers have been repaired since our last visit, but we considered that some covers were rather flimsy and might easily break if weight was put against them. The manager is advised to look again at all radiators and assess any risks, particularly where a bed is adjacent to a radiator. Some beds had a single bed rail fitted and it is safer to always use them in pairs. Staff training needs to continue to make sure that all staff are kept up to date with safeguarding training to ensure that the people living at the home are kept safe. Care Homes for Older People Page 7 of 25 More care staff need to achieve a national vocational qualification (or equivalent) in care to make sure that as many as possible have up to date knowledge and skills in providing care for the people who live at the home. 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. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 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 9 of 25 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. Peoples needs are assessed before they go to live, or have a short stay, at the home. This is to make sure that their needs can be met. Evidence: When we visited there were 27 people living at the home. Two of these people were having a short stay. In the care plan we saw a full assessment that had been provided by a social worker for one of these people before she came to the home. The other person had come in as an emergency following a bereavement and information about his needs had been given by telephone. The manager usually visits any person interested in coming to the home and assesses whether their needs can be met. The assessments are recorded in writing and used to develop care plans. A significant number of the people living at Wrenbury Nursing Home have a degree of cognitive impairment and/or confusion. We considered that they also had care needs Care Homes for Older People Page 10 of 25 Evidence: due to poor mobility or other physical ailments and the staff appeared able to provide the support they needed. We discussed with the manager the possibility of the home owner applying to change the conditions of registration of the home in order to accommodate people whose primary needs are due to dementia. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living at Wrenbury are met by the homes staff with support from healthcare professionals as needed to make sure people stay as well as possible. Evidence: Each person has a care plan that details their needs, any risks identified and the care that they require. We looked at some of the care plans to see what care people needed and how this was recorded. The plans we saw were detailed and clearly written. When a persons needs had changed, the care plans had been revised to reflect this. At the time of our visit two people were very frail and had pressure sores. Wound charts were in place and were completed at each change of dressing to show progress. Appropriate pressure relieving equipment was being used for people identified as being at risk. The local GP visits the home each week and also provides an out of hours service. The care plans recorded that people have visits from healthcare professionals as needed and on the day of our visit, one of the people living at the home was having Care Homes for Older People Page 12 of 25 Evidence: an assessment by a physiotherapist. The arrangements for the ordering, storage, recording and administration of medicines are good. Medicines received are all signed into a book, and any items that are carried over from one month to the next are recorded on the new medication administration record sheet. This helps to keep a check on what medication is in stock each month. Storage was neat and tidy with no old stock. Recording, including controlled drugs, was good and showed that people receive their medicines as prescribed by their doctor. All bedrooms are single rooms and all care and support is carried out with due respect for peoples privacy and dignity. The people we spoke with during our visit to the home considered that staff were polite and respectful. A visitor told us that the home is very caring and a social worker thought their client was treated with dignity and respect at all times. Care Homes for Older People Page 13 of 25 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 who live at the home are able to choose how they spend their time and there are social opportunities for people who wish to join in so they can stay active. Evidence: There is a choice of two comfortable lounges or people can spend their time in their own room if they wish. The bedrooms are personalised with residents own belongings, such as pictures and ornaments, to make them feel more homely. People who we spoke during our visit with expressed their satisfaction with daily living arrangements. There is now an activities organiser for the home. She is a member of the housekeeping staff who has recently taken on the role of activities organiser. She is enthusiastic about providing more social opportunities for the people who live at the home and has made a good start. On the first day we visited, nine people had gone on a trip out, and on the second day, four people were joining in making Easter bonnets. They were particularly enjoying the social interaction and there was much laughter. We were told that people had recently enjoyed baking and a visit to a local pub. Entertainment and a special tea were provided for Mothers Day and eight relatives Care Homes for Older People Page 14 of 25 Evidence: joined in. Trips out have been arranged for forthcoming months and letters have been sent out inviting families to planned events. The home has contacts with local church groups and a communion service is held monthly in the home. Young people from local schools also visit during the year. Two residents go out regularly with their families. The dining room is bright and spacious, and can accommodate all of the people who live at the home. People may have their meals in their own room if they prefer. A cooked breakfast is provided for people who would like this. We looked at the menus, which showed that a good choice is available at all meals. The people we spoke with were happy with the quality and quantity of their meals and staff considered that people receive a nutritious diet. Care Homes for Older People Page 15 of 25 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. There are good processes for complaints and safeguarding at the home so people living there are protected from harm and their concerns are listened to and acted upon. Evidence: There is a complaints procedure for the home and this is included in the information given to new residents and their families. It is also displayed in the entrance area of the home. In the information the manager sent us about the home, she told us that one complaint had been received by the home in the last year. Full records had been kept and these showed that the complaint had been dealt with by the owner of the home who had responded to the complaint in writing. The manager has been providing safeguarding training for staff, and training records showed that nearly all of the staff have now attended this training. Incidents that have occurred during the year have been reported to social services following the correct procedures. This helps to make sure that the people living at the home are protected from harm. Care Homes for Older People Page 16 of 25 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable but upgrading work needs to continue to ensure that people have pleasant surroundings to live in. Evidence: The home is comfortable and homely, but it is an old building that requires ongoing maintenance and upgrading. In the information the manager sent us she told us that the following improvements had been made since our last visit to Wrenbury. A new fire alarm system that identifies each room has been installed. Two bedrooms have been fitted with ensuite toilet and shower. The dining room has been upgraded. There are new carpets in some ground floor corridors. New curtains and armchairs in the lounges. New equipment in the managers office. Care Homes for Older People Page 17 of 25 Evidence: More adjustable beds provided. New carpets, bedding and curtains in some bedrooms. Six new wheelchairs and new hoist. Some new kitchen equipment. Lighting updated. Treatment room updated. Further development of the gardens. We looked at all public areas and some of the bedrooms. Some windows in the lounges were being replaced. Radiator covers have been repaired since our last visit, but we considered that some covers were rather flimsy and might easily break if weight was put against them. The manager is advised to look again at all radiators and assess any risks, particularly where a bed is adjacent to a radiator. Some beds had a single bedrail fitted and it is safer to always use them in pairs. Some rooms are personalised with peoples own belongings to make them more homely and familiar for them. The building was clean throughout. There is a full time maintenance person for the home to help make sure that it is well maintained. Care Homes for Older People Page 18 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of the people who live at Wrenbury are met by qualified and experienced staff. Staff recruitment processes are thorough to help make sure that they are suitable to work with the people who live at the home. Evidence: Six registered nurses, including the manager, are employed at the home and 15 care staff. Six of the care staff have an national vocational qualification in care and two are working towards this qualification. NVQs are nationally recognised qualifications for staff working in the field of social care and show that staff are competent to provide care. There are two staff working at the home who are NVQ assessors so they can support other staff who are working towards these qualifications. One of the overseas staff has a social work qualification that she achieved in her home country. There is always a nurse on duty, with four care staff in a morning, three in an afternoon/evening, and two at night. When needed, agency care staff are used to maintain these numbers. During our two visits to the home we saw there were enough staff to meet the needs of the residents and the staff rotas indicated that adequate staffing levels are maintained. There are two domestic staff on duty on weekdays and one at the weekend, a cook and a kitchen assistant every day, and a laundry assistant every day. The staff we spoke with were pleasant and helpful. Care Homes for Older People Page 19 of 25 Evidence: We looked at the recruitment records of the three most recently recruited staff, a nurse and two care assistants. Two new care assistants are from eastern Europe. They were recruited by an agency which provided all of the required background information. We saw induction training records that included safe moving and handling training, and this had been translated into their first language to ensure that they fully understood. The manager told us that she was very pleased with these members of staff and was waiting for two more staff to start who have been recruited from the same country. The new nurse had been working at the home since September 2008. A Criminal Records Bureau disclosure and two satisfactory references had been received and her nurse registration had been checked to make sure that she was suitable to work with the people living at the home. The staff who completed our questionnaires were satisfied with the induction and ongoing training they received. Training records showed that staff receive regular updates of health and safety related training which helps to make sure that they provide safe care, in line with current guidelines. Care Homes for Older People Page 20 of 25 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. The home is well-managed to ensure that people are kept safe. Evidence: The home manager has been in post for ten years and has shown great commitment to the service. She has continued to develop her own knowledge and skills and has gained qualifications relating to health and safety, and teaching and assessing. The home owner visits three times a week and the staff we spoke with all knew the home owner. Regular staff meetings are held and the home owner attends some of these meetings. The most recent minutes we saw were from October 2008. A meeting had been held in February 2009 but the minutes were not yet typed up, and there was a nurses meeting the week before our visit. One of the staff who completed a questionnaire told us that the staff work as a team in every department. Care Homes for Older People Page 21 of 25 Evidence: We observed that relatives have good relationships with the manager. The manager does not hold resident or relative meetings but said that she regularly gets the views of residents and relatives informally on a one to one basis. The home does not look after the finances of any residents but small amounts of personal spending money can be put in safekeeping and full records are kept. Information provided by the manager indicated that all plant and equipment are regularly checked, serviced and maintained. Following a recent visit by the local authority, a report identified improvements were needed in the environment. A fire risk assessment was written in 2007 and updated in 2008. The fire officer visited in December 2008 and made a requirement about replacing smoke seals on doors. This had been done when we made our visit to the home. We saw records of a weekly fire alarm test, and records of regular fire training and drills, including night staff. A new fire alarm system has been installed and the emergency lighting is being tested and replaced as needed. The maintenance person and the home manager have completed a health and safety course. Policies and procedures were all reviewed and updated in 2008. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 38 13 Residents must be protected 31/05/2007 from the risk of burns from hot surfaces. Timescale of 30/11/05 and 31/08/06 not met in full. Care Homes for Older People Page 23 of 25 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 19 13 Checks must be made to ensure that residents are not at risk from hot radiators. This is to make sure that they cannot fall on the radiators and hurt themselves. This is an outstanding requirement that has been partly met. 29/05/2009 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 1 19 Where bedrails are needed thay should be used in pairs for safety. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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