Inspection on 27/09/05 for Wrenbury Nursing Home

This inspection was carried out on 27th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wrenbury Nursing Home 17/11/09

Wrenbury Nursing Home 02/04/09

Wrenbury Nursing Home 05/04/07

Wrenbury Nursing Home 22/06/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Wrenbury Nursing Home Wrenbury Hall Drive Wrenbury Nantwich Cheshire CW5 8EJ Lead Inspector Wendy Smith Announced Inspection 27th September 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wrenbury Nursing Home Address Wrenbury Hall Drive Wrenbury Nantwich Cheshire CW5 8EJ 01270 780114 01270 780114 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Wrenbury Ltd Mrs Gaynor York Care Home 33 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (33), of places Physical disability (3) Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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). * 1 named service user aged over 65 years with dementia DE(E). This person`s care plan to be reviewed on a monthly basis. The registered provider must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 31/05/05 2. Date of last inspection Brief Description of the Service: Wrenbury Nursing Home is a two storey converted detached property situated in its own attractive grounds in a rural setting. It is close to the local amenities of Wrenbury village and there is a bus service to Nantwich town centre. Ample car parking space is available. Bedrooms are on two floors with a passenger lift and staircase providing access to the first floor. There are twenty-nine single bedrooms, six of which have en suite facilities, and two double bedrooms. All rooms have hand wash basins. Assisted bathing facilities are provided and there are adaptations and aids throughout the home. The home has two lounges and a separate dining room. A telephone is available for residents’ use and a nurse call system is provided in all areas. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced visit took place over a period of three and a half hours as part of the Commission for Social Care Inspection’s statutory inspection programme. The home had 27 residents, of whom 25 were receiving nursing care and 2 were receiving personal care. A tour of the building, including all communal areas and most bedrooms, was completed. Health and safety records, and staff training records, were inspected. Time was spent in conversation with the home manager. Three residents were spoken with in their bedrooms, and three were spoken with in the lounge. Most of the staff on duty, and a visitor, were also spoken with. Some of the information contained in this report is taken from the preinspection questionnaire that had been completed by the manager. One comments card was received from a relative and expressed his satisfaction with the home. No comments cards were received from residents. What the service does well: Wrenbury Nursing Home is situated in a peaceful rural location and has a very attractive garden that is accessible and safe for residents. The home manager and three other members of staff have worked at the home for over ten years and have given great commitment to the establishment. Care is provided within a friendly, informal and homely atmosphere and visitors are made welcome. Medicines are well managed. The home provides good ‘home cooking’ with individual choices and needs catered for. Six care staff have NVQ level 3 qualification. The standard of record keeping at this home is consistently good. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? Some bedrooms furnishings. have been improved by re-decoration and new soft The wood floor in the dining room has been stripped down and this has improved its appearance. Six new profiling beds have been purchased. Water systems in the home have been inspected and tested for Legionella. The building has been tested for asbestos. Work has been carried out to comply with requirements made by the Fire Officer. A deputy matron has been recruited. What they could do better: 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. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Standard 6 is not applicable. Prospective residents are provided with written information about the home. Prospective residents are assessed before admission is agreed to ensure that the home can meet their needs. The home is able to meet the needs of residents however one resident is waiting to move to a more appropriate place. EVIDENCE: The home provides written information about its services in a Statement of Purpose and a Service User’s Guide. These documents were available in the entrance area of the home. The manager goes out to visit prospective residents who are referred to the home. She has been training the deputy manager so that she can assess anyone referred to the home for personal care. Assessment information is also received from social workers making the referrals. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 9 The home has one resident who is under 65 years of age and has physical disabilities. This person’s health and mobility have improved considerably since admission and at his last review with social services in July 2005 it was agreed that more appropriate accommodation should be found for him, where his social needs can be better catered for. The manager said that there had been no progress so far in this regard. Another resident, who has been diagnosed as suffering from a dementing illness, is being managed successfully at the home. A warning device is fitted outside his bedroom door to alert staff if he leaves his room during the night. Wrenbury Nursing Home does not provide intermediate care. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9, 10 and 11. Medicines are well managed. The privacy and dignity of residents are protected. Staff provide care and comfort for residents who are terminally ill. EVIDENCE: On the day of the inspection one resident was terminally ill. This person has ulcerated areas on her legs due to circulatory problems. She was being cared for in bed and said she was not in any pain. Her care plan showed that she was receiving appropriate care, including prescribed pain-relieving medicines. This resident was clean, comfortable and settled. There was a drink available close to her. Her care plan had been updated to reflect the change in her condition and provided evidence of regular visits from her GP. This person does not have any close family but staff had put a vase of flowers in her room. Residents spoken with expressed their satisfaction with the care they receive from the home’s staff. They said that the staff were kind and considerate and Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 11 never rushed them. Care staff spoken with were aware of the need to respect the privacy and dignity of residents. The pharmacist inspector carried out an inspection of medicines in January 2005 and found arrangements to be satisfactory. The home obtains prescribed medicines for the residents from the local dispensing doctor’s practice, and any unused medicines are returned there. The documentation of the audit trail is clearly and carefully maintained. Facilities for storage are satisfactory. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14 Residents are able to maintain contacts with their families and friends and to be part of the local community. Residents are supported to maintain control over their lives and to exercise choice. EVIDENCE: The home has one resident who is under 65 years of age and has physical disabilities. This person’s health and mobility have improved considerably since admission and at his last review with social services in July 2005 it was agreed that more appropriate accommodation should be found for him, where his social needs can be better catered for. At present he attends hydrotherapy weekly, but is not able to go to a Day Centre as the home is too far away. A resident who came to live at the home in May 2005 was spoken with in her bedroom. She prefers to stay in her bedroom and has her meals there. She told the inspector that she had ‘no regrets’ about giving up her home and was very happy at the home. She has many friends and family members who live close by and she visits them regularly and joins in social events in the village. She had been to a wedding the previous week. Her health has improved considerably since admission. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 13 Three residents were spoken with in the lounge. They also said that they were very happy at the home. Carers spoken with confirmed that residents are able to chose when they get up and go to bed. They told the inspector that there are about three residents who always like to be up early. No one goes to bed before 7pm unless they are unwell or particularly request this. Residents are assisted to have a rest on the bed in the afternoon if they wish. Sometimes residents like to have a lie-in in a morning. Visitors are welcomed to the home at any reasonable time. One resident said that her husband visits every evening. The son of another resident visits regularly in a morning and reads the newspaper to his mother in the lounge. On the day of the inspection a relative brought in cakes, sherry and chocolates for everyone to celebrate her mother’s birthday. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. Complaints are dealt with appropriately. EVIDENCE: No complaints had been recorded since last inspection. Policies and procedures are in place for dealing with complaints and these had been followed when dealing with matters that arose earlier in the year. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The home provides a pleasant environment for residents, however some matters relating to health and safety of the environment require attention. All areas were clean and free from offensive odours. EVIDENCE: Wrenbury Nursing Home is situated in a peaceful rural location and has a very attractive garden that is accessible and safe for residents. A programme of planned maintenance and refurbishment for the forthcoming year was shared with the inspector. The home was visited by the Fire Officer in June 2005 and requirements were made regarding some of the doors. Work has been carried out to comply with these requirements. The home was last visited by an environmental health officer in February 2005 and no major contraventions of the legislation were found. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 16 Since the last inspection, some bedrooms have been re-decorated and have new soft furnishings, and one has a new carpet. Six new profiling beds have been bought. The wood floor in the dining room has been stripped down and this has improved the appearance. The home also has a new cooker but unfortunately it is too big and will have to be exchanged. The water systems of the home have been tested and it was identified that work is needed to make the systems safe. This work must be carried out without delay. See requirement. The building has been tested for asbestos. A report has not yet been received but the manager said that floor tiles on the stairs and landing may need to be replaced. Commodes in some of the bedrooms have become shabby and rusty and should be replaced. See recommendation. Strips of wood have been fitted to radiators in the bedrooms to protect residents from the risk of burns from the hot surface. In some bedrooms the arrangements were very flimsy, were coming apart, and had wide gaps between the strips. The manager must carry out a risk assessment of radiators and identify where improvements are needed to ensure that residents are safeguarded. The work required should then be carried out without delay. See requirement. All areas of the building were found to be clean and there were no unpleasant odours. A laundry and sluices are provided to meet the required standard. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. The home provides staff to meet the needs of residents. Recruitment policies are in place but four staff are still in need of a second reference. Staff receive training for the work they perform. EVIDENCE: The home employs six registered nurses, however one of these people is off sick long-term. There are also 22 care staff and nine ancillary staff. In a morning there are five care assistants on duty with either one or two registered nurses; in an afternoon and evening there are either three or four care assistants and one or two nurses; at night one nurse and two carers. The home has not been able to obtain two written references for four staff. The deputy manager said that she had written again to the referees whose responses were outstanding. A training matrix records all training courses attended by each member of staff, however at the time of the inspection this was in need of updating. Fire training had last been provided in April 2005. Staff had attended moving and handling training in May and June 2005. Infection control training has also been provided for all staff. Adult protection update training has been booked for ten staff to attend in October. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 18 A number of care staff are working towards NVQ qualification. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. The home is managed by a competent and experienced person. Formal and informal systems are in place for quality assurance. Residents’ personal money is handled appropriately. Arrangements are in place to protect the health and safety of staff and residents, but attention is needed to the water systems and to radiators. EVIDENCE: The manager is a first level registered nurse and has a management qualification. She is registered as manager with the Commission for Social Care Inspection. The home also has a deputy manager who is not a nurse. The deputy manager has NVQ level 3 qualification and is working towards a Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 20 registered managers award. She assists the home manager in administration duties and with training and assessing care staff. The home has a quality assurance programme that is carried out on a monthly basis and look at all aspects of the running of the home. The manager also undertakes a three monthly control audit which includes identifying strengths, weaknesses and action to be taken. A pro forma is available to seek the views of relatives. The manager works full-time in the home and knows all the residents and their families very well. During the inspection it was evident that relatives and residents felt comfortable and confident to come into the office and speak with the manager. Relatives are involved at all levels with the life of the home and the manager said that during a recent illness she received a number of get well cards and messages from relatives of the residents. The manager works as part of the team of nurses. She sees, and is involved in the treatment of, any pressure ulcers or other wounds. The manager also sees all accident reports and these are referenced and filed. The person who is proposed as responsible individual for the home visits every two weeks and makes a monthly report to the Commission for Social Care Inspection as required by regulation 26 of the Care Homes Regulations. One resident has appointeeship from the local authority Most residents have some personal money in safekeeping in the home’s safe. Records were inspected and showed that these were mostly amounts below £50. Transactions are recorded and signed. Staff received fire training in April, and moving and handling in May and June. Health and safety training was provided in 2004. Infection control training has also been provided for all staff. The water systems of the home have been tested and it was identified that work is needed to make the systems safe. This work must be carried out without delay. See requirement. The building has been tested for asbestos. A report has not yet been received but the manager said that floor tiles on the stairs and landing may need to be replaced. The home was visited by the Fire Officer in June 2005 and requirements were made regarding some of the doors. Work has been carried out to comply with these requirements. The Fire Officer also required the fire risk assessment for the building to be revised. The manager has done this and identified that the construction of a ramp outside the dining room fire doors would make evacuation quicker and safer for residents using wheelchairs. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 21 The manager provided evidence that all plant and equipment used in the home had been inspected and serviced as required. Strips of wood have been fitted to radiators in the bedrooms to protect residents from the risk of burns from the hot surface. In some bedrooms the arrangements were very flimsy, were coming apart, and had wide gaps between the strips. The manager must carry out a risk assessment of radiators and identify where improvements are needed to ensure that residents are safeguarded. The work required should then be carried out without delay. See requirement. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 2 3 Standard OP29 OP38OP19 OP38OP19 Regulation 19 23 13 Requirement Two written references must be obtained for all staff. The water systems of the home must be made safe. Residents must be protected from the risk of burns from hot surfaces. Timescale for action 30/09/05 30/11/05 30/11/05 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 Refer to Standard OP19 Good Practice Recommendations Commodes that have become shabby and rusty should be replaced. Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wrenbury Nursing Home DS0000041864.V252950.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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