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Inspection on 12/08/09 for Wrottesley Park House Nursing Home

Also see our care home review for Wrottesley Park House Nursing Home for more information

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are happy in the home, have good relationships with staff, and make daily decisions about their lives. Care is provided the way they want and risk taking is supported. Activities people said they like include bingo, computer games, exercise and regular outings in the community. Relatives and advocates spoke highly of the home and are kept closely informed: "home does most things well, would be difficult to improve"; "The health, feeling of wellbeing, independence, dignity and freedom of choice is always of prime importance..." Staff work well as a team to meet individual needs. "The home is run very well by management...and things are quickly solved if any problems arise." People experience good outcomes in most regards, and we complimented staff practice and management on our visit. Care planning and well managed systems for consistent staff, medication and communication ensure people`s needs and rights are met with good access to specialist healthcare and physiotherapy. Competent staff have training and guidance to understand people`s conditions, update clinical practice, provide rehabilitation and encourage independence. Facilities and staff promote privacy. The home is clean with controls to prevent the spread of infection. People, relatives and professionals influence the running of the home. The management team are highly motivated and sustained high satisfaction. The home continues to learn and develop through the complaints process, audits and inspections. Abuse is acted upon and people keep safe in the home and in the community.

What has improved since the last inspection?

Open days were held for the public. The admission process is now consistent, with personal and health care plans used and understood by staff. A dignity champion was assigned. The administrator delivers mail directly to people`s rooms to respect privacy. Activity coordinators complete six monthly forms with people about activity and outing likes/dislikes; there is now more choice and use of community facilities. Healthy living and wellbeing is promoted, and there are closer links with community health services. There was clinical training so that people do not need to make unnecessary trips and be attended to by strangers for flu vaccinations, blood tests and infection screening. People only go to hospital when necessary. The home improved their ability to meet people`s needs rapidly in an emergency. The Gold Standards Framework in end of life and palliative care planning was introduced, which is best practice. Management strive for excellence, continued learning and service development. A manager`s surgery was introduced so that people and families have a regular time to talk privately. Surveys are now sought from visitors as well as people. An Investors in People Award was attained in 2008 which shows that the home has excellent staff support. Wrottesley Park House are now a teaching care home for University of Wolverhampton student nurses. This helps retain and recruit staff and also benefits people by keeping staff up to date.An assistant manager was appointed and responsibilities are now shared by a management team. Managers kept up to date on new laws about people`s rights and safeguards, undertake further qualifications such as in learning disabilities and clinical techniques, and provide accredited in-house training for staff. A new system for health and safety was introduced. Wolverhampton City Primary Care Trust accredited the home with a bronze award in infection control and regular checks ensure these standards are maintained. New carpets, flooring and some new furniture was provided, and people`s rooms were decorated. The patio was further developed and an area of garden was landscaped.

What the care home could do better:

There was no contract for one person funding their own care. Published information about the home does not reflect improvements made for people`s benefit. The entrance hall can be more welcoming so that visitors can read their noticeboard and people can use the phone. Goal planning should include people`s aspirations so that their independence, rehabilitation and quality of life are fully addressed. Following the inspection the home confirmed there are appropriate food stuffs to manage someone`s health and diet. Recruitment checks on staff need to be consistent to fully protect people; satisfactory action was taken after our visit. A proactive health and safety culture is needed, timely maintenance and repairs to prevent accidents and minimize risk of infection spreading. Furniture and equipment should match people`s needs, and refurbishment should prioritize health and safety. People need sufficient protection from current smoking arrangements.

Key inspection report Care homes for adults (18-65 years) Name: Address: Wrottesley Park House Nursing Home Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Tina Smith     Date: 1 3 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 36 Information about the care home Name of care home: Address: Wrottesley Park House Nursing Home Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902750040 01902755510 zoes@abbeyhealthcare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Abbey Healthcare Homes Ltd care home 63 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is: 63 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 20, Physical disability (PD) 58 Date of last inspection Brief description of the care home Wrottesley Park House is on the main A41 Wolverhampton/Telford road; the entrance is shared with a housing development. It is on a main bus route, and there is off-road car parking. The premises and grounds are accessible for wheelchairs. Offices are behind the signing in desk. The home is purpose built with four wings on two floors; each wing has communal areas. There is a main dining room, multi-sensory room, smoking room and laundry on the ground floor, and a pay telephone in the entrance hallway. There is a lift to the first floor where there is an exercise room with Care Homes for Adults (18-65 years) Page 4 of 36 Over 65 0 0 20 58 Brief description of the care home physiotherapy equipment. All bedrooms have en-suite facilities and a shower. There are additional assisted bathing rooms. Many of the ground floor bedrooms have french windows and the garden is not enclosed. A fee range is not published as this depends upon the nursing and care required, explained in the service user guide. Nursing care is funded by the national health service. There are standard terms and conditions that explain what is included and excluded from the fee. This information was correct at the time of our visit; for up to date information enquiries should be made to management. Care Homes for Adults (18-65 years) Page 5 of 36 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was held on 12/06/07 when no requirements or recommendations were made. Prior to our visit the home sent their Annual Quality Assurance Assessment (AQAA). The AQAA provides information about what has improved and is planned for the future, and current information about running the home. The AQAA arrived on time and had all the information we asked for. The self assessment quality was generally good. Information from this and from other sources was also used when forming judgments on the quality of the service. The home sends us notifications about legally required events, and we receive reports from other sources such as multi-agency safeguarding minutes. We received 17 out of 30 surveys we sent to people in the home, relatives and staff. Two inspectors visited the home over two days. The home was not informed that we would be visiting. We looked around the home, spoke with nine people and 11 staff and examined four care records. Medication administration was observed twice, Care Homes for Adults (18-65 years) Page 6 of 36 breakfast and dinner were also observed. Records about the running the home were seen including: staff files, communication and training records, contractor certificates and maintenance logs, audits, Abbey Health Care spot check reports, and quality assurance reports about the views of people, relatives and professionals. We also saw the homes published information and certificates on display. Policies and procedures were seen and/or discussed about complaints, adult protection, mental capacity, fire safety, smoking and human resource processes. The home manager was present on both days. We were also assisted by the deputy and assistant manager. We discussed our findings with these managers. As a result of our visit no immediate requirements were made as management acted on concerns we raised and people are safe. No requirements have been made. Recommendations are at the end of this report. Care Homes for Adults (18-65 years) Page 7 of 36 What the care home does well: What has improved since the last inspection? Open days were held for the public. The admission process is now consistent, with personal and health care plans used and understood by staff. A dignity champion was assigned. The administrator delivers mail directly to peoples rooms to respect privacy. Activity coordinators complete six monthly forms with people about activity and outing likes/dislikes; there is now more choice and use of community facilities. Healthy living and wellbeing is promoted, and there are closer links with community health services. There was clinical training so that people do not need to make unnecessary trips and be attended to by strangers for flu vaccinations, blood tests and infection screening. People only go to hospital when necessary. The home improved their ability to meet peoples needs rapidly in an emergency. The Gold Standards Framework in end of life and palliative care planning was introduced, which is best practice. Management strive for excellence, continued learning and service development. A managers surgery was introduced so that people and families have a regular time to talk privately. Surveys are now sought from visitors as well as people. An Investors in People Award was attained in 2008 which shows that the home has excellent staff support. Wrottesley Park House are now a teaching care home for University of Wolverhampton student nurses. This helps retain and recruit staff and also benefits people by keeping staff up to date. Care Homes for Adults (18-65 years) Page 8 of 36 An assistant manager was appointed and responsibilities are now shared by a management team. Managers kept up to date on new laws about peoples rights and safeguards, undertake further qualifications such as in learning disabilities and clinical techniques, and provide accredited in-house training for staff. A new system for health and safety was introduced. Wolverhampton City Primary Care Trust accredited the home with a bronze award in infection control and regular checks ensure these standards are maintained. New carpets, flooring and some new furniture was provided, and peoples rooms were decorated. The patio was further developed and an area of garden was landscaped. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 Adults (18-65 years) Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 36 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. There is an accurate assessment of needs and preferences by trained staff and people can be confident that these will be met. There is written information about the home and fees, and people can visit to decide if it is suitable. Evidence: People told us that staff are very nice and its a nice place to live; ... I can come and go as I like...the food is nice and there are three choices for dinner. Someone having a short stay felt their health was well supported. They could return home during the day and come back to sleep, which made them feel secure and more confident. This shows us that people are helped to settle in and have the support they need. On our visit there were 48 people in the home, two for short stays. The AQAA told us that there were 18 admissions and 48 people who came for short stays in the past year. There is no intermediate care service. Abbey Health Care does not have a website, but we were told that the home can be found by searching the internet. People and families told us they had enough information to make a decision about the homes suitability. We wanted to look at the Care Homes for Adults (18-65 years) Page 11 of 36 Evidence: accessibility and detail of information for people with complex needs and how decisions are made about admission and discharge. We looked at four pre-admission assessments and spoke to nine people and observed their support. All four preadmission assessments were thorough and accurate. Two people were visited in hospital by the home; multi-professional meetings and family visits to the home took place. Relevant information was gathered from health and social care before the home determined that complex needs and preferences could be met. This was followed by a trial period. One person was admitted in a crisis from another home that could not extend their stay during an emergency, and information from the home was obtained. There are some regular respite programmes. One person was preparing to move, and two other people were discharged in the past year, which shows us that the home promotes independence. We advised an independent mental capacity advocate is sought for a person involved in a dispute about their best interests to stay or move. The service user guide, statement of purpose and a brochure are available in a range of languages and a large font so that it can be easily read. These describe the facilities and service people can expect, terms and conditions. A minor inaccuracy about the providers name was queried. We were told that staffing and qualifications are added by hand so that they are accurate. Inspection reports are on display at the entrance. The home is aware that published information is outdated and the AQAA told us that they plan to review this. It is not showing how people benefit from improvements made since the last inspection, and the design could be more consistent and accessible. Some but not all documents use symbols to assist people with specialist communication needs. The manager acted on our suggestion that people are involved in improving publications by approaching a service user with computer skills, who was pleased to be asked. People can be confident that services included and excluded from the fee are clear in the terms and conditions. One person in the home for some time and funding their own care did not have a contract on file. The manager will be following this up with their family and Head Office. We were shown the format of a self-funders contract, so we know that these are now in use. Other people currently in the home are funded by health and social care agencies all over the country, and also have contracts with these organisations. Care Homes for Adults (18-65 years) Page 12 of 36 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People, representatives and professionals take part in care planning or make rehabilitation and best interest decisions together. Staff have clear guidelines and responsive communication systems to support people the way they want and need. Independence, education and healthy living are promoted. Evidence: Care planning is person-centred even though people have diverse and complex needs and conditions, and not all can make their own decisions. Assessments are used to form personal care and health action plans which are agreed with people and their representatives and signed. Staff read them, know people well and we saw communication plans put to use,helping people to take control of their lives. People take part in purposeful activity for their interests, personal development or rehabilitation. All four records take account of peoples interests, preferred names, likes and dislikes about food and daily routines, along with spiritual needs, and choice of staff gender Care Homes for Adults (18-65 years) Page 13 of 36 Evidence: for help. One record has detailed guidance about religious customs. Objectives are broken down into achievable steps. These promote health, wellbeing, social interaction, education, independence and manage behaviour and personal safety when necessary. Goal planning does not include aspirations, so that rehabilitation, independence and quality of life are fully planned for. People experienced good outcomes. Emotional wellbeing of several people improved after re-assurance, management of health conditions, anxiety and frustration. For example, a person without speech is now smiling all day but previously held their head downcast. Someone was waiting delivery of an electric wheelchair to improve their independence. The Gold Standards Framework has been introduced to raise standards for people with degenerative conditions and for end of life care planning. This shows us that the service is holistic for adults at all stages of life. Staff were friendly and helpful to people, and two praised their keyworkers. Staff respected privacy and dignity, and did not rush people while administering medication and during meals. People chose where and when they want to eat. In the dining room people prefer to eat alone at a table and have their main course and pudding served together, so they decide which to eat first. Several people told us about their contact with friends and family, activities they were taking part in and had recently enjoyed. Staff, including activity coordinators and a physiotherapist encourage people to try new things for personal, sensory and physical development and recovery from trauma. Risk assessments were in place for two out of four people, however all care plans had instructions for staff to prevent falls, pressure sores and malnutrition. Some documentation for people with high nursing needs were incomplete, including a falls and wellbeing checklist but their needs are met. Bedrail risk assessments were in place but on examination we raised concerns which were immediately addressed for peoples safety. Detailed care plans are regularly reviewed and evaluated, along with monitoring measures, such as daily records and health care charts. Staff have training and guidance to understand peoples conditions and clinical techniques. Shift handovers ensure that care and nursing is adjusted quickly. Staff provide information for people to make informed decisions to consent or refuse care and treatment. The right to take risks is respected. there is education about healthy eating and personal safety. Support is in keeping with their decisions and the protection of others. This was evident through care records and safeguarding processes. There was free movement throughout the home and grounds for people assessed to be safe to do so. Some people have identified needs for staff escorts outside, door alarms, checks at night or care plans to manage behaviour and Care Homes for Adults (18-65 years) Page 14 of 36 Evidence: protection to others or self harm. Consent forms are signed about photographs, which are used for nursing, administering medication, and as a precaution if people go missing. Records are securely kept for confidentiality. Managers had training about peoples rights and lawful restrictions on peoples lives. One Deprivation of Liberty authorisation was recently made and referred to the council supervisory body. Behaviour management avoids the need for restraint by diversion and calming, which is best practice. Bedrails are used only to prevent falls from bed. Doctors conduct regular medication reviews about drugs prescribed. Some people have powers of attorney, named individuals or advocates who help them with their financial affairs. When requested, the home assists people to manage personal allowances. There is a good system in place with receipts and accounts that tally. Money is spent in accordance with peoples needs and wishes, for example on hairdressing, chiropody, theatre tickets. We complimented helpful advice given to people about budgeting and action the home have taken to safeguard peoples financial interests. Care Homes for Adults (18-65 years) Page 15 of 36 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the home is fully responsive to meet everyones needs. Flexible routines mean people can lead their own lifestyles, worship as they choose and take part in activities, education and outings. Good relationships are maintained with families and friends. Food is nutritious and most dietary needs are catered for. Evidence: There are flexible routines and visiting arrangements. People said they lead the life they choose, getting up and going to bed when they want to. Most people are out of bed for periods during the day, and we confirmed with a person that they choose to remain in bed. Records note whether people prefer baths or showers and how often, religious customs, and any hobbies, worship or social activities they want to continue in the home or community. A few people attend educational classes such as English language and poetry, day services and social clubs, such as Age Concern or at the Care Homes for Adults (18-65 years) Page 16 of 36 Evidence: supported housing scheme next door. Religious needs are reviewed and people are offered attending a place of worship or seeing visiting clergy in the home. On both days of our visit people went on outings in the morning and afternoon, shopping and to the theatre in the homes transport. Others occupied themselves in their rooms and wings, and the physiotherapist saw people individually. We saw a wii being played, books read and one person is designing a newsletter on their laptop. People decide what to watch on TV, and TV is not always on. People and relatives suggested in surveys that the choice of activities and outings could be widened to meet all age groups and tastes. The homes records show us that this is regularly reviewed with people, and there was a chart of the week on display. One of the two activity coordinators retired just before the inspection. We were told they will be replaced, and there are other volunteers who come to the home regularly to assist with activities and outings. The home confirmed that an annual holiday is not provided. Some people go out on their own, with friends and family or have visits in the home. Staff keep named representatives informed. People in ground floor bedrooms can use their French windows to go out when they want. Some people need an escort to use the grounds or on outings to keep safe. Where there is a risk of someone going missing, door alarms alert staff to attend for their safety. During our visit we how quickly staff attend. People were wearing their own clothing, in keeping with their age and gender, likes and dislikes. Daily people choose whether to eat in the dining room, their wing or their room. The home could do more to prepare people for independent living, such as helping themselves to breakfast and preparing sandwiches as well as the cakes currently made together. A staff dignity champion was appointed and we found dignity promoted as well as issues to be addressed. Some people tidy their rooms by themselves, but one person wanted more help from staff. A survey said that the laundry service could improve and although action was taken after a residents meeting to launder clothing within 48 hours, we saw delay in the return of clean clothing to peoples rooms. Staff lacked clarity about this role. People in one wing cannot get to the toilet in time because communal facilities are out of order. People said the food is good and there are three choices, which is above average in care homes. They are consulted about the menu at resident meetings. On our visit Care Homes for Adults (18-65 years) Page 17 of 36 Evidence: five people were peg fed at appropriate intervals. Vegetarian, diabetic and cultural choices were on offer. Catering staff said they are made aware of peoples needs, however we had cause to query how one persons dietary needs were met. The home confirmed action taken immediately after the inspection so that there are appropriate products to prepare food to manage their specific health condition. We tried the food and saw menus which showed that most people have a balanced and nutritious diet. Food is tasty but some was not hot enough, which we queried. Food is fortified so that those with small appetites or who need a high calorie intake are catered for, and we noted people at malnutrition risk were gaining weight. We complimented diabetic cakes identical to others on the menu but tastier. Fresh fruit and vegetables were in stock and snacks are always available. Care Homes for Adults (18-65 years) Page 18 of 36 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their needs are met. Dignity, recovery and independence is promoted through effective care and nursing. The fitting of equipment needs to protect people from accidents. The medication system is well managed and protects health. Evidence: People were dressed appropriately for the weather. Their appearance and personal hygiene was good. Most people said that staff are available when needed. We saw dignity promoted by staff using preferred names, prompting continence discretely, knocking on doors and waiting so there is privacy. One person said on the odd occasion they had to wait for help and were not treated with dignity at the time. This was discussed with the manager, who had already taken action but will follow this up further. There are several people independently mobile in manual or electric wheelchairs. There are risk assessments to minimize risk of injury to one person who refuses footplates and footwear. Two people avoided collision with their wheelchairs, and an ensuing argument was quickly diffused by staff. Someone fell while mobilizing Care Homes for Adults (18-65 years) Page 19 of 36 Evidence: independently using an aid. Staff were respectful and responsive, checking for injury and assisting the way they wanted to get up independently. An emergency alarm also went off accidentally, and staff attended without delay. People at risk of falling had a variety of beds, bedrails and bumpers. We were notified of two injuries from collapsed bedrails in the past year, so we looked at these closely with the manager. There are good risk assessments and care plans with fitting instructions, but these were not always followed. Some people were at risk of head and limb entrapment from gaps, positioning of the rail, and loose fittings. Action was taken during our visit to check all fittings and provide alternative rails and a bumper where necessary so that people are safe. One persons bedrails have bent several times, from reasons the manager discussed with us (see environment). There are detailed instructions about dietary needs, manual handling and clinical interventions. Catheter care and peg feeding is appropriately planned, monitored and provided. Good liaison with other professionals ensures that rehabilitation is consistent and effective. For example, checking with hospital staff about positioning, care, equipment and nursing requirements prior to hospital discharge. When problems arose recently with catheters, there was liaison with consultants and community nurses and emergency support for two people who needed surgical intervention. A rehabilitation consultant visits the home monthly and prescribed treatment that made people more supple so that physiotherapy can be carried out at the home. This has improved peoples recovery of use of their limbs. People gained or lost weight in accordance with risks to their health so that malnutrition and obesity are avoided or treated. The effectiveness of the care plan and food/fluid intake monitoring is evaluated. One person with an objective to lose weight had a dietician previously involved. Waterlow scores were recorded in most records identifying people at risk of developing pressure sores. Appropriate pressure mattresses were in place at the right settings, but the setting is not always noted in care records. One person told us about a sore being treated which they thought was from their wheelchair. We queried this and the wheelchair seat was found to need adjustment. People have annual checks with opticians, dentists and doctors and regular chiropody. Specialists involved include consultants, speech and language therapy, dieticians, rehabilitation services and nurse specialists, such as Parkinsons Disease. Links with community health services, the University and the promotion of health and wellbeing improved. Epilepsy management has seen a dramatic reduction of seizures. Clinical Care Homes for Adults (18-65 years) Page 20 of 36 Evidence: training was expanded and nurses now provide blood tests, flu vaccinations and infection screening. Individuals are only sent to hospital and health centres when necessary. The home now has a defibrillator and training from the West Midlands Ambulance Service to meet peoples needs rapidly in an emergency. Best practice is used in end of life and palliative care planning via the Gold Standards Framework. The medication system is well managed, including homely remedies. Medication is administered by trained nurses. There is written guidance in care records so that staff understand its purpose and effects, and recorded preferences which we saw used. Refusals are respected and when necessary risk assessed, and doctors regularly undertake reviews. There are internal and external medication audits and we are not aware of any medication errors. Controlled drugs are checked at each shift change, are well recorded and appropriately stored. There is an air conditioning unit where medication is stored, and regular temperature checks. The supply of medication is out of synchronization with the ordering system used with the pharmacy. Frequent remedial action is taken up with prescribing doctors so that there is always enough medication. We suggested how this can be addressed in the longer term. Care Homes for Adults (18-65 years) Page 21 of 36 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can report a complaint or concern inside or outside of the home and can have confidence this will be taken seriously and be acted upon in a timely manner and in accordance with local protocols. People are supported to take risks by keeping safe strategies, and legal duties are met in safeguarding people with mental incapacity. Evidence: The complaints procedure is on display and in peoples rooms. This details how people can report a concern inside or outside of the home. The latest version should replace an older version in the entrance hall. Contact details of advocacy services were removed in the newer version, but as this promotes peoples rights we suggested this is reviewed. The procedure could be made user friendly for people with specialist communication needs. Local advocacy services are used to help people make decisions. We advised that a statutory advocate is sought for someone facing a series of serious best interest decisions, in accordance with the local council contract. People and families know who they would report a concern or complaint to, and have confidence that management will take appropriate action. There were five complaints in the past year in the homes log. The timescale was met and complaints resolved to peoples satisfaction. This is checked regularly through Abbey Health Care audits. Suggestions raised in meetings and surveys with people have action plans. This shows us that the home takes peoples views seriously and acts upon them. Care Homes for Adults (18-65 years) Page 22 of 36 Evidence: During the past year the home faced some difficult situations we were notified about, such as suicide and attempted suicide by people with progressive conditions. On our visit we saw good risk assessments and care plans to manage self harming behaviour with clear triggers, guidelines and involvement of mental health services. Emergency resuscitation equipment and training was sought after incidents where ambulances were delayed. Abuse, safeguarding and legal duties are also taken seriously. There are checks on staff before they are employed, including temporary staff and volunteers. Timely action has ensured people are protected inside and outside of the home, and that abuse is prevented where possible. The home works well with other agencies to keep people safe, in accordance with their up to date policies and individuals mental capacity. Support and education is provided to people at risk of abuse in the community, of exploitation by friends and family and by their own lifestyle and relationship decisions. The home raised three adult protection referrals with the local council, and are working with statutory agencies regarding two other concerns. Two reports were made to a government list to protect vulnerable adults throughout the care industry. People who pose risk to others in the home have behaviour management and personal safety plans. These safeguard everyone in the home as well as provide least restriction of rights, which is best practice. For instance relationships are maintained in accordance with informed consent and personal safety plans however one visitor is restricted, which is proportionate to the circumstance and risk. Where restrictions on peoples lives are necessary, consent is sought or best interest decisions are made in accordance with law and codes of practice. We discussed a recent Deprivation of Liberty Safeguard Authorisation responsibly made by the manager. Application was made to a council body as per new legal duties. If the council continues the authorisation, a formal representative will be appointed to review this regularly with all concerned. The home acted to protect two peoples financial interests. The homes code of conduct prohibits staff from roles in peoples financial affairs or benefiting from wills. Formal powers of attorney are appropriately consulted, and people have budgeting advice from staff for their own decisions or for their personal development. There are up to date inventories of personal possessions, and no reports of things going missing. Care Homes for Adults (18-65 years) Page 23 of 36 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 comfortable and clean, and peoples rooms promote privacy and independence. Refurbishment, audits and a proactive culture need to prioritise and promote health and safety, prevent the spread of infection; repairs and maintenance needs to be timely. Action was taken to prevent scalds from hot water. Evidence: Wrottesley Park House is not distinguishable as a care home. It is currently hard to find. The homes discrete sign is no longer readily visible as the entrance is shared with a new housing scheme built in the same style. The home is purpose built, designed to be wheelchair accessible. The garden extends around the home and is not enclosed, so people without road safety awareness are risk assessed. The home has a minibus and a car purchased by service users and fund raising; running costs are met by the home. We looked around the home, talked with people and staff and saw the homes records. People and stakeholders are consulted about the environment, the colour of their room, cleanliness and facilities and are mainly satisfied in the homes own surveys. The atmosphere is welcoming and homely, but could improve. In response to views the lighting was improved in the entrance hallway. We advised that this hallway is still too dark for visitors to read their noticeboard, and for people who use the pay phone Care Homes for Adults (18-65 years) Page 24 of 36 Evidence: or an organ. Lighting is important because the AQAA told us that nearly half of the people using the home have sight impairment. Each wing has a large lounge with chairs set out so that people can talk together or watch large screen TVs, appropriate for visual needs. However the lighting could improve in one wing, where people used a wii computer console provided by the home. Bedrooms are personalised by photographs and some people bring furniture. Room layout or shelving could improve in two rooms to prevent trailing electrical wires for individuals own possessions. The home has specialist facilities that they want to expand. There is a physiotherapy room and equipment, used most days. There is a multi-sensory room and Redwood has tropical fish for calming and stimulation. People suggested that a computer area is developed, which is being planned. We discussed expanding facilities for people with sensory impairment after viewing a complaint in the homes log. The AQAA told us that there is a rolling maintenance and renewal programme for the fabric and decoration of the premises. We had recent complaints from families about a leaking toilet and smell affecting two bedrooms, which was addressed when the leak was found. The home told us about storm damage affecting the atrium of one wing; work will commence shortly, planned to present least disruption to people living there. The standard of decor, furnishing and equipment is adequate but needs modernisation and is not fully in keeping with peoples needs. Damage, wear and tear will be frequent and some have special needs. It is not apparent that health and safety has been considered in the homes planning. There is only one modern profiling bed, which one person brought with them. Bedrails and footboards or grab aids with strength need to be sourced to match individual needs, and loose bedrails eradicated by consulting an Occupational Therapist. We were not satisfied with manufacturers advice sought by the manager during our visit. There were cracked bed bumpers and tilt chairs, posing infection control risk to peoples health. The home was clean and generally smelled fresh, but mattresses airing in two rooms had mild odours. We raised other cross-contamination risks. A food trolley was too close to a soiled laundry trolley which staff did not notice or act upon our query. Clean laundry was hanging in communal areas of two wings for most of our visit. We were told about problems six months ago with equipment breakdown. Staffing hours for laundry were increased, and the manager said they are now on top of this, but this was not evident on our visit. Care Homes for Adults (18-65 years) Page 25 of 36 Evidence: Two communal bathrooms in one wing had hazards and posed risks to people. One room was in darkness with only a flashing light. This room should have been out of action with a warning sign to prevent accidents, but it only had an out of order sign on the bathtub. The other room had dripping sink and bath taps; flooring coming away from the side of the bath. We were told they are waiting for an electrician, a plumber and spare parts; that people mainly want showers and use facilities on other wings. We had a steaming hot tap tested as it scalded our fingers, and the water temperature was lowered so that people are safe. We had other comments about furniture, outside security lighting, and the replacement of bed linen, pillows and towels. Repairs are not timely, and audits/spot checks need to be conducted more critically. Health and safety hazards are not always noticed or acted upon in a timely way, to prevent accidents and for peoples health, fire safety and dignity. During our visit the manager removed hazards, and acted on matters we raised, and will be following up others. Maintenance records and contractor certificates were checked as the AQAA told us that some were out of date. The emergency alarm system had not been serviced; this was arranged during our visit. The following have been maintained: gas appliances and heating system, hoists and slings, bacteria control in the water supply, and emergency lighting. One person told us they did not have a call system, which was rectified during our visit, however two call systems were not fully accessible in bed due to the room layout or location of the plug. We examined smoking arrangements as we had a report of concern after a recent fire in a bedroom, caused by a cigarette and rubbish in a bin. We were told that this was quickly put out by night staff. The home has a policy whereby people who smoke are risk assessed; some need to use a dedicated room, and others use their bedrooms, or smoke outside their rooms in the garden. Bedrooms where smoking takes place do not have signs to warn those who enter, and bedding is not fire rated. The smoking room in Cedar wing has a sign, but does not have a window for fresh air. It has an extractor fan and portable fan to remove smoke and re-circulate stale smelling air, however when the door is opened smoke can briefly come into the home where some people have lung conditions. We were told that council environmental health inspected and passed this facility in 2007, and that the homes fire risk assessment is up to date. We will discuss our concerns with the council and fire safety officer so that people have sufficient protection from fire and for their health. The AQAA said that the home used government guidance about infection control, and the home have a bronze award from the Primary Care Trust. Two thirds of staff are Care Homes for Adults (18-65 years) Page 26 of 36 Evidence: trained in infection control and safe food handling. There is a training plan to address this shortfall. In most regards we found best practice in use - liquid soap, paper towels, readily available anti-bacterial gel, gloves and aprons. There are sluices on each wing, and a laundry room. The home has a 4H award in good food hygiene. The kitchen is clean with appropriate food storage and food hygiene records. We queried whether the Bain Marie was working as some of the food was not hot, and the manager will be undertaking a trial to determine if it needs replacement. The manager confirmed there is a contingency plan about influenza. Standards are maintained through monthly audits, however neither identifed risks and worn out furnishings we queried to prevent the spread of infection and illness. Care Homes for Adults (18-65 years) Page 27 of 36 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a competent staff team who keep up to date and have good support to meet peoples needs at all times. Recruitment checks need to be consistent to protect people. Evidence: Since the last inspection people have benefited from improved clinical procedures. People said that there are usually enough staff in the home who act on what they say, and praised their relationships with keyworkers. Staffing levels are adjusted as peoples needs change, and any shortfall met by consistent temporary staff or extra hours by existing staff. We saw staff rotas over four weeks to confirm this. On our visit one worker went home ill, and managers worked extra hours. Care records were completed before the end of shifts. The manager is increasing staff in response to higher occupancy levels, and a student nurse was offered a permanent post. Staff are clear on their roles, except laundry. Robust checks are made from police in the UK and abroad, and government lists before staff are confirmed in post, however this was not re-checked after one promotion. Recruitment checks were not consistent about references and a work permit in two out of three records of new staff. There are good risk assessments evaluating information from vetting checks. After our visit we confirmed satisfactory Care Homes for Adults (18-65 years) Page 28 of 36 Evidence: action was taken so that people are safe while the home seeks further checks to meet legal requirements. We know from the homes history of safeguarding that disciplinary action is taken in accordance with the homes policies, procedures and code of conduct. Staff are confirmed as competent following in-house and Skills For Care inductions, progressed in a timely way. Nurses we spoke to have best practice knowledge, specialist experience and clinical supervision. Care qualifications continue to meet the minimum standards, despite the home losing six staff in the past year. Just over half the staff have NVQ levels 2, 3 and 4. The manager is undertaking a qualification in learning disability. This shows us that staff have good opportunities to gain more knowledge, qualifications and experience for their development. There is bi-monthly supervision of staff. Nursing students are supervised and links with the University also keep staff up to date. Views are regularly sought in staff meetings. Annual appraisals of staff performance and learning needs are up to date. There is a training plan to progress mandatory training and refresher needs of staff, including infection control, food hygiene and adult protection. First aid training was renewed for nurses in 2008 and more is planned. Manual handling and first aid training is provided by an accredited external trainer, and adult protection training is provided by the council. Staff and managers attend external training so that they can train other staff, for example about mental capacity law. There is additional training about new ways of working, clinical techniques and equipment so that peoples conditions are understood and managed. Training was provided about equipment such as hoists, bedrails and pressure mattresses. Also venopuncture, tissue viability, falls prevention, and peg feeding. In response to tragedy, training was undertaken in Huntingtons Disease, mental health, end of life and palliative care. There is reference information and guidance about peoples conditions and medication so that staff effectively monitor health and wellbeing. Good communication systems and shift handovers about peoples moods and health ensure care is adjusted quickly. Care Homes for Adults (18-65 years) Page 29 of 36 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent 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 run and managed to benefit people. People and visitors influence the running of the home. There are good systems, policies and procedures and audits to maintain high professional standards. Risk management needs further development about safe working practices and refurbishment, for health and safety. Evidence: The manager is an experienced nurse in medicine and cardiology, holds an NVQ Level 4 and Registered Management Award and is registered by the Commission. They attended a number of train the trainer courses so that they can keep staff up to date and benefit people, for example about resuscitation equipment. She is held in high regard by everyone we spoke to and is approachable, holding regular surgeries so that people and visitors can speak to her privately. One relative survey said The manager...strives to improve in any way that she can the lives of both the service users and their families. The company are preparing a new policy about Deprivation of Liberty Safeguards, but the manager has already put this into effect following council training. Care Homes for Adults (18-65 years) Page 30 of 36 Evidence: The manager has support from Abbey Health Care, a deputy and assistant manager, and we saw that they work together well to maintain a person-centred approach that maximizes independence and recovery. They share an on-call system so that the home has support day and night. The AQAA told us that more delegation has been introduced to develop staff. The 3 managers and 3 staff now share supervisory roles. People and visitors influence the running of the home in a variety of ways. There are monthly meetings with service users, separately with staff, where findings from quality assurance and the system of monthly audits by the manager and visits by Abbey Health care are discussed. Plans are prepared by keyworkers with people about how they want to participate in giving feedback and be involved in consultations. Minutes and surveys are explained to people; the home are planning to improve minutes with symbols. Every suggestion we saw from people and visitors has an action plan, such as requests for a wider range of outings and more support for people with hearing impairment. These show good practice and high satisfaction has been sustained. There are innovative staff recruitment and retention strategies. An Investors in People Award was attained in 2008, showing us that an external body has accredited staff development. High standards of nursing and personal care were in evidence. They have taken proactive and creative steps such as increasing permanent staffing and planning in advance for their training; making the home a learning centre for the University and nurse training. An assessor from another nursing home assesses end of life care quality at Wrottesley Park House. Most human resource processes are robust. We have confidence management will improve consistency in recruitment checks. Abbey Health Care check staff vetting. A new health and safety system was adopted and we saw a range of thorough audits and spot checks kept up to date. However these did not identify a variety of environmental risks we queried. We recommended the manager keeps a chart so that there is more oversight of environmental checks. Filing could also improve so that the homes maintenance records are up to date. One contractor certificate had not been received, and one contractor check had been missed, although both were obtained during our visit. Other record keeping improved since the last inspection. Policies and procedures reflect best practice and government safety alerts, but are not always applied in practice about bedrails, hot water and infection control. We were told that the homes fire and risk assessments are kept up to date, but we are requesting other regulators confirm the homes smoking arrangements and policies sufficiently minimize risk for peoples health and safety. Care Homes for Adults (18-65 years) Page 31 of 36 Evidence: We discussed with management how the health and safety culture could improve, and this needs to be reflected in the homes refurbishment and training priorities, safe working practices and equipment. Audits and the AQAA need critical analysis about the environment to match the needs of people and the homes statement of purpose, prevent the spread of infection and accidents. We saw up to date registration and insurance certificates on display. There are good systems for responding to, recording and analysing incidents and accidents that are timely for peoples safety and to prevent recurrence where possible. The home keeps the Commission well informed and shares inspection reports with people and visitors. Care Homes for Adults (18-65 years) Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 36 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 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 1 The statement of purpose, service user guide and brochure could be more accessible for people with sight and specialist communication needs. People using the service could contribute to its design. All self funders should have a contract with clear terms, conditions and fees, regularly reviewed. Goal planning could include personal aspirations to fully maximise independence and quality of life. Consideration should be given to a weeks annual holiday or day trip equivalents for each person so that they maintain contact with the community. There should be appropriate products readily available so that food is prepared to match all assessed dietary needs. Repairs and maintenance checks need to be timely, and controls put in place to prevent accidents. People should be consulted about their room layout, accessibility of call systems and help to keep their rooms tidy. 2 3 4 5 6 12 5 6 7 17 24 24 Care Homes for Adults (18-65 years) Page 34 of 36 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 8 28 Advice should be sought from from the fire officer and environmental health about smoking arrangements so that people have sufficient protection from fire risk and smoke. Cross-contamination could be further minimised for peoples health: a. food should not be placed near soiled laundry b. clean laundry should be returned to people promptly rather than be left in wings for long periods c. cracked bedrail bumpers and tilt chairs should be replaced d. repair flooring coming away from a communal bath Consistent recruitment checks should include appropriate references and authentification, explanations of all employment gaps, and work permit checks in accordance with the Commissions guidance and the law. A health and safety culture needs proactive and critical risk management and timely repairs to prevent accidents and risks to health from sources such as bedrails, beds, assisted bathrooms, hot water, cracked furnishings, catering equipment, the laundry service. Refurbishment and service development plans should be prioritised from the homes risk assessments and findings about infection control, health and safety and dignity. Essential equipment and furnishings could also be modernized. 9 30 10 34 11 42 12 42 Care Homes for Adults (18-65 years) Page 35 of 36 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). 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