CARE HOME ADULTS 18-65
Wrottesley Park House Nursing Home Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN Lead Inspector
Pat Scott Unannounced Inspection 12th June 2007 10:00 Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 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 Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 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 Adults 18-65. 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. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wrottesley Park House Nursing Home Address Wergs Road Tettenhall Wolverhampton West Midlands WV6 9BN 01902 750040 01902 755510 zoes@abbeyhealthcare.org.uk 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) Abbey Healthcare Homes Ltd vacant post Care Home 57 Category(ies) of Learning disability (15), Physical disability (57), registration, with number Terminally ill (5) of places Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide accommodation and care in the Home for a maximum of 57 service users comprising up to 57 service users in the category `PD - physical disability`, up to 15 service users in the category of `LD - learning disability`, and up to 5 service users in the category of `TI - terminally ill`. If out of any of the above categories a service user is or reaches the age of 65 they may remain in the home. In addition the registered person may continue to provide accommodation and care for the one service user in the category `MD mental disorder, excluding learning disability or dementia` presently accommodated in the Home as at 12 January 2007. 8th January 2007 Date of last inspection Brief Description of the Service: Wrottesley Park House is owned by Abbey Healthcare Homes Limited. It is located on the main A41 Albrighton/Telford road out of Wolverhampton on the Wergs Road, half a mile past Tettenhall Village Green. It is a purpose built home with three residential areas on the ground floor, each having fifteen private bedrooms and communal areas. The first floor has twelve bedrooms. All bedrooms have en-suite facilities and include a shower. Services such as catering, laundry and cleaning are provided in-house. There is a passenger lift for accessing the first floor. There is extensive car parking facilities, and easily accessible gardens. The service makes the CSCI inspection reports available for reading. Fee rates start at £1,000 and rise depending on assessment and care required. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection?
A significant improvement has been made making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. Personal support is more responsive to the varied and individual needs and preferences of the people who use services. The delivery of personal care is individual and flexible. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. Staff listen to people who live in the home and take account of what is important to them. The ethos of the home is that it now welcomes complaints and suggestions about the service, uses these positively and learns from them. The manager has ensured that the physical environment of the home provides for the individual requirements of the people who use the service who live there. The living environment is appropriate for the particular lifestyle and needs of the residents and is more homely, clean, safe, comfortable and well maintained. Individuals living in the home say that they are more satisfied with the service, feel safe and well supported. All staff working at the service know the Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 6 importance of taking the views of residents seriously, and of listening to, and responding to, raised issues. People who use services spoke of their confidence in the staff that care for them. The service ensures that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. The service has improved the training and staff report that they are supported through training to meet the individual needs of people living at Wrottesley Park. The manager communicates clearly and is able to evidence a sound understanding and application of the service’s operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. Equality and diversity issues are given priority by the manager who is aware of the varying strands this involves. 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. The summary of this inspection report can be made available in other formats on request. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Key Standard 2 Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The admission and pre-admission records of two service users new to the service were examined. One person had been admitted for long term care and the other for planned respite. Both people were spoken with. The assessments were personalised and addressed physical health, mental health, social care and spiritual needs of the individual. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. One stated about their admission process “ I was so impressed with them (the staff) compared to other homes-here is fantastic”. A staff member spoken with stated that he had completed the respite care plan with the service user. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Key Standards 6,7,9 The individual needs and choices are listened to and addressed through the health and personal care planned so that care preferences are delivered in a way that addresses risk . This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal care plans were examined for five individuals. The content of these demonstrates people are involved in the planning of care and the impact of such care on their lifestyle and quality of life. A Service user spoken with stated that the keyworker had been involved in writing the care plan with her. She felt that she had been able to make decisions about her care in life and in the event of her death. Risk assessments documented showed that safety issues are addressed whilst not impinging too much on the freedom of the individual to take risk. A new service user stated that they had attended a
Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 10 service user meeting. This person also stated that they had been involved in decision making about furnishing their bedroom. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 12,13,15,16,17 The service provides opportunities for service users to develop their social and communication skills. People living at the home are involved in daytime activities of their own choice and according to their interests and capabilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Menus seen are nutritionally balanced and food and drinks are readily available. There is a lot of choice and a service user comment was “meals are fantastic-too good”. During the inspection 12 service users were engaged in making sausage rolls on one of the units. Staff interacted well with service user who were encouraged to do as much as possible. During the lunch time of various service users, they were seen to be supported to eat their meal with dignity and without hurry. One person said the kitchen staff were very accommodating as he likes a late breakfast. The hairdresser was on site.
Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 12 Service users said that routines in the home are flexible as they are asked what their preferred time is to retire and get up. A service user has asked for the key to her bedroom door which is being arranged. This person also stated there are many activities to enjoy and that college opportunities are being looked into. The activity co-ordinator had visited her and discussed likes and hobbies and they will be going shopping to choose clothes. Activities are displayed on the notice board and service users were able to point these out and what they had chosen to participate in e.g. some were going to the cinema that evening. Staff were observed to knock on doors and wait for an answer before entering. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Key Standards 18,19,20 Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users’ health matters are always safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person centred plan (PCP) and health action plan (HAP) of five individuals were examined in detail. All had care plans derived from the initial assessments. Each plan had a recorded monthly evaluation of the elements of
Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 14 care. They provide clear detail as to how care is to be delivered by staff in a way that the service user prefers. The recording of clinical interventions in care has significantly improved. Staff spoken with stated that the PCP provides them with a clearer picture of the person’s needs and progress. Keyworkers also spoke of how they had involved service users with their care planning, which service users confirmed. The service does not evidence this on the written records. Daily records monitor the progress of individuals which provide clear indications of how a person has spent their day. The plans demonstrate contact with healthcare professionals such as the community psychiatric nurse or general practitioner. Service users spoken with stated that support is flexible as they spoke of the various bed/rising times which are accommodated and always delivered in a way that respects their privacy. Other comments include “I feel confident that the home manages my medical conditions”, “staff attend to my personal needs whilst maintaining my independence”. Service users all appeared well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. The service accepts responsibility for administering medication to service users and has improved practice in this area. At present no service user is assessed as being able to manage their medication by themselves. The service has suitable storage facilities for all prescribed drugs and for homely remedies. Written records for receipt, administration and disposal of medication are in place. Service users’ charts detail individual preferences for taking their medication e.g. to take with a drink or food. The service audits the medication administration charts on a weekly basis for errors. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 22,23 The service has a complaints procedure which is accessible so that people who use the service know how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users spoken to said that they would go to the manager or one of the staff if they had a problem. All expressed confidence that issues would be dealt with. A new service user stated she had been shown a copy of the complaints procedure but had not had to make any complaints since admission to the home. Concerns spoken about by service users had been promptly dealt with and a satisfactory outcome reached. These were mostly ‘minor’ comments and service users said they could put comments and/or suggestions in a box in the foyer. There is a good level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 24,30 The physical design and layout of the home has improved, through service user choice, so that they live in a safer, better-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been some redecoration of bathrooms by service users and staff. The materials used in this activity are not easy to keep clean but the manager gave assurance that the hygiene of the rooms would not be compromised. New seating has been provided in communal areas. All areas seen around the home are clean and rooms personalised and decorated according to the wishes of those service users occupying them. This has been welcomed by those living at the home and many favourable comments were made about the recent changes. The improvements made respects the diversity of service user groups regarding preference; for example the pictures on display, the change of
Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 17 names to the units, sprucing up of patio gardens, and the service has respected these viewpoints. A service user questionnaire highlighted some problems with the laundry service which the manager has planned to address. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 32,34 (not inspected as there have not been any new recruits),35 Staff in the home are being trained and are in sufficient numbers to fulfill the aims of the home and meet the changing needs of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing in the home is more stable so that continuity of care has improved. The service users know the staff very well and observation showed that they provide a personal but professional service. The manager has implemented a new check list record for the recruitment process. A training matrix is in place which indicates that mandatory and other training (such as pressure mattress training, fire marshal training) is well under way. A file is kept to evidence certified training having been attended by staff. A system is in place to provide yearly appraisals and two monthly supervision.
Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 19 Records were seen of these having been conducted. 13 out of 25 staff are qualified to NVQ level 2 with a further 12 working towards this qualification. Service users spoken with confirmed that staffing is stable and also “staff are absolutely fantastic, so patient and understanding”. Staff have received training specific to the new care planning system. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Key Standards 37,39,42 The management and administration of the home is based on openness and respect and with effective quality assurance systems and audits in place, service users are assured that the overall conduct of the home is being well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager’s practice is service user focussed and customer satisfaction is high on the agenda. This is evidenced by the commitment to conducting service user surveys (last one April 2007), quarterly service user chaired meetings that are minuted (last one May 2007), relatives meetings also three monthly and staff surveys and meetings. Care plans state the service user
Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 21 ability to attend meetings and how to involve them in any feedback. Surveys are collated and an action plan developed to address any points raised. Changes are then made in the daily management of the home to reflect the outcomes of the surveys. People who use the service stated that they trust the staff and feel safe in the home. One stated that the manager has “been so kind and helpful, is a good listener, and consults me fully”. This comment was verified by a visiting social worker. The manager demonstrated a commitment to the equality and diversity of service users by addressing needs arising out of age, sex, disability and mental health problems. Those service users who have mental health problems are not segregated and care provision is inclusive of all living at the home. The annual quality assurance assessment by the home identified a shortfall in some of the policies and procedures in the home relating to clinical procedures, contact with/visits by family and friends, emergencies and crises and record keeping which is being addressed. Record keeping systems have improved. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed and elements of the annual quality self assessment were seen to be in place. e.g. redecoration, complaints update, quality assurance processes. Risk assessments for the management and safe working practices in the home are in place. The manager has reviewed and improved these through additions such as automatic beds, wheelchairs and clinical waste. Risk assessments are conducted after researching best practice from the Health and Safety Executive and The Department of Health. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 x Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA18 YA40 Good Practice Recommendations The service should demonstrate through written records that service users have been consulted with in the development of their PCP and HAP. To develop policies and procedures relating to clinical procedures, contact with/visits by family and friends, emergencies and crises and record keeping. Wrottesley Park House Nursing Home DS0000036983.V337817.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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