Care Home: Church View Nursing Home

What the care home does well Our findings tell us that people`s needs are assessed and well documented before they are admitted. The care planning and other associated records have continued to improve and people`s particular preferences are identified and recorded. The service liaises well with external health care professionals to both ensure peoplereceive the right level of support but also to improve certain process and systems within the home itself. Improvements to the environment now mean people live in a clean and comfortable home. Staff are recruited well and necessary checks are carried out prior to staff starting work to ensure they are suitable to be working with vulnerable adults. What the care home could do better: Some improvements are however needed in the recording of assessment reviews and care plan content. Staff need to make sure that they are actually recording their actions so that a good audit of care can be demonstrated. The manager does have arrangements in place to keep monitoring this however. Staff must be given training and support when they are required to support specific and sometimes challenging needs. We were informed that training for challenging behaviour is being planned for the future but training and support must be delivered as soon as possible to all staff involved in the care of the one person discussed during this inspection. Random inspection report Care homes for older people Name: Address: Church View Nursing Home Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA one star adequate service 29/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janice Patrick1 Date: 1 7 0 6 2 0 1 0 Information about the care home Name of care home: Address: Church View Nursing Home Church View Nursing Home Rainer Close Stratton St Margaret Swindon Wiltshire SN3 4YA 01793820761 01793820180 churchview@hallmarkhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joanna Butler Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hallmark Healthcare (Swindon) Ltd care home 43 Number of places (if applicable): Under 65 Over 65 43 0 3 old age, not falling within any other category physical disability terminally ill Conditions of registration: 0 3 3 No more than 3 service users with a terminal illness may be accommodated at any one time: The staffing levels set out in the Notice of Decision dated 1 December 2003 must be met at all times The maximum number of service users who can be accommodated is: 43 Date of last inspection Care Homes for Older People 2 9 0 9 2 0 0 9 Page 2 of 11 Brief description of the care home Church View is a purpose built care home providing nursing care and accommodation for up to thirty-seven people. The home is part of the Hallmark Healthcare Group. The home is located within a residential development in Stratton St Margaret, situated on the outskirts of Swindon, and is within walking distance of a local shop. Accommodation comprises of thirty-five single rooms and currently there is one double room, located over two floors. All rooms have en suite facilities. People also have access to a lounge and dining area on each floor and enclosed garden and patio area. As the home provides nursing care, registered nurses are on duty at all times and are supported by care assistants. Domestic, laundry, catering, maintenance and administration staff are also available. Current fees range from £477.32 to £825.00 dependent on the assessment of needs. Information about the free nursing contribution is provided by the company. Care Homes for Older People Page 3 of 11 What we found: Before we (the Care Quality Commission) visited the service we considered all the information we had gathered since the last key inspection, which was carried out on 29th September 2009. We revisited the last key inspection report and saw there were no outstanding requirements. We reviewed the notifications the service had sent us since September 2009. These inform us of any deaths and occurrences that effect service users and they have been appropriately forwarded to us. We considered the most recent information sent to us by the home called the annual quality assurance assessment, (AQAA). This document is completed by the registered manager/provider and tells us what the home considers it is doing well, how they evidence this, what improvements have been made and any plans for the next 12 months. One inspector then visited the service for a period of three and three quarter hours and spoke to some of the people who live there and some of the staff. We inspected a selection of care records, staff recruitment records and medicine records. We walked around the building and noted its general condition and looked at its infection control arrangements. We inspected the care records of two people recently admitted. These told us that a comprehensive pre admission assessment had been carried out by staff of the service. Each person had been visited and a record made of their needs and the care and support they were likely to need once admitted. This information is then passed on to staff in the home so that on admission, all required preparations have been made to receive the person and the staff are aware of the individuals basic needs. Following admission people are helped to settle in and the type of support they require, their preferences and health needs are explored in more detail with them. If this is not possible then close relatives or a representative will be encouraged to get involved on their behalf. This information is recorded and the care that is to be delivered is set out in the written care plans. We read the care plans for both of these people. What was documented gave staff clear guidance on how the care was to be delivered. The care plans also identified specific preferences, for example one person preferred a shower to a bath. Since the last key inspection the registered manager has continued to audit the care documentation. She is very keen that the improvements made over the last year are maintained. We did comment on how basic some of the things were that she was needing to remind qualified nurses to do and record. After speaking to one nurse and hearing how busy they are we wondered if nurses were under some pressure to get their paper work completed. We asked the manager if she felt there were enough staff on duty to meet the needs of everyone in the home and to complete necessary record keeping. She confirmed that the company, Hallmark had reviewed the staffing a while back and it was reduced but this had not been satisfactory, so on her request it was returned to how it had been. The manager explained that there are still many people with very complex needs within the home. This level of dependency was evident when we read one persons care file. The home were accessing external health care professionals for advice and support in meeting some of this persons particular health needs. The persons General Practitioner and a wound and skin specialist nurse had been very involved. The associated records for this persons Care Homes for Older People Page 4 of 11 wound care were well maintained. Other areas of care and monitoring were more difficult to evidence. Although we could see entries that indicated care was being delivered and we evidenced this by talking to one of the registered nurses, the assessments and care plans were not reviewed and updated as we would have expected for someone with such changing and complex needs. For example the assessment for determining pressure sore risk had been last reviewed in April, the same for the persons nutritional risk. This told us that staff are probably not always evidencing what they are doing and not always using the assessments and care plans as working documents. This would fall inline with some of the comments made by the manager in her audits. Another example was found in the second persons care file. Staff had reported that certain aspects of care had been carried out but there was a lack of outcome and evaluation recorded. One care plan in particular demonstrated various interventions but lacked outcomes and after reading this we were still left unclear as to the current needs and care required. Other areas of this persons care file were very specific to the individual and demonstrated that certain preferences were being accommodated. In particular that these were still being considered when also trying to reduce certain risks. We looked at the activities record kept for one person and it was obvious that they are regularly asked if they would like to join in various activities but the person had declined most times. We witnessed some very frail people being helped with their food at teatime. Staff were sitting quietly beside the person they were feeding and no one was rushing. The inspector felt this was a huge improvement compared with the last time they observed this being carried out (in this inspectors case, in April 2009). This confirms that the improvements seen by the inspector visiting in September 2009, have been maintained. During this inspection we observed the interactions between one person and staff. This person was clearly making demands of the staff that needed to be carefully managed. The response from staff was respectful and measured each time. Staff were following a care plan that had been devised and agreed by the person receiving the support, family and the registered manager. We spoke to one member of staff who was responding to these demands at the time of this inspection and they confirmed that there are times when this person can present with some very challenging behaviour, which can be difficult to deal with. We asked this carer if they had ever been given any specific training or support to meet this persons needs. They confirmed they had not. We spoke to the manager about this who said that a request has been made in the past to the registered provider, Hallmark for training in challenging behaviour. The manager informed us that arrangements are being made to deliver this training in the future. Our view is that this person has been in the home for sometime with specific and specialised needs and therefore staff should be provided with training on how to manage these as soon as possible. In the future, such specific needs as these should not be accommodated unless staff have been supported and trained to meet them. In the past this service has accepted people with very complex and diverse needs without considering the impact this may have on the whole service. We spoke a little more about this to the registered manager who had inherited this problem when she took over the management of the home. The manager feels that she now has more control over who is admitted. She also confirmed that the changes being made by Hallmark in how training is provided for staff is begining to improve staffs knowledge and abilities. Training is now Care Homes for Older People Page 5 of 11 less relient on basic electronic (on line) training and is being blended with face to face training sessions delivered by Hallmark trainers. We inspected the majority of controlled medicine stock and associated records held on the first floor unit, which at the time of this inspection were correct. The Deputy Manager explained that she continues to audit the medicine records and the system. We spoke to one person who had specialised equipment to help them communicate. This person told us they were very content at the home. This person enjoys watching the sport on their own television in their room and were looking forward to Wimbledon starting. We asked this person if they go outside for fresh air. The person explained that they cannot sit in the sun, so currently they were more than happy to sit in their bedroom. They had not yet had their tea but confirmed that the food was usually good. They told us that they were due to have a new and more updated communication machine in two weeks time. We looked at some photographs with this person, which clearly brought back amusing memories and we left with the impression that, despite this persons physical disabilities their sense of well being was good. We inspected the recruitment files of two new staff members. Both had started work in the home after receipt of appropriate checks through the Independent Safeguarding Authority (ISA). One had clearance from the Criminal Record Bureau (CRB) on starting, the other had not. In this case the manager had not had sight of a previous CRB clearance so a risk assessment should have been completed regarding this persons employment before receipt of a CRB clearence. However, arrangements had been put in place to ensure the staff member was supervised when at work. Both staff had completed a medical declaration. One had a contract in place, the other was awaiting one. The registered manager told us that both staff were being provided with basic induction training and both were receiving levels of supervision according to their need. We walked around the building and observed that many improvements had been made. These improvements included new carpets, some new chairs, decoration and lighting alterations in the communal rooms. We noted that bedrooms had been re-decorated and re-carpeted. There were no offensive odours, no staining on the armchairs seen and the environment generally looked clean and tidy. The manager explained that the service had been working very hard with the local Primary Care Trusts (PCT) lead nurse for infection control to ensure the home is prepared for the new essential standards in infection control. This has included staff training sessions and an audit of the infection control arrangements in the home. The last audit identified that the home did very well and was well on its way to being compliant in all essential steps. We were informed that Hallmark have also been very proactive in ensuring their support with this and the next audit will be carried out in September of this year. What the care home does well: Our findings tell us that peoples needs are assessed and well documented before they are admitted. The care planning and other associated records have continued to improve and peoples particular preferences are identified and recorded. The service liaises well with external health care professionals to both ensure people Care Homes for Older People Page 6 of 11 receive the right level of support but also to improve certain process and systems within the home itself. Improvements to the environment now mean people live in a clean and comfortable home. Staff are recruited well and necessary checks are carried out prior to staff starting work to ensure they are suitable to be working with vulnerable adults. 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 set out on page 2. Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 18 The Registered Persons 31/07/2010 must provide staff with relevant training and support to enable them to carry out the care required and which is directed in a persons care plan. In this case this refers to the specific needs of one person discussed during this inspection and which can result in challenging situations needing to be managed by staff. This is so that staff can deliver the planned support in a confident and knowledgeable manner. It is also so that a potential escalation of challenging behaviour can be avoided. It is also that the person is protected from potential and unnecessary abuse or harm occurring through the involvement of ill prepared staff. Care Homes for Older People Page 9 of 11 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 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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