Care Home: Great Wheatley

What the care home does well People using the service receive the care and support they need including in relation totheir healthcare. Care plans give staff the information they need to be able to provide care to people in the way they need and prefer. People`s dignity and their right to make choices is respected. Information received from people using the service told us that they receive the care and support they need, that staff are generally available when they need them, that the home arranges activities they can take part in if they want to, that they like the meals at the home and that the home is always fresh and clean. Staff showed good understaning of individual residents` care needs. They were observed to spend time interacting with residents and to treat them with respect. There are clear systems in place to safeguard people living at the home that include training for staff and policies and procedures to help them in everyday practice. People also feel able to raise concerns and speak up if they are not happy about something. Comments received from residents/relatives confirmed that people feel that staff usually listen to them and act on what they say and that there is someone they can speak to informally if they are unhappy. While there has been a change of manager at the home, the new manager has worked at the home for some time as a lead nurse and so knows the residents and the staff providing some continuity. The registered provider has systems in place to support the new manager, to monitor their effectiveness and the quality of care outcomes for people living at Great Wheatley and to promote health and safety. What the care home could do better: Medication storage, administration and recording practice need to be reviewed to ensure safe management and best outcomes for residents. Random inspection report Care homes for older people Name: Address: Great Wheatley 3a Great Wheatley Road Rayleigh Essex SS6 7AL two star good service 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: Bernadette Little Date: 2 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Great Wheatley 3a Great Wheatley Road Rayleigh Essex SS6 7AL 01268777281 Telephone number: Fax number: Email address: Provider web address: greatwheatley@abc-care-solutions.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mr Raju Ramasamy,Mr Inayet Mohmed Patel Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 21 Number of places (if applicable): Under 65 Over 65 0 21 dementia old age, not falling within any other category Conditions of registration: 21 0 The maximum number of service users who can be accommodated is: 21 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: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Great Wheatley is a care home, which provides services for older people in need of nursing care. Whilst most service users have long term care requirements, the home also offers short-term respite care provision when needed. The home is situated in a residential area of Rayleigh, close to all amenities and within a quarter of a mile from the A127 London/Southend. Service provision includes nine single rooms and six double bedrooms five of which have ensuite facilities. Assisted bathrooms and WCs are provided on both floors. There are four communal areas for service users and a small terraced garden with seating. Car parking for up to four cars is provided at the front of the property. Both trained nurses and carers make up the staff team. The range of fees for accommodation and nursing care at the home is between £605.00 per week for a shared room and £635.00 for a single room. Other services such as hairdressing, chiropody and aromatherapy are available at an additional charge. Care Homes for Older People Page 3 of 11 What we found: This was an unannounced random inspection. The visit took place over one day by one inspector and lasted a total of five hours. The purpose of the site visit was to monitor compliance to the Outcome Groups relating to Health and Personal Care, Complaints and Protection and Management and Administration. The manager was present and assisted throughout the site visit. We looked at all the information that we have received or asked for about Great Wheatley since the last key inspection, including the Annual Service Reviews undertaken in August 2008 and March 2010. As part of the recent annual service review we sent surveys to the manager to distribute to residents and staff. We received completed surveys from two staff and two service users/relatives and information they provided is included in this report. Prior to this site visit, the previous manager submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the service does well, what could be done better and how they plan to improve it. Information given in this document has been considered as part of this inspection process. As part of the process records relating to people who use the service, staff and the general running of the service were examined. We spoke with residents, staff, relatives and the management of the service. The assistance provided by all those involved is appreciated. The new manager confirmed that a preadmission assessment is always undertaken before a service is offered and evidence of this was seen on files sampled. This allows the manager to be sure they can meet the persons needs at Great Wheatley and forms the basis for the persons plan of care. Surveys received from and discussion with people using the service told us they received enough information to help them decide if this home was the right place for them before they moved in. The new manager advised that they had rewritten the care plans for all residents. Those sampled were clear and easy to read, covered a wide range of areas of needs and linked to associated risk assessments all of which showed regular review and updates. This helps to ensure that staff have up-to-date information on how to meet peoples needs in the way that they prefer, helping to promote the well-being and safety of the resident and staff. It was noted positively that care plans were written in a person centred style and where for example a person was living with dementia, the care plan showed how this would impact on their care needs in all relevant areas of their daily life. Surveys received from residents/relatives confirmed that they always receive the care and support they need including in relation to medical care. One survey had the comment I am totally satisfied with the care (resident) receives. A resident spoken with also confirmed that they are satisfied with the care received. Staff told us that they are always given up-to-date information about the needs of the people they support and that generally there are enough staff to meet the individual needs of the residents. They were also aware of the needs of the people they were caring for. Healthcare records sampled Care Homes for Older People Page 4 of 11 indicated clearly that the manager and staff monitor residents health care needs and take appropriate action to access healthcare professionals and services. This includes in relation to nutritional needs and pressure area care and the manager told us that not one person in the nursing home had a pressure sore and that this was important to them. Medication administration, recording and storage was reviewed and some concerns were identified. A monitored dosage system is used. The Medication Administration Record (MAR) folder was well organised with a separate section for each resident with their name and photograph to support accurate identification. Records are kept of when medicines are received into the home and when they are given to people and these were generally of good order. When medication is given at different times to those printed on the medication record forms the actual time it is given is not recorded. This could result in people being given medicines too close together. However, the nurse and manager stated that there would be a corresponding time delay at each medication administration round that would prevent this from happening. The medication prescribed for a persons specific condition was recorded as being given at 8am but observed to be administered to them at 10am. The nurse told us that this occurred regularly as there was a set routine as to which room number the medication round started at. The manager and business manager understood that for the residents specific condition it was important that the medication was given at the recorded, earlier time to best benefit the resident. They agreed to review this institutional type practice and amend it to be more person centred. The temperature of the medication storage room was not routinely being monitored and recorded. During the inspection this was found to be above the recommended maximum. The failure to store medicines at the correct temperature could result in people receiving medicines that are ineffective. We watched some medicines being given to people during the morning and observed that medication was assembled for more than one person at once and carried on a tray around the home for administration to people. The nurse told us that this method was not usual practice and occured only because of the hot weather and residents being in the garden. This practice significantly increases the risk of medication error and so puts residents at risk. The manager and business manager confirmed that the above issues would be addressed without delay. The subsequent medication round was observed and medication was administered for one person at a time. In light of this immediate requirements were not issued but this report will contain requirements in relation to improving medication practice to promote residents well being. We reviewed the management of complaints and safeguarding of vulnerable people at Great Wheatley and found them satisfactory. The complaints procedure was displayed. All information received from people using the service/their relatives confirmed that they would know how to make a complaint and also that there is somebody they can talk to informally should they wish to do so to raise any concerns. The manager has maintained detailed records of complaints received since they took up with post. This demonstrated that people are listened to and appropriate actions are taken in response. Care Homes for Older People Page 5 of 11 The Commission has recently received one anonymous complaint regarding changes to staffing levels and concerns regarding moving and handling and care practices. The registered person provided a detailed response and explanation to us for the changes in staffing levels and confirmed care practices were positive and safe. Our observations at the time of the site visit, review of care management records and discussions with staff, residents and relatives, indicate that staffing levels are appropriate to meet the needs of the people at the service and that staff are aware of, and implement safe moving and handling and appropaite care practices. Policies and procedures on protecting vulnerable people from abuse were available in the home and the business manager advised that all policies and procedures are currently being reviewed. A copy of the current Southend, Essex and Thurrock safeguarding guidance and protocols was not available and recommended to be obtained. The manager provided evidence that they had attended training on safeguarding and stated that they would inform the business manager of any concerns. The business manager in turn confirmed that they would refer appropriately to the safeguarding team and have previous experience with this. The training record indicates that staff have received training on safeguarding. Staff spoken with confirmed attendance at training and awareness of whistleblowing, information on which was clearly displayed in the home. Surveys received from staff confirmed that they would know what to do if anyone had a concern about the home. Records of recent compliments received included the comments the standard of cleanliness is excellent and there are no unpleasant smells. I am so relieved (resident) is in this nursing home where the nursing care is excellent and nothing is too much trouble. The care staff are so wonderful, so kind efficient and helpful. I have the greatest confidence in (the manager) and all their staff and since (resident) has been in your care you have greatly improved their quality of life.... thank you for the dedication and patience and at Great Wheatley staff give a friendly and warm welcome and the new activity coordinator works hard to bring out the patients. Residents/relatives spoken with were also complimentary regarding the staff, the food served and opportunities to make choices and be treated with dignity and respect. A relative said they think that staff are good, they interact with residents and think they make people feel that they have worth. There are clear management systems in place. A new manager has recently been appointed and has experience working as as a lead nurse at the home for some time. They are currently considering undertaking NVQ level IV in management. The manager advised they have had a three-month induction that included reviewing the care needs of all the residents as well as relevant training by the previous manager and business manager. They will be making prompt application for registration to the Commission. The business manager and area manager are providing ongoing support to the new manager. The registered provider has completed the required visits and reports to demonstrate monitoring that the home is being effectively managed and run in the best interests of the residents. No health and safety hazards were identified at the site visit. There was a well organised annual maintenance programme. We reviewed a number of safety inspection certificates and all were found to be satisfactory. What the care home does well: People using the service receive the care and support they need including in relation to Care Homes for Older People Page 6 of 11 their healthcare. Care plans give staff the information they need to be able to provide care to people in the way they need and prefer. Peoples dignity and their right to make choices is respected. Information received from people using the service told us that they receive the care and support they need, that staff are generally available when they need them, that the home arranges activities they can take part in if they want to, that they like the meals at the home and that the home is always fresh and clean. Staff showed good understaning of individual residents care needs. They were observed to spend time interacting with residents and to treat them with respect. There are clear systems in place to safeguard people living at the home that include training for staff and policies and procedures to help them in everyday practice. People also feel able to raise concerns and speak up if they are not happy about something. Comments received from residents/relatives confirmed that people feel that staff usually listen to them and act on what they say and that there is someone they can speak to informally if they are unhappy. While there has been a change of manager at the home, the new manager has worked at the home for some time as a lead nurse and so knows the residents and the staff providing some continuity. The registered provider has systems in place to support the new manager, to monitor their effectiveness and the quality of care outcomes for people living at Great Wheatley and to promote health and safety. 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 9 13 Residents must be safeguarded by having their medication administered to them safely on an individual basis and medication must not be assembled for more than one person at a time. This will protect people from the risk of medication error. 16/07/2010 2 9 13 Medication must be stored 16/07/2010 under suitable environmental conditions. This will ensure people receive medication of suitable quality. 3 9 13 Accurate records must be kept of medication administered. This will demonstrate people received the medicines as prescribed for them. 16/07/2010 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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