Care Home: St Wilfrid`s Hall Nursing Home

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What the care home does well Person centred care is being given a good focus at St Wilfrid’s. Assessment and care planning information gives a good picture of the whole person, their back ground, likes and dislikes. Decision making is supported which helps people to maintain their independence. Staff training is well organised, helping to ensure that staff have the necessary skills and knowledge for their role. Qualification training opportunities for care staff are excellent, with the majority of care staff holding an appropriate NVQ (national vocational qualification). This means that people are supported by staff who have had their work practice assessed and have been deemed competent for the work they carry out. Catering and domestic staff are also supported to gain qualifications in their field of work. Good feedback was received regarding the personal qualities of staff. Comments included; "I find the staff very helpful" and "the staff they have do very well, they have some excellent staff." What has improved since the last inspection? Feedback indicates that meals at the home have improved and good quality monitoring in this area continues to take place. Records are kept of the meals eaten by residents, which allows for nutritional monitoring to take place. Good progress has been made with the refurbishment programme at St Wilfrid’s. A new fire sprinkler system has been installed and one wing of the building has been totally refurbished. The main lounge and dining room have been redecorated and new carpets laid. The ‘quiet’ lounge has also been re carpeted. A number of bedrooms have also been decorated, with new furniture and new carpets fitted. Improvements have also been made to the garden areas, with a new pathway being laid. This has improved access to the grounds, which are a real asset to the home. Qualification training for care staff has improved and this is now a real strength of the service. What the care home could do better: Good progress is being made with the refurbishment programme for the home. This should continue to ensure that all parts of the home are maintained and decorated to a good standard.St Wilfrid`s Hall Nursing HomeDS0000006155.V376764.R01.S.docVersion 5.2Appropriate staffing must be in place to ensure that the needs of residents are met. Feedback from people at the home, relatives and staff indicate some dissatisfaction with care staffing levels. The viewing of recent staff rotas also showed that some staff absences have been difficult to cover. Adequate staffing levels must be maintained at all times. Ongoing review of staffing arrangements will help to identify where and when changes should be made. Recruitment practices could be strengthened by ensuring that records are kept of the decision making process regarding employing staff, where checks have revealed potentially negative information. A record of the reasoning behind making the appointment should be maintained as evidence that the information has been satisfactorily addressed. Although there are good temporary management arrangements in place, applications to register a manager and a responsible individual from the provider organisation, must be submitted to the Care Quality Commission Key inspection report CARE HOMES FOR OLDER PEOPLE St Wilfrid`s Hall Nursing Home Foundry Lane Halton On Lune Lancaster Lancashire LA2 6LT Lead Inspector Lesley Plant Key Unannounced Inspection 09:30 17th and 21st July 2009 DS0000006155.V376764.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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 older people 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. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 2 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 St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Wilfrid`s Hall Nursing Home Address Foundry Lane Halton On Lune Lancaster Lancashire LA2 6LT 01524 811229 01524 811949 stwildfrids@caringhomes.org latham@caringhomes.org Latham Lodge Ltd 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) Manager post vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (1) of places St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 Physical disability - Code PD (maximum places - 1) The maximum number of service users who can be accommodated is: 41 Date of last inspection 9th August 2007 Brief Description of the Service: St Wilfrid’s is situated in the small village of Halton-on-Lune, some 4 miles north of Lancaster. The home has many historic features including original fireplaces and stained glass windows and is set in its own extensive grounds. The home is a three-storey building, with resident accommodation on the ground and first floors. There are three lounges and a separate dining room, plus additional seating areas in the hall and on the first floor landing. The bedrooms all have a wash basin, with the majority having ensuite facilities of a toilet and wash basin. The home has its own transport that is used to take residents out. Details of the current fees can be obtained by contacting the home. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The site visits for this inspection were unannounced and took place over two days. There were 30 people resident at the home at the first visit and 31 people resident at the second visit. All of the key national minimum standards, plus the standard relating to staff supervision were assessed. The home currently has no manager registered with the Commission. The provider organisation has a team of peripatetic managers who temporarily cover management absence. A peripatetic temporary manager has been based at St Wilfrids since February 2009; however this manager was on leave at the time of the inspection visits. (This person is referred to in this report as the temporary manager of the home.) Two other peripatetic managers were however available and they provided certain information. Time was spent talking to people staying at the home and observing staff as they went about their duties. Discussion also took place with the two peripatetic managers, the deputy manager, kitchen staff, the maintenance worker and two care staff. Two visitors were also spoken with and telephone contact was made with a further relative. Records were viewed and a tour of the building took place. Care Quality Commission questionnaires, inviting feedback about the service provided at St Wilfrids were received from 4 members of staff and 15 people staying at the home, with some relatives also providing feedback on these surveys . The AQAA (annual quality assurance assessment) completed by the temporary manager of the home, also provided some useful information. This is a self assessment focusing on how well positive outcomes are being achieved for people using the service. Since the last key inspection in August 2007, a random inspection was conducted in October 2008. (Random inspections are conducted to look into particular areas of service provision and do not look at all the key national minimum standards.) A copy of the report relating to this random inspection would be made available on request. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 6 What the service does well: Person centred care is being given a good focus at St Wilfrid’s. Assessment and care planning information gives a good picture of the whole person, their back ground, likes and dislikes. Decision making is supported which helps people to maintain their independence. Staff training is well organised, helping to ensure that staff have the necessary skills and knowledge for their role. Qualification training opportunities for care staff are excellent, with the majority of care staff holding an appropriate NVQ (national vocational qualification). This means that people are supported by staff who have had their work practice assessed and have been deemed competent for the work they carry out. Catering and domestic staff are also supported to gain qualifications in their field of work. Good feedback was received regarding the personal qualities of staff. Comments included; I find the staff very helpful and the staff they have do very well, they have some excellent staff. What has improved since the last inspection? What they could do better: Good progress is being made with the refurbishment programme for the home. This should continue to ensure that all parts of the home are maintained and decorated to a good standard. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 7 Appropriate staffing must be in place to ensure that the needs of residents are met. Feedback from people at the home, relatives and staff indicate some dissatisfaction with care staffing levels. The viewing of recent staff rotas also showed that some staff absences have been difficult to cover. Adequate staffing levels must be maintained at all times. Ongoing review of staffing arrangements will help to identify where and when changes should be made. Recruitment practices could be strengthened by ensuring that records are kept of the decision making process regarding employing staff, where checks have revealed potentially negative information. A record of the reasoning behind making the appointment should be maintained as evidence that the information has been satisfactorily addressed. Although there are good temporary management arrangements in place, applications to register a manager and a responsible individual from the provider organisation, must be submitted to the Care Quality Commission 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. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments take place and help to ensure that no one is admitted to the home unless their needs can be met. EVIDENCE: The majority of Commission surveys completed by people living at the home, with some containing feedback from relatives, confirm that information about St Wilfrid’s had been provided prior to admission. This information helps all prospective residents, to make an informed decision regarding moving into the home. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 10 A full assessment of individual needs is carried out before anyone is admitted to the home. These assessments are only carried out by qualified and experienced staff. The assessment information for three people living at the home was viewed. Each file contains a completed pre admission and dependency document, which provides detailed information regarding the needs of each person. New assessment and care panning documentation has been introduced, which helps staff to provide a more person centred type of support. Information within the AQAA states that this will be reviewed after six months to check that it is effective. The records viewed showed that individual preferences and routines, along with biographical information were being given more focus and that this is incorporated into individual care plans. St Wilfrids does not provide intermediate care. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care, health and medication needs are met and people are treated with dignity and respect. EVIDENCE: The care plans and supporting documentation for three people were viewed. Care plans address a range of needs including; personal hygiene, challenging behaviour, nutrition and social inclusion. The care plans viewed, were all being regularly reviewed, with changes made where necessary. Feedback from discussion and Commission surveys completed by those living at St Wilfrids, with some containing feedback from relatives confirm that people are happy with the care they receive. To the question, what does the home do well? St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 12 responses included; cater for individual needs, I find the staff very helpful and caring nurses and carers. Good health care screening takes place. For the first five days following admission close monitoring of food and fluid intake is carried out, with records being kept. This helps to identify any specific needs regarding nutrition. As well as nutritional screening a manual handling assessment takes place, with the resulting care plan giving good detail of the support required and how many staff are needed to provide this support. Risk assessments address areas such as skin integrity, falls, dehydration and the use of equipment such as bed rails. If equipment such as bed rails are to be used, consent forms signed by the individual or their relative are in place, with these being viewed on files. Information within the AQAA completed by the temporary manager of the home states that individualised care planning is being promoted and some good examples of this were evident. One care plan viewed gave good direction to staff regarding responding to difficult or challenging behaviour and the signs which may indicate that the person is of low mood. Directions for staff included; to talk to the person regarding topical events to try to build up a rapport with the individual and for staff to always explain what they are doing. For this same person there was a separate care plan in place regarding personal choice and wishes and staff were observed following the agreed guidance contained within the care plan. Care plans also address spirituality and any religious needs, including where possible the individuals end of life wishes. One record viewed included details of how they would like their life to be celebrated and included particular hymns to be sung. Good records are maintained of any contact with other professionals such as the GP, optician and chiropodist. This means that any health problems can be monitored and any treatment tracked. At the time of the inspection one person was awaiting a visit from their GP, in relation to recent health issues. Good records had been maintained, showing a clear response to the problem. Several people at the home need to have their food and fluid intake monitored and appropriate records were viewed as were records of turning related to pressure care. Residents and the two visitors spoken to all responded that they were confident that any health needs would be met and professional input sought as necessary. The home has a room dedicated to medication storage. The two medication trolleys, when not in use, are kept locked in this room. There is also a fridge for medicines which have to be stored at a cool temperature. Only the qualified nurses administer medication and the dispensing pharmacist has recently held a training session for all the nursing staff. The deputy and one of the senior nurses are responsible for the ordering of medication and the control of stock within the home. The controlled drug stock for one person was checked against the record of medicines held and was correct. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 13 There is a record of sample signatures of those who administer medication and this contains sample signatures of care staff who may act as a witness when specific drugs are administered. The medication administration records for two people were viewed and showed that appropriate records are being maintained. Each record includes a photograph of the individual, which helps prevent mistakes when giving medication. Risk assessments are carried out, regarding self administration of medication and signed forms giving consent for staff to administer medication are also in place. Any medication, such as liquids, which is not supplied in blister packs, is dated when it is first used. This is good practice as it helps to prevent medication being used past its use by date and also provides a clear audit trail for medication within the home. A written protocol is in place for medicines which have been prescribed to be administered when required. It is documented if the individual can communicate when this is needed or the signs and symptoms which need to be considered by staff administering this medication. This helps to ensure consistency and also helps to ensure that people get their medication, such as pain relief, when it is needed. Regular audits and checks take place. The importance of promoting privacy and dignity is addressed during the induction period for new staff and is also covered within NVQ (national vocational qualification) programmes undertaken by the majority of the care staff. Staff were observed responding to people in a respectful manner, using their preferred term of address, such as their first name or their title and surname. Double bedrooms are only shared by couples in a relationship and there are plans to make the remaining double rooms into large single rooms with new ensuite facilities. Although this will reduce the number of places at the home, it has been recognised that the majority of people prefer to have their own room and not share. There is a quiet lounge in the centre of the home, plus seating in the hallway and upstairs landing area where people can talk to visitors away from the main communal rooms. People are also able to receive visitors in their bedroom, as happened during the inspection visits. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual and group activities are provided and community contact is promoted, providing interest for those staying at St Wilfrids. The quality monitoring of meals helps to ensure that any necessary improvements can be addressed. EVIDENCE: Care planning information includes details of hobbies, past occupation, lifestyle and interests, with social inclusion being addressed. An activities coordinator works for five hours on four days of the week, with the specific role of arranging and supporting activities. Individual records are kept for each person, detailing their interests and past hobbies, with records of the activities they have taken part in. These records show that one to one chats and activities such as having the newspaper read out loud, a walk in the garden or a manicure, take place as well as group activities. Regular group activities include dominoes, keep fit and trips out in the minibus. A monthly coffee St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 15 morning is held, which is open to anyone in the local community and a church minister holds a regular service at the home. Activity records also show who has had a visitor or trip out with their family. There is a resident’s notice board in the main hallway of the home, giving details of the trips out, the weekly activity programme and information regarding the regular residents meetings. The maintenance worker drives the mini bus for trips out. At the time of the inspection visits the mini bus was in the garage for repair, however it was confirmed that it would soon be back and ready for use. Commission surveys returned by people living at the home, with some including comments from relatives, ask if the home arranges appropriate activities. The responses show that the majority of people feel that there are always or usually activities that they can take part in. The visitors spoken to confirmed that they are made welcome by staff. People are able to bring their personal possessions into the home with them and so make their bedroom more homely and have their favourite things close to them. Individual records include details of preferences and routines, with specific care plans in place regarding choice and wishes. Care plans are personalised and promote decision making, such as one care plan for dressing which began with establish what clothes (name) would like to wear. Staff were observed working patiently with individuals, such as when the kitchen assistant served drinks and biscuits. This member of staff took time to talk to each person, showed them the choice of biscuits and drinks and encouraged the individual to make their own choice. Three of the kitchen staff were spoken with during the two inspection visits and a lunch time meal was eaten with residents. The menu for each day is displayed on each dining table. A good deal of choice is provided at breakfast with a full cooked breakfast being available plus cereals and toast. Several residents spoken to said that they enjoyed having a cooked breakfast and that it was their favourite meal of the day. People are able to choose from two meals at lunchtime, with tea being a selection from soup, sandwiches and snack meals. Special diets are catered for and food is pureed for those who require this. Records are kept of meals eaten by each person. A nutritional improvement group, comprising of three residents, the head chef and the activities coordinator meet regularly to look at the quality of meals provided and if any improvements need to be made. The head chef also meets with six residents each month and the feedback from these meetings is reviewed by the hospitality manager for the provider organisation. Although a number of residents spoken with felt that meals had improved and the results of a recent survey showed a general satisfaction with the meals provided, some people spoken with responded that improvements still need to be made. Quality monitoring in this area of service provision should continue. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures, good practice and staff training help to ensure that any concerns are dealt with and that those living at the home are protected. EVIDENCE: A copy of the complaints procedure is displayed in the reception hall. Feedback within Commission surveys from relatives and those living at the home confirm that people are aware of the formal complaints procedure and also that informal concerns can be raised. This view was reflected during conversations with people living at the home. Regular residents meetings take place, giving good opportunity for any issues to be raised and discussed. Good records are kept of complaints, detailing if the investigation found the complaint to be upheld and any action taken. The temporary manager completes a monthly management report, which includes details of any complaints received. These reports are then sent to the regional manager, who oversees the running of St Wilfrid’s. Written policies are in place regarding whistle blowing and safeguarding procedures. The whistle blowing procedure helps to ensure that staff St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 17 understand their responsibility to report any concerns or bad practice. Managers within the organisation are aware of locally agreed safeguarding procedures and the roles of other agencies in responding to any concerns relating to the protection of those living at the home. Where issues have been raised these have been responded to appropriately. The staff training matrix shows that most staff have undertaken training regarding adult protection, which helps staff to understand the potential vulnerability of people in care homes. Issues of abuse and protection are also addressed within qualification training courses for care staff. The AQAA completed by the temporary manager of the home shows that further training regarding mental capacity and deprivation of liberty safeguards is planned. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and provides a comfortable environment for those living there. EVIDENCE: St Wilfrid’s is situated in the small village of Halton-on-Lune, some 4 miles north of Lancaster and is set in its own extensive grounds. The home is a three-storey building, with resident accommodation on the ground and first floors. There are three lounges and a separate dining room, plus additional seating areas in the hall and on the first floor landing. The bedrooms all have a wash basin, with the majority having ensuite facilities of a toilet and wash basin and are sited on the ground and first floors. The good range of St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 19 communal rooms means that people can choose where to spend their time, such as in the quiet lounge when they have visitors. There are bathrooms on each floor and a hairdressing room on the first floor. There is an ongoing programme of refurbishment and since the last key inspection some major improvements have been made to the home. A new fire sprinkler system has been installed and one wing of the building has been totally refurbished. The main lounge and dining room have been redecorated and new carpets laid. The ‘quiet’ lounge has also been re carpeted. A number of bedrooms have also been decorated, with new furniture and new carpets fitted. There are plans to continue this improvement plan, with some double bedrooms being fitted with ensuite facilities to make large single bedrooms and the exterior of the building is due to be decorated in the Autumn. New furniture has been ordered for the dining room, ‘quiet’ lounge and entrance hall. A new platform lift is planned, to improve access to three bedrooms which are reached by a small number of steps and at present can only be used by people with good mobility. Improvements have also been made to the garden areas, with a new pathway being laid. This has improved access to the grounds, which are a real asset to the home. There are plans to provide more raised beds, pergolas and seating areas, as well laying more of the external areas to lawn. There are still areas of the home requiring attention such as some bedrooms which need redecorating following work to rectify leaking windows. However these rooms are currently not in use and will not be occupied until they have been refurbished. Some bathrooms had been out of use, awaiting new safety equipment. This was delivered on the second day of the inspection, meaning that these facilities are now in use again. Domestic staff are employed and the home appeared clean. There is a sluice facility on each floor and a separate laundry room. The majority of staff have undertaken infection control training and written policies regarding infection control, disposal of clinical waste and food safety are also in place. Hand sanitising gel is located around the building for staff and visitors to use, which helps to prevent the spread of infections. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive good training to help them in their work role. The majority of care staff are qualified, have had their work practice assessed and have been deemed competent in their job. Staffing levels do not consistently meet the expectations of residents and relatives. EVIDENCE: Staffing arrangements were discussed with the deputy manager and the peripatetic manager currently based at the home. On the days of the inspection visits there were two nurses and five care staff on duty during the morning, which reduced to four care staff during the afternoon. At night there are three staff on duty, including one qualified nurse. On each of the visits there were two kitchen staff, two domestic staff, a laundry worker, a maintenance worker and an administrative worker on duty. This means that care and nursing staff are able to focus on the care and nursing needs of residents. An activities coordinator works for five hours on four days of the week. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 21 Feedback gained via discussions and Commission surveys, from staff, relatives and those living at the home indicate some dissatisfaction with care staffing levels and that adequate staffing levels are not always maintained. To the question Are the staff available when you need them? Three people living at the home responded always, nine people usually and two people sometimes. Comments included; Some times have to wait for buzzer to be answered and better if they have on the correct amount of staff and a few more to cover those off on holiday and sick. Only one of the four staff who returned Commission surveys responded that there are always enough staff to meet the individual needs of those staying at the home. The viewing of recent staff rotas also showed that some staff absences have been difficult to cover and that for a short period each evening there is often only two staff on duty, which could pose risks for residents. The peripatetic manager explained that staffing levels are to increase now that the number of residents has reached 31. It is important that staffing levels are kept under review and that adequate staffing levels are maintained, with practical plans in place to ensure that staff absences can be covered. Feedback regarding the personal and professional qualities of staff was extremely positive. Comments from those living at the home and relatives included; all very friendly, I find the staff very helpful and the staff they have do very well, they have some excellent staff. Qualification training for staff is promoted and supported at St Wilfrids. 15 of the 17 care staff have gained NVQ (national vocational qualification) level 2 or above, which exceeds the 50 as recommended within the national minimum standards for care homes. Catering and domestic staff are also supported to gain NVQs in their field of work, with the majority of ancillary staff having gained a relevant qualification. The administrator is currently working towards an NVQ in administrative work and the deputy manager has gained the Registered Managers Award, a level 4 NVQ. Recruitment records for two care staff appointed in 2009 were viewed. Files contain a photograph of the applicant, application form, record of interview, two references and a CRB (criminal records bureau) disclosure, which includes a check against the nationally held list of people who have been deemed unsuitable to work with vulnerable people. Should a CRB contain details of any past incident, even if this did not result in a charge or caution, this should be discussed with the applicant. A record of this discussion and the reasoning behind making the appointment needs to be maintained as evidence that the information within the CRB has been satisfactorily addressed. The provider organisation has its own training company Training in Care which provides the training programme for staff at St Wilfrids. There is a structured induction programme in place for new staff, which addresses the Skills for Care (national training organisation) induction standards. A senior St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 22 staff member signs off each element when it has been completed. During the induction period new staff access the organisations rolling training programme for certain elements of skills and knowledge. This programme includes moving and handling, fire safety, first aid, infection control, food hygiene, health and safety, the protection of vulnerable adults and customer service. The training matrix for the home shows that the majority of staff have completed these courses. Some staff have also completed training regarding dementia and challenging behaviour. Some elements of the training programme are delivered via group sessions and some by e learning, whereby staff complete the course via a computer programme. Training certificates were viewed on individual staff files. The four members of staff who returned Commission surveys all responded that they are given training relevant to their role, which helps them to understand and meet the needs of people in the home, are kept up to date with new ways of working and that training provides enough knowledge about health care and medication. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good interim management arrangements are in place and strong quality assurance systems ensure that those living at the home can give feedback about the service provided. Staff training, policies and good practice help to promote health and safety at the home. EVIDENCE: The home currently has no manager registered with the Commission. The provider organisation has a team of peripatetic managers who temporarily cover management absence in their homes. A peripatetic temporary manager St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 24 has been based at St Wilfrids since February 2009; however this manager was on leave at the time of the inspection visits. Two other peripatetic managers were however available and they provided certain information. It was confirmed that the temporary manager or one of peripatetic managers will remain in charge at St Wilfrid’s until a new manager has been appointed and has settled into their role. Changes at regional level within the organisation mean that there is no senior person registered with the Commission as the responsible individual for the organisation. This is being addressed. The temporary manager has worked hard to support staff in their roles. Supervision for staff is now established and feedback from Commission surveys completed by staff confirmed that the temporary manager has made positive improvements in the running of the home. Comments included; “At this present time we have a new manager who is I find making a huge difference to the home. Making changes for the better.” And “since the change of management earlier this year the morale has lifted in the home.” The staff spoken to during the inspection visits endorsed this view, stating that training, support and supervision had all improved. There are internal and external systems in place, which help to monitor the quality of the service and lead to improvements being made. The home has achieved the externally accredited ISO 9001- 2000 hospitality quality award and there are good opportunities, including surveys and residents meetings, for people living at the home to give their views of the service provided. Surveys are also sent to relatives and staff are sent feedback surveys each year. Some of the recently returned service user surveys were viewed. These, as all other returned surveys are then sent to the organisations head office, who collate the results and provide a report for the home. The temporary manager completes a monthly audit report, which is sent to the regional manager. This looks at many aspects of service provision; including the environment, medication, staff training, accidents and any complaints. The regional manager also carries out a monthly visit to the home and produces a report of the findings. Some people at the home are able to manage their own financial affairs and for others a relative or representative will take on this responsibility. Where money is held on the person’s behalf records are kept of income and expenditure such as hairdressing costs. For others, a record of expenditure is maintained, with the appropriate person then being periodically sent a bill. Any money held is kept in a safe. The money held for two people staying at the home was checked against their record of income and expenditure, with both being correct. The administrative worker keeps good records and these and any money held is regularly audited by the manager. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 25 Since February both nursing and care staff have received regular supervision, with good records being kept. Records show that work practice issues and personal development issues such as training are discussed at these meetings. For most staff supervisions take place approximately every six weeks, however where necessary staff have more frequent supervision meetings as seen in the records viewed. Regular supervision helps to ensure that staff are working well together and promote a consistency in the care provided. The maintenance worker carries out a series of regular checks which help to maintain the health and safety of residents, staff and visitors. These include checking water temperatures, call bells, smoke detectors, fire doors and the emergency lighting. These regular checks help to ensure that any problems are quickly identified and put right. Good records are kept of these checks and of the regular fire drills which take place. Information within the AQAA completed by the temporary manager confirms that equipment such as the lift and services such as gas and electricity supplies within the home have been serviced during 2009. The staff training matrix for the home shows that most staff have completed relevant training, such as health and safety, moving and handling, first aid, infection control, fire safety and food hygiene. This training helps to ensure that staff are aware of health and safety risks and are aware of safe working practices. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18 Requirement Adequate staffing levels must be maintained at all times, in order to meet the needs of service users. An application to register a manager with the Care Quality Commission must be submitted. An application to register a responsible individual with the Care Quality Commission must be submitted. Timescale for action 10/08/09 2 OP31 8 01/11/09 3 OP31 7 01/11/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP19 Good Practice Recommendations The refurbishment of the home should continue to ensure that all areas are maintained and decorated to a good standard. St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 28 2 OP27 Staffing levels and the deployment of staff should be kept under review to ensure that adequate staffing is provided at all times. Should a CRB contain details of any past incident, this should be discussed with the applicant. A record of this discussion and the reasoning behind making the appointment needs to be maintained. 3 OP29 St Wilfrid`s Hall Nursing Home DS0000006155.V376764.R01.S.doc Version 5.2 Page 29 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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