Care Home: Stretton Hall Nursing Home

What the care home does well People expressed a high level of satisfaction with the service they are provided with. One person told us `We are well looked after and it`s a lovely place`. People can be confident they will be supported by skilled staff. Residents tell us the staff are sensitive and understanding. One person said `The staff are very kind there is always someone to share your thoughts with`. People tell us they enjoy their meals and one person said `The meals are absolutely marvelous, we get regular drinks and we can have a snack when we want to`. People are provided with a service that discretely meets their nursing needs and enables them to focus on the social side of their daily lives, although this could be better recorded. Despite people`s frailty and mobility needs the staff at Stretton Hall provide a range of stimulating social and recreational activities both inside the home and trips further a field. What has improved since the last inspection? People can be confident that there are training programmes in place to develop the skills of staff and keep them up to date with changes in nursing practice as the service develops. This first inspection provides a benchmark from which to assess compliance with the Regulations and future improvement of the service. What the care home could do better: The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. Recording of the rationale for use of bed rails could be more detailed. This should include documenting the person centered aspect of the safety management including discussion had with other parties in the multi-disciplinary team. Recording regular checking of the integral bed rails and any maintenance required. Training should be implemented for all staff who use them during their work. Wound care records need to be more specific and clear as to the description of the wound at each evaluation, current dressing regime and frequency and rationales for changing treatment. Daily records should give an indication of how the person has spent their day giving consideration to the general well being and emotional/social support of the person receiving care. Key inspection report Care homes for older people Name: Address: Stretton Hall Nursing Home All Stretton Church Stretton Shropshire West Midlands SY6 6HG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pat Scott     Date: 3 0 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Stretton Hall Nursing Home All Stretton Church Stretton Shropshire West Midlands SY6 6HG Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Helen Ellerby Type of registration: Number of places registered: care home 50 Morris and Company Limited Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 50 The registered person may provide the following categories 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 50 Dementia Code DE 50 Physical Disabilities Code PD 10 Date of last inspection 50 0 0 10 Over 65 0 0 50 0 Care Homes for Older People Page 4 of 27 Brief description of the care home Stretton Hall lies within the heart of the Shropshire Hills, located in an Area of Outstanding Natural Beauty in the village of All Stretton located a short distance from the town of Church Stretton which has good amenities. The home has 50 single en-suite rooms, with some retaining the original architectural features of the former country manor house. There are large landscaped gardens and good parking facilities for visitors. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the first inspection carried out following the registration of the service October 2009. This inspection site visit provided an opportunity to find out how peoples developing care needs are being met, together with the services plans for improvement. This report draws on information received from the home in their Annual Quality Assurance Assessment, which is a self-assessment process that requires care services to record how well care outcomes for the people living in their service are being met as well as providing a range of statistical information about the service. We also looked at information we have about how the service has managed any complaints and responded to safeguarding referrals. We reviewed what the service has told us about things that have happened in the Care Homes for Older People Page 6 of 27 service, these are called notifications and are a legal requirement. We gathered relevant information from other organizations such as the Environmental Health Office (EHO), Health and Safety Executive (HSE) and the Fire Safety Officer (FSO). We spoke with 5 people about their experience of care and reviewed their care plans. 4 staff working at the home were interviewed and records were reviewed. One Regulatory Inspector and one Local Area Manager carried out this inspection over 8 hours. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with good information so that they can make choices about how their care needs will be met if they decide to move into the home. Evidence: The statement of purpose and service user guide are available in the foyer within a brochure. People who responded to our surveys verified that they received enough information to help them decide if Stretton Hall was the right place for them before they moved in. The manager receives assessments from the placing authority. These are usually within enough time to allow her to make a decision on whether the home can meet the needs of the person and to offer/accept a placement. The manager conducts her own assessments before people move in to explain and discuss their care, treatment and support options with them. Admission assessments Care Homes for Older People Page 11 of 27 Evidence: reviewed showed that the resident, or those acting on their behalf, had been involved in this process. The manager stated that in doing this she can ensure that the facilities, staffing and services provided by the home meet the ethnic and diversity needs of the individual through face to face contact. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the personal care they receive will be based on their individual needs and support their dignity. Records for wound care problems are not robust enough so that current treatment and care may not be clearly understood by staff. People will be supported to have their medicines and there are safe systems in place for people who need help with this area of their lives. Evidence: To assess whether people are receiving the care and support they need according to their individual wishes we have considered the views of residents and relatives we spoke to during our visit or received surveys from. We have also reviewed relevant care and medication records and taken account of the information we received from community health & social care professionals, who visit Stretton Hall and the information we received from the managers self assessment. Discussion with the manager showed that she recognises the diversity and rights of Care Homes for Older People Page 13 of 27 Evidence: people who live in the home. Observation of care showed that the staff maintain privacy, dignity and independence of the people in their care. The manager has recruited male carers so that people can have a choice of male, female and age related preferences when delivering personal care. Care plans seen show that people receive personal and healthcare support that has been thought out between both parties and delivered in a way that respects their individuality and independence. However, basic information for the safe and appropriate use of items such as bed rails is in place. We discussed with the manager the need to make the initial assessment/rationale undertaken to use them, more specific to the individual and those involved in their care. Records of frequent review, recording, training and checking of the rails could be improved. Documentation regarding wound care did not provide enough detail to clearly distinguish between assessment (i.e. size, depth, appearance), current treatment/rationale for changes to treatment and evaluation. It is clear wound care is provided but not recorded well enough. When changes to peoples health does occur the manager now makes relevant referral to other professionals, such as, tissue viability nurse. Daily records are minimal and do not give an indication of the well being of a resident or how the care provided that day has had an impact on the emotional/social/person centred aspect of their lives. There are good systems in place for ensuring people receive their prescribed medication safely and audits are carried out to confirm staff are working to the homes polices and procedures. Regular assessments of peoples nutritional status and weight are carried out. Where needed people are given dietary supplements to boost their intake and immune system. Our interviews with staff confirmed their understanding of the key worker role in supporting the needs and interests of individual residents. Keyworker staff record their interaction with residents in the support plan. Staff have been provided with dementia care training so that they can be alert to changes in mood, behaviour and general well being and understand how they should respond and take action. All the residents we spoke with were well groomed, clean and looked well-looked after physically. Care Homes for Older People Page 14 of 27 Evidence: People we spoke with were complementary about the staff that care for them. Comments were made such as: The staff are very kind to me and they look after me well Everything is good here, and the manager is always available to speak to me The staff are kind and friendly with the residents. There is a personal touch. I think its lovely here. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People express a high level of satisfaction with the arrangements made to provide stimulating activities, social occasions including friends and family, entertainment and meals they enjoy. Evidence: The residents and relatives we surveyed and spoke to during our visit were able to confirm that there are opportunities to take part in a range of stimulating activities and social events. These include pampering sessions, exercise classes, films and trips to town. People are supported to maintain any religious connections they may have and are supported to go out to church if they wish. The activities organiser plans a programme that encourages people to think about things outside the home and there are opportunities for family and friends to attend social occasions. Special occasions are supported and celebrated. Details are printed into a newsletter called The Stretton Hall Chronicle. There is a good understanding of peoples individual preferences with regard to their Care Homes for Older People Page 16 of 27 Evidence: meals and dietary needs. People are able to have their meals in a dining room or their own rooms as they wish. People are able to have drinks of their choice including wine and sherry with their meals. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they will be listened to if they have any concerns and involved in discussions about any action that needs to be taken. People feel safe and protected at Stretton Hall because they are fully involved in decisions about their lives and their rights are respected. Evidence: The manager has daily contact with residents and makes sure the company procedures for seeking the views of residents and their relatives are implemented. She sees her day to day involvement with residents as key to making sure standards are maintained and peoples individual wishes are respected. This means any emerging problems are dealt with as they arise and there are a low number of complaints. We have received notification of two areas of concern from families which have been referred through the safeguarding process. The final outcome of these is not yet known. The manager is now more aware of the types of incidents which necessitate a referral to the commission. Surveys show us there is a high level of satisfaction with the service which tells us people feel safe and supported. Staff fully understand their role in making sure peoples rights are protected and they report any concerns. They receive training to maintain their skills and level of awareness in this area. Care Homes for Older People Page 18 of 27 Evidence: The manager demonstrated an understanding and awareness on the use of nursing equipment, such as bed rails, that could be seen as restrictive but this is not properly assessed and recorded. Staff receive training in understanding the Mental Capacity Act and peoples rights to make decisions for themselves. Peoples capacity to make decisions in various aspects of their lives is assessed and recorded in their plan of care where necessary. Independent advocacy services are available for people who need additional support. Care Homes for Older People Page 19 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that Stretton Hall will provide them with a clean, comfortable, well-maintained home to live in that supports their individual needs. Evidence: People living at Stretton Hall experience a Country Hotel style atmosphere in a building with many period features. The bedrooms are of varying sizes and the manager considers this when assessing peoples nursing needs. Specialist equipment in the form of height adjustable beds and aids to independence in bathrooms and toilets is provided. People are able to personalise their rooms with furnishings and fixtures. There is a variety of pleasant communal lounges and dining rooms which means people have a choice of space to spend their time in. A high standard of housekeeping is maintained. All areas were fresh and clean. Staff receive training in preventing infections and are provided with the protective equipment they need. There are good hand washing facilities for residents and staff. People are provided with a high standard of laundry which means they have smart clothing and fresh crisp bed linen. People commented: Provides a lovely place to live in. The premises are immaculate. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they will be provided with a consistent and high quality service because there are rigorous recruitment processes in place and staff are carefully selected and well trained. Evidence: Our assessment on the quality of the staff provided at Stretton Hall is based on our discussions with residents and observation of the interaction between residents and staff on the day of our visit, discussions with staff and a review of personnel and training records. Residents describe very positive relationships with the staff who support them. A flexible approach to staffing the home enables the manager to make additional staff available at key times. Review of staff files confirmed that all checks are done for suitability, references, criminal records and health checks before people start work in the home. New staff complete an induction covering key areas of health & safety, ethos of the service and responsibilities towards residents. Staff place a high priority on making sure residents receive quality care. The personal identity numbers of the registered nurses are checked with the Nursing Care Homes for Older People Page 21 of 27 Evidence: and Midwifery Council to make sure they maintain their registration to practice. The nurses are supported to maintain their clinical skills through training. A recent initiative has been for many staff participating in a 12 week dementia care course. People commented in surveys: My Mother is happy here, she knows her nurses and carers well and they understand her needs. The staff are very nice and caring. They look after me well. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the service provided at Stretton Hall because the home is well managed, their views are fully considered and the company systems for monitoring the quality and safety of the service are kept up to date. Evidence: Stretton Hall is well managed and the interests of the residents are at the fore front of the managers approach. Helen Ellerby is new in post at this new service. The self assessment she provided us with focused on the present and how the service had evolved so far. She demonstrated enthusiasm in planning future developments to further enhance peoples experiences. Stretton Hall has quality monitoring systems in place that involve visits and reports from the provider. The manager is supported by administration and group managers. Care Homes for Older People Page 23 of 27 Evidence: The records we saw indicates that audits are kept up to date and there are clear lines of accountability within the home in relation to monitoring health & safety. However, it was noted that an incident regarding equipment such as bed rails had not been fed into the health and safety monitoring system within Morris Care as a company. The manager acknowledged that this would be good practice to monitor any trends. Staff receive the training they need to work safely but need to have more awareness around risk assessing bed rails more thoroughly in a person centred way. The managers self assessment indicates the systems for maintaining and servicing safety systems, including gas, water, fire and hoist safety are kept up to date. Accidents are recorded and the manager keeps us up to date with events occurring in the home. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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