Care Home: Walcot Hall

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What the care home does well Walcott Hall has a homely feel that is promoted by the staff. Those residents who made comments during the inspection said they liked living at the home and gave positive comments about the home and the staff. One visitor told us that "the staff are always helpful and pleasant", and that they always found the person that they came to visit well kept, clean and happy. Another visitor said that "the staff could not have done anything more" when their mother died and that "the staff are so kind and caring". Another visitor told us that they always visit unannounced and always find their relative well looked after. The service continues to offer good nutritional food; one resident said that "food is good, I choose what I want the day before and I have my meals in my room". The service has a core staff group who demonstrate that they are committed to caring for those people they look after and also to providing suitable activities for those who wish to join in.The staff are good at supporting the people who live in the home in a way that helps them to maintain their dignity and they treat them with respect. The service remains committed to meeting all the criteria laid down in the Standards especially in relation to enhancing the environment. The service handles recruitment of new staff well and is robust in its checking system to ensure that the residents are protected. The service provides many opportunities to support the residents. The service also ensures by completing a very good needs assessment that no one is admitted to the home unless their assessed needs can be met. What has improved since the last inspection? Work has continued to be carried out in relation to the upgrading of the premises. Since our last visit the service has taken steps to improve their system for formal supervision of staff. A number of special beds have been purchased to enable those residents who are dependent to have more control over their movement in bed. Improvements have been made in relation to the administration of medicines. CARE HOMES FOR OLDER PEOPLE Walcot Hall Walcot Green Diss Norfolk IP22 5SR Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 27th June 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walcot Hall Address Walcot Green Diss Norfolk IP22 5SR 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) 01379 641030 01379 644511 Saxlingham Hall Nursing Home Limited Ms Susan Doherty Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 29/06/06 Brief Description of the Service: Walcot Hall provides nursing care for older people. The Home is situated in a small hamlet adjoining the market town of Diss. The original building is a two storey detached property built in the 18th Century and has been extended to provide an additional wing of 18 beds. It is set in three acres of ground with a small lake in the lawned area of the gardens. The Home is accessible by road and the nearest rail station is in Diss. Parking is available in a large area to the side of the building. There is a twice daily bus service from a near by bus stop into town; it would be beyond walking distance for older people. The home is undergoing refurbishment and many areas have been upgraded, a new extension is planned. The home is supported by the local GP surgery and other professional agencies. A copy of the last inspection report is available from the manager of the home. The range of fees are £600 to £725 per week. Walcot Hall DS0000065021.V367860.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 that the people who use this service experience good quality outcomes. This was an unannounced inspection that was undertaken over seven and a half hours. The key inspection for this service has been carried out using information obtained various sources including previous inspections, information from the Annual Quality Assurance Assessment (AQAA), some residents, visitors and people who work in the home. The AQAA is a report that the manager has completed and sent to us to tell us how the service is operating. We use the information provided to help us to plan our inspection visit. The main method of inspection used was ‘case tracking’. This involved selecting individual care plans and information available about people who live at the home and tracking the experience of people and speaking to them and their relatives about the outcomes they experience as a result of the support provided. During our visit a tour of the premises was undertaken and resident records and staff files were looked at. What the service does well: Walcott Hall has a homely feel that is promoted by the staff. Those residents who made comments during the inspection said they liked living at the home and gave positive comments about the home and the staff. One visitor told us that “the staff are always helpful and pleasant”, and that they always found the person that they came to visit well kept, clean and happy. Another visitor said that “the staff could not have done anything more” when their mother died and that “the staff are so kind and caring”. Another visitor told us that they always visit unannounced and always find their relative well looked after. The service continues to offer good nutritional food; one resident said that “food is good, I choose what I want the day before and I have my meals in my room”. The service has a core staff group who demonstrate that they are committed to caring for those people they look after and also to providing suitable activities for those who wish to join in. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 6 The staff are good at supporting the people who live in the home in a way that helps them to maintain their dignity and they treat them with respect. The service remains committed to meeting all the criteria laid down in the Standards especially in relation to enhancing the environment. The service handles recruitment of new staff well and is robust in its checking system to ensure that the residents are protected. The service provides many opportunities to support the residents. The service also ensures by completing a very good needs assessment that no one is admitted to the home unless their assessed needs can be met. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 7 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 Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have good information about the home in order to be able to decide if the home is right for them. The assessment before admission means that people’s needs are identified and planned for before they move into the home. EVIDENCE: Files for two recently admitted residents showed that the information gathered was used to assess whether the service could meet their needs. This information was very detailed and it was evident that the people’s physical, emotional and social needs had been assessed prior to admission. We discussed the admission process with two relatives who said that they felt that they had been given sufficient information to make a decision about whether their next of kin would find the home suitable for them and if their Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 9 needs could be met. One visitor said that they had visited a number of homes and that this home was the right for their next of kin and that “the staff had provided them with enough information to make a decision”. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care planning and the delivery of care means that the residents can be confident that their health and personal care needs will be fully met. The overall improvements that have been made in relation to how medicines are given means that the residents are better protected. EVIDENCE: We looked at six care plans; the thorough assessment of needs had been used to formulate the plans of care that also included guidelines for all areas to do with medication. These care plans were very detailed and had evidence of review and had been updated when the needs changed. We noted for one resident there was a good wound care plan for a pressure sore and this also had had, frequent evaluation. Another resident has frequent falls and we found a risk assessment was in place and also a plan of care to help manage Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 11 this problem; records for all falls were firstly identified in the daily notes and then recorded and audited formally, all records were seen for this activity. There were good plans in place for another resident who was a diabetic with clear monitoring of the blood sugar levels. We were able to speak with number of visitors and some residents and they were all very positive about the care and the way everyone was looked after and treated. One visitor told us that “ I always find this person clean and tidy and although they are unable to communicate they are always laughing and smiling”. Another visitor shared with us that “the staff are so kind and caring”; two more visitors said, “ the care is lovely, staff are good and there are no smells”. One resident whom we spoke with discussed the kindness of the staff and said “I choose what I do and I have my meals in my room, my choice”. The residents’ have ‘advanced’ care plans in order to ensure the needs of the dying are met, having first been agreed with the residents and relatives. One relative we spoke with told us that “the staff looked after my mother who died here and they could not have done anything more, they have been so kind and caring”. We asked three staff members how they knew what to do for each resident; they told us that they used the care plans to guide them and that the information they were given at the start of each shift was very helpful. All medicines that are in use are kept in small locked cabinets in the residents’ rooms along with their medication records. We randomly checked two residents’ medication records and found that they tallied with medicines that had been given and those that had not; these records were clear and we also noted that the staff do spot audits of all medication every ten days. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An improved range of activities within the home and the community mean the residents have a range of stimulating and motivating activities that they can participate in; the deputy manager is aware of the areas that could be improved. EVIDENCE: The service has continued to improve the provision of activities; we talked with one of the two carers that organise and conduct the activities. This carer was very enthusiastic about her role and told us about some of the activities that the residents are able to participate in. The deputy manager and the carer told us that they have some people who come into the home to do some very interesting creative work with the residents; we saw a number of examples of this and the residents we spoke with said that they enjoyed these days. One resident told us that they were always informed of forthcoming activities but “I prefer to stay in my room, but I know I could join in if I wished”. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 13 The carer went on to tell us that she was doing a course to do with music and movement and hoped then to introduce this into the home; she told us “when I do activities with the residents I wear a different uniform so that confusion does not arise in relation to my role and it makes it easier for the residents to know that is what I am doing”. The residents go out for walks and sometimes the staff find time to look at newspapers with those residents who wish to do this. We asked the carer if the residents’ involvement in activities were recorded, she said they were, but could not locate the book with these records in; we noted that there were no records kept in the plans of care. What we did establish was that activities do not take place every day and none are offered at the weekends. We discussed this with the deputy manager who said that they were aware of this and hoped to extend the activity programme. We discussed with the cook about the menus. These were good and appeared nutritious and varied and the residents’ likes and dislikes have been taken into consideration. The residents were given a choice of three dishes on the day that we were visiting the home and this included fish and chips, quiche, poached fish and a selection of vegetables and potatoes. One resident when asked if the food was good answered “ the food is good, I choose what I want the day before and I have all my meals in my room”. Two visitors also made comments about the food and said, “it is always good”. Those residents who have chosen to eat their meals in the dining room appeared to be enjoying their food in a relaxed manner. A number of residents who need assistance with their meals were served their lunch where the staff could sit with them and take their time assisting them. We noted that special guidelines in relation to feeding were highlighted in the plans of care. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents feel safe and listened to and the processes in place are consistently applied so that the residents are protected. EVIDENCE: The complaints procedure is easy to read and a copy can be located in the entrance to the home. We left a notice in the reception area to say that we were visiting the home and would be available if anyone wanted to speak with us; however no one requested to see us. We asked some residents that we had spoken with if they knew how to complain and air their concerns; we also asked some visitors this question. One resident said, “I have no concerns and I know who to go to if I did, but I don’t”. Another resident informed us that they felt they could talk to anyone about anything. A visitor told us that they mostly visit unannounced and have always found the manager helpful and addressed their concerns. We checked the records for complaints and the service had received two since our last inspection; the complaints had been dealt with within the time limit highlighted in the service users guide. These records also documented how the complaints were addressed and the action taken and the outcome of the actions. The Commission has not received any complaints about this home. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The improvements and refurbishment that has taken place or is planned means that the residents live in an adequate environment and the potential risk of the residents living in an inadequate environment is continually being reduced. EVIDENCE: We noticed as we drove down the driveway that leads to the home that a lot of improvements have taken place outside since our last visit. The garden area around the front of the house has been landscaped and tidied up and we noticed the maintenance man hard at work. The deputy manger advised us that the area around the water which leads to the summer house was going to have walk ways and wheelchair access so that eventually the residents would be able to use the summer house that up to now has served as a store room. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 16 The garden area was well furnished with garden furniture and was easily accessible to all the residents. The deputy manager told us that one resident spent a lot of time outside and chose to do this. A new laundry is going to be installed and planning permission has been granted for a new twenty-six bedded extension. The provider told us that as this was being done so all the other rooms that have not been refurbished would be. During our tour we noted that a new bath and shower facilities had been installed along with the refurbishment of three rooms. The sitting room and dining room are still in need of refurbishment, however the provider is aware of this and as already mentioned will be carried out along with other plans. New chairs and dining room furniture have been purchased and also twenty special profile beds, which, allows for greater independence for those residents who have difficulty in moving. We looked a number of rooms with the residents’ permission and one resident told us “I really am glad to be back in my newly re-done room”. Another resident and a visitor commented on the some areas of the home that needed attention, however they were aware that these were being addressed. We also noted that three window frames in the front of the house have been replaced. The refurbishment programme has been completed in the original part of the house, which has provided larger rooms and added comfort for the residents. The home was very clean and tidy and the housekeeper told us that there are three cleaners on duty every day except Sundays when there were two. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well is well staffed and the staff have the knowledge to ensure that they understand all areas of sage guarding adults. Some adjustments are needed to the training plan to further extend the training, which will result in better outcomes for the people using the service. EVIDENCE: We checked the duty rosters for the past week and for the day we were inspecting, these confirmed that there were sufficient staff on duty to meet the assessed of the residents. We noted whilst we were at the home that the call bells were being answered in good time. Comments from residents suggested that they felt that they were getting the support they required, one said “the staff are so good, I don’t want for anything” another commented “I am being well looked after”. The staff themselves felt that they were adequately staffed and that they were able to give the care that was needed; they were also clear about their roles. An induction programme ensures that new staff are given essential information to allow them to do their jobs well. We spoke to two staff members who told us that that they had completed an induction programme and that it had been informative and useful; one said that the induction had covered aspects about Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 18 health and safety, what to do in the event of a fire, hygiene, confidentiality and manual handling. Staff were clear about their roles and the carers used the plans of care to deliver care. A training plan is in place, however, it needs to include sessions in relation to the specific care of the residents and their medical diagnosis. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements are meeting the needs of the people who use the service; however this area could be improved to ensure that there is a system in place to monitor formally the quality of the service that is offered. EVIDENCE: We spoke with some residents about the management of the home; they were aware of the responsible persons and knew they could speak with them whenever they wanted to. A relative said that the “manager is always easy to talk to and so are all the sisters”. One member of staff we spoke with told us “the manager is very approachable”. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 20 The staff have appreciated the management style of the home since it has been taken over and felt that a number of improvements had been made. Staff informed us that they now received formal supervision and we able to see records for his. Although the manager and her deputy are committed to quality issues within the home we noted that the service had not yet introduced a formal system for this. There were very good records in place for all checks made in relation to safety of equipment and all things related to maintenance in the home including fire testing and water testing. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 21 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 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 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 18 2 3 x x 3 x 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x x 3 3 3 x 3 Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP33 Regulation 24 Requirement The registered persons must establish and implement a system for monitoring and improving the quality of the service with copies of associated reports supplied to the Commission. This is a repeated requirement. Timescale for action 30/08/08 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 OP30 Good Practice Recommendations It is recommended that a training programme is introduced that contains specific subjects relevant to the conditions of those people using the service. Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Walcot Hall DS0000065021.V367860.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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