Care Home: Whitby House Nursing Home

What the care home does well People interested in going to live at Whitby House have a full assessment of their needs and information about the home is provided for them. This helps to ensure that it will be the right home for them. The health and personal care needs of the people living at the home are met to a very good standard and this is fully recorded in their care plans. The people we spoke with were very happy with the service provided. Comments written in cards and letters received recently included `everyone was so kind, caring and helpful`, `Thank you to everyone for their care, friendship and understanding of Dad whilst he was in Whitby House`, `Thank you especially for all the love and affection shown by you all`. People`s medicines are very well managed to ensure that they always get what has been prescribed by their doctor. People who live at Whitby House are able to choose how they spend their days. Social activities are organised for those who are able to join in and there is a good standard of catering with choices available at all mealtimes. The people who live at Whitby House can be confident that any complaints are taken seriously and are addressed. Whitby House provides a comfortable and safe environment. Bedrooms are personalised to make them more homely. All parts of the building were clean and well maintained. People living at the home are protected by good staff recruitment procedures and regular staff training to ensure that staff know how to work safely. The home is very well managed. People are given opportunities to express their views about the service provided and how it can improve. The overall standard of record keeping is excellent, including records to show that the health and safety of staff and residents are protected. What has improved since the last inspection? Since the last inspection an activities organiser has been recruited and this means that there are more social opportunities available to keep people active. Since the last inspection there is a new general manager and care manager who are both very competent and experienced professionals. What the care home could do better: The staff rotas should be flexible to ensure that there are always enough staff on duty to look after people with a high level of need, and to allow the staff to have time to spend meeting people`s social and emotional needs as well as their physical needs. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Whitby House Nursing Home 99 Pooltown Road Whitby Ellesmere Port Cheshire CH65 7AE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Smith     Date: 0 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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: Whitby House Nursing Home 99 Pooltown Road Whitby Ellesmere Port Cheshire CH65 7AE 01513571007 01513568679 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne Homes Ltd care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 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. The maximum number of service users who can be accommodated is: 40. Date of last inspection Brief description of the care home Whitby House is a care home providing nursing care and/or personal care for up to 40 older people. The home is a purpose built, two-storey building set in its own grounds in the Whitby area of Ellesmere Port. It is close to local amenities and is convenient for the local bus service. There is parking space at the front of the building and a garden to the rear. Bedrooms are on both floors. There are 34 single rooms and three double rooms. All bedrooms have washbasins and nurse call points. There are no en-suite facilities. Day space consists of a lounge and a separate dining room on the ground floor and a Care Homes for Older People Page 4 of 27 Brief description of the care home lounge with combined dining room on the first floor. A passenger lift and a staircase provide access to the first floor. 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: three star excellent 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: The quality rating for this service is three stars. This means that the people who use this service experience excellent quality outcomes. We visited Whitby House unannounced on 1 May 2009 as part of this inspection. During the visit we spoke with residents, staff and visitors. We walked round the building to see all the communal areas and were able to visit some of the bedrooms. We checked some of the records kept at the home and spent time talking with the registered manager. We also looked at any information that we had received about Whitby House since our last inspection there. Before the inspection the manager was asked to complete a Care Homes for Older People Page 6 of 27 questionnaire to give us up to date information about the service and survey forms were sent out for staff to give us their views. 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 set out 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 interested in going to live at Whitby House have a full assessment of their needs and information about the home is provided for them. This helps to ensure that it will be the right home for them. Evidence: When we visited, there were 37 people living at Whitby House. The double rooms were being used as single rooms and one person who usually lives at the home was in hospital. The home no longer keeps a separate unit for the people who do not require nursing care, but the manager told us that whenever possible the more mobile people are accommodated on the ground floor which makes it easier for them to get to the main lounge and dining room and to go outside. The manager goes out to meet and to check the care needs of anyone who is interested in going to live at Whitby House. We looked at the checks that had been Care Homes for Older People Page 11 of 27 Evidence: done with three people who had come to the home quite recently. The assessment for a person who was very poorly identified that he would need a special bed, a pressure relieving mattress and a nebuliser, and these were provided before he went to Whitby House. There was information from the hospital and a record of his family visiting the home. A pre-admission draft care plan gave the staff details of his needs. For another person there was a discharge care pathway from the hospice where they received treatment as well as a check of their care needs that had been done before they moved into Whitby House. In the self assessment, the manager told us that detailed information is provided for any prospective service users. The leaflets that tell people how the home works (service user guide) and who it is for (statement of purpose) are available in the reception area and on audio and DVD formats. Enquirers are welcomed to view the home at any time. Trial visits and stays are available for people to sample the care, food, ambience and activities before making a final decision. The marketing plan has been discussed at a full staff meeting so that all staff are aware of the procedure should an enquiry take place in the managers absence. There is an initial six week trial period. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of the people living at the home are met to a very good standard to make sure they get the support they need in the way they prefer and this is fully recorded in their care plans. Evidence: We looked at the care plans for a selection of people who live at the home. The care plans are comprehensive and include a full assessment of peoples needs. All of the assessments are reviewed and updated monthly. The care plans we looked at all included a photograph of the person and a life history. The care plans also provided evidence that families are consulted regularly and are involved in the care of their relative. The care plans are person centred and based on information gained from the resident, their relatives and information received from other professionals. The manager told us that they aim to reflect both care requirements and peoples preferences of how it will be delivered. The staff who completed our survey forms considered that they have access to up to date information about peoples needs. Care Homes for Older People Page 13 of 27 Evidence: The care plans contained good records of wound care, including photographic records. The daily notes were detailed and recorded what people had done each day and how they were feeling. There were copies of any accident forms relating to that person and evidence of measures taken to reduce falls and other accidents. There were a significant number of very frail and poorly people being cared for in bed. They all appeared comfortable and well cared for. The home has links with the Macmillan nursing service for terminally ill residents and a good relationship with the local hospice for equipment, advice etc for end of life care. Most of the people living at the home are patients of a local GP practice that provides a regular weekly visit. This means that they are able to have a regular review, including medicines review. One of the people we spoke with had a spinal problem and had been referred to an occupational therapist for assessment to get a more suitable wheelchair. The primary care trust carried out a very detailed audit of medicines management in the home on 20 April 2009. No issues were identified. A recent medicines audit done by the homes new care manager recorded 100 compliance. Medicines storage is good, although not very convenient, being in the nurses office. Recording was very good and any handwritten entries on the medicines administration records were signed by two nurses. Running totals are kept of all medicines that are not supplied in blister packs. One resident we spoke with said Im very well looked after, and another person told us I think Ive done a good thing coming here. Comments written in cards and letters received recently included everyone was so kind, caring and helpful, Thank you to everyone for their care, friendship and understanding of Dad whilst he was in Whitby House, Thank you especially for all the love and affection shown by you all. We spoke with a visitor whose husband has lived at the home for a short while. She was very pleased with how he has settled and said that he seems happy and his health is improving. Care Homes for Older People Page 14 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 who live at Whitby House are able to choose how they spend their days so they continue to have some control over their daily lives. Social activities are organised for those who are able to join in and there is a good standard of catering so people can enjoy a varied diet. Evidence: The home has an activities organiser working 20 hours a week. On the day we visited, eleven people were in the lounge to join in a weekly game of bingo. The day before, they had a singer to entertain them in the afternoon. The activities organiser told us that she is organising a trip to a safari park. One of the staff who completed a survey form considered that the service could improve by providing trips out as most residents never go anywhere. We met several visitors at the home and they were made welcome. Visiting is open and flexible and visitors are encouraged to participate in the activities of the home. Families can join residents at meals on Sundays and at Christmas. Most bedrooms are small and there are no en-suites but the care staff and Care Homes for Older People Page 15 of 27 Evidence: housekeeping staff have gone to great effort to make sure that each room is personalised to make them more homely. There are two cooks employed and a catering agency is used to cover holidays. The home uses the Southern Cross Nutmeg system to ensure that meals are nutritious. The manager told us that she and the head cook are attending further training about this. There is four weekly menu cycle with two choices at all meals plus other options available. On the day we visited the choice was fish and chips or quiche, with fresh fruit salad and cream to follow. The dining tables were nicely set. A food comments book was introduced a few years ago when there were problems with catering at the home, but recently only positive comments have been recorded for example, resident said the beef was so tender that she didnt need a knife and the trifle was lovely. The head cook attends some of the resident and relatives meetings so that she can hear their views. The manager told us that plans for future development include installing a hatch between the kitchen and dining room to ensure that the chef is aware of reaction to the food served. Care Homes for Older People Page 16 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. Complaints are taken seriously so that the people who live at Whitby House can be confident that their complaints and concerns will be listened to and acted upon. Evidence: The homes complaints procedure is displayed in the entrance area and is very clear and easy to follow. In the self assessment the manager told us that four complaints had been received by the home in the last year. We looked at the complaints records and found that all of the issues raised had been investigated. There was good documentation and peoples complaints had been responded to in writing. Appropriate action had been taken to address the issues raised. The six members of staff who completed CSCI survey forms all replied that they would know what to do if they received a complaint or concern from a resident or visitor. The manager told us that the complaints system is used as a positive, quality assurance tool. A whistle blowing policy is in place for any staff who have concerns. Nearly all staff have had safeguarding training in 2008 or 2009 and a new safeguarding training programme, which all staff have to attend, has just been introduced by Southern Cross. This is to make sure they know what to do to safeguard people who live at the home from harm and abuse. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whitby House is well maintained so that people live in comfortable, safe, clean and homely surroundings. Evidence: Displayed in the entrance area are the homes certificate of registration, current insurance certificate, the complaints procedure, details of activities board, and information about the employee of the month, who gets a £10 prize. The home looked well-maintained internally and externally but the manager feels that the corridors now need re-painting. A full-time maintenance person is employed and he works together with the maintenance person from another Southern Cross home to get bigger jobs done. A maintenance book is kept in reception to record any issues and there is a programme of annual maintenance. Communal space is limited, but the ground floor lounge is comfortable and homely and five people were sitting in the lounge in the morning. The first floor lounge/dining room is pleasant and tables were nicely laid for lunch. The home lacks space for training or holding meetings; the manager shares an office with the administrator, and the nurses office is also the medicines room, however we considered that they do the best they can with the limited space. Care Homes for Older People Page 18 of 27 Evidence: Equipment needed for residents with limited mobility, such as hoists, grab rails, adjustable beds and assisted baths are available. Bedroom doors are fitted with holdopen devices that close automatically when the fire alarm is activated. There are several sluices, and they were clean and tidy. When we walked around the home everywhere was clean and there were no unpleasant odours. Three domestic staff are on duty each weekday, and two at a weekend. The home manager and operations manager carry out a monthly audit of the environment and identify areas for improvement. Plans for future development include making a patio area at the front of the home where there is plenty of space. This would be enjoyed by residents who like watching the comings and goings. Care Homes for Older People Page 19 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. There are good staff recruitment procedures used at the home and regular staff training so people living at Whitby House are protected from possible harm and poor practice. Evidence: We found all of the staff to be pleasant and helpful. We met some students who were on a work placement from their school. They were helping serve drinks and said that they were enjoying their placement. There is a registered nurse on duty at all times with six care staff in a morning, five in an afternoon and three at night. There is a vacancy for nine hours a week but there have also been three staff on maternity leave whose hours need to be covered. There has been some use of agency staff over last month, mainly on night duty, to maintain staffing numbers. Five of the care staff have achieved NVQ level 2 in care, and four have NVQ level 3. Five are working towards level 2 and five others are waiting to start their training. We looked at the recruitment records of three people who have started working at Whitby House quite recently. We found that all of the required checks had been carried Care Homes for Older People Page 20 of 27 Evidence: out before they started their employment. Good references had been obtained from their previous employers and there were records to show that they receive induction training. A training chart showed that nearly all staff are up to date with the mandatory training that they need to refresh regularly, but a few people are overdue for their updates. The manager was aware of this and taking action to address shortfalls. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed. People who live there are given opportunities to express their views about the service and how it can improve to make sure Whitby House is run in their best interests. Good records are kept to show that the health and safety of staff and residents are protected. Evidence: The manager is a registered nurse with considerable management experience. She also has a management qualification and has completed the process to be registered with the commission as manager of this service. A care manager has been appointed recently after the post was vacant for several months. The home also has an administrator and we found that the overall standard of record keeping was very good. This means that clear, accurate, and up to date information is readily available. The manager provided us with very good information in the annual self assessment and this showed that she has identified where improvements to the service can be made, and she has a clear and realistic vision of how these improvements can be achieved. Care Homes for Older People Page 22 of 27 Evidence: The manager is required to send a monthly return to head office which gives details of events at the home and any areas of concern. There is also a monthly monitoring visit by the homes operations manager. Care plans are audited regularly to ensure that the required standard is being maintained and there is a monthly audit of medicines and accidents. Incidents occurring at the home are reported to the Commission as required by the Care Homes Regulations. We spoke with a relative whose mother has lived at the home for several years. He felt that the home has had some ups and downs with changes of management, but feels that the current manager knows her job. He thought that sometimes the home has been short of staff and he has discussed this with manager. The manager holds an evening surgery every two weeks and relatives are invited to come and discuss any aspects of the service provided. There are also regular relative and resident meetings. There are regular staff meetings and we saw the minutes from the most recent meeting which was held on 28 April 2009. The staff had a number of issues that they were given the opportunity to raise and the manager said that she will address the points that are within her control and pass others on to Southern Cross. The staffs concerns are mainly related to the high dependency of residents and staff feeling stressed trying to maintain high standards of care. Two members of staff who completed our questionnaires told us more staff would help the residents by taking them out or more activities to stimulate them and they could do certain things like being able to stop for a little chat with residents if there were more staff or things like the tea trolley to be out on time. The manager said that overall dependency has gone up significantly since Christmas. A satisfaction survey was carried out by Southern Cross in February 2009 and this was summarised in a report for staff and relatives meetings. Overall we considered that there was very good evidence of consultation with a range of people to find out their views of the home. Residents are able to keep small amounts of personal spending money in safekeeping at the home. The administrator explained the system used and showed us very detailed records for each person. Southern Cross policies and procedures are in a bookcase at top of stairs and are available for all staff to look at. The most recent health and safety meeting was held on 2 April 2009 and minutes were available to look at. An environmental health officer visited two months ago and made no requirements. The fire officer visited on 19 March 2009, The fire records showed that a weekly fire alarm check is carried out and some information about the test is Care Homes for Older People Page 23 of 27 Evidence: given each week. Regular fire drills are carried out and the names of the staff attending are recorded. Some of the drills are timed so that night staff are included. The maintenance person keeps good records. A fire risk assessment has been carried out and documented. The managers self assessment gave us details of when all plant and equipment had been tested and serviced and these all appeared to be up to date. Staff record any accidents that occur and the accident records are audited monthly. We saw that one person had a significant number of recorded falls. There was evidence that this had been discussed with his GP and his son, and measures put in place to protect him from injury. 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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