Care Home: Wickwar Nursing & Residential Home

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What the care home does well Residents live in a home that is really well run. The views of the residents are central to how the home operates and it is run with kindness. Mrs Mwale is a thoughtful and very `open` manager. Residents and other people who are interested, can find a good amount of information made available about the home and the service provided there. Residents needs are being well met the staff who care for them. Care plans show clearly the help and support that people require. Residents can do a variety of social and therapeutic activities. Residents are provided with a well cooked well balanced diet. Complaints when they are received, are properly addressed and investigated. The environment is homely, safe and a relaxing place for residents to live in. Staff do a good variety of training to make sure they can do their job effectively. What has improved since the last inspection? There were no requirements set at the last inspection. The overall rating for the home has remained as `Excellent`. What the care home could do better: Ensure that all staff verbally communicate to all residents. This relates to our observation of some staff helping particularly vulnerable residents,without explaining to the person what they were going to be doing. Key inspection report Care homes for older people Name: Address: Wickwar Nursing & Residential Home Castle House Sodbury Road Wickwar Sth Gloucestershire GL12 8NR     The quality rating for this care home is:   three star excellent 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: Melanie Edwards     Date: 2 9 1 2 2 0 0 9 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 26 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Wickwar Nursing & Residential Home Castle House Sodbury Road Wickwar Sth Gloucestershire GL12 8NR 01454294426 01454294936 wickwar@ashbourne.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Pyela Mwale Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Manager must be a RN on part 1 or 12 of the NMC register. May accommodate up to 20 persons aged 65 years and over requiring personal care only. May accommodate up to 3 persons aged 50 years and over requiring nursing care. May accommodate up to 35 persons aged 65 years and over requiring nursing care. Staffing notice dated 30/05/2001 applies. Date of last inspection Brief description of the care home Wickwar Nursing Home is owned by Southern Cross Healthcare and is situated on the Sodbury Road in the village of Wickwar. There is a bus service up to 3 times a day. The village has a post office, hairdresser, coffee shop, newsagent and public house. Care Homes for Older People Page 4 of 26 Over 65 45 0 Brief description of the care home The home is a converted property providing accommodation on 2 floors; there is adequate lift access. There are single and double rooms; all have a wash hand basin, but there are no en-suite facilities. Communal space is spread across seven areas. Utility/bathroom areas are well equipped for the residents needs in the home. The home is pleasantly situated and has a well-maintained garden that is enjoyed by the residents. There is an activities organiser and regular activities are arranged. Fees range from around 500 to 750 pounds per week depending on the type of care and support that a person requires. Care Homes for Older People Page 5 of 26 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: We met twenty of the residents living at the home. We spoke to the manager, Mrs Pyela Mwale,two nurses,three care assistants and a cook about roles, responsibilities, training needs and what they do to help residents. We saw staff help residents with their needs. We saw lunch being served and we ate a meal. We read a variety of records to do with the running and management of the home. The records we looked at included the service users guide, the statement of purpose, information about social activities, menus, the complaints procedure, the record of complaints, training information, the staff duty rota, finance information, quality assurance information, accident records and health and safety information. Care Homes for Older People Page 6 of 26 We found the home was operating within the required conditions of registration that we impose. The conditions of registration detail the type of care and the needs of residents and the numbers of residents who may stay at the home. The home have been sent an aqaa document to complete and return to us by the end of December this year. We chose to bring the date of our inspection forward as part of our inspection schedule for this year. For this reason we have not been able to use this years aqaa document in this report. Care Homes for Older People Page 7 of 26 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. 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 8 of 26 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 9 of 26 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. There is up to date information available for people to find out about the home. The care and support that residents will need is well planned, before and after they move in to the home. Evidence: We looked at the range of information available for prospective residents and their representatives to find out about the home. We read the statement of purpose and the service users guide. Each resident has their own copy of the service users guide so they can find out about life in the home. We also saw a brochure with colour photographs of the home to show what daily life is like there. We saw in the service users guide information about the service provided, qualifications of the staff and the accommodation that residents can expect. The statement of purpose includes the aims and objectives of the home and how the service aim to meet residents needs. The complaints procedure is in the service users guide so that people know how to Care Homes for Older People Page 10 of 26 Evidence: complain if they need to. The company has a website that has useful information on it about the home and the services provided. We read four residents nursing assessment records to see how well needs are identified. The assessment records are also used to help plan what sort of care and support people will need. We found the assessment records that we read were informative and they set out the residents different physical,mental and social,nursing and personal care needs. We read some really helpful information about the actions taken to support each person in the assessment records. The assessment records we saw were being regularly reviewed and updated. This helps show that the information in them is still current and that residents are getting the right care and support in the home. The staff talked to us about how residents needs are assessed. They explained the system for allocating care each day. They told us a nurse and a small group of care staff will be allocated to take specific responsibility for building up a really good relationships with the residents while caring for them. The home does not provide intermediate care for residents. Care Homes for Older People Page 11 of 26 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. Residents needs are met and care plans contain a good level of information to show how people are being supported and cared for. Residents medication is managed safely. Residents are treated with respect and their privacy is mostly maintained. However residents would benefit if staff ensured they communicate with all residents effectively. Evidence: We read four residents care plans to find out more about what is done to ensure residents are properly supported by staff to meet their nursing and personal care needs. The information we read in the care plans was helpful and explained clearly to us how to meet the health care needs of each resident. The care plans set out what actions staff need to do to help the resident to meet their needs and live their daily life to their maximum potential. We saw that care plans are being reviewed and updated regularly by registered nurses. This helps to show residents needs are being Care Homes for Older People Page 12 of 26 Evidence: monitored and that staff can continue to offer the right support in the home. We read some detailed and helpful information in residents care plans which demonstrated residents are well supported with their physical health care needs. We saw information that confirmed residents see the GPs, the dentist and the chiropodist regularly. The residents who we met told us that staff are really helpful when they assist them with their needs. One person said, the staff are marvelous another person said, Im very happy here they do everything I ask. The home have two designated dignity champions, whose role is to guide and lead staff in developing and improving the way that residents are cared for. This is a national government led initiative, to ensure that people in care homes are treated with dignity and respect at all times. We noticed staff assisting residents in a polite and friendly manner. We saw the staff knock on bedroom doors before they went into them to maintain residents privacy. However we did see three staff,on different occasions fail to knock on doors before entering bedrooms. This reduces residents privacy if people fail to do this. We also noticed on three occasions staff helping residents with their care without verbally explaining to them what they were going to be doing for them. We checked the practices and procedures for giving out,storing and getting rid of residents medication, to find out if the home has safe systems for handling medication. We checked nine medication administration records charts in detail. We saw a photo of each resident kept with his or her administration chart to help staff give out medication safely. We found that medication stock was satisfactorily organised and administration charts were being kept up to date. We checked and found that there is a satisfactory system for ordering and receiving medication and the records were up to date. Medication stock is stored in a metal cupboard which is kept in a locked room. We saw there are locked movable metal trolleys used to take around the home to give out medications. There are regular medication audits carried out to makes sure that residents medication is being kept and looked after in a safe way. Care Homes for Older People Page 13 of 26 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. Residents are able to take part in a variety of social and therapeutic activities. Residents are able to make choices in their daily lives. Residents are offered a well cooked diet. Evidence: The home employs a full time activities co-ordinator who works for five days a week. We saw the activities co-ordinator putting on different social event with the residents, including a game of bingo in the afternoon. The residents looked as if they were really enjoying this activity. We saw a timetable of social activities on display in the entrance hall of the home. We also saw some photos taken at recent social events. The residents looked as if they had had a really good time at these events. There is also a regular newsletter that is written for residents and their families and significant others to read. The newsletter is a really good way to improve communication in the home for residents and the staff. There is a cat who belongs to the home, who is a source of obvious pleasure for residents based on their comments. Care Homes for Older People Page 14 of 26 Evidence: We saw residents receive visitors during the inspection. We were told that the home has a very relaxed visiting policy and people can come to the home when they like. We were told that residents can have a meal in the home with their visitors if they want to. This is a really social way to help residents and the people who matter to them to keep in close contact. We saw residents talking with the staff, they looked really relaxed and settled in their surroundings. We also noticed that residents got up at different times during the morning. This tells us residents can make choices in their daily lives. We also saw the residents menu records and these showed that residents are asked what meal options they would like on a daily basis. This is another way to offer residents choices in their daily lives. There is a hairdresser who visits three times a week and cuts hair while residents are at the home. We ate a portion of the lunchtime meal. The lunch commenced with fresh home made soup, followed by a choice of pork chops and mashed potatoes, with two cooked vegetables or fresh cooked salmon. We saw there was a homemade rice pudding for dessert. The meal was tasty and well presented. We saw staff serving meals to residents and assisting some people. The staff were polite and friendly in the way that they helped residents with their meals. We noticed that residents who did not want either main meal choices were offered other meal options. This is a very good example of offering residents choices in a really important part of their daily lives. We saw the daily menu on display on the tables in the dining rooms, to help residents to know what meals are on offer that day. We saw the cook asking the residents what meal choices they would like for the following day. The residents menu choices that we saw looked well balanced and traditional. Residents can make a choice of what meal they would like to have. The residents who we met were really positive about the quality of the meals that they have at the home. Care Homes for Older People Page 15 of 26 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. Residents are properly supported to be able to make complaints and these are dealt with well. Residents are protected from abuse. Evidence: We saw a copy of the complaints procedure in the reception area each resident is also given their own copy. The procedure includes our details for anyone who needs to contact us. The contact details of a senior manager from Southern Cross who run the home, are in the complaints procedure if people wish to contact them directly to make a complaint. The residents we met told us they would make a complaint to Mrs Mwale or the nursing staff. We saw Mrs Mwale spend time talking to one of the residents who had a concern. We saw that Mrs Mwale took their concern very seriously. This helps to show that residents complaints are welcomed and responded to positively. There is a procedure in place relating to the issue of protection of vulnerable adults from abuse. The procedure makes reference to the need to contact and be guided by the Adult Protection team in the event of an allegation of abuse. We saw a copy of the homes safeguarding policy for staff to respond in the event of Care Homes for Older People Page 16 of 26 Evidence: an allegation of abuse. The staff do training on the subject of how to keep residents safe from abuse. Care Homes for Older People Page 17 of 26 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. Residents live in a safe and homely place where they feel happy and relaxed. Evidence: Wickwar Care Home is a large detached property, which is a listed building in the village of Wickwar in South Gloucestershire. The home is built over three floors which can be reached by stairs or lift. The building is over two hundred years old and is about a fifteen minute car ride away from the town of Yate. In Yate are local shops, a library, a church and pubs. We saw special equipment and adaptations are in place throughout the home. This is to help residents and visitors who may have reduced mobility. There is also a lift giving access to all floors of the home. We found that the environment was clean and tidy in all the areas that we viewed. Bedrooms are mostly for single use,however there are three double rooms. The rooms we saw were satisfactorily decorated. We saw that bedrooms have been made to look more personal to reflect the tastes of the residents. We saw photos, mementos and items of furniture in the bedrooms. We found the standard of furniture and fittings is satisfactory. Care Homes for Older People Page 18 of 26 Evidence: There are toilets located close to the dining rooms and lounges. Communal bathrooms were clean and well maintained and were free of any unpleasant odours. We saw that there are bathrooms and toilets near to bedrooms that do not have these facilities. We saw a washbasin in each bedroom. We saw that there are two dining rooms and three lounges. We saw residents sitting in communal areas looking really relaxed and comfortable in the home. We found the home was well ventilated and warm with plenty of natural light. Care Homes for Older People Page 19 of 26 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. Residents are cared for by enough competent and properly trained staff. Residents are protected by the way that new staff are recruited to work at the home. Evidence: We saw the staff helping residents with their care needs in a warm and kind way. This helps to demonstrate that staff are skilled at caring for the residents. The residents who we met spoke really positively about how kind and helpful the staff are to them. We checked the number of staff on duty for each shift over a twenty four hours, to find out if there is enough staff to meet residents needs. There is a minimum of two registered nurses on during the day and eight care assistants in the morning. There is two registered nurses and six care assistants in the afternoon. At night there is one registered nurse and three care assistants on duty. There are four domestic staff on duty most days, a cook, a kitchen assistant and a maintenance person. We found that residents needs are being met by the number of staff on duty. Mrs Mwale works nine to five hours,she also spends time every day with residents supporting them. Mrs Mwale is also assisted in her role by administration assistants. We saw training records for one nurse and two care assistants to see if staff are keeping up to date with their knowledge and practice. We saw up to date information Care Homes for Older People Page 20 of 26 Evidence: that showed that registered nurses and care staff have done a range of relevant training sessions and updating over the last twelve months. The care staff we met told us they have either completed National Vocational Qualification in care awards to Level 2 or Level 3. This means that residents are cared for by well trained staff. We checked staff recruitment records for three staff to find out if the home carry out the required employment safety checks on all staff before they start work. We could see from the information we read that the necessary checks before employing new staff are being carried out. We saw written references taken up for all new staff before they start work, as well as criminal records bureau disclosures checks and protection of vulnerable adult checks. This helps to show residents are protected by the way staff are recruited. Care Homes for Older People Page 21 of 26 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 run. There are really effective ways used to monitor the overall quality of care and the overall service in the home. Residents finances are looked after safely. Peoples health and safety is well protected in the home. Evidence: Mrs Mwale is a first level registered nurse with many years of experience caring for people with a range of nursing needs. Mrs Mwale has been registered with us since June of this year. She has been the manager of the home for eighteen months. We were told by residents and by staff that they see Mrs Mwale often and that she is really approachable. This demonstrates Mrs Mwale puts the needs of the residents first. Care Homes for Older People Page 22 of 26 Evidence: We read some recent and very comprehensive information that showed how the quality of the service is being regularly checked and measured,using a range of different ways. The care and overall service in the home is reviewed based on checking on what life is like for the residents and the daily outcomes they experience. This is a really good way to improve standards even more in the home. We looked three residents finance records to see if the home look after residents money safely. The records we checked were well maintained and in good order. We found records to do with the managing of the home were also satisfactorily maintained, up to date and in order. We have referred to other records elsewhere in the report. We found that the environment looked safe and satisfactorily maintained in all the areas that we inspected. We saw training information that showed that staff do regular training in health and safety subjects including first aid,food hygiene and safe moving and handling. This should help protect residents if staff have a good knowledge of health and safety matters. We saw fire record information that showed fire alarm tests are being carried out. We saw confirmation of fire drills being carried out on a regular basis to help protect the health and safety of residents and staff. We saw records to show that high risk foods are temperature checked probed before serving to residents. This is done to ensure the food has reached above minimum required temperature and is safe to eat. Care Homes for Older People Page 23 of 26 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 24 of 26 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 1 8 Staff should ensure they communicate effectively with all residents when helping them. Care Homes for Older People Page 25 of 26 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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