Care Home: Widecombe Nursing Home

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What the care home does well The way most of the staff approach people living at the home continues to be in a respectful manner. One person said, "they all treat me well". During the inspection a person sitting in a lounge suddenly became unwell, staff attended to them straight away and provided reassurance and support. When staff are recruited to care homes there are safety checks that need to be done, this helps to protect the people living at the home. Management must make sure for example, that they receive at least two references and carry out a check known as a Criminal Records Bureau check, this helps them to decide if the person is going to be suitable to work with people. We looked at all the files for the most recently employed staff and found that all the required checks had been done before those staff had been allowed to work. People living at the home feel that the standard of food provided is good. Many people commented that they are given sufficient in quantity and that they find the meals satisfactory. People are given a choice at mealtimes. Staff are also good at making sure that if a person needs a food supplement, that there are plenty in stock and that the person is offered these. What has improved since the last inspection? Some of the carpeting in the home, especially the ground floor corridor and front reception had been worn and stained at the last key inspection. All the carpets in these areas have been replaced over the past 12 months. In addition a new commercial kitchen has been fitted and re decoration of several areas in the home.This had improved the environment for the people living at the home and provided enhanced facilities for staff to work in. We looked at medication systems in the home, as there had been concerns at the last inspection. We found the storage of medication was good, and when we audited a sample of medicines we found that all balances and records were correct. This means people receive their medication when they should. What the care home could do better: There are various documents maintained by staff on the care provided to people living at the home. These include care plans and risk assessments. Although there are care plans in place, the standard of information they contain must improve. One example of this was a person had a plan in place concerning a wound they had. The nurses were undertaking dressing changes to this, however the care plan did not include the type of dressing, frequency of dressing change or action to be taken if a deterioration was noted. This is important so that there is continuity in care provision, and staff have specific guidance to follow. Key inspection report Care homes for older people Name: Address: Widecombe Nursing Home 36 Grasmere Road Luton Bedfordshire LU3 2DT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 0 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: Widecombe Nursing Home 36 Grasmere Road Luton Bedfordshire LU3 2DT 01582505575 01582583686 ashley.brooks@widecombenursinghome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Niram Investments Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: No one falling into the category of terminall illness (TI) or (TI)(E) maybe admited to the home where there are 4 persons of these categories already accommodated within the home. No one under the age of 65 years can be admitted to the home where there are 3 persons, excluding those with a diagnosis of TI already accommodated within the home. The home can accommodate a maximum of 38 service users of either sex. There is currently a variation for one specific service user to the home, this is to continue. Date of last inspection Brief description of the care home Widecombe nursing home is a 38-bed facility in a quiet residential area of Luton. The home has all communal and individual accommodation on the ground floor, with offices Care Homes for Older People Page 4 of 26 Over 65 38 0 4 0 3 4 Brief description of the care home and staff facilities on the first floor. The home is set in well-tended grounds and has car parking for staff and visitors. It is close to bus routes to both Luton and Dunstable. The home provides nursing care, including palliative care for people, most of whom are over 65 years of age. The registration of the home allows them to admit up to three people under this age. The nursing needs of people living at the home vary and can include terminal illness. The fees for this home range from £656.00 per week up to and including £750.00 for people who have Continuing Care Funding CCF. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out on the 9th December 2009. The care of three people was looked at in detail and this is known as case tracking. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Care Homes for Older People Page 6 of 26 Observations of care practise and communication between the people living at the home and staff was also made at the inspection. Prior to the visit taking place the Care Quality Commission had sent to the home an Annual Quality Assurance Assessment (AQAA). This was returned prior to the visit and provided information on how the service self assess their own performance. During the visit we checked some of this information to make sure that what had been submitted was accurate. The focus of this inspection was to look at the key standards. 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. Care Homes for Older People Page 8 of 26 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 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 10 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. Information about people who move into the home continues to be sufficient for staff to know all their individual needs and preferences. Evidence: As assessed at the previous inspection care files examined included pre-admission assessment. Assessments included information from visiting the person at the hospital, or wherever he or she was living prior to admission and information from any referring social worker or health professional. There were sections covering the social, psychological and physical needs of the person. Assessments seen at this visit were comprehensive and clear, the manager and staff through discussion also demonstrated an awareness of their contents and purpose. Again copies of the terms and conditions of residency were seen alongside contracts. These gave an outline of fees, responsibilities and notice periods. Care Homes for Older People Page 11 of 26 Evidence: We spoke with two people about their admission to the home. Both people confirmed that information was available to them when they moved. One person advised that their relative had visited several homes and it was their view that the staff had been so welcoming when they had visited this one, that it was that reason they felt they had chosen this service. The statement of purpose was examined. The document provided information on the staffing, accommodation and services available at the home. Intermediate care is not provided at the home. Care Homes for Older People Page 12 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. Access to health care support is good so people benefit from this advice and care to improve their overall well being. Evidence: Care documentation was seen to be in place within the care records for people living at the home. Care plans, monthly reviews and risk assessments had been undertaken. However the standard of entries needs to improve and was discussed with the manager at the time of this inspection. This view had also been shared by a local member of the safeguarding team when they visited the home in November 2009. One example was a person who had difficulties with swallowing. They had been issued with general swallowing advice from the hospital, this had not been Incorporated into the care plan, in fact it was not even kept in the main folder. However there was no evidence seen that indicated guidance had not been followed. Again information submitted by the home stated that everyone was registered with a General Practitioner and received medical support through referrals from them. Records seen at this visit and people spoken to confirmed that this was correct. Staff if Care Homes for Older People Page 13 of 26 Evidence: needed would escort people to appointments at the local hospital for example. In addition documents were seen from varying health care professionals within the records to show that they had received varying treatment, including support from dietitians and physiotherapy Departments. One person sitting in the main lounge suddenly became unwell at this visit. We observed that staff attended to them immediately. The person became unresponsive but staff continued to give constant reassurance and moved the person to provide privacy for them. Accident forms had been completed following any accident or incident. Documents and staff demonstrated that follow up had taken place and when needed medical attention had been sought in a timely manner. Observations of care delivery were that people are treated with dignity and respect. With the exception of one staff member that was discussed with the manager, staff addressed individuals in a very supportive way. Explanations were given when providing care and support, we also observed staff offering encouragement when a person was finding moving from their chair difficult. People in the home all appeared well cared for and content, and staff were observed taking short periods of time to sit and chat briefly with people. The general atmosphere was friendly and relaxed. A requirement had been made at the last key inspection concerning medication, this was seen to have been met.The storage of medication was secure, only nursing staff had access to the keys for all medication. The medication administration records were up to date, containing initials when medication had been given and contained the type, dosage and frequency. On undertaking an audit of five medications for five different people, we found all balances were correct and matched those of the medication documents maintained by the staff. Care Homes for Older People Page 14 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. People living at the home feel that the standard of food provided is good and meets their individual needs in this area. Evidence: Since the previous key inspection a new commercial kitchen had been fitted. On speaking with the chef they advised that this had made a huge amount of difference, they reported that the improved environment assisted them in being more organised and helping to provide the nutrition to the people living at the home. Meal options are avail be and people are able to choose a meal option that provides a diet that includes the main food groups including protein, carbohydrates and vegetables. Observations of lunch showed that staff provided assistance when needed to people if they required support to eat their meals Staff were seen to assist those who required help to eat their meals. We spoke with four people living at the home about the food provided, all confirmed that they were satisfied with the meals provided.In addition when a person had been assessed as requiring additional supplements, these were seen to be in stock and given by staff. As assessed previously information seen within the individual care records of people and people themselves confirmed that a programme of activities were in place. A Care Homes for Older People Page 15 of 26 Evidence: member of staff specifically employed to offer social activities was on duty at the time of this visit. With the varying dependency levels of the people living at the home, activities provided varied greatly. For some people she would spend time talking with them as they were unable to participate in a group activity, others had a choice to attend quizzes as one example. Again people living at the home spoke of the flexibility in when their friends and families could visit them at the home. We spoke with three people about this. All three advised that they received visitors when they wanted to, they were not aware of any restrictions and if they wished to see them in private they could use their own individual rooms. Information on peoples families and friends was seen within the care records examined, this included how staff should contact them if the person needed them. Observation of the interaction between all staff with the exception of one and people living at the home was made throughout this inspection; a good level of communication was noted during this time. Within the communal areas of the home staff were seen to instigate communication with people living at the home, offering an explanation of the actions that they were taking so that the person were kept fully informed at all times. Care Homes for Older People Page 16 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. Staff continue to have a good understanding of safeguarding adults and awareness of local policy to protect the people living at the home. Evidence: Information submitted within the AQQA submitted by the service show that staff had undertaken training in safeguarding adults. Staff through interviews demonstrated a sufficient level of knowledge on the types of abuse including physical and psychological. In addition the homes procedure in this area was examined, it continued to reflect the local guidance. The management had sought a copy of the local protocols and these were seen. The management and staff at the home did demonstrate through discussion an understanding of the need to refer any allegation or suspected abuse. During the past 12 months the staff at the home have reported any suspected abuse, the actions that they have taken demonstrated that they are able to apply their knowledge and put this it to practise. A system for complaints was noted to be in place. Records of complaints received were maintained and kept in a folder, within the past 12 months the service had received 5 complaints direct. The folder contained written complaints and other comments received on how people felt there could be improvements. At the time of the visit complaints received had been investigated, where any shortfalls had been identified by the manager action Care Homes for Older People Page 17 of 26 Evidence: had been taken to remedy these, one complaint was still being looked into by the manager. People living at the home confirmed that they understood that they had a right to complain and were aware of the procedure in the home. Care Homes for Older People Page 18 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. Improvements and changes to several areas in the home has provided a pleasant environment for people to live in. Evidence: We observed at this visit that the replacement of carpets had been undertaken in many of the areas in the home within the past 12 months.In addition re decoration in parts on the home had also taken place. All the communal areas provided comfortable furnishings, and were clean and tidy. In addition a full refurbishment of the homes kitchen had been carried out. A new commercial kitchen had been fitted, alongside new flooring.The garden surrounding the home were neat and looked well maintained. Individual rooms that were seen were all clean and free of odours. All rooms contained personal effects of the person, including photographs, ornaments and in some instances small items of furniture. Bathrooms and toilets were tidy and the people had the choice of mechanical aids to assist them with bathing. No odours were detected at this visit. 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. People living at the home feel staff that work there treat them kindly and will spend time with them. Evidence: The induction and training of staff was recorded in the individual records of all employees. We looked at the induction of staff at this visit and noted that the records of the employees learning and understanding met national guidance. Records viewed and staff confirmed that all statutory training had been undertaken. In addition further training is undertaken by staff, one example is the nurses employed at the home are currently being updated on the end of life programme. We looked at 3 staff files relating to recruitment.References are taken prior to staffs commencement and the relevant Criminal Records Bureau check is also carried out and evidence of this having been undertaken was seen. Application forms and other checks needed had also been carried out. Certificates of qualifications are present within staff files. All records that we examined showed that all checks required were in place prior to the person starting work at the home. Registered nurses, care assistants, catering and housekeeping staff are employed at Care Homes for Older People Page 20 of 26 Evidence: the home. The rotas supplied by the home show that there are sufficient numbers of staff on duty throughout the day and night to meet the needs of the residents at this time. People confirmed that staff were available to help and assist them when they need help. Observation of the support provided by the staff at this visit, showed with the exception of one that staff engaged in a positive way. Through informal discussions with staff they were able to demonstrate that they had a good level of understanding of the needs of the people at the home. As outlined within the health and personal care section, staff demonstrated during this inspection their ability to act swiftly when needed, this was when a person suddenly became unwell. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager continues to provide an encouraging and supportive style of leadership to staff so they feel valued in their work. Evidence: The comments from people living at the home and staff at this visit repeated what was reported at the last key inspection.Everyone spoken to spoke highly of the manager. All staff felt that she provided the support and guidance that they needed to carryout their roles. Staff felt she had continued to improve the standards of care since and the home had improved further under her leadership. People living in the home also praised the manager describing her as thoughtful and kind. Quality assurance systems were in place, surveys had been sent periodically over the past year to gain the views of people living at the home and relatives for example. In addition the Area manager had undertaken monthly visits in accordance with Regulation 26, these included reviewing the standards of care in the home. Care Homes for Older People Page 22 of 26 Evidence: Health and safety records maintained by the home show that safety checks are carried out to ensure equipment in the home is kept in good working order. Copies of the most recent inspections undertaken by the fire service and environmental health were seen and evidence was also seen that work had been undertaken in response to any recommendations made. Staff and training records confirmed that they had undertaken training in this area including, moving and handling, fire safety and food hygiene. 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 1 7 15 Care plans must contain sufficient guidance to staff on how and when they should provide care and support. This will ensure people receive continuity of care. 12/02/2010 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 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. 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