Care Home: Wilton House Nursing And Residential Home

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What the care home does well Since our last visit the Care Quality Commission has approved the position of Monica Gilice as Registered Manager following an assessment of experience and integrity. The home has been accredited by Hertfordshire County Council to provide a dementia care service. The Registered Manager reported that she has now recruited a stable team of staff to take this service forward. This will enable her to continue with the positive changes that have taken place and move towards a more in-depth understanding within the staff team of promoting person centred care. The organisation have continued to support training provided by an external provider to make sure staff have the skills they need and receive regular updates. The Registered Managers self assessment (AQAA) tells us that 64% of care staff have achieved NVQ qualifications in care. This is above the 50% bench mark standard set for care home providers. The planned refurbishment of the environment has continued. Flooring has been replaced, individual rooms and shared areas have been decorated and worn furniture is being replaced. New shower rooms have been installed. Some external windows have been replaced. The extensive grounds to the rear of the building have been cleared and it was reported there are plans to create a sensory garden. What the care home could do better: We have asked the Registered Manager to look at the practice of getting people up early so their individual preferences are reflected in the care they receive. Personal support needs to be responsive to the varied and individual needs of the residents. Additional staff need to be provided to support this where people`s needs increase and flexibility in routines do not achieve a person centred approach. The Registered Manager has attended a one day infection control course organised by Hertfordshire Health Protection Unit so she can take a lead on these matters within the home and receive regular updates. She now needs to introduce an infection control audit to meet Department of Health Guidelines, including the new Hygiene Code. Other areas to review to make sure the correct preventative measures are in place should includeproviding people with individual hoist slings and ensuring staff cover their uniforms when serving food and feeding residents. The manager has attended a moving and handling train the trainers course to enable her to provide staff training. We have advised that the size of hoist sling to be used for each person is included in their moving and handling assessment as we did not see this information. Random inspection report Care homes for older people Name: Address: Wilton House Nursing And Residential Home 73-77 London Road Shenley Hertfordshire WD7 9BW one star adequate service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sheila Knopp Date: 0 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Wilton House Nursing And Residential Home 73-77 London Road Shenley Hertfordshire WD7 9BW 01923858272 01923856760 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Monika Gilice Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wilton House Limited care home 51 Number of places (if applicable): Under 65 Over 65 51 51 31 dementia old age, not falling within any other category physical disability Conditions of registration: 0 0 0 The home may accommodate 25 people with physical disabilities who require personal care. The home may accommodate up to 25 older people who require personal care. The home may accommodate up to 25 older people with dementia who require personal care. The home may accommodate up to 26 older people who require general nursing care or who are elderly mentally infirm and require nursing care. The home must ensure a minimum of 5 suitably qualified and experienced staff work at Care Homes for Older People Page 2 of 10 night within the home. Date of last inspection Brief description of the care home Wilton House Nursing & Residential Home opened on 3 June 1987. The home is currently registered to admit 51 older people who are physically frail and may have dementia. The home can also accommodate twenty-six older service users within the overall capacity of the home, who require nursing care.Wilton House is a purpose built home in a village location. Residents have single rooms with en-suite facilities. Assisted bathing and toilet facilities are provided. The village shops and pubs are a short distance from the home. Extensive car parking is provided to the rear of the building for visitors. The home is on a sloping site. There is pedestrian access from the main road or residents/visitors can enter the home from the rear car park via the lower ground floor taking the lift to the ground floor. Although there are extensive grounds at the back of the building there is only a very small garden accessible to service users. The Statement of Purpose, Service User Guide and previous inspection reports are available on request from the manager. A copy of the Service Users Guide will be provided to prospective service users by the home. The current fees per week are in the range of £590 for personal care, £621 for dementia care and £842 for nursing care correct on 7/5/10. Extra is payable for toiletries, hairdressing, chiropody and newspapers. Variable fee levels are charged to local authorities purchasing places at Wilton House. Care Homes for Older People Page 3 of 10 What we found: This visit was planned to review issues from the last inspection and information we had received regarding the homes approach to providing person centred care, according to peoples individual needs and choices. The visit by two inspectors took place between 06:30 am and 1 pm and was unannounced. The focus of the visit was on the more dependent people receiving nursing care who live on the first floor. We have also reviewed the information we have received about this service since our last full key inspection, which took place on 30th July 2009. We made survey forms available to residents and staff earlier in the year so the views of a wider group of people could be included in our review of the service. Responses were received from 5 residents and 7 staff. A relative told us that Wilton House cares so well for the residents and all the staff are very kind and understanding. We have also received comments from two health & social care professionals who have regular contact with the service. They told us that the new manager was a making a difference to the quality of care people receive and the professional approach of the service. We have not received any complaints about this service from relatives or service users since our last visit and the manager is keeping us informed about any events that take place in the home, that we need to be notified of. We have also looked at the Registered Managers Annual Quality Assurance Assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also provides us with numerical data. We found that the staff approach to residents was gentle and there was a calm atmosphere. On arrival in the home there was a fresh odour free atmosphere, which tells us people had received the attention they needed during the night to meet their personal care needs. Residents appeared to be comfortable. On arrival at 6.30 am we found that the night staff had started to wash, dress and get some of the residents up. These people then went back to sleep either in their chair or on their bed. Their care plans did not reflect that getting up early was their chosen option. The night staff are given a printed list of people to attend to. The Registered Manager reported that different people are included each day. A lot of work has gone into updating risk assessments and putting care plans in place for specific issues. These are pre-printed care pathways and staff insert the persons name and any special instructions. In effect descriptions of how staff meet peoples care needs are very similar and lack individual detail about how staff provide comfort and support peoples strengths, so they maintain independence in aspects of their lives, however limited they are by their condition. Staff are able to describe the things they do to support people and the manager has introduced summary sheets for then to refer to. These are brief and would benefit from having information from relatives about how people like to be dressed, what soap they like etc so that things that make a difference to Care Homes for Older People Page 4 of 10 someones life are included. The Registered Managers self assessment (AQAA) indicates that safety checks on equipment has been increased from monthly to weekly. We were able to confirm that staff have received moving and handling and hoist are available to assist them. During the morning the activity organiser spent time with a group of residents in the new sensory room. People were listening to music and having relaxing hand massages. Once residents had got up there were long periods when they were sitting in chairs without anything to do. The activity organiser reports that she does do one to one room visits but understandably her time is limited. The Registered Manager reported that the home has just appointed a second activity organiser, which will help develop this area further. However the care staff need to be more involved so they think about how to promote a positive sense of wellbeing each time they have contact with residents and provide them with a newspaper, book, music or tactile object to engage with. The Registered Manager has told us about resources provided by the Alzheimers society to provide stimulation and aid communication. The Registered Manager has introduced systems for monitoring peoples food and fluid intake where they need staff support. The care plans we reviewed showed us that peoples nutritional needs are kept under review and they are referred to their general practitioner and dietitian when problems are identified. On the day we visited the chef prepared beautifully cooked and seasoned baked fish followed by a light chocolate sponge and vanilla custard. Other options were available. Puree diets are prepared for people who need them. For breakfast staff prepared trays supporting peoples individual choices. However these trays were then put into two open tray racks, which were taken out into the corridor for staff to help themselves to as they moved about giving people their breakfasts in their rooms. The plates of porridge were left uncovered and cooling over a forty minute period, when the last tray was served. Staff preparing and serving food did not cover their uniforms. We reviewed the systems for giving people their prescribed medicines and found these were well organised. The Registered Manager carries our regular audits to make sure staff are following the correct procedures. We were notified of one incident when medication was not given as prescribed and the information we received indicated the manager took appropriate action. There is a low reported incidence of pressure sores. The Registered Manager has recently notified us of one person who has developed a pressure sore. Details of the treatment and improvement being made are recorded. Pressure relieving equipment is available to prevent people at risk from developing skin problems. The Registered Manager is well organised and was able to provide records supporting the monitoring of health & safety systems, staff training, supervision and recruitment. There are opportunities for service users, relatives and staff to give their views on the running of the home through meetings and surveys. Staff are being given training to enable them to understand the Mental Capacity Act their responsibilities to work in peoples best interests when making decisions. Staff tells us they know who to go to if they have any concerns and are aware of the whistle-blowing procedure, which is in place to support them. We have recommended that a copy is displayed in the staff room so it is freely available. The staff surveys we received were positive. One resident felt staff should Care Homes for Older People Page 5 of 10 speak better English. We raised this at our last inspection and have been told that English language assessments are carried out. Staff completing their National Vocational Qualifications (NVQ) also have a literacy and numeracy test. Our experience during this visit was that the staff we had contact with had better language skills than some people we had encountered during our last visit. The staff who completed our surveys were positive about the support they receive from the Registered Manager. We did not review the overall rating for this service at this time. However there have been a lot of positive developments since our last visit and we would expect this progress to continue. What the care home does well: What they could do better: We have asked the Registered Manager to look at the practice of getting people up early so their individual preferences are reflected in the care they receive. Personal support needs to be responsive to the varied and individual needs of the residents. Additional staff need to be provided to support this where peoples needs increase and flexibility in routines do not achieve a person centred approach. The Registered Manager has attended a one day infection control course organised by Hertfordshire Health Protection Unit so she can take a lead on these matters within the home and receive regular updates. She now needs to introduce an infection control audit to meet Department of Health Guidelines, including the new Hygiene Code. Other areas to review to make sure the correct preventative measures are in place should include Care Homes for Older People Page 6 of 10 providing people with individual hoist slings and ensuring staff cover their uniforms when serving food and feeding residents. The manager has attended a moving and handling train the trainers course to enable her to provide staff training. We have advised that the size of hoist sling to be used for each person is included in their moving and handling assessment as we did not see this information. 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 2. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 7 Continue to develop a person centred approach in line with current practice to enable people with dementia to maintain their independence and autonomy. Guidance is available from the Department of Health & Social Care Institute for Excellence. Review the practice of getting people washed and dressed early in the morning to ensure this is by choice and is reflected in their plan of care. Review the breakfast arrangements to ensure people receive their food at an appropriate temperature and their food is covered while it is waiting to be served. To prevent the spread of infection and promote good practice the Registered Manager should: 1. Introduce an infection control audit. 2. Take advice from the Health Protection Unit as to whether people should have their own hoist slings 3. Ensure staff cover their uniforms when serving food and feeding residents. 2 14 3 15 4 26 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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