Care Home: Wrawby Hall Care Home

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What the care home does well The home provides a very friendly and relaxed atmosphere. People using the service, their friends and relatives told us the service had improved and they were generally very happy with the service provided. The needs of people using the service are appropriately assessed to ensure it can meet them appropriately. The health of people living in the home is generally well met and health professionals told us staff maintain contact with them well and follow their advice. The home provides a comfortable and well maintained environment. Staff are friendly and generally well trained to ensue the needs of people living in the home are appropriately met. A healthy choice of meals is provided and people using the service told us they enjoyed them and could have alternatives if required. What has improved since the last inspection? Extensive improvements have been made to the building in a major refurbishment programme including rewiring and installation of a new lifts, fire alarm, nurse call and kitchen with upgrades to the bedrooms and communal areas. Improved medication system have been put in place with staff training provided to ensure they know how to give this to people living in the home safely. Confidential records belonging to people living in the home are now stored securely away in order to maintain their rights and privacy. A programme of mandatory statutory training has continued to be delivered to staff and more of this is planned. What the care home could do better: Quality assurance systems for the home must be further developed and implemented. This is to ensure the service is run in the best interests of people living in the home. Accurate records must be kept of the finances belonging to people living in the home. This is to ensure their financial interests can be safeguarded. Fire doors must not be not wedged open by unauthorised means. This is to ensure people using the service are safeguarded from potential harm. An up to date statement of purpose should be developed for the home. This is to ensure people thinking about using the service know what to expect from the service. Care plans belonging to people using the service should be further developed to enable a more person centred approach to delivering support and ensure individual wishes and feelings about this are better promoted. Staff supervision should be further developed to ensure a more person centred and customer focused approach to delivering support is provided. Activities for people living in the home and specialist training about them should be further developed. This is to ensure the changing needs, choices and wishes of people living in the home can be better met. The service should have a manager who is registered with the Care Quality Commission to run the home. Key inspection report Care homes for older people Name: Address: Wrawby Hall Care Home Redholme Vicarage Road Wrawby Brigg S Humberside DN208RP     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: Rob Padwick     Date: 2 4 0 8 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: Wrawby Hall Care Home Redholme Vicarage Road Wrawby Brigg S Humberside DN208RP 01652655311 01652655311 wrawbyhall@trustcare.co.uk www.trustcare.co.uk Trust Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is: 27 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categoriey: Old Age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Wrawby Hall Care Home is registered to care for up to 27 people with residential care needs. The home is situated on the outskirts of the village of Wrawby, near the main town of Scunthorpe. It is a large three story detached Victorian house set in a quiet residential area. The home is on three floors and The residents bedrooms are located on the first two floors. There are 2 lifts to the upper floors. The owners for the service Care Homes for Older People Page 4 of 26 Over 65 27 0 Brief description of the care home were registered in January 2009 to provide care under the Care Standards Act and have since that time carried out substantial work to improve and upgrade the building. All the bedrooms are single and have a wash hand basin fitted and the majority of bedrooms have en-suite facilities. There is a range of communal space available including three sitting rooms, a large dining room and a large attractive rear garden with patio. The home provides care for those with problems of old age and will take permanent, respite and emergency admissions. Residents health needs are met with the assistance from staff and local health care professionals for example general practitioners and district nurses. The home does not offer nursing care. Information about the home and its services can be found in the statement of purpose and service user guide, which are available from the acting manager. The current fee at the time of this inspection ranged from £ 360.95 to £ 400.00. 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: This inspection report is based on information received by The Care Quality Commission since the new owners were registered with us to run the home in January 2009. It includes information gathered during a site visit to the home. As part of the inspection process, we send out a self assessment document that the Registered Person must complete and return to us. This helps us know how well the home is meeting regulations and National Minimum Standards and what has been done to improve it and what still needs to be done. Other information used included feedback from people living in the home and their relatives, Professionals who know the home well and official notifications sent to us by the home. This information helps us to reach judgments about the service provided. The site visit took place on 24th August 2009 and lasted for 6 hours. The provider was not told in advance when it would take place. The deputy manager was available throughout the period of our site visit and as well as speaking to her, we talked one of the people that own the home, staff who were on duty and people who were living in the home. We looked round the building, including Care Homes for Older People Page 6 of 26 the bedrooms and shared areas of the home and we inspected the records of peoples care, staff files, health and safety documents and other records kept by the service. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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: Quality assurance systems for the home must be further developed and implemented. This is to ensure the service is run in the best interests of people living in the home. Accurate records must be kept of the finances belonging to people living in the home. This is to ensure their financial interests can be safeguarded. Fire doors must not be not wedged open by unauthorised means. This is to ensure people using the service are safeguarded from potential harm. An up to date statement of purpose should be developed for the home. This is to ensure people thinking about using the service know what to expect from the service. Care plans belonging to people using the service should be further developed to enable a more person centred approach to delivering support and ensure individual wishes and feelings about this are better promoted. Staff supervision should be further developed to ensure a more person centred and customer focused approach to delivering support is provided. Activities for people living in the home and specialist training about them should be further developed. This is to ensure the changing needs, choices and wishes of people living in the home can be better met. The service should have a manager who is registered with the Care Quality Commission to run the home. Care Homes for Older People Page 8 of 26 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 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. The needs of people using the service are appropriately assessed to ensure it can meet their needs and information about the home is available to help them to make an informed decision about using it. Evidence: Since the last time we visited the service, the home had been taken over by new owners and information about it developed to help people thinking about using the service to make an informed decision about it. Owing to improvements made to the service in this time, some of this information needed updating and a recommendation is made about this. Case files belonging to people living in the home contained assessments about them which were obtained as part of their admission and information in the self assessment indicated wherever possible prospective residents are invited to spend some time in the home in order to gain an experience of it and try the home out for themselves. Care Homes for Older People Page 11 of 26 Evidence: The home does not provide intermediate care and therefore National Minimum Standard 6 is not applicable. 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. Whilst the health and personal needs of people living in the home are generally supported appropriately, a more person centred approach to care planning would enable staff to ensure individual wishes and feelings are better met. Evidence: Comments from people using the service and their relatives were generally positive and indicated that health and personal care needs were met. Case files belonging to people living in the home contained individual care plans together with information about how individual wishes and needs were to be supported. Whilst there was evidence of a range of assessments and information about the management of risks, there was evidence these needed to be further developed to ensure a more person centred approach is adopted. The acting manager / owner told us he was aware of this and showed us plans to implement a new care planning system. However despite recent staff training on Customer Service, there were times when we witnessed staff could have provided a more supportive role to enabling and promoting independence and ensuring the wishes of people living in the home are better met. Care plans were available to support the individual health needs of people living in the home and we Care Homes for Older People Page 13 of 26 Evidence: saw evidence of regular monitoring and appropriate liaison with health professionals about these. Two local Doctors attended the home during our visit and feedback from District Nurses confirmed the home staff worked well with them. People using the service told us staff respected their wishes for privacy and we saw evidence of this with them choosing to spend time in their own rooms or in the company of others. The last time we visited the service we made requirements about medication administered to people living in the home. We saw evidence the new owners had introduced new policies and procedures about these, together with evidence of college training for staff responsible for this on the safe use and handling of medication. Regular checks of the medication were now being carried out monthly and a random inspection of medication supplies and records was satisfactory. 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 in the home are able to take part in a variety of activities to ensure they can experience a lifestyle that generally meets there needs and wishes. Evidence: People living in the home told us they were able to experience a meaningful lifestyle and take part in a variety of activities and a number went out to a local ice cream specialist on the afternoon of our visit. Records contained evidence of exercise sessions, board games and quizzes and the home has a member of staff employed to support them with these. There was some evidence activity provision could be further developed and individualised and whilst the self assessment told us the new owners were hoping to develop a structured plan to enable residents to choose activities they want to be involved with a recommendation is made about this. The service welcomes the involvement of relatives and we saw evidence people living in the home are encouraged to maintain contact with friends and families. We observed a number of relatives visiting at the time of our visit and those we spoke to were generally very supportive and confirmed improvements had been made since the last time we visited. People living in the home commented positively about the standard of food offered and we heard compliments from them about this during our visit. We observed alternative menu choices being offered and there was evidence of work to develop Care Homes for Older People Page 15 of 26 Evidence: mealtimes into more of a social occasion with the dining room decorated to make it more comfortable. New menus had been developed by the owners that showed a varied and balanced diet was provided and those case files inspected confirmed the nutritional needs of people were being monitored. 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. Whilst the concerns and complaints of people using the service are taken seriously and training provided to ensure they are safeguarded from harm, more accurate recording systems of monies belonging to them would ensure their financial interests are better protected. Evidence: The service has complaints policies and procedures to ensure the concerns of people using the service are taken seriously and information about these were displayed in the reception area and included in the service user guide given to people living in the home. Information provided in the self assessment indicated the service adopts a positive approach to receiving complaints in order to improve the service further. No complaints had been received by the service since the new owners had taken over the running of the home and an anonymous complaint received by us had been investigated by them appropriately. There are policies and procedures in place to ensure people using the service are safeguarded from harm and we saw evidence staff had received training about this aspect of their work. We made a check of the records of monies held by the home on behalf of people using the service and despite policies to ensure these are appropriately safeguarded, we found some minor discrepancies with these that could not be immediately accounted for. A recommendation is made about this (See Management and Administration). 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. People living in the home are provided with an clean and tidy environment that can comfortably meet their needs. Evidence: Since the new owners had taken over the running of the service, substantial work had been carried out to improve the environment with a major refurbishment and re wiring of the building, which at the time of our inspection visit had been nearly completed. Two new passenger lifts have been installed to improve access to the first floor bedrooms, together with a programme of decoration, including carpeting of communal and other areas. Bedrooms have been upgraded with a new kitchen, nurse call and fire alarm installed. People using the service confirmed they had been involved and consulted about improvements to their home and told us they were happy with the results. A plumber was visiting to rectify a fault with the hot water system on the day of our visit and the home was clean and comfortable with evidence of further work planned to upgrade the laundry facilities. Care Homes for Older People Page 18 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. Staff are trained to ensure they can do their jobs, however further professional supervision and direction of them would enable a more customer focused and person centred approach to support that is delivered. Evidence: At the time of our visit two care staff were on duty to meet the needs of the fourteen people living in the home and they were supported by the home deputy and acting manager. There was evidence the new owners were taking their role seriously and that action had recently resulted in three staff recently leaving the service due to concerns about their attitude to work. The acting manager told us that following refurbishments to improve the home more staff were in the process of being advertised for in order to meet the needs of the expected increased numbers of people using the service and that agency staff were temporarily being used to cover this shortfall. Policies and procedures were in place to ensure staff are safe to work with people using the service and the files of three newly recruited members of staff we inspected all contained evidence these had been robustly followed and carefully checked. The acting manager confirmed he also would ensure agency staff are properly checked. There was evidence that staff training date was up to date and that courses had been identified and booked where this was needed. The acting manager showed us plans to Care Homes for Older People Page 19 of 26 Evidence: further develop the training for the home and staff files contained evidence of an appropriate induction and mandatory training. An NVQ programme is in place and information in the self assessment told us twelve of the fourteen permanent care staff have obtained this qualification at level 2 or above. However, whilst staff were receiving regular professional supervision and appraisals of their work to help them do their jobs, there was some evidence this needs to be further developed in order to ensure a more person centred and customer focused approach to supporting people using the service is provided. Care Homes for Older People Page 20 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. Whilst systems were in place to ensure the smooth running of the business, further development of these would ensure the health, safety and welfare of people living in the home are better promoted. Evidence: Feed back from people using the service, their relatives and professionals who know the home, was generally positive and confirmed improvements had been made to develop the service since the last time we visited. Substantial refurbishments to the building had been nearly completed and new policies and procedures introduced. The previous manager had recently left due to personal reasons whilst in the process of registration with us and the acting manager / owner confirmed he was hoping to appoint a replacement in the near future. The self assessment told us the service was currently being managed on a day to day basis by the directors of the home, who have over 30 years of experience between them of managing care businesses at varying and increasing levels however despite this, a recommendation is made about this. Systems were in place in place to check quality of service and the acting Care Homes for Older People Page 21 of 26 Evidence: manager / owner told he was planned to develop these further but that other priorities had so far prevented this. A recommendation is made about this. All sections of the self assessment had been completed which gave us a reasonable picture of the current situation within the service, however there were some areas where more supporting evidence would have been useful to show the ways they are planning to develop the home. We checked the records of monies held on behalf of people living in the home and found evidence more accurate recording systems were needed to ensure their financial interests are properly safeguarded; a recommendation is made these are regularly audited by an independent person and that recording systems for them are more robust. Appropriate checks were being carried out to ensure the home is safely maintained, with tests of equipment and certificates up to date. On the day of our visit a plumber was rectifying a boiler fault which meant the central heating was turned on. However a number of fire doors had been left wedged open and a requirement is made about this as this places people at risk of potential harm. Care Homes for Older People Page 22 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 23 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 38 12 The Registered Person must 25/08/2009 ensure fire doors are not are not wedged open by unauthorised means. This is to ensure people using the service are safeguarded from potential harm. 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 1 The Registered Person must ensure the service has an up to date statement of purpose and service user guide. This is to ensure people thinking about using the service know what to expect from the home. The Registered Person should develop the care plans belonging to people using the service to enable a more person centred approach to delivering support and ensure individual wishes and feelings about this are better promoted. The Registered Person should ensure activities are further developed and that specialist training about this is provided to staff. This is to ensure the changing needs, choices and Page 24 of 26 2 9 3 12 Care Homes for Older People 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 wishes of people living in the home can be better met. 4 29 The Registered Person should ensure professional supervision and appraisals of staff is developed to enable a more person centred and customer focused approach to supporting people living in the home. The Registered Person should ensure the service has a manager who is registered with the Care Quality Commission to run the home. The Registered Person should develop and implement quality assurance systems for the home to ensure the service is run in the best interests of who live there.. The Registered Person should ensure monies held on behalf of people using the service are regularly audited by an independent person and that recording systems for these are more robust. 5 31 6 33 7 35 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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