Care Home: Wray Common Nursing Home

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What the care home does well The home ensures that all residents have an assessment prior to admission to the home and care plans and risk assessments are then written with the assistance of the resident and/or their relative or representative. A visit to the home is also encouraged where possible. A varied programme of activities is available which include group activities but also one to one interactions. Mealtimes are unhurried and all meals are home cooked with an alternative option being available for each mealtime. Staff are available in each dining room to assist with the residents with their meals if required. There is an efficient complaints procedure in place and the homes processes and staff training should protect the residents in the event of an allegation of abuse. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to residents. The home has a staff team that have the necessary skills and experience to the meet the needs of current residents and staff training is on going. The management and administration of the home is good, with evidence of consideration being given to the residents and/or their relative`s opinion. The providers have a good knowledge of the service and the residents and offer support to the manager on a daily basis. What has improved since the last inspection? One requirement was made following the last inspection in June 2006. The home was requested to lock the cupboard that contained the substances that are hazardous to health. This has now been met. CARE HOMES FOR OLDER PEOPLE Wray Common Nursing Home Wray Common Road Reigate Surrey RH2 0ND Lead Inspector Lesley Garrett Unannounced Inspection 28th February 2008 10:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000013372.V357753.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000013372.V357753.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wray Common Nursing Home Address Wray Common Road Reigate Surrey RH2 0ND Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 242647 01737 249996 Dovestone Estates Limited Mrs Karin Edit Isabella Edgren Care Home 51 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (51) of places DS0000013372.V357753.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Services users may be admitted from the age of 60 years Date of last inspection 8th June 2006 Brief Description of the Service: Wray Common Nursing Home is situated in a quiet residential area of Reigate. The home provides care for up to 51 service users and accommodation is offered in single or shared bedrooms. There is plenty of communal space in the three lounge and dining areas. There are two gardens, one to the side of the property, overlooked and accessed from one of the lounges and a central courtyard garden, which is overlooked by some bedrooms. The home can provide respite care, day care for up to five people, terminal care for up to three people and care for up to twenty people who may have dementia. Fee ranges are from £500 to £868.00 per week. DS0000013372.V357753.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Mrs L Garrett Regulation Inspector carried out the inspection and the deputy manager represented the service. The providers for the service were also at the home and attended the inspection for the feedback session. The providers were also able to assist the inspector by giving information that was required in the absence of the registered manager. For the purpose of the report the individuals using the service will be addressed as residents, individuals or people who use the service. The inspector arrived at the service at 10.40 and was in the home for five hours and thirty minutes It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The Commission did not send questionaires to people associated with the service. The use of an ‘expert by experience’ (who is a person who visits the service with the inspector to help the get a picture of what it is like in or use the service) was also not used as part of this inspection. The home had supplied the commission with a documented Annual Quality Assurance Assessement (AQAA) some detail of which has been included within the report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, medication procedures, staff files, a variety of training records and health and safety records. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of residents who have diverse religious, racial or cultural needs. DS0000013372.V357753.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? One requirement was made following the last inspection in June 2006. The home was requested to lock the cupboard that contained the substances that are hazardous to health. This has now been met. DS0000013372.V357753.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000013372.V357753.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000013372.V357753.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People who use the service only move in following an assessment and feel confident the home can meet their needs. EVIDENCE: The deputy manager stated that prior to an admission to the home the manager will try to obtain the health needs assessment form that is completed if they are in hospital. A pre-admission assessment visit the takes place and the deputy stated this is carried out by either herself the manger or a suitably qualified nurse. The deputy stated that residents and/or their representatives are encouraged to visit the home prior to admission and an assessment can take place at this time. DS0000013372.V357753.R01.S.doc Version 5.2 Page 10 The home does not provide intermediate care. DS0000013372.V357753.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Health and personal care that individuals receive is based on their individual needs. Respect, privacy and dignity are maintained at all times. EVIDENCE: Three care plans were sampled and these were found to be well documented and contained the medical and personal care needs for each resident. The AQAA stated that these care plans are holistic in nature and comprehensive. There was no evidence that resident’s biographies had been completed to make the plans individual. The deputy stated that the manager was developing a questionnaire and plan and an example of the proposed document was shown to us. One resident stated ‘if you ring the bell the staff come to you. They help me get washed and dressed in the morning they are very good’. Suitable risk assessments are in place for all areas of the residents’ daily life in order to promote independence whilst ensuring personal safety and wellbeing. DS0000013372.V357753.R01.S.doc Version 5.2 Page 12 The deputy stated that the residents are consulted and where necessary the relatives are involved with the resident’s permission. Daily care records were well written and maintained to reflect the individual residents needs and care provided. The care plans evidenced that regular and appropriate health care appointments are attended and the General Practitioner (GP) visits the home when necessary. The deputy stated that the home has residents registered with six different GP surgeries but all are a good support to the home. The deputy also stated that they have access to specialist nurses at the hospital for support and advice. It was also observed in the care plans that the residents have access to the opticians, dentist, podiatrist and a Marie Curie specialist nurse for any resident with palliative care needs. The deputy manager showed the procedures for medication administration. The medicines are ordered every month from a pharmacy, which the home has used for fifteen years. The nurses hand write the medication administration charts (MAR) that are valid for three months. These charts were sampled and the information on the charts did not match the information on the medicine bottles from the pharmacy. A requirement will be made at the end of the report for the administration charts to contain all the information that is contained on the medicine bottles or packets. It was also noted that there was no documentation to evidence the non-administration of medicines and the reasons why that medicine was not given and this will be a recommendation at the end of the report. Throughout the day the inspector observed that residents were addressed in a polite and courteous way by staff and were observed knocking on residents’ doors prior to entering the bedroom. The deputy stated that privacy and dignity is discussed during the induction for all new staff and that all residents are offered the opportunity to choose male or female carers only for personal care. DS0000013372.V357753.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 & 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Recreational activities take place regularly and have been further developed by the home to meet the residents’ expectations and needs. Food served in the home is of a good quality. EVIDENCE: The deputy manager stated that the home has the benefit of two activity organisers who divide the activities between them. On the day of the site visit there was no activity organiser on duty. The programme of activities available that week was displayed on the wall which showed that crosswords, board games, arts and crafts and indoor games were all available. To meet the needs of those residents that do not always come out of their rooms the organisers arrange one to one visits and can also provide a hand massage for those residents that would like this. The manger states in the completed AQAA that activities have been increased to two full days and three afternoons a week. It is also stated that the range of activities have been broadened to include complimentary therapies and crafts. DS0000013372.V357753.R01.S.doc Version 5.2 Page 14 The AQAA also states that an attendance record is also being developed so that there is a record of participation and this will also chart resident’s preferences for activities. This will then be developed into the person centred plans being developed by the manager. During the site visit it was observed that family and friends visiting the home were comfortable to visit the office and discuss any issues with the deputy manger. The deputy stated that the home has an open door policy and those residents and relatives are told on admission to discuss any issue however small at the time. It was observed that the bedrooms had been personalised and private telephone were available for those people who requested it. Lunchtime was observed and residents were served their meal in a relaxed unhurried manner. Tables were laid with tablecloths and napkins and the meal was served in the dining rooms. Drinks were available and staff were seen to be offering choices to the residents about what they would like to drink and eat. One resident said that ‘the food was very good and there was always plenty. Another said ‘I haven’t got an appetite but I really like the mashed potato’. The home has two chefs and also provides cover over the weekends. There is a six weekly rotation of menus and they offered choice and demonstrated that fresh vegetables and fruit are available every day. DS0000013372.V357753.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People living at the home are protected by the homes complaints and safeguarding adults procedures. EVIDENCE: The home has a complaints procedure. The deputy manager stated that all complaints are fully investigated and the records kept by the home evidenced this. One complainant contacted the Commission with information concerning a complaint made to the service since the last inspection. This concern was referred under the safeguarding adults procedures that asked the home to investigate. The complainant did not contact the home again to pursue the concern. The provider stated that they have kept this open in case the family contacts them again. Records sampled indicated that staff had attended safeguarding vulnerable adults training and for newly recruited staff this had been included in the induction programme and ongoing training provided by the home. The home has a copy of the local authority’s multi-agency procedures for safeguarding vulnerable adults. There have been no other referrals made under these procedures since the last inspection. DS0000013372.V357753.R01.S.doc Version 5.2 Page 16 DS0000013372.V357753.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The design and layout of the home enables people to live in a safe wellmaintained and comfortable environment. EVIDENCE: The location and layout of the home remains suitable for its stated purpose. The home is well maintained and all areas of the home, including the garden are accessible to Residents. The AQAA states that the decoration programme for the home remains ongoing and the home was viewed as pleasantly decorated and providing a homely environment for residents. The AQAA also stated that routine maintenance is also undertaken in the home when necessary and to assist with this the home employs a maintenance person. DS0000013372.V357753.R01.S.doc Version 5.2 Page 18 During the tour of the building it was observed that bedrooms have been personalised and residents have the benefit of hi-lo beds. Communal bathrooms are available and contain suitable equipment to assist with the bathing of the residents in particular those residents who need assistance with a hoist. The home has an infection control policy in place and staff are trained in infection control procedures and were observed adhering to infection control measures. The laundry person confirmed that they had received infection control training and showed a good knowledge of procedures in the laundry room when dealing with infected items for washing. DS0000013372.V357753.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 & 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are trained and skilled and in sufficient numbers to support the residents in the service. Employment practices need to be reviewed to ensure the safety of the residents. EVIDENCE: The home had a relaxed atmosphere and staff was observed to undertake their tasks in a quiet and orderly manner. The inspector observed staff interactions with clients all of which were professional and supportive. The staff in the home during the day were relaxed and calm with the residents. Comments received during the day from residents included that the staff were always helpful and kind. One resident said ‘they seem competent in their jobs, nothing is too much trouble and they do their jobs very well. If I ring my bell they always come’. The staffing levels of the home were evidenced and considered adequate to meet the current needs of the residents. The rotas were seen and there is always four nurses on in the morning with eleven carers, two nurses in the afternoon and seven carers and two nurses at night with the support of three carers. The deputy stated that these are the numbers of staff working when DS0000013372.V357753.R01.S.doc Version 5.2 Page 20 the home is full. Dependency levels are also completed to determine staffing levels and this meant that staffing levels were increased. The deputy manager stated that all staff receives induction prior to start working and will then progress to a national organisation induction programme that links to the National Vocational Qualification (NVQ) training programme. Most staff in the home have got their NVQ level 2 some are currently undertaking this qualification or they are qualified nurses in their own country. Three staff recruitment files were viewed and it was evidenced that these files did not contain all items required under the Care Homes Regulations 2001 and a requirement will be made at the end of the report. The provider stated that he would review these files to ensure they contain al the required documents. The management must make sure that all criminal record bureau (CRB) and POVA first checks are in place. Those members of staff working without the documents are working under the supervision of a senior member of staff and have documentation from their own country to confirm checks have taken place there. The deputy manager stated that the manager ensures that all training in the home takes place including the mandatory training. Training includes manual handling, safeguarding adults, fire awareness and infection control. When the manager has dates for this training it is highlighted on the rotas so that staff are aware and the deputy stated it is compulsory for the staff to attend. Specialised training also takes place to ensure that the needs of the residents at the home can be met. Specialised training for this year includes dementia, tissue viability and syringe driver update. DS0000013372.V357753.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management of the home is robust to ensure the safety and wellbeing of residents and they are consulted regarding the running of the home. Their health and financial interests are safeguarded. EVIDENCE: On the day of the site visit the manager was not on duty but the deputy manager was in charge with support from the providers. The proprietors have their offices at the home and have daily contact, which supports the manager and senior staff team. Clear lines of management accountability and responsibility were demonstrated during the day of the inspection. DS0000013372.V357753.R01.S.doc Version 5.2 Page 22 The deputy stated that the manager has completed her registered managers award and this was confirmed in the completed AQAA. It was also stated that the manager attends all training sessions available to her. The providers showed the inspector the last survey sent out to seek the views of the residents and their relatives was completed in February 2007. The provider said this was about to be repeated. When the surveys are returned the comments are summarised and an action plan written so that the manager can address any concerns that may be highlighted. It will be a recommendation at the end of the report that the home seeks the views of all people who visit the home including other health care professionals. The provider said that the home is not responsible for the resident’s personal allowances. All expenses are paid by the home and relatives or residents are invoiced each month. Records indicated that health and safety checks are maintained, fire safety equipment and records were documented and equipment serviced. The sluice and laundry areas were noted to be clean and tidy. Clinical waste was appropriately stored to reduce infection in the home and hand-washing facilities were available for staff. Special arrangements have been made for the collection of clinical waste. DS0000013372.V357753.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000013372.V357753.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement The management should make sure that the administration charts contain all the information that is contained on the medicine bottles or packets for the safety and well being of the residents. The management should review all recruitment files to ensure that they have all the necessary information to enable the home to employ staff safely. Timescale for action 21/03/08 2. OP29 19 & schedule 2 21/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP33 OP9 Good Practice Recommendations It is recommended that the home seek the views of other people who visit the home to include other health care professionals. It is recommended that all non-administration of DS0000013372.V357753.R01.S.doc Version 5.2 Page 25 medications be documented to ensure records are complete. DS0000013372.V357753.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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