Care Home: Wyncroft House Nursing Home

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What the care home does well The information about the home was up to date and easy to understand, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had a contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, "I like the memory tree, it shows they care". Each person, and as appropriate, their relatives were involved in the plan of how their care is to be provided. Care plans were well written and up to date, giving staff instructions how to care and support each person. The medication systems were managed well and people received their medication at the time prescribed by their doctor.Wyncroft House Nursing HomeDS0000004891.V377486.R01.S.docVersion 5.2There were good relationships with the local health care services, providing support for people living at the home. People were encouraged to treat the home as their own home and to be as independent as possible. People could make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. There were activities, events and outings, which people told us they liked. There was good involvement in the running of the home and people had contributed their views about the activities, planned outings and food. People told us they enjoyed their meals, which looked appetising. Relatives and visitors were invited to have refreshments and meals at the home if they wished. The home had achieved a 5 Stars Award for food safety and healthy eating. There were links with local churches and arrangements were in place for people to practice their faith. People knew how to raise concerns and make complaints and were confident these would be dealt with. Staff had completed safeguarding training and they understood about how to keep people safe. The home had a relaxed, homely ambience and it was warm, generally clean and comfortable. People were encouraged to personalise their bedrooms with their possessions, furniture and bedding if they wished. The staff were caring, committed, flexible, and well trained. Staff were checked to make sure they are suitable to work with vulnerable people. The home had `Dignity Champions`, who monitor how people are treated and look for additional ways to improve people`s lives at the home. Comments included, "the staff are wonderful, helpful and caring." There were effective management systems with regular quality audits to make sure people are cared for in a safe environment. Comments included, "our recent manager is very innovative and full of ideas which are already being put into place." Relatives` comments included, "he has been at the home for 19 months, they look after him really well. I sometimes stay for lunch, the food is very good. I have recommended this home to another person looking for a home for her mother" and "happy with the care, staff are always friendly and welcoming, X has put on weight since he came here a few weeks ago."Wyncroft House Nursing HomeDS0000004891.V377486.R01.S.docVersion 5.2Page 8 What has improved since the last inspection? The organisation has appointed a new manager who has made considerable improvements in a short time. Improvements have been made to assessment of each person`s needs, care plans, health screening assessments, which means people`s health and well being are promoted. As a result of listening to people`s views meals and meal times have been changed, with the chef serving food. This means that meal times are `protected` and less rushed. There is an on going programme of redecoration and refurbishment and improvements had been made to achieve better facilities such as renovated bedrooms, an additional dining room on the dementia unit and a more secure, attractive rear garden area, providing places for people to visit if they chose. Comments included, "the extension to the dementia unit has made a great improvement. It actually feels more like home." Continued professional development to keep staff up to date has improved so that people living at the home benefit from best practices. The management have assessed and improved security arrangements, and there are improved fire evacuation plans in place to safeguard people in the event of fire. What the care home could do better: The staffing levels and skill mix must be carefully monitoring to make sure that each person`s needs can be met in a timely way. Comments included, "the dependency of some people is high and more staff are needed for extra care." There are a number of areas requiring improvement to promote health and safety and effective standards of infection control. Health care records should be maintained more consistently so that changes to people`s health are not missed. A small number of areas of medication administration and recording must be improved so that there is assurance that everyone living at the home receives their medicines as prescribed. The repairs, renewal and maintenance plan must be continued with the improvements already identified, in a timely manner, such as improving the bathing facilities and sluices, so that the standards of the premises are pleasant and safe for people using the service.Wyncroft House Nursing HomeDS0000004891.V377486.R01.S.doc Version 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Wyncroft House Nursing Home 16 Moss Grove Kingswinford Dudley West Midlands DY6 9HU Lead Inspector Jean Edwards Key Unannounced Inspection 2nd September 2009 07:30 DS0000004891.V377486.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 2 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 Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wyncroft House Nursing Home Address 16 Moss Grove Kingswinford Dudley West Midlands DY6 9HU 01384 291688 01384 402260 wyncrofthouse@schealthcare.co.uk www.schealthcare.co.uk Exceler Healthcare Services Limited 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) Vacant Care Home 40 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (40), Physical disability (6) of places Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 40 Physical disability (PD) 6 Dementia (DE) 8 The maximum number of service users who can be accommodated is: 40 4th September 2008 2. Date of last inspection Brief Description of the Service: Wyncroft House Nursing Home is owned by the Southern Cross Healthcare group. Accommodation and nursing care for people with physical health conditions, and specialist dementia care services (8 places for personal care) are provided to a maximum of 35 adults. The two-storey property is near the centre of Kingswinford Village where there are local amenities and public transport. There is a car park at the side of the home. The original house is used mainly for dementia care and staff offices, and has an enclosed garden. There is an extension used mainly for nursing care, with a dining room and access to a large rear garden. There are 36 single bedrooms, with a passenger lift to the first floor. The home reduced their registered rooms, and one is now used as a viewing room for people looking around the home, another has been used to create an extra dining room. There are communal toilets, assisted bathrooms and shower room facilities throughout the home. The fees range between £362 and £615.69 per week, depending on the level of care required and the accommodation, and any NHS funding for nursing care. The fees do not include extra services such as dry cleaning, hairdressing, chiropody, physiotherapy, aromatherapy, reflexology, and a staff escort to preWyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 5 arranged health appointments. People are advised to contact the home for up to date information regarding fees. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods used to obtain evidence and make judgements included discussions with the acting manager and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the Commission. We looked at a number of records and documents. The registered manager submitted the homes Annual Quality Assurance Assessment (AQAA) as requested. We looked around the premises, including communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. Surveys were sent to people living at the home, relatives, advocates, staff and health professionals. Collated views and comments have been included in this report. The quality rating for this service is Two Stars. This means the people who use this service experience good quality outcomes. What the service does well: The information about the home was up to date and easy to understand, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had a contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, I like the memory tree, it shows they care. Each person, and as appropriate, their relatives were involved in the plan of how their care is to be provided. Care plans were well written and up to date, giving staff instructions how to care and support each person. The medication systems were managed well and people received their medication at the time prescribed by their doctor. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 7 There were good relationships with the local health care services, providing support for people living at the home. People were encouraged to treat the home as their own home and to be as independent as possible. People could make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. There were activities, events and outings, which people told us they liked. There was good involvement in the running of the home and people had contributed their views about the activities, planned outings and food. People told us they enjoyed their meals, which looked appetising. Relatives and visitors were invited to have refreshments and meals at the home if they wished. The home had achieved a 5 Stars Award for food safety and healthy eating. There were links with local churches and arrangements were in place for people to practice their faith. People knew how to raise concerns and make complaints and were confident these would be dealt with. Staff had completed safeguarding training and they understood about how to keep people safe. The home had a relaxed, homely ambience and it was warm, generally clean and comfortable. People were encouraged to personalise their bedrooms with their possessions, furniture and bedding if they wished. The staff were caring, committed, flexible, and well trained. Staff were checked to make sure they are suitable to work with vulnerable people. The home had Dignity Champions, who monitor how people are treated and look for additional ways to improve peoples lives at the home. Comments included, the staff are wonderful, helpful and caring. There were effective management systems with regular quality audits to make sure people are cared for in a safe environment. Comments included, our recent manager is very innovative and full of ideas which are already being put into place. Relatives comments included, he has been at the home for 19 months, they look after him really well. I sometimes stay for lunch, the food is very good. I have recommended this home to another person looking for a home for her mother and happy with the care, staff are always friendly and welcoming, X has put on weight since he came here a few weeks ago. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: The staffing levels and skill mix must be carefully monitoring to make sure that each persons needs can be met in a timely way. Comments included, the dependency of some people is high and more staff are needed for extra care. There are a number of areas requiring improvement to promote health and safety and effective standards of infection control. Health care records should be maintained more consistently so that changes to peoples health are not missed. A small number of areas of medication administration and recording must be improved so that there is assurance that everyone living at the home receives their medicines as prescribed. The repairs, renewal and maintenance plan must be continued with the improvements already identified, in a timely manner, such as improving the bathing facilities and sluices, so that the standards of the premises are pleasant and safe for people using the service. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 9 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. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 10 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 Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Standard 6 is not applicable. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an easy to read statement of purpose and service user guide and people living at the home have contracts terms and conditions of occupancy. This means that that people and their advocates have good information regarding their rights and entitlements, and how care will be provided. The home uses comprehensive assessment tools so that each persons needs are thoroughly assessed to ensure that their needs and preferences will be met. The home actively encourages introductory visits, which gives people the opportunity and time to make decisions, which are right for them. EVIDENCE: The information contained in the homes AQAA (Annual Quality Assurance Assessment) about what it did well stated, prior to admission we carry out Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 12 individual detailed assessments to ensure we can meet the needs of prospective residents, these are completed by the manager or registered nurse in the managers absence and we include the service user, family, relatives and multidisciplinary team where possible. We encourage preadmission visits and stays, and introduce named carers. All service users have a four week trial period followed by a full review of care and includes any multidisciplinary agencies involved in care as well as the placement agency. We formulate a full person centred care plan with emphasis on the service users strengths and personal preferences. Statement of purpose and service user guides are available on request and displayed in reception and are now available on audio cassette, large print and alternative languages on request. We were able to verify the information in the AQAA. We saw that the home had an up to date statement of purpose and service user guide on display and in each bedroom. These documents could also be provided in alternative formats. The aims, objectives and admission criteria were clearly set out and information about the home was easy to read and understand. The service user guide also had information about the range of fees and payment arrangements. The information was useful for people to help them make decisions about their choice of home. We looked at a sample of case files of people recently admitted to the home, which showed that each person was provided with a contract and statement of terms and conditions. This document had been updated and was easy to read and understand and set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. Responses from discussions during the inspection visit confirmed people felt they had the right information to make a choice about the home and had received a copy of their contract or terms and conditions for their stay at the home. There was also evidence from the sample of care records and from discussions, which confirmed the good practices claimed in the homes AQAA, such as pre admission assessments. These were conducted professionally and sensitively and had usually involved the family or advocate. The pre-admission assessment documentation was usually well completed and individual preferences were recorded such as rising, retiring, preferred activities, likes and dislikes. There were assessment records, which had not been signed and we recommended that the homes record of assessment of each persons needs should be signed by the person completing or reviewing the assessment. There were life histories and personal preference plans for each person. This meant that staff had good and accurate information about each persons needs and preferences about how they wished their care to be provided. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk management provide staff with the information and guidance to meet peoples needs and preferences. Good multi disciplinary working takes place on a regular basis, giving people assurances that their health needs care needs are identified and well met. People living at the home can feel confident they will receive their medicines as prescribed by their doctor. People living at this home can be assured that they will be treated with dignity and respect. EVIDENCE: We looked at a sample of care records for new people admitted to the home and people who had lived at the home for longer periods of time. Each person had a comprehensive care plan to meet their needs for care and support. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 14 There was good practice of involving the person and their relatives or advocates in the development and review of their planned care. Care plans were based on comprehensive assessment information and included information about each persons needs and identification of any associated risks. The personal preferences such as preferred daily routines for staff guidance, and the introduction of personal preference plans, made sure that care was delivered with a person centred approach. This initiative was being implemented well. From records and discussions we saw that each persons health was monitored with appropriate action taken. There was evidence of well documented health care assessments, and screening tools, such as falls assessments, tissue viability and the Malnutrition Universal Screening Tool (MUST), which were used to assess skin condition and weight. Some improvements were needed to make sure all care records were maintained consistently and updated where there were changes. For example there were inconsistencies between the weight records and MUST screening assessments and evaluation of mobility records for one person who had frequent falls. However the additional control measures, support and monitoring had been put in place. We saw that the care of someone being nursed in bed, with a PEG feed for nutrition was being managed well. They looked well cared for, clean and comfortable. There were appropriate records of dietary nutrition and we saw some evidence of mouth care but there was no oral care chart to show how often this was carried out. We also recommended that the information for the care of the PEG site should be expanded, for example, to include instructions to rotate the tube 360 degrees each 24 hours to prevent buried stump syndrome. We saw that all persons living at the home had good access to health care services to meet their assessed needs. The home used the services of a local GP who provided care for the majority of people and attended the home for a weekly surgery. We were told that some people were able to remain with their own GP within the limits of geographical borders. There was documentary evidence to demonstrate that all persons had good access to dentists, opticians, and other community services such as chiropody. There were examples where significant changes had been referred to doctors and health care professionals, such as speech and language therapists and occupational therapists, for advice and support and appropriate reviews and monitoring. Advice had been sought for the care of someone with challenging behaviour when being assisted to move, which was incorporated into the moving and handling assessment and care plan. We saw that staff were Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 15 following the guidance, showing patience and sensitivity when the person displayed the behaviour. There were appropriate monitoring arrangements for people with diabetes living at the home. However we recommended that the home should make use of Dudley PCT specialist diabetic nurse services for additional advice, support and training for staff. The home operated a named nurse and key worker system to enhance the quality of individual, person centred care for people living at home. This fostered good relationships between each person and their named workers. Staff spoken to demonstrated that they knew about each persons needs and preferences. We looked at the homes systems to manage the medication. The home used a Monitored Dosage System (MDS) for people living at the home on a permanent basis. We saw that the supplying pharmacy supported the home with advice related to medication issues at regular audit visits. We were told that staff involved in medication administration had received medication training. The nurses and senior staff were knowledgeable about each persons medication and the systems for ordering, receipt, storage and administration were well managed. There was a specimen staff signature list but the acting manager acknowledged that this needed to be updated. This was important because the homes uses bank nurses. The lockable medication refrigerator was checked daily, with the minimum and maximum temperatures documented and recorded. This meant that peoples medication requiring refrigeration was stored at the correct temperatures to maintain its integrity and effectiveness. The storage of medication was well organised and there was good stock control with no excessive medication stocks. There was appropriate storage and records of Controlled Drugs and the random audits we carried out were accurate. We looked at a sample of MAR (Medication Administration Records) charts, which document each persons current medicine requirements and regime. These were well maintained, which meant that there was an accurate record to show medicine prescribed by their doctor was recorded, checked, monitored and administered in accordance with instructions. There were appropriate procedures and checks in place to make sure that people received their correct medicine at the right time. There were protocols and care plans for the administration of when and as required (PRN) medication. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 16 We saw effective practices such as variable dosages recorded but there were handwritten entries on MAR charts, which had not been signed and witnessed by two staff to make sure the information was correct, which reduced the risk of errors. The receipt, administration and disposal of medicines were also well recorded. The date of opening of medicines in original containers was documented, which meant it was easy to carry out audits. We carried out audits on a random sample of medication to ensure that medicine had been given to each person as prescribed by the GP. The random audits undertaken of prescribed medication were found to be accurate. However we recommended that a triangle should be obtained for hygienic and accurate audits of tablets dispensed in original containers. From our observations and in discussions it was evident that all staff were aware of how to treat each person with respect and to consider their dignity when delivering personal care. We received comments from people living at the home, visitors during the inspection visit and in surveys returned to us, which were very positive about the staff. However they also felt the home was short staffed and did not always have enough time to attend to peoples needs. We were told, Staff here are special people, staff are wonderful and staff caring and friendly but need more to do what they do well, even better. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the 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 have access to appropriate activities and social stimulation to enjoy. They are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person are catered for with a balanced and varied selection of foods that meet their preferences and nutritional needs. EVIDENCE: The homes AQAA cited the following evidence of what was done well, At Wyncroft House we understand and actively promote the importance of respecting the human rights of the service users, with fairness, equality, dignity, respect and autonomy all being seen as central to the care and support being provided. Service users enjoy a full and stimulating lifestyle. Wyncroft House has sought the views of the service users and considered their varied interests when planning their routine for daily living and arranging activities. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 18 We saw evidence, which confirmed the accuracy of the claims made in the homes AQAA. We saw that staff listened to people, were aware of their needs and made considerable efforts to provide flexible daily living routines, though they sometimes appeared to be hampered by the number of staff available, especially during the afternoon shifts. We noted earlier in the report that the home had a named nurse and key worker system, which enabled closer relationships between the people living at the home and staff, where likes, dislikes and needs were known in more detail and were met in a person centred way. Staff had awareness that some people preferred to spend their time in their own bedrooms, and they were supported with individual interests. We were told that one person received regular visits from the local Roman Catholic Church so that they could receive Holy Communion, which was an important aspect of their faith. A registered nurse who has been ordained as a minister holds services for people at the home who wish to attend. The acting manager told us that she was exploring options with other faiths to provide for peoples spiritual needs. Staff were completing life histories and personal preference plans for each person, which gave staff valuable insight into each persons history and preferences and improved the person centred aspect to their care. There were two activity organisers and we saw a reminiscence quiz taking place, where the organiser made efforts to include as many people as possible, using their name to encourage them to answer and participate. We saw evidence that family and friends were welcomed and people we spoke to told us they knew they could visit the home at any time. We were told that the management and staff team always made time to talk to visitors, offer refreshments and share information where this was appropriate. Comments included, I am very pleased to be able to have some meals with my husband, the food is very good. We discussed nutrition with the catering staff and the acting manager. They were knowledgeable about each persons nutritional needs and we saw that choices were always offered. There was regular use of the MUST (Malnutrition Universal Screening Tool) and BMI (Body Mass Index) screening. This made sure that any concerns about each persons weight were quickly identified with action taken to involve doctors and dieticians as needed. We saw that the monitoring arrangements also reflected the good hydration and nutrition at the home. We saw plenty of cool drinks available around the home and heard staff offering frequent warm drinks. Special diets such as soft and pureed diets were provided. However the chef told us that a person with diabetes could have normal food because their condition was controlled with medication. The acting manager took immediate action to make sure that an appropriate healthy diet was offered for this person. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 19 The home had achieved an award from Dudley Environmental Health for healthly eating and a 5 star rating for Scores on Doorsaward for food safety. We discretely observed mealtimes and saw that staff were aware of the needs of people who found it difficult to eat and we noted that they offered sensitive assistance with feeding. They were aware of the importance of offering food at the persons pace, so that they were not hurried. We saw a carer making conversation about the food as she fed someone. A small number of people chose to have their meals at a different time, or in their bedrooms, to allow them time and space to eat at their own pace. Efforts had been made with the dining rooms to make them look inviting with attractive linen tablecloths, napkins, crockery and condiments. The colour co-ordinated table cloths were changed after each meal time. There were individual gravy boats and individual tea pots, which encouraged personal choice and independence. There were printed menus to show daily meal choices. The acting manager told us that there were plans to introduce large print and pictorial menus. These would assist people to make real choices for their meals. The meals appeared appetising, and meal times were protected to provide a sociable, enjoyable experience. We asked a sample of people about the food at meal times, and received generally very favourable comments. The comments book in the dining room contained, like home made porridge, bread and butter pudding - it was really lovely, lovely Sunday lunch, and congratulations on the rhubarb pie. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the 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 can feel assured that any concerns and complaints are listened to and action is taken to look into them, with systems in place to record investigations and outcomes. There are good arrangements in place to safeguard people living at the home from risks of harm. EVIDENCE: There were copies of the homes complaints procedure displayed in the reception area and in the service user guide and in information packs given to each person. We saw signatures in care records demonstrating each person had received their copy. The AQAA cited the following about what the home did well, At Wyncroft House we have a complaints policy that is acted upon immediately with a written response within 28 days. There is a complaints procedure available in each service users bedroom. We provide a comments book which is situated in the reception area. Before all new members of staff commence employment a full POVA check and CRB are obtained. All staff undergo yearly training in abuse and POVA. We operate an open door policy for all staff, relatives and service users. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 21 Information in the Homes AQAA told us that the home had received two complaints, over 12 months, which had been investigated and upheld by the provider within 28 days, with satisfactory resolutions implemented. There was detailed information about the investigations and outcomes in the homes complaints log. The responses during the inspection indicated that people were aware of how to raise concerns or use the homes complaints procedure. The acting manager had introduced a weekly surgery, where anyone could drop in to talk to her. She told us that to date this had not been used but she felt people could speak on a daily basis when they saw her around the home. This demonstrated positive practice and the homes proactive response to peoples experiences and perceptions of the service. We also saw that advocacy information was readily available around the home. There was a copy of Dudley DACHS (Directorate of Adult Community and Housing Services) multi-agency Safeguard and Protect procedures relating to safeguarding vulnerable persons. There were also organisational policies and procedures such as Whistle blowing, though some of these had not been reviewed annually as recommended good practice. Individual managers did not have the authority to update Southern Cross policies and procedures. The majority of staff had attended training, which provided appropriate awareness of safeguarding vulnerable adults and staff we spoke to were aware of what they needed to do should an incident occur. The organisation followed appropriate recruitment processes to make sure only staff suitable to work with vulnerable people were employed at the home. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a warm, homely, comfortable environment for people living there. The systems for maintaining effective infection control are not sufficiently robust. EVIDENCE: Wyncroft House was a large detached property, extended, adapted and renovated. There have been considerable efforts recently to make it homely and comfortable for people. There were two units; Bishops Lodge for people with dementia; and a nursing unit. Each unit had a separate lounge, with a communal quiet lounge which could be used by visitors. An additional dining room had been created on Bishops Lodge and had been named Coley Café in memory of a person who had lived on the unit. There was also a refreshment Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 23 bar in this area, with a kettle, microwave, and fridge so that visitors could make drinks. The dementia unit had lots of aids to orientation, such as pictures, tactile symbols and a new vanity area with a mirror, beauty items and different styles of hats for the men, which they enjoyed trying on. The corridors in this area had many interesting ideas such as an art gallery of painting by people living in the home, familiar local scenes and a bus stop. The recently appointed acting manager had made efforts to improve the interior of the home so that it was brighter, cheerful and homely. There were improvements to security of the rear gardens, with garden furniture and a gazebo for people to use in the warm weather. We saw that the acting manager had a maintenance and renewal plan and a reporting system for minor repairs, which required a reactive response. She told us that the organisation employed maintenance staff to carry out on-going redecoration, renovation and refurbishment and we saw evidence of this during the inspection visit. For example damaged plasterwork in the laundry was rectified during the visit. The carpet in the ground floor corridor on the nursing unit was very worn and heavily stained. The acting manager told us that quotations had been obtained and this was due to be replaced very soon. There were adequate bathing and toilet facilities throughout the home. Red toilet seats had been provided on the dementia unit, as recommended good practice, to improve orientation and recognition. Some bathing facilities needed to be renovated and we were told that these were included on the maintenance programme. However a bathroom on the first floor of the nursing unit had flooring, which was lifting and posed a potential tripping hazard. The acting manager told us she would obtain an urgent quotation for replacement flooring. A risk assessment and control measures to minimise the hazard must be implemented as an interim measure. Toiletries left in this bathroom, which might have been used communally were removed by the manager during the inspection visit. We looked at a sample of bedrooms with peoples permission where possible. The majority were attractively furnished and some had been renovated and improved since the last inspection visit. These had been attractively redecorated and personalised according to individual preferences, such as family photographs, ornaments and small items of personal furniture. The homes AQAA cited the following improvements to the environment, redecoration programme included accessories that bring out the colour schemes better for visual effect. The homes plans for improvement in the next 12 months were, to focus more in depth on the six strands of diversity in regards to the environment. Redecoration of the front of the home. Flooring and carpet changes in designated areas. Administration and managers office to be moved to the lower ground floor. We were told that this would provide improved accessibility for visitors to the home in the reception area. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 24 The large laundry was well equipped with commercial washers and tumble dryers and a rotary iron. The laundry service was generally well organised and the staff were aware of infection control guidance. There was a laundry procedure and supplies of disposable gloves and aprons readily available in the laundry. However there was no separate hand wash basin, which would promote more effective infection control for staff. The kitchen was maintained in good order, and it was clean and tidy and well organised. There were stocks of dried, frozen, and fresh foods, which included alternatives for people with special diets such as low-fat and reduced sugar items. We were told the sluices, which contained worn, cracked porcelain facilities were on the refurbishment programme. The organisation must upgrade sluicing facilities to ensure effective infection control measures. This was important because the home had accommodated people with infectious conditions. Whilst looking around the home we identified some further improvements which needed to be made, such as appropriate hand wash signs in all bathing and toilet facilities. We noted that pressure settings on pressures relieving mattresses were recorded in care plans but the settings on two mattresses were not accurate. These should be regularly checked and maintained at correct pressure settings. The risk assessments for bedrails had not been completed to include the condition of each person and one set of bedrails in use with a pressure relieving mattress was below the Health and Safety Executive (HSE) permitted dimension of 220 mm. The person carrying out checks acknowledged that he had not received specific training in relation to bedrail safety. We saw a number of wardrobes, which were not secured to the walls posing a potential risk of accidents. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a stable staff team and good skill mix and people receive adequate standards of care. The staffing levels do not always ensure there is sufficient time to meet each persons individual needs. The staff recruitment processes are robust, which means that there are effective safeguards for people living at the home. There is a strong commitment to staff training and development. EVIDENCE: The homes AQAA cited the following as evidence of what they do well, there are senior care staff in charge of the dementia house and the unit has a senior leader who is suitably qualified. The nursing area is looked after by registered nurses and carers with a good overview of the care given. Both units are overlooked and managed by the home manager. Appropriate staff numbers and skill mixes are maintained on a daily basis. Staff are recruited in line with company policy and procedures including obtaining two written references and a criminal record check. Staff receive a comprehensive induction on commencing employment and are supported to complete the NVQs in care. We have two in-house trainers, two in-house moving and handling trainers. We also have an in-house trainer for Yesterday, Today and Tomorrow, dementia awareness training. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 26 We were able to verify the majority of good practices claimed from observations, discussions and examination of samples of records during this visit. However we received comments from people living at the home, relatives and staff indicating that there were not always sufficient staff available to meet peoples needs in a timely way. This was not a reflection on the quality of the staff on duty. We noted that there were 26 people accommodated, with a variety of dependency levels and diverse needs. There were seven people accommodated on the dementia unit and 19 people accommodated on the nursing unit, with clinical nursing needs. The acting manager told us that she reviewed staffing levels on a regular basis, taking account of the occupancy and dependency levels of the people accommodated. However we noted that staffing levels had to be agreed and were monitored centrally by the organisation, which meant that the manager did not have sufficient autonomy to increase staffing if necessary at short notice. We were told that the staffing ratios included one suitably qualified nurse on duty at all times. There were two carers, including a senior carer on early and late shifts and one carer on night duty on the dementia unit. There were four carers on the early shift, three carers on the late shift and one carer on the night shift on the nursing unit. We were told the staffing had been increased by one night carer for the dementia unit since the last inspection visit. We noted during the inspection visit that a 15 people at the home required two staff to assist them with personal care and mobility, 19 people needed assistance with feeding and there were also people who required close supervision to ensure safety. There are comments about staffing levels at the Health and Personal Care section of this report. There were times when people were waiting for attention and at times during the afternoon when there was one member of staff giving assistance, where the care records showed the person needed the assistance of two staff. We observed one person who had to wait for staff to be available for assistance to the toilet say, its too late, indicating they had been incontinent. The Home has had a generally stable staff team including four permanent nurses, five bank nurses, 23 care staff, 12 ancillary staff, and the acting manager. Seven staff had left the homes employ since in the past 12 months, for valid reasons and there was ongoing recruitment as staff vacancies occurred. The home had used agency workers for a time but we were told that no care shifts had needed to be covered by agency workers since June 2009. We looked at a sample of staff personnel files, which were well organised and contained necessary documentation. The acting manager was able to tell us about the recruitment procedures, which were robust. The organisation and acting manager demonstrated a strong commitment to staff training and development and had continued to provide all staff with Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 27 appropriate training to raise awareness and skills to respond to peoples changing needs. We saw evidence that 13 of 23 care staff had achieved a National Vocational Qualification (NVQ) level 2 care award with new candidates registered for training. We were also told about accredited dementia training, also made available to relatives, which helped them with their understanding of people with these conditions. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective management systems providing leadership and direction, with safeguards for people. There are systems for consultation with people living at the home with peoples views formally sought and acted upon. EVIDENCE: Barinda Sumon had been appointed as acting manager at Wyncroft Care and had made considerable improvements in a short time. She was a qualified Registered General Nurse (RGN) with a Bachelor of Science Honours degree and managerial experience. She told us that she would be submitting an application to be the registered manager. She was undertaking the NVQ level 4 Award and was due to enrol on the Leadership and Management skills Award course delivered by external trainers. She continued to demonstrate a Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 29 commitment to her own professional development, for example she had undertaken training in palliative care level 3 and dementia care level 3. She had a good awareness of the recently implemented Deprivation of Liberty Safeguarding Regulations (DOLs) and its implications for people living at the home. She planned to arrange for staff to receive appropriate training to raise their awareness and knowledge to benefit people using services provided at the home. The registered manager was supported by the deputy manager, and the senior team. There was also support from the organisations regional manager. During discussions there was evidence of an open, approachable ethos, which encouraged good communication with people living at the home, their relatives and staff. People told us of the improvements since the appointment of the acting manager. We saw evidence that the nominated representative for the registered provider, Southern Cross Healthcare, visited the home regularly. We looked at the Regulation 26 Reports held at the home and noted that they were comprehensive and constructive. The organisations quality assurance system was based on KLORA (Key Lines of Regulatory Assessment) and equality and diversity. We saw evidence of quality audits during this inspection visit, which meant positive outcomes for people receiving the service. The home had a number of dignity champions, including the acting manager, which meant that there was a continual effort to improve the experience at the home for each person. There were clear lines of accountability within the home, and through the management structure. There was an annual business and development plan for the home for the current year. We saw evidence that the acting manager had used the organisations auditing systems effectively. These included monthly audits of areas such as peoples case files, medication, food, the environment, staff recruitment and training, and accidents, incidents and falls, with remedial actions to minimise any risks identified. The registered manager and staff team have continued their efforts to involve people living at the home, their relatives, representatives and other community stakeholders in the running of the home. We noted that there were regular weekly residents meetings with minutes available and efforts to encourage participation. The home had good support from relatives, who have helped with fund raising, activities and outings especially for people on the dementia unit. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 30 The homes survey questionnaires had been distributed to people at the home, relatives and stakeholders in April and May, with completed forms returned, and results collated and published. We saw evidence that the results had been acted upon in any area where there were concerns or where performance needed improvement. For example the meals had been discussed and reviewed, with meal times and choices changed and meals now served by the chef. We noted that staff meetings were taking place, with minutes available. The structured formal supervision system appeared to be effective with supervision sessions identifying training needs, personal development and support. This staff development had benefits for people living at the home. We noted that people were offered the opportunity to manage their own money if they wished, and the home provided facilities to help keep it safe. We looked at a random sample of records of monies banked in temporary safekeeping on behalf of people living at the home, which were accurate, with documented records of all transactions. However we noted that there were communal receipts from the hairdresser. We recommended that there should be individual receipts for all transactions to demonstrate compliance with the Data Protection Act and maintain confidentiality. We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and well organised. There was evidence that all staff received mandatory training appropriate to their roles, such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training. The registered manager had an effective system for auditing, analysing and evaluating accidents involving people at the home, with effective measures implemented. Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 31 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 3 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 3 X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 2 Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 32 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 OP29 Regulation 12(1) Requirement To demonstrate that the number of staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 2. OP38 13(4) Risk assessment and control 01/10/09 measures to minimise the hazard must be implemented as an interim measure for the flooring in the first floor bathroom. This is to safeguard people living at the home. 3. OP38 13(4) The sluices must be renovated or 01/12/09 replaced to ensure effective infection control measures. This is to protect the health, wellbeing and safety of people living at the home. 4. OP38 13(4) To ensure the safe use of DS0000004891.V377486.R01.S.doc Timescale for action 01/11/09 01/11/09 Version 5.2 Page 33 Wyncroft House Nursing Home bedrails, including correct fitting, rigorous risk assessments, diligently followed, documented checks and staff guidance and training relating to bedrails. This is to safeguard the health, well being and safety of people living at the home. 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. Refer to Standard OP4 Good Practice Recommendations The homes record of assessment of each persons needs should be signed by the person completing or reviewing the assessment. Care records should be maintained consistently and be updated where there are changes. The information for the care of PEG site should be expanded to include instructions to move and rotate the tube 360 degrees each 24 hours to prevent buried stump syndrome. Advice from Specialist Diabetic Nursing Service should be sought for people with diabetes, living at the home, with records of screening, support and advice offered and that a record be maintained of staff training in relation to diabetes. There should be regular documented checks to ensure pressure relieving mattresses are maintained at the correct setting for each person. All handwritten entries on MAR charts should be signed and witnessed by two staff to make sure the information is correct to reduce the risk of errors. The specimen staff signature list for administration of DS0000004891.V377486.R01.S.doc Version 5.2 Page 34 2. 3. OP8 OP8 4. OP8 5. OP8 6. OP9 7. OP9 Wyncroft House Nursing Home medication should be updated. 8. OP9 It is recommended that a triangle should be obtained for hygienic and accurate audits of tablets dispensed in original containers. It is recommended that there should be individual receipts for all transactions to demonstrate compliance with the Data Protection Act and maintain confidentiality. Communal bathing facilities should be free from items which might be used communally and would not maintain good infection control measures. All wardrobes should be secured to minimise risks of accidents A separate hand wash basin should be provided in the laundry to promote effective infection control measures are available for staff. 9. OP37 10. OP38 11. 12. OP38 OP38 Wyncroft House Nursing Home DS0000004891.V377486.R01.S.doc Version 5.2 Page 35 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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