Inspection Report on Stansty House Nursing Home Stansty House Nursing Home 34 Stansty Road Rhosddu Wrexham LL11 2BU Date of Publication 27 December 2018 Welsh Government © Crown copyright 2018. You may use and re-use the information featured in this publication (not including logos) free of charge in any format or medium, under the terms of the Open Government License. You can view the Open Government License, on the National Archives website or you can write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] You must reproduce our material accurately and not use it in a misleading context. Description of the service Stansty House Ltd is registered with Care Inspectorate Wales (CIW) to provide a service ‘Stansty House Nursing Home’ to care for 77 persons over the age of 65 years requiring nursing care and care for a number of people living with dementia. Of this number, four people can be accommodated by the service under the age of 65 years. The service is located in Wrexham near to the town centre. A person is appointed as the responsible individual to represent the company and oversee the service. The registered manager left employment on 08 August 2018. A person was immediately appointed to manage the home and they are registered with Social Care Wales. Summary of our findings 1. Overall assessment A new manager has been appointed; the manager is pro-active and receptive to feedback. A senior / management restructure has also been undertaken and these changes have helped to improve staff morale. Staff feel better supported and valued and enjoy coming into work. This ultimately has a positive impact on the care and support people receive. Staffing levels have improved, staff are less rushed and have time for people, which means people don’t feel ignored. Staff were positive about the changes made / being made. The increase in staffing levels means people receive a timelier response to their care and support needs therefore peoples’ dignity is maintained. 2. Improvements Auditing and monitoring systems have been introduced to improve standards in the home. Action has been taken to address staffing matters. A Welsh language policy has been introduced. A system to monitor staffs’ annual self-declaration relating to criminal convictions and the DBS (Disclosure and Barring System) has been introduced. 3. Requirements and recommendations Section five of this report sets out our recommendations to improve the service. 1. Well-being Summary People have things to do to help them pass the time of day and staff are available to support and engage with people. People are able to speak the language of their choice and the manager has introduced a policy to ensure language need is reviewed on a regular basis. Our findings People can be involved, participate in their community and are supported by staff to positively occupy their time. The manager told us since the last inspection a full time activity co-ordinator has been employed, which means there are now three activity co-ordinators in post to help people pass their time and prevent boredom. The manager told us they have introduced a new initiative where a person using the service is nominated in turn and pampered for a week. They receive flowers, have their hair and nails done, have their picture taken and go out or do whatever they wish for the whole week the choice is theirs. We saw a reminiscence pod was used to help engage people and we saw other new stocks of activities were available such as jigsaws, crafts with lace and robotic pets were in use as part of dementia care therapy. The manager told us, fake money had been introduced to support people who became concerned about paying for things; they explained this measure has helped to alleviate peoples’ distress. A ‘playtime’ opportunity was arranged with a local childminding group to visit the service and engage with people using the service. Unfortunately, this was cancelled with short notice but will be re-arranged to take place on another date. We spoke with a person visiting the home who told us there were “More activities going on down here (in this part of the home)”. We spoke with a member of staff who told us the approach to activities was flexible so people can do what they want. We observed staff assisting people to undertake light exercise to encourage movement. We also saw care staff encouraged people to engage in conversation and reminiscence. Christmas lunch has been organised at a local restaurant. We saw a notice board, which displayed pictures of people involved in various activities. We looked at records, which showed the activities booked for November and December 2018. The arranged activities were aimed to help people socialise and maintain involvement with the local community and celebrate Christmas; these included, a Christmas fayre, entertainment, choir and crafts. The manager issued 61 questionnaires to obtain feedback about activities and 21 responses were received. 57.14% of people expressed they liked to partake in activities’ and 47.62% of people were happy with the choice of activities’ offered. Overall, improvement has been made and people are supported to occupy their time with the things they like to do. People can receive a service in Welsh. Since the last inspection, the manager had introduced a Welsh language policy to “Promote bilingual Wales” so people could receive a service in their preferred language. The policy stipulated at least one member of Welsh speaking staff were employed to provide a consistent service in language of choice and signs / signage were bilingual. The manager told us if requested, the ‘Active Offer’ is provided and Welsh language was reviewed annually and improvements made where possible in line with the services policy. Overall, the manager has taken action to promote the Welsh language and bilingualism so people can speak the language of their preferred choice. 2. Care and Support Summary More information has been included in the care plans so staff know what matters to the people in their care. The mealtime experience has improved so people enjoy a more sociable occasion. Our findings Individual needs and preferences are better understood. For people assessed as being at risk of falls and who were unable to use the call bell to request staff support, supporting records and equipment including bed rails, and pressure mats with alarms had been introduced. This measure was used to alert staff to an individual’s movements / whereabouts to manage the risk. Such measures restrict a person’s freedom to move. To manage this, the manager applied for a standard Deprivation of Liberty Safeguarding authorisation. The authorisations we viewed were granted and provided a timescale for review; the manager had made a record of this. This is considered good practice to ensure people’s liberty is not unduly restricted. In terms of pain management, a new ‘as and when required’ medication protocol was introduced; information was more specific and the medication was listed. New records were introduced which included a body map. There were clear instructions so staff knew what was prescribed and where to apply topical treatments (creams). Staff dated, timed and signed the record as part of evidencing they had provided this aspect of care. The manager explained this practice was overseen by the nursing staff who carry out ‘spot checks’ to ensure people were receiving the care they needed and peoples’ needs were reviewed to ensure prescribed treatments were effective. We observed a person was in some discomfort which they reported to staff. We looked at records and saw timely action had been taken to seek professional advice as a result medication was prescribed to treat the condition. We observed people generally looked clean and well presented. We spoke with a visitor to the home who raised concern about a person’s fingernails being unclean and told us they provided this aspect of care to ensure it was done. We observed some peoples’ nails were clean and some ladies’ nails were painted with nail varnish. We looked at a care plan and saw nail care formulated part of a person’s care plan but there was no individual risk assessment in place or recognition of any potential health condition which may increase the risk when providing this aspect of care. We discussed our concerns with the manager so all peoples’ dignity could be maintained, individual risk assessments could be undertaken and a policy implemented to help keep people safe. The manager must also ensure staff responsible for this aspect of care have the competencies to do so. We looked at compliments received by the service in relation to peoples’ care and support. comments included “Thank you for everything you did for my XXX. The care and support you gave was much appreciated”. “Thank you for the care you gave XXX …. I know XXX felt safe and very happy in Stansty House” and “(We) would like to thank all the staff for the kindness shown to XXX”. Overall, staff are providing care and support in line with care plans which ensures people get the care and support they need in the way they want. People are supported to be healthy, mealtimes are relaxed and people are involved in decisions which affect them. We observed prior to lunchtime staff started conversations with people about lunchtime. This approach helped to orientate people to time of day and prepared people for their lunch. Staff were kind and warm in their approach and reassured people when needed. One person required support with equipment to mobilise so they could go to the dining room.