Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Stansty House Nursing Home
34 Stansty Road Rhosddu Wrexham LL11 2BU
Type of Inspection – Focussed Date(s) of inspection – 19 August 2013 Date of publication – 7th November 2013
You may reproduce this report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers
Please contact CSSIW National Office for further information Tel: 0300 062 8800 Email: [email protected]
www.cssiw.org.uk
Version 1.1 07/2012
Summary
About the service Stansty House is located a short distance from the town of Wrexham. It is registered to provide care for 77 people, over the age of 65 years, four people under this age may also be accommodated. Divided into two units it offers nursing and personal care. A third unit, providing dementia care is located to the side of the main building. Each unit has its own manager.
Stansty House Limited is part of the Minster Care Group of homes. Colin Farebrother is the responsible individual and Julia Roberts, the registered manager, oversees the overall operation of the service. She has NVQ 4 in the management of care and is registered with the Care Council for Wales.
What type of inspection was carried out? This was an unannounced baseline inspection focussing on all areas of the report. We also looked at discharge and admission procedures following a recent adult protection strategy meeting for a vulnerable adult who is no longer resident at the home.
The visit took place on the 19th August 2013 between the hours of 11: 00am and 3:30 pm. A further meeting was arranged due to the absence of the registered manager at the initial inspection. The following methodology was used. Observation of interactions between people living in the home with staff. Conversation with seven people living in the home, staff, 3 unit managers and registered manager. We spent a percentage of the time on each unit and viewed a care plan from each. We spoke with visiting professionals
The “we” referred to in the report refers to the Care and Social Services Inspectorate Wales (CSSIW)
What does the service do well? The service is provided to people with a wide variety of needs including mental health and complex nursing needs. Relatives and friends who visit are very happy with the care provided. This is evidenced by the positive feedback during the visit and quantities of letters and comments received from relatives and friends of people living in the home and the continued placements by the commissioners of care services.
What has improved since the last inspection? Since the last inspection improvements and innovations have been introduced to the service they include: 1. involvement in the re-introduction of student nurses in their first year of training to the care home environment 2. Involvement in a 5 year stroke research study by Bangor University 3. Joint working with the NHS Local Health Board to develop clinical practice
The benefit to people using the service is that they have their care provided by staff who have access to the most recent research based care and can benefit from ongoing research based innovations in care.
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What needs to be done to improve the service? One area of non compliance was identified in relation to administration of medication and compliance was checked during a subsequent visit during the inspection process. Three good practice recommendations have been made in this report. 1 The home provide CSSIW with an updated copy of the admissions procedure and falls policy for the nursing unit no later than 18th November 2013 2 The Home puts in place measures to ensure that referrals made to external agencies are followed up in a timely manner. 3 The home ensures that the programme of activities cater for times when the Co- ordinater is not on duty or away on a trip with other people using the service .
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Quality of life
Overall we found that people living in each unit were treated with dignity and respect. People’s individual needs were being met and nursing practice was reflecting current NHS best practice guidelines.
During the visit we spent time on each of the units. We found that people were listened to and care was delivered in response to their individual needs. We spoke with visiting relatives who commented positively on the atmosphere of the home and the care provided. One person commented that they did not feel that their relative was getting as much exercise as they thought they should have. We spoke with the activities organiser who confirmed that the person did participate and this was evidenced in the records viewed.
People using the service cannot always be confident that the admission process meets their individual needs. In response to issues raised during an adult protection process We reviewed a total of 6 care plans over two visits to the home. It was evidenced in one care plan that important information had not been passed to the home in relation to a medication that was administered by District nursing staff. The home had subsequently not received the assessment carried out by the commissioning authority and when the care plan did arrive, staff did not act on the information contained within the document. It was only until a relative identified that medication had not been given that the home took remedial action. This was a serious flaw in the admission process which may have resulted in significant harm. This evidenced that managers and staff did not ensure that the information contained within commissioning care plan was reviewed and included in the existing care plan drawn up by the home. It is therefore a recommendation of this report that the home ensures that a robust admissions policy is in place and provide CSSIW with an updated copy of the policy.
Whilst reviewing accident reports on falls in the home which was raised in the adult protection proceedings, we evidenced in 3 care plans that staff in the dementia care unit sought advice from district nurses and on one occasion provided first aid until an assessment could be undertaken. The recording of assessment of the individual after the fall followed the pathway provided and that staff documented that they observed for any signs of deterioration in the persons condition. We evidenced a copy of an updated policy on falls management in the home. The policy contained an overarching requirement that all people who fall should attend hospital. This statement does not apply to the nursing unit, and a separate policy is required to be put in place to reflect this. All falls were found to have a corresponding accident form. All accident forms are audited on a monthly basis and copies of the audit are sent to the Company’s head office. We evidenced in one care plan that a referral request had been made to the GP for attendance at a falls clinic. There was no evidence that this resulted in an appointment at the clinic and it is a recommendation of this report that the home ensures that referrals to external professionals are followed up by the home to ensure that the individual receives the appropriate assessments for the home to meet their needs . We acknowledge that the home uses the Local Health Board Falls Care Pathway and have been involved in the initial piloting of this document.
Discussion with nursing staff identified concerns regarding the disparity of services provided by the Local Health Board in respect of occupational therapy support. Examples were given of delays in the provision of specialist equipment and specialist assessments. This caused delays to care and was having a detrimental effect on 5 Version 1.1 07/2012 people’s quality of life. It was agreed that issues would be raised in the first instance by CSSIW with the Health Board and in liaison with the Unit manager for the Nursing Unit.
People could not be satisfied on this occasion that medication administration was not managed in accordance with the homes procedures and policies on medication administration and guidelines provided by the Nursing and Midwifery Council. This is because whilst undertaking a medication audit prompted by a previous medication error we found gaps in more than one persons medication chart. Some of the medications were prescribed on a “when required” basis whilst others which included food supplements, thickened drinks for people with swallowing difficulties and laxatives may result in a deterioration in health for the person if omitted. This was brought to the attention of the unit manager who agreed to take the appropriate action. This affected more than one resident and given the seriousness of this a non compliance notice was issued. A subsequent inspection visit during the process found that the home had held a meeting and changes had been put in place as to how certain food supplements and medications given as required are recorded.
People are active, positively occupied and stimulated. An activities person is employed and spends time, throughout the day on each unit. On the day of our visit a group of men from each of the units had visited the local museum exhibition to view the Mold Cape before it returns to the British Museum. The activities person intends to take a group of ladies next time as each group has varying needs and interests and managing trips this way enables all groups to have their individual needs met. This was highlighted as good practice.
An activities programme was in place but people using the service stated that this was not as varied as they would like and would appreciate “more organised activity when the activities organiser is not here.
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Quality of staffing
Overall people using the service can be confident that they are being cared for by skilful staff who have received appropriate training based on their qualifications and role in the home. From viewing the training matrix we found evidence that staff have received mandatory training in safe moving and handling, adult protection and medication. Link nurses were trained and competent in tissue viability and infection control. Specialised training is also been provided for staff in palliative care, dementia, challenging behaviour, peg and naso-gastric feeding and medication. The nurses on the nursing unit have also established links with the Local Health Board Clinical Development Team which ensures they receive updates in care practice.
Over the two visits we observed staff on all three units caring for people in a respectful and dignified manner. This was also reflected in conversations we had with people using the service, who praised the care they received and the attention shown to their individual needs.
People using the service can expect to be cared for by familiar staff as turnover is low, sickness rates are low and there is limited use of agency staff. The home has an established team of dedicated staff. We were able to evidence that the home has a staff member of the month award and that from the citations on the certificate it is clear that staff often provide additional care above and beyond what is expected of them in order to make a difference to the quality of life for people living at the home.
People can be confident that staff are thoroughly vetted during the recruitment process and receive a full induction. We reviewed staff files of a unit manager, carer and cleaner. We found that all checks to ensure their fitness had been carried out and copies of appropriate documents were in place on each file. We viewed the induction programme. It is carried out over a four week period and covers the essential information and knowledge required of a new person commencing work at the home.
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Quality of leadership and management Overall people using the service can expect that what it says it provides is matched by their own experience of the service. This is because, despite a previous change in ownership of the registered company, the registered manager has consistently lead the service and ensured that quality of care is maintained throughout the home with the support of the unit managers and staff employed in the home. This has a positive impact on everyone who lives, works or visits the home and raises the profile of the home in the local community.
People see visible accountability and know that there are people who are over seeing the service. This is because each unit has their own unit manager who is responsible for the day to day running but report directly to the registered manager. The home also has dedicated administrative staff responsible for managing the financial aspects of the business and the recruitment documentation of new and existing staff. The registered company owns a number of homes nationally. The responsible individual delegates his regulatory responsibilities to a regional manager who undertakes visits to the home and is available to staff for advice or support in the absence of the registered manager. Staff commented that the Company ensure that monies are available to replace broken equipment or to provide specialist equipment not available through the NHS in accordance with the assessed needs of the individual.
People using the service can be confident that the home is providing a service based upon quality improvement. This is because we were able to evidence two examples on the nursing unit. The first example is that the home is part of a pilot to re-introduce nursing students into the care home environment. The benefit to people using the service is that the home will have a direct link with Glyndwr University and have access to current care nurse education and research. This will ensure that the care given is evidence based and provides improved outcomes for people using the service. The second example is that the home is part of a 5 year project that is researching the development of a stroke care pathway for people in care homes. The benefit to people using the service is that they will be the first to benefit from any innovative practice in this field of medicine.
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Quality of environment Overall People using the service can feel reassured by an environment which helps to reinforce a sense of identity and personal worth. This is because the domestic staff have been at the home for a number of years and take personal responsibility in ensuring that it is a clean odour free environment.
People can be confident that equipment is safe because of good maintenance. This is because during the visit we observed that the maintenance staff was servicing an en- suite bathroom. We were able to evidence that the appropriate precautions had been put in place and to ensure there was as little disruption to people using the service, staff and visitors as possible. We also observed that hoists were regularly serviced and in good working order.
People find it easy to do things for themselves or with the minimum of support because of thoughtful design, signposting and layout. This is particularly true of both the residential and dementia care units where people using the service are more independently mobile. The layout of the home is all on one level and rooms are clearly identified. We did observe that in some areas of the home there are signs of wear and although they are not immediately obvious to people passing through the home on closer inspection you can see damage to doors caused by wheelchairs and tears in some of the wallpaper. There is a refurbishment programme in place to address these areas identified, but on the nursing unit the staff themselves have taken the opportunity to redecorate a bathroom, which demonstrates a pride in the workplace and placing the needs of people using the service above the schedule of refurbishment.
People are able to meet others and develop relationships in communal areas and have private space should they need it. We observed that, with the exception of the nursing unit, because of the fragility of people using the service, the communal areas are well used but, equally people can choose to spend quiet time in their own rooms. We observed that some people in the nursing unit who are more independently mobile can go downstairs and take part in the activities provided.
People using the service can explore freely, go outside and be inside. During the recent hot weather the home have made chairs and tables outside the home accessible to people using the service. Large umbrellas ensure that potential risks to exposure to the sun are minimised. People spoken with liked the opportunity to go outside and commented positively on the support given by staff to enable as many people as possible to take up the opportunity.
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How we inspect and report on services We conduct two types of inspection; baseline and focussed. Both consider the experience of people using services.
Baseline inspections assess whether the registration of a service is justified and whether the conditions of registration are appropriate. For most services, we carry out these inspections every three years. Exceptions are registered child minders, out of school care, sessional care, crèches and open access provision, which are every four years.
At these inspections we check whether the service has a clear, effective Statement of Purpose and whether the service delivers on the commitments set out in its Statement of Purpose. In assessing whether registration is justified inspectors check that the service can demonstrate a history of compliance with regulations.
Focussed inspections consider the experience of people using services and we will look at compliance with regulations when poor outcomes for people using services are identified. We carry out these inspections in between baseline inspections. Focussed inspections will always consider the quality of life of people using services and may look at other areas.
Baseline and focussed inspections may be scheduled or carried out in response to concerns.
Inspectors use a variety of methods to gather information during inspections. These may include;
Talking with people who use services and their representatives Talking to staff and the manager Looking at documentation Observation of staff interactions with people and of the environment Comments made within questionnaires returned from people who use services, staff and health and social care professionals
We inspect and report our findings under ‘Quality Themes’. Those relevant to each type of service are referred to within our inspection reports.
Further information about what we do can be found in our leaflet ‘Improving Care and Social Services in Wales’. You can download this from our website, Improving Care and Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW regional office.
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Care and Social Services Inspectorate Wales
Care Standards Act 2000
Non Compliance Notice Care homes for older people
This notice sets out where your service is not compliant with the regulations. You, as the registered person, are required to take action to ensure compliance is achieved in the timescales specified.
The issuing of this notice is a serious matter. Failure to achieve compliance will result in CSSIW taking action in line with its enforcement policy.
Further advice and information is available on CSSIW’s website www.cssiw.org.uk
Stansty House Nursing Home
Stansty House Nursing Home 34 Stansty Road Rhosddu Wrexham LL11 2BU
Date of publication – 7 November 2013
You may reproduce this notice in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers
Please contact CSSIW National Office for further information Tel: 0300 062 8800 Email: [email protected]
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Care Homes for Older People (GIRPT01E1.0001035549(amended)) Version 8.1 July 2012
Care and Social Services Inspectorate Wales
North Wales Region Government Offices Sarn Mynach Llandudno Junction Conwy LL31 9RZ
03000625609 03000625030
Home: Stansty House Nursing Home
Contact telephone number: 01978 290373
Registered provider: Stansty House Ltd
Registered manager: Julia Margaret Roberts
Number of places: 77
Category: Care Home Nursing - Older
Dates of this inspection from: 19th August 2013 to: 10th September 2013
Dates of other relevant contact since none last report: Date of previous report publication:
Inspected by: Steve Watson
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Quality of life
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for Regulation number completion To ensure that medications are 31/10/13 13 (2) administered in accordance with best practice guidelines
The service is not compliant with regulation 13 (2)
This is because medication administered was not in accordance with the Care Homes (Wales) regulations 2002 and Nursing and Midwifery Council Guidelines for the safe administration of medicines.
The Evidence Whilst case tracking a service users Medication Administration Record we found that a medication due at 18:00 had not been signed for. We checked a further 3 peoples charts for medication given at the same time and found a gap in the charts Whilst we are not able to establish if the drugs were in fact given but not signed for, this is a breach of the homes medication Policies and Procedures.
The impact on people using the service is that some of the medications were prescribed on a when required basis whilst others which included fortified drinks, thickening for people with swallowing difficulty and laxatives which could have a detrimental impact on the person if omitted.
Page 2 Care Homes for Older People (GIRPT01E1.0001035549(amended)) Version 8.1 July 2012
Quality of staffing
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for Regulation number completion
None
Page 3 Care Homes for Older People (GIRPT01E1.0001035549(amended)) Version 8.1 July 2012
Quality of leadership and management
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for Regulation number completion
None
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Quality of environment
Non compliance identified at this inspection and action to be taken
Action to be taken Timescale for Regulation number completion
None
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