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. 3 Version 1.1 07/2012 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 . 4 Version 1.1 07/2012 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.