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Inspecting for better lives
Key inspection report
Care homes for older people
Name: Wenham Holt Nursing & Residential Care Home
Address: Hillbrow
Liss
Hampshire
GU33 7PB
The quality rating for this care home is:
three star excellent service
A quality rating is our assessment of how well a care home, agency or scheme is
meeting the needs of the people who use it. We give a quality rating following a full
assessment of the service. We call this a .key. inspection.
Lead inspector: Christine Bowman
Date: 20/02/2009
This is a report of an inspection where we looked at how well this care home is meeting
the needs of people who use it. There is a summary of what we think this service does
well, what they have improved on and, where it applies, what they need to do better.
We use the national minimum standards to describe the outcomes that people should
experience. National minimum standards are written by the Department of Health for
each type of care service.
After the summary there is more detail about our findings. The following table explains
what you will see under each outcome area.
Outcome area (for example Choice of home)
These are the outcomes that people staying in care homes should experience. They reflect the things
that people have said are important to them:
This box tells you the outcomes that we will always inspect against when we do a key
inspection.
This box tells you any additional outcomes that we may inspect against when we do a
key inspection.
This is what people staying in this care home experience:
Judgement:
This box tells you our opinion of what we have looked at in this outcome area. We
will say whether it is excellent, good, adequate or poor.
Evidence:
This box describes the information we used to come to our judgement.
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 Commission for Social Care Inspection aims to:
• Put the people who use social care first
• Improve services and stamp out bad practice
•Be an expert voice on social care
•Practise what we preach in our own organisation
Our duty to regulate social care services is set out in the Care Standards Act 2000.
Care Homes for Older People Page 2 of 32
Reader Information
Document Purpose Inspection report
Author CSCI
Audience General public
Further copies from 0870 240 7535 (telephone order line)
Copyright Copyright © (2009) Commission for Social Care
Inspection (CSCI). 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 CSCI
copyright, with the title and date of publication of the
document specified.
Internet address www.cqc.org.uk
Care Homes for Older People Page 3 of 32
Information about the care home
Name of care home:Wenham Holt Nursing & Residential Care Home
Address:Hillbrow
Liss
Hampshire
GU33 7PB
Telephone number:
01730895125
Fax number:
01730893782
Email address:
wenham.holt@btconnect.com
Provider web address:
Name of registered provider(s):
Wenham Holt Homes Ltd
Name of registered manager (if applicable)
Mrs Rosemary Anne Gorvin
Type of registration:
care home
Number of places registered:50
Conditions of registration:
Category(ies) : Number of places (if applicable):
Under 65 Over 65
dementia 50
learning disability 50
old age, not falling within any other 50
category
physical disability 50
Additional conditions:
The maximum number of service users to be accommodated is 50.
The registered person may provide the following category/ies of service only: Care
home with nursing - 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 Dementia - DE Physical disability - PD Learning
disability - LD
Date of last inspection
Brief description of the care home
Wenham Holt Nursing and Residential Home is a family run business that is situated in
a rural area near to the small village of Liss. The home offers nursing care for older
Care Homes for Older People Page 4 of 32
Brief description of the care home
people with dementia, terminal illness and physical disability. The home is also
registered to take up to five service users with dementia between fifty and sixty-four
years of age, and ten persons with a learning disability can also be accommodated.
Sixteen of the beds within the home are designated as continuing care and this is in
partnership with the local primary care trust. This facility is linked but separate from
the rest of the home.
The fees for this home range from £625 to £677 per week.
Care Homes for Older People Page 5 of 32
Summary
This is an overview of what we found during the inspection.
The quality rating for this care home is:
three star excellent service
Our judgement for each outcome:
Choice of home
Health and personal care
Daily life and social activities
Complaints and protection
Environment
Staffing
Management and administration
peterchartPoorAdequateGoodExcellent
How we did our inspection:
This inspection report includes information gathered about the service since the
previous site visit on 1st March 2007 under the Commission's 'Inspecting for Better
Lives' (ILB) process. The registered manager, Mrs Rosemary Gorvin, completed an
Annual Quality Assurance Assessment (AQAA) giving up-to-date factual evidence about
the running of the home and informing us of what they think they are doing well, how
they have improved the service and of their plans for further improvements. Residents
completed six service user surveys, some with support from their relatives and
representatives, giving their views on the running of the home. Eight staff members
and four healthcare professionals also completed surveys, giving their views on the
care and support given to the residents. An unannounced site visit was conducted on
20th February 2009, to assess the outcomes of the key inspection standards for older
Care Homes for Older People Page 6 of 32
people with respect to the residents living at the home. The registered manager was
interviewed and provided support for the inspection process by making residents' and
staff files and other documents available to be sampled. A tour of the premises was
undertaken and communal areas and some of the residents' bedrooms were viewed. A
number of staff and residents were spoken with throughout the day and observations
were made of the residents and of staff as they carried out their duties. Residents' and
staff records, maintenance certificates and complaints and compliments records were
sampled and the Statement of Purpose, the Service User Guide and policies and
procedures were viewed.
What the care home does well:
A health care professional commented on what they thought the care service does well,
'it provides overall excellent care and meets the needs of very sick patients, many
towards the end of life, with skill and compassion. Good team work, good
communication with patients, relatives, and other health professionals. They provide
nursing and health care workers, who work to high standards.'
Residents are treated as individuals, who are supported to follow their personal
interests, enjoy stimulating activities, both within the home and in the community, and
to retain as much of their independence as possible. Contact with important people in
their lives is promoted and nutritious and attractive meals are provided. On the tour of
the premises, in a large lounge, in the main house, residents were taking part in a
song and dance session with a visiting entertainer. Some of the residents were dancing
with the staff and their animated faces confirmed they were having a good time. Those
who were watching were singing along and smiling.
A relative wrote on a resident's survey, 'I consider Wenham Holt to be an exemplary
example of a care home, run by a person and staff, who are obviously dedicated to the
well-being of elderly and very vulnerable people. It is a great comfort to me that my
wife is in their care', and another relative stated, 'I don't think anyone could improve
upon this service.' A resident commented, 'this place exudes kindness and care and I
cannot recommend it more highly. I feel part of it, as a family.'
There was an open, positive and inclusive management approach at the home and staff
spoken with felt valued. This home continues to be a family business and the manager
stated, ' our philosophy is, that Wenham Holt Nursing Home is, above all, a home for
our residents. We strive to offer a service, which is as personal as it can be, and
recognise the importance of the relationship between a person receiving care and a
care provider, and take the provision of care very personally, as we are so involved in
this respect, with our residents. We all work very hard at providing an environment
where everybody feels valued and an important member of our small community'.
A relative commented, 'the caring staff provide a first class service.'
What has improved since the last inspection?
Many improvements had been made over the previous year, as a result of listening to
the people who use the service, including, improved access to the garden by
constructing a new drive to the side of the home, improving the patio area for the
enjoyment of the residents, and the installation of a hot water outlet to enable
relatives, friends and other visitors, to make themselves a hot drink.
New bedroom and garden furniture had been purchased, arrangements had been made
to use the hydrotherapy pool at the sister home of Eastfield, a new menu had been
introduced offering a wide range of choice to the residents, and the activity coordinator's
hours had been extended to include activities such as hand massage,
aromatherapy and social interaction.
Other environmental improvements included external re-decoration, a new soakaway
Care Homes for Older People Page 8 of 32
to prevent flooding at the rear of the extension and replacement fencing, in addition to
the on going maintenance and internal re-decoration programme to ensure this
remains a pleasant home for the residents to enjoy.
What they could do better:
Residents live in a well managed home, in which their opinions are sought and acted
upon for the improvement and development of the service. This service is committed
to continuous improvement.
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 set out 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.
Care Homes for Older People Page 9 of 32
Details of our 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)
Outstanding statutory requirements
Requirements and recommendations from this inspection
Care Homes for Older People Page 10 of 32
Choice of home
These are the outcomes that people staying in care homes should experience. They
reflect the things that people have said are important to them:
People are confident that the care home can support them. This is because there is an
accurate assessment of their needs that they, or people close to them, have been
involved in. This tells the home all about them and the support they need. People who
stay at the home only for intermediate care, have a clear assessment that includes a
plan on what they hope for and want to achieve when they return home.
People can decide whether the care home can meet their support and accommodation
needs. This is because they, or people close to them, have been able to visit the home
and have got full, clear, accurate and up to date information about the home. If they
decide to stay in the home they know about their rights and responsibilities because
there is an easy to understand contract or statement of terms and conditions between
them and the care home that includes how much they will pay and what the home
provides for the money.
This is what people staying in this care home experience:
Judgement:
People using this service experience good quality outcomes in this area. We have
made this judgement using a range of evidence, including a visit to this service.
Sufficient information and a good introduction to the home enable prospective
residents to decide if the home meets their needs. A full needs assessment is carried
out to ensure individual's needs and aspirations are taken into consideration and
planned for and that they can be met at the home.
Evidence:
The home provided full, detailed and current information to prospective residents in
the Statement of Purpose and Service User Guide, the Wenham Holt Continuing Care
Unit Patient Guide, and a small brochure giving initial information about the service.
The documents were illustrated with colour photographs of the home, the continuing
care unit, the garden and a map giving details of its location. The manager wrote in
the AQAA, 'the information pack is available in various formats if required, and an
electronic version is on our web site'. The objective of the home was 'to treat everyone
as an individual' and the philosophy of care promised prospective residents they would
Care Homes for Older People Page 11 of 32
Evidence:
be 'treated with dignity and respect' and provided with 'holistic, relational care in a
warm, safe and friendly environment'. Visitors were offered a minibus pick up service
from local railway stations, and a visit to the home at a time convenient to them.
The six residents, who completed surveys, confirmed they had received enough
information about the home prior to moving in, to decide if it was the right place for
them. A relative commented on behalf of a resident, ' I was shown around the home
on behalf of my relative, and all my questions were answered. I was very concerned as
my relative had already been to two other homes. The staff at Wenham Holt really put
my mind at ease, and having suffered an extremely distressing eighteen months, I
was grateful, and I felt that my relative would be in good hands.' Another relative
stated, 'they made my wife feel very welcome.'
Resident's files sampled, confirmed that a comprehensive needs assessment had been
carried out. The manager stated that the assessor would usually be a qualified nurse
or another highly qualified member of staff. The nursing home had a team of
registered nurses who were experienced in assessing the health needs of a prospective
resident. Personal care needs, prevention of pressure sores, a continence assessment,
psychological needs, physical needs and nutritional screening all formed part of this
assessment process. The manager wrote in the AQAA, 'we actively encourage other
health professionals and relatives to be part of the assessment process and if a
resident is coming to us from another establishment, and a care plan has been kept,
we insist on receiving a copy of this before admission'.
Assessment documentation sampled included information with respect to equality and
diversity to ensure the resident would be treated as an individual and that their
personal, emotional and spiritual needs and interests would be taken into
consideration in drawing up their care plan. Care plans, which included risk
assessments for any identified risks and measures to reduce them, had been signed by
residents or their representatives to confirm their acceptance.
Care Homes for Older People Page 12 of 32
Health and personal care
These are the outcomes that people staying in care homes should experience. They
reflect the things that people have said are important to them:
People.s health, personal and social care needs are met. The home has a plan of care
that the person, or someone close to them, has been involved in making. If they take
medicine, they manage it themselves if they can. If they cannot manage their
medicine, the care home supports them with it, in a safe way. People.s right to privacy
is respected and the support they get from staff is given in a way that maintains their
dignity.
If people are approaching the end of their life, the care home will respect their choices
and help them feel comfortable and secure. They, and people close to them, are
reassured that their death will be handled with sensitivity, dignity and respect, and
take account of their spiritual and cultural wishes.
This is what people staying in this care home experience:
Judgement:
People using this 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 addressed the residents' health, personal and social care needs and
residents had been involved in compiling them. Safe arrangements were in place for
the handling of medication to protect the residents and the staff and the residents'
right to privacy was upheld and their dignity maintained.
Evidence:
Residents' care plans sampled clearly recorded their personal and healthcare needs
and detailed how they would be delivered. Care plans covered all the residents'
assessed needs including physical, social and psychological. Records confirmed that
the care plans had been reviewed at least monthly, and the manager stated that the
residents' key registered nurse was responsible for ensuring this task was completed.
The residents and their relatives or representatives were invited to contribute to the
care planning process. A newsletter, of which four were produced annually, welcomed
relatives and representatives to liase with key nurses with respect to this involvement.
The six residents, who returned surveys, recorded that they always received the care
and support they needed, five recorded that they always received the medical support
Care Homes for Older People Page 13 of 32
Evidence:
they needed and one that they usually did. A relative commented, 'the caring staff
provide a first class service.'
Records showed that residents were registered with General Practitioners (GP) of their
choice and all appointments were listed in the care plans to inform the staff of any
changes made as a result of consultations. Seven of the eight staff, who completed
surveys, confirmed that they were always given up-to-date information about the
needs of the people they support or care for, in their care plan, and one that they
usually were.
The manager stated that the residents benefited from at least one regular GP visit
each week, a fortnightly visit from a Consultant, a weekly visit from a pharmacist, and
access to community based specialists, such as psychiatric nurses, through the GP's as
required. The four health and social care professionals, who completed surveys,
recorded that the care service always seeks advice and acts upon it to manage and
improve individuals' health care needs, and that individuals' health care needs are
always met by the care service. One commented, 'excellent standards of care. All
patients' needs are met.' The manager wrote in the AQAA, 'we ensure continued
access to all NHS services and the possibility of private healthcare services are
maintained. Staff ensure that care is person led, is flexible, consistent and able to
meet the changing needs of the residents.'
Medication administration records inspected had been completed in a satisfactory
manner, showing that residents had received the required dosage of their prescribed
medication, as set out by their medical practitioners, and there were no unexplained
gaps in the recordings. The nurses, who took responsibility for this task, had received
training in the safe handling of medication, and their individual training and
development logs confirmed this. The continuing care unit held a stock of controlled
drugs at the time of the site visit, under licence from the Home Office, supplied and
monitored by a National Health Service pharmacist. This was to ensure that changes in
prescribed doses of pain relieving drugs by GPs would be readily available, should
residents require this treatment. A controlled drugs register was held to record this
information and running totals recorded. A sample taken, matched the drugs stored in
the controlled drugs cabinet.
Observations of the staff throughout the day confirmed that they were respectful and
polite in their interactions with the residents, who smiled in response to them and
appeared relaxed and happy in their home. All the bedrooms in the continuing care
unit were for single occupancy. The main house provided a number of shared rooms,
which had been provided with screens to promote the residents' privacy and dignity.
Consultations with healthcare professional and private meetings with relatives and
Care Homes for Older People Page 14 of 32
Evidence:
representatives could be held in resident's bedrooms with the assurance of
confidentiality, where they were occupied by only one resident, and a small quiet room
was provided for the use of residents in shared bedrooms. The manager recorded in
the AQAA, 'respecting a person's right to privacy and dinigity is a fundamental
requirement in any relationship and so training and supervision is given to care staff to
enable them to ensure that this is achieved within the nursing home with clients,
relative and colleagues. A vital part of our induction and training is to emphasis that
clients and colleagues are entitled to treated with respect and dignity and this involves
ensuring that you knock on a door before entering, and making sure that a client
agrees to you calling them by their first name'. Some residents had their own personal
telephone lines and the home also had a mobile telephone, on which, residents could
receive private calls in their bedrooms.
100% of the surveys returned by health and social care professionals confirmed that,
'the care service always respects individuals' privacy and dignity'. A health care
professional commented on what they thought the care service does well, 'it provides
overall excellent care, meets the needs of very sick patients, many towards the end of
life, with skill and compassion. Good team work, good communication with patients,
relatives, and other health professionals. They provide nursing and health care
workers, who work to high standards.'
Care Homes for Older People Page 15 of 32
Daily life and social activities
These are the outcomes that people staying in care homes should experience. They
reflect the things that people have said are important to them:
Each person is treated as an individual and the care home is responsive to his or her
race, culture, religion, age, disability, gender and sexual orientation. They are part of
their local community. The care home supports people to follow personal interests and
activities. People are able to keep in touch with family, friends and representatives.
They are as independent as they can be, lead their chosen lifestyle and have the
opportunity to make the most of their abilities. People have nutritious and attractive
meals and snacks, at a time and place to suit them.
There are no additional outcomes.
This is what people staying in this care home experience:
Judgement:
People using this service experience excellent quality outcomes in this area. We have
made this judgement using a range of evidence, including a visit to this service.
Residents are treated as individuals, who are supported to follow their personal
interests, enjoy stimulating activities, both within the home and in the community, and
to retain as much of their independence as possible. Contact with important people in
their lives is promoted and nutritious and attractive meals are provided.
Evidence:
The home employed an activities co-ordinator, who was very enthusiastic about her
role. She stated that she spent time with individuals getting to know them well and
also interviewed relatives to build up a full picture of each resident's life history and
interests. One to one time spent with residents was recorded and a record was also
kept of resident's participation in the group activities provided. The activities coordinator
stated that, 'the staff also spent one to one time with the residents, and that
sessions could include a chat, a manicure, a hand massage, a facial including cleanse
tone and moisturise, aromatherapy, hydrotherapy, or being read to'. The activities
programme was displayed for all the residents to see and advertised in the newsletter.
It included bingo, cookery, art/craft therapy, reminiscence quiz, music and
entertainment, visiting puppy, keep fit, fun and games, poetry, and one to one social
care therapy sessions. The home had a minibus, and three or four times a week, trips
Care Homes for Older People Page 16 of 32
Evidence:
were taken to local places of interest for the enjoyment of the residents and to provide
stimulation. The activities co-ordinator stated, 'in addition to receiving fantastic
support from all the staff and the owners, I also get good support from NAPA (an
organisation promoting activities for older people), of which I have been a member for
four years, and I have also undertaken specific dementia training to assist me in my
work'.
Five of the six residents, who returned surveys, wrote that there were always activities
arranged by the home that they could take part in, and one that they were unable to
take part. Comments included, 'the activities co-ordinator is wonderful. A very kind
and compassionate person, who seems to know each resident well and understand all
their ways. The lady who sings to the residents is also very considerate and
understanding.'
The manager wrote in the AQAA, 'we offer a varied choice of activities that go towards
ensuring our residents are able to enjoy a full and stimulating lifestyle. Weekly
luncheon club trips (Salvation Army), trips to local school events and religious services
keep the residents involved in the local community'. Residents were encouraged to
exercise choice in relation to all aspects of the home, and there was flexibility with
respect to routines to allow for this.
The home's philosophy of care encouraged a sense of 'homeliness' and, as a
consequence, there were no limitations on the visiting hours, except to ask visitors to
warn the night staff if visiting at night. Relatives and friends of residents were
encouraged to have meals with them, free of charge, and were also able to stay for
the night if they wished. A visiting relative spoke about the monthly carers/relatives
meeting, organised by the manager and, which relatives of former residents were also
invited to attend. They stated that it was an excellent support group, and social
occasion, and that excellent refreshment was provided. The activities programme
included seasonal celebrations to which relatives were also welcomed, and reminded
the residents of the weekly visit from the hairdresser. Residents and their families
were able to use the home's minibus for individual trips out to their homes and/or
family events.There were no retrictions on family pets visiting and currently one client
kept an aquarium. In order to enhance the homeliness of residents' bedrooms, the
manager stated, 'they were advised on admission that they could bring personal items
including furniture and pictures to make their new home more familiar to them'.
Providing a nutritious diet for the residents at the nursing home was considered one of
the most important elements of the service provided. The manager stated that, 'the
staff of the nursing home are trained to understand that nutrition contributes
significantly to the physical, social and psychological care of the clients in the nursing
Care Homes for Older People Page 17 of 32
Evidence:
home. The menus are designed to provide a balanced diet with daily fresh vegetables
and fruit, and to be responsive to the needs and popular tastes of the clients. A high
proportion of the clients of the home require pureed food and consideration is given to
the presentation of the food, so that all foods are liquidised separately. During
mealtimes residents have the opportunity to choose from the main dish being cooked
or a selection of alternatives. We endeavour to meet the wishes of everyone without
exception and have a good supply of alternatives available, if we do not have them to
hand we will go to the local supermarket to purchase them. Residents are assessed
regularly and if they have difficulty eating, the staff will directly assist them. The
majority of our residents require considerable assistance with feeding and are given
this assistance in a discrete and sensitive manner. All residents are given the time
they need to finish their meals comfortably'. On the day of the site visit, observations
confirmed this statement.
Five of the six residents, who returned completed surveys, always liked the meals at
the home and one usually did. Comments included, 'my mother has enjoyed her meals
whenever I have been present, and I have noticed that the cook pops in and chats to
the residents at times. This kind of communication gives the home a nice warm
atmosphere.' Another relative commented on behalf of a resident, 'my wife enjoys her
meals and the staff show patience and care when feeding her.'
The four health and social care professionals, who completed surveys, confirmed that
the care service always supports individuals to live the life they choose, and one
commented, 'patients are encouraged to remain independent when appropriate.' They
also thought that the care service always respond to the different needs of individuals,
with respect to equality and diversity.
Care Homes for Older People Page 18 of 32
Complaints and protection
These are the outcomes that people staying in care homes should experience. They
reflect the things that people have said are important to them:
If people have concerns with their care, they or people close to them know how to
complain. Any concern is looked into and action taken to put things right. The care
home safeguards people from abuse and neglect and takes action to follow up any
allegations.
People.s legal rights are protected, including being able to vote in elections.
This is what people staying in this care home experience:
Judgement:
People using this service experience good quality outcomes in this area. We have
made this judgement using a range of evidence, including a visit to this service.
Residents, their relatives and representatives are confident they would be listened to,
should they express concerns, and a satisfactory procedure was in place to deal with
complaints, should they arise. Residents are protected from abuse by well-informed
staff, who know how to protect them.
Evidence:
The complaints procedure was available in the service user guide and displayed in the
home. It included a timescale by which the complainant could expect to receive a
response to a complaint, and contact details of the Commission for Social Care
Inspection were included to inform residents, their relatives and representatives. The
AQAA recorded that it was available in larger print on request and, could be provided
in other formats, if required. Four of the six residents, whose surveys were returned,
knew who to speak to if they were not happy, and five of the six residents, knew how
to make a complaint. One relative commented, 'due to her dementia, my mother does
not know who is at the home, however, I am confident that there is always someone,
who will be sensitive to her needs and moods,' and another relative wrote,
'complaints!! In all the years my wife has been at Wenham Holt, I've never had reason
to complain'. The four health and social care professionals, who completed surveys,
confirmed that the care service always responded appropriately if concerns were raised
about the person using the service. One commented, 'excellent team approach'.
Care Homes for Older People Page 19 of 32
Evidence:
The AQAA recorded that there had been no complaints over the previous twelve
months, but a number of compliments had been received, including, 'thank you for the
loving care and kindness shown to our relative', 'I just wanted to thank you for the
lovely way that you looked after my mum. You were all so patient with her, and
nothing was too much trouble for your staff to do. Your sense of humour was always
spot on, and you made a difference at a very difficult time for me. The atmosphere at
Wenham Holt was lovely', 'thank you so much for the loving care with which you
looked after our relative in the final week of her life. You treated her with compassion
and respected her dignity,' and 'I am so grateful for everything you do for mum, and
for the friendly welcome we always receive from your lovely staff.'
The home had an up to date copy of the local authority safeguarding procedures, and
a local procedure based on this to clarify referral details for the staff. The staff training
and development logs, sampled, confirmed that the staff had accessed the Protection
of Vulnerable Adults training. No safeguarding referrals had been made since the
previous site visit.
Care Homes for Older People Page 20 of 32
Environment
These are the outcomes that people staying in care homes should experience. They
reflect the things that people have said are important to them:
People stay in a safe and well-maintained home that is homely, clean, pleasant and
hygienic.
People stay in a home that has enough space and facilities for them to lead the life
they choose and to meet their needs. The home makes sure they have the right
specialist equipment that encourages and promotes their independence. Their room
feels like their own, it is comfortable and they feel safe when they use it.
This is what people staying in this care home experience:
Judgement:
People using this service experience good quality outcomes in this area. We have
made this judgement using a range of evidence, including a visit to this service.
Residents live in a homely, comfortable, safe and well-maintained home, which fulfils
their needs and is clean, fresh and odour free.
Evidence:
The home was located down a drive from the Petersfield to Liphook road and there
was a dedicated parking area. The large and imposing three-storey country house was
surrounded by its own, well-maintained landscaped gardens, covering an area of six
and a half acres, and bordered by woodland. There was a peaceful ambiance and a
great deal of birdsong in the vicinity of the home. Attached to the home was a single
story, continuing care unit, which had been tastefully designed to complement the
original building. The home was a well-maintained and attractive place for the
residents to live. Through the main entrance to the home, was a welcoming, carpeted,
hall leading to a wide staircase, and a large and beautiful, stained glass window shed
plenty of natural light into the area. A resident commented in a survey, ' the complete
site is beautiful and so well kept. I hope I don't awake to find I was dreaming.'
A tour of the premises, including the shared facilities, and some of the residents'
bedrooms was undertaken. There were four dedicated lounges equipped with suitable
seating and a relaxation/sensory room where some of the residents were enjoying
sensory stimulation. In a large lounge, in the main house, residents were taking part
Care Homes for Older People Page 21 of 32
Evidence:
in a song and dance session with a visiting entertainer. Some of the residents were
dancing with the staff and their animated faces confirmed they were having a good
time. Those who were watching were singing along and smiling.
The continuing care unit was accessed through a keypad-operated door so that the
residents, who were able to walk freely around the house, except in areas assessed as
unsafe, could not wander into the unit. The unit was self-contained and purpose built
to cater for sixteen residents. There was a lounge/dining room with a kitchenette
attached to enable relatives to make drinks and snacks, should they wish to do so. All
the bedrooms in the unit were single occupancy and most had en-suite facilities. All
the bedrooms had French windows, which could be fully opened in the warmer weather
for access to the terraced areas outside, which had been provided with bird tables for
the winter months. 'Residents are able to choose their own decor, fittings, and
furnishings', the manager stated, 'and welcome to bring in their own furniture if they
wish to do so'.
Bedrooms viewed had been appropriately personalised, according to the residents'
wishes, and throughout the home, necessary aids such as adjustable beds, grab rails,
call bells, assisted baths, a lift and other specialist items to support the residents live
as independently and comfortably as possible, had been supplied. In the main house
there were twenty-eight single and twelve double bedrooms, some of which were
being used as singles. The manager had ensured that a small quiet room was at the
disposal of residents wishing to meet with their relatives, or visiting professional, in
private.
There was an on-going programme of maintenance, repair and the replacement of
carpets and furniture, to keep up the good standard of accommodation offered at the
home. The AQAA confirmed that, the external wood, stonework and fencing had been
painted over the last twelve months, and some of the patio at the rear of the home
had been re-laid, in order to facilitate access to the garden. Plans were in place to look
into the incorporation of a garden room for the enjoyment of the residents, to upgrade
the sensory room, and to facilitate access to the garden by providing ramps to
the ground floor bedrooms from the outside. New handrails had been added to the
garden ramps to support the residents to access the garden independently.
The home had an infection control policy and alcohol gel dispensers at entrance and
exit doors and between the nursing home and the continuing care unit. The laundry
room was clean and fresh, in keeping with the home as a whole. Over the previous
twelve months, the home had invested in two commercial washing machines, which
incorporate a sluice action cycle and commercial dryers, for washing and drying the
residents' clothes and bed linen. Hand-washing facilities were available to promote
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Evidence:
infection control and staff training records confirmed that infection control training was
included in the mandatory updates for all the staff. 100% of the residents, who
completed surveys, thought the home was always clean and fresh. A relative wrote on
behalf of a resident, 'the home is attractive and fresh looking and in the garden the
hanging baskets and tubs, full of seasonal flowers are a delight.' Another resident
recorded, 'it always smells fresh' and another, 'it is very bright and clean'.
Care Homes for Older People Page 23 of 32
Staffing
These are the outcomes that people staying in care homes should experience. They
reflect the things that people have said are important to them:
People have safe and appropriate support as there are enough competent staff on duty
at all times. They have confidence in the staff at the home because checks have been
done to make sure that they are suitable to care for them. Their needs are met and
they are cared for by staff who get the relevant training and support from their
managers.
There are no additional outcomes.
This is what people staying in this care home experience:
Judgement:
People using this service experience good quality outcomes in this area. We have
made this judgement using a range of evidence, including a visit to this service.
A stable, committed and well-trained staff team, which have been safely recruited to
ensure the residents' protection, provide their care.
Evidence:
The home benefited from having a loyal staff team offering consistency and continuity
to the residents. The AQAA recorded that forty care staff and registered nurses worked
at the home. Domestic staff were also employed including two cooks, kitchen
assistants, cleaning and maintenance staff. Five of the eight staff, who returned
surveys, recorded that there were always enough staff to meet the individual needs of
the residents, and three thought there usually were. One staff member commented, '
Wenham always has the correct number of nurses and carers working, and with the
manager also working hard within the home, individual's needs are very well met.
There is good team spirit and staff are prepared to be flexible to support the resident's
needs.'
The AQAA recorded that fourteen of the twenty-eight care staff had completed a
National Vocational Qualification (NVQ) in Care or Health and Social Care at level 2 or
above to support them in their role and that six were in the process of working
towards a NVQ award. The manager stated that two staff had achieved a NVQ at level
Care Homes for Older People Page 24 of 32
Evidence:
4 in Health and Wellbeing, and wrote in the AQAA, 'the nursing home is an approved
centre for City & Guilds, registered to offer both NVQ 2 & 3 and NVQ 4 in Health and
Wellbeing. All the staff, who completed surveys, recorded that they were being given
training, which is relevant to their role, helps them to understand and meet the
individual needs of the residents with respect to equality and diversity issues, and
keeps them up-to-date with new ways of working. One staff member commented, 'I
have been involved in both internal and external training courses to keep up to date
with information.' The Spring Training programme included the Mental Capacity Act,
Health and Safety, Fire Safety, Infection Control, Moving and Handling, Promoting
Choice and Protection, Abuse Awareness, Dementia Care, Food Hygiene, First Aid, Risk
Assessment and Reflective Practise. Staff training and development files sampled,
contained certificates to confirm the staff had received mandatory training in a timely
fashion and other certificates for the Administration of Medication, Communication,
Tissue Viability, Nuitritional Needs and Malnutrition, Palliative Care and Oral Health
Awareness. The manager stated that the registered nurses were encouraged to keep
up their professional development by attending courses and other relevant training
identified in appraisal.
The files of two staff, recruited since the previous site visit, were sampled and they
confirmed that all the necessary pre-employment checks had been carried out for the
protection of the residents, including two written references, the Protection of
Vulnerable AdultsFirst and Criminal Record Bureau checks. 100% of the staff, who
returned surveys, recorded that their employer had carried out checks, such as
Criminal Record Bureau and references, before they started work.
The staff induction programme was based on the Skills for Care Common Induction
Standards, which is an introduction to the caring role, which promotes the service
users' rights to be treated as an individual, and have their equality and diversity needs
respected. Stages of completion of the full induction programme were signed off by
the employee and their supervisor to confirm competence. Five of the eight staff, who
completed surveys thought their induction covered everything they needed to know to
do the job, very well, and the remainder thought it mostly did.
All the residents, who completed surveys or were supported to complete surveys by
their relatives, reported that the staff listen to them and act on what they say and five
of the six confirmed that the staff were always available when they needed them.
Comments included, 'there is a good staff ratio', 'the staff are kind and reassuring',
'the staff are very kind and understanding', and 'every time I visit the home, the staff
show a real caring attitude to my wife and myself.' The four health and social care
professionals, who completed surveys, thought that the care staff always have the
right skills and experience to support the individuals' social and healthcare needs. One
Care Homes for Older People Page 25 of 32
Evidence:
commented, 'the standard of care is excellent. The staff are skilled and caring. They
maintain good communications with relatives, where appropriate, supporting the
residents' social needs.' The manager wrote in the AQAA, ' we have provided training
on cultural and racial diversity, and as part of this, encouraged open discussion on the
differences in cultural practices and how this influences relationships in the work place.
Care Homes for Older People Page 26 of 32
Management and administration
These are the outcomes that people staying in care homes should experience. They
reflect the things that people have said are important to them:
People have confidence in the care home because it is led and managed appropriately.
People control their own money and choose how they spend it. If they or someone
close to them cannot manage their money, it is managed by the care home in their
best interests. The environment is safe for people and staff because appropriate health
and safety practices are carried out.
People get the right support from the care home because the manager runs it
appropriately with an open approach that makes them feel valued and respected. The
people staying at the home are safeguarded because it follows clear financial and
accounting procedures, keeps records appropriately and ensures their staff understand
the way things should be done. They get the right care because the staff are
supervised and supported by their managers.
This is what people staying in this care home experience:
Judgement:
People using this service experience excellent quality outcomes in this area. We have
made this judgement using a range of evidence, including a visit to this service.
Residents live in a well managed home, in which their opinions are sought and acted
upon for the improvement and development of the service. Effective systems are in
place to promote the residents' health, safety and welfare creating a safe environment
for them to live in.
Evidence:
The registered manager, who is a Registered General Nurse with a degree, and post
graduate diplomas in social research, and in the management of community care for
older people, had more than twenty years of experience of care home management.
She had also received certificates for extended study courses involving the care of
people with dementia, physical illnesses of old age, and care of the dying. She kept
herself up to date with current practise and the latest research, by membership of the
English Community Care Association (ECCA), was booked to attend a Conference on
Dementia Care Mapping, had completed the Mental Capacity Act training and updated
her National Vocational Qualification (NVQ) Assessors Award. The Responsible
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Evidence:
Individual, Dr Dennis Greenwood, was also very well qualified, having being awarded a
PhD for research into dementia and psychotherapy, an MSc in Counselling and
Psychotherapy and was an accredited psychotherapist. The 'relational' care approach
provided at Wenham Holt and its sister home, Eastfield Nursing and Residential Care
Home, is explained in his publications, 'Greenwood, D., Loewenthal D & Rose T. (2001)
'A relational approach to providing care for a person suffering from dementia', Journal
of Advanced Nursing 36(4), and Greenwood, D (2007) 'Relational care: learning to
look beyond intentionality to the 'non-intentional' in caring relationship', Nursing
Philosophy Vol. 8 Issue 4.
There was an open, positive and inclusive management approach at the home and
staff spoken with felt valued. A discussion about the problems of the icy weather of the
previous week, prompted a staff member to say that they had voluntarily stayed at the
home to cover for staff, who were unable to travel to work, and they had thoroughly
enjoyed the team approach to ensuring the residents' care was not affected. A staff
member commented, 'I have worked in several homes, and find the support I receive
from all the staff, and the owners of the home, is fantastic.' Another staff member
recorded under what they thought the service did well, 'the best thing about Wenham
Holt is the care and friendship it offers to both the residents and their families. All the
staff take time to get to know the residents and there is a real family feel in the home.
The food is home-cooked, the residents make their own choices and are respected as
individuals, the home is very clean and well-maintained, there is a varied activity
programme, offering something for everyone to enjoy, and I am very proud to be part
of the staff team,' and another added, 'I enjoy working at this nursing home because I
feel that the residents get all the care they need and the staff get all the support,
including working equipment, they require to perform their duties to a high standard'.
The collated results of the quality assurance questionnaires completed by the
residents, their relatives and representatives, confirmed satisfaction with the service
provided, with 100% of the respondents stating that they thought the service was
either very good or good. Comments included, 'your service and the care provided
must be one of the best in the country', 'the high standard of care provided would be
difficult to improve', and ' a family atmosphere that includes management, staff and
patients.' An annual development plan had been produced, following the return of the
evaluation forms and in consultation with relatives, visiting professionals and staff,
setting targets for the forthcoming year.
Many improvements had been made over the previous year, as a result of listening to
the people who use the service, including, improved access to the garden by
constructing a new drive to the side of the home, improving the patio area for the
enjoyment of the residents, and the installation of a hot water outlet to enable
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Evidence:
relatives, friends and other visitors, to make themselves a hot drink. New bedroom
and garden furniture had been purchased, arrangements had been made to use the
hydrotherapy pool at the sister home of Eastfield, a new menu had been introduced
offering a wide range of choice to the residents, and the activity co-ordinator's hours
had been extended to include activities such as hand massage, aromatherapy and
social interaction.
In addition to the annual quality assurance assessments, sent out by the home to gain
the views of stakeholders, the home also held monthly carers/relatives meetings,
which were organised by manager. All carers/relatives of current residents were
invited to come to this forum and the relatives of some of former residents also
attended. A relative spoken with stated that the support group was very helpful.
The health, safety and welfare of the residents were promoted by regular staff training
in moving and handling, fire safety, first aid, food hygiene and infection control.
Certificates were viewed on staff personnel files to confirm this. The Annual Quality
Assurance Assessment, completed by the manager confirmed that policies and
procedures with respect to health and safety were in place to keep the staff informed,
and that the essential maintenance of equipment had been carried out according to
manufacturers' recommendations to ensure it was safe to use. A sample of certificates
were seen on the day of the site visit confirming that maintenance checks had been
carried out in a timely fashion. Since the previous site visit, a full time facilities
manager had been appointed, who had many years experience at management level in
the public sector with respect to enforcing health and safety legislation, and was able
to advise on regulatory matters with respect to fire safety, food safety and health and
safety.
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Are there any outstanding requirements from the last inspection?
Yes £No RAre there any outstanding requirements from the last inspection?
Yes £No R
Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not
been met. They say what the registered person had to do to meet the Care Standards
Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No.
Standard
Regulation
Requirement
Timescale for
action
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Requirements and recommendations from this inspection:
Immediate requirements:
These are immediate requirements that were set on the day we visited this care home.
The registered person had to meet these within 48 hours.
No.
Standard
Regulation
Requirement
Timescale for
action
Statutory requirements
These requirements set out what the registered person must do to meet the Care
Standards Act 2000, Care Homes Regulations 2001 and the National Minimum
Standards. The registered person(s) must do this within the timescales we have set.
No.
Standard
Regulation
Requirement
Timescale for
action
Recommendations
These recommendations are taken from the best practice described in the National
Minimum Standards and the registered person(s) should consider them as a way of
improving their service.
No.
Refer to Standard
Good Practice Recommendations
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Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may
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Care Homes for Older People Page 32 of 32