Bebington Care Home
Four Seasons Healthcare
165 Heath Road, Bebington, Wirral, CH63 2HB
Piara Miah, Kristen Beatty, Elaine Evans
Healthwatch Wirral would like to thank Four Seasons Healthcare for welcoming Healthwatch Authorised Representatives who visited to view the facility and talk to staff, patients and visitors on 16/01/2019.
Please note that this report relates to findings observed on the specific date and time of the visit. Our report is not a representative portrayal of the experiences of all service users and staff, only an account of what was observed and contributed at the time.
What is Enter and View?
Part of the Healthwatch Wirral’s work programme is to carry out Enter and View visits. Local Healthwatch representatives carry out these visits to health and social care services to find out how they are being run and make recommendations where there are areas for improvement.
The Health and Social Care Act allows local Healthwatch Authorised Representatives to observe service delivery and talk to service users, their families and carers on premises such as hospitals, residential homes, GP practices, dental surgeries, optometrists and pharmacies.
Enter and View visits can happen if people tell us there is a problem with a service but, equally, they can occur when services have a good reputation – so we can learn about and share examples of what they do well from the perspective of people who use the service first hand.
General profile of the service that was entered and viewed
Bebington Care Home is a Nursing Home located in a quiet residential area of Bebington in Wirral. It is part of the Four Seasons Healthcare Group. It is a purpose built care home providing residential and nursing care for up to 87 people with varying needs. These include specialist nursing support, respite care, end of life and general assistance with everyday living for people with dementia. Accommodation is offered over 2 floors with a lift providing access to both. Parking is available to the front of the building for staff and visitors.
Purpose of visit
Revisit – Check any improvements made since last visit in August 2018. Responding to a request from a services regulator or commissioner. Verification of service user feedback.
Type of Enter & View visit undertaken
The visit is not designed to be an inspection, audit or an investigation, rather it is an opportunity for Healthwatch Wirral and Elected members to get a better understanding of the service by seeing it in action and talking to staff, service users and carers/relatives. If during a visit Healthwatch Wirral identifies any aspects of a service that it has serious concerns about, then these concerns are to be referred to the appropriate regulator or commissioners of the service for investigation or rectification. Any safeguarding issues identified will be referred to the Local Authority or Commissioner for investigation.
The rectification of less serious issues may be directly with the service provider on the day.
Healthwatch Wirral visits are a snapshot view of the service and findings are reported based at the time of the visit.
Enter and View visits are conducted in accordance with Merseyside Safeguarding Adults Combined Board’s principles and procedures. Information will be shared accordingly in order to safeguard adults at risk on Wirral and promote quality of local services.
Discussions, findings and observations
Healthwatch Wirral Authorised Representatives were welcomed by the Manager who was previously employed as the Deputy Manager. We were asked to sign in but not requested to use the hand gel for infection control purposes. We were escorted to a side room for a brief discussion about the home and any improvements made since our last visit in August 2018.
Health and Safety
We were informed that the home uses the Personal Emergency Evacuation Plan (PEEP) and that staff practice the evacuation procedure.
We asked whether the plans had been updated and the Manager reported that they had.
At the last visit we recommended that the rubbish stored by the front entrance car park should be placed in a skip and removed and we were informed that it had been. However, at the time of this visit we observed further items had been left again and there was no skip. A large yellow waste bin had also been over filled.
The Manager informed us that Four Season will not allow the home to order a skip until there is enough to fill it and due to the refurbishment programme ongoing at the home rubbish accumulates and there is no bin/skip to place the items in.
The Manager did not appear to be surprised about staff overfilling the yellow bin and said that staff ‘just fill the nearest bin’.
The Manager reported that care plans are person centered and are recorded on the Care.doc system. The home involves residents by including them in decisions made about the home.
We asked whether the care records, plans and risk assessments were appropriate and met the residents’ needs and we were informed that they had been improved since the last CQC visit.
We were informed that the home had lost a lot of staff recently to a new ‘Transfer to Assess’ unit. Four Seasons had successfully bid for the contract to run the facility.
The Manager was recruiting staff to cover the lost posts and was having to use Bank and Agency staff in the interim.
The home intends to complete the ‘6 Steps’ End of Life training and gain the accreditation.
Staff receive regular supervision and have an annual appraisal.
Medications are stored in locked trolleys in locked rooms. Staff receive training in medication administration and competencies. We asked about the management and documentation of medication and whether it had improved since the last CQC inspection and we were informed that it had.
The complaints procedure in the home is made available to residents and their families. We were told that
all residents and their relatives understand the procedure.
The Manager has an open door policy for receiving and resolving complaints at a very early stage and it was reported that the complaints procedure had been improved recently.
The main type of complaints received were about food or laundry related.
Although the home does not hold specific meetings, residents can feedback their views by using the digital technology provided in the form of an iPad.
Residents, families and visiting professionals, such as GPs and Social Workers, are invited to use the iPad to offer ideas and suggestions to help to maintain or raise standards.
We were informed that all comments are received directly by the Home Manager who takes any necessary actions immediately.
Nutrition and Hydration
We were informed that the kitchen is managed by an external company and kitchen staff are not employed by Four Seasons.
The home has a Food Hygiene rating of 4.
It was reported that residents are asked about their food preferences and dietary requirements.
The home celebrates events and special occasions with special meals throughout the year.
Residents can eat in the dining rooms or, if they prefer, they can be served their meal in the privacy of their own rooms.
The home uses the MUST Tool and monitor residents weight when they come to live at the home and regularly after that.
It was reported that staff assist residents to eat and drink and ensure that resident’s fluid intake is sufficient for their needs.
We were informed that the home reports Safeguarding alerts to Central Advice and Duty Team at the Local Authority. All are documented and investigated. Lessons learned may result in increased observations or changes in practice.
Bebington Care Home monitors the quality of the service it provides by conducting audits, using the Quality of Life iPad system to monitor feedback and monitoring care planning and risk assessments.
At our last visit we were informed that the home is in the process of recruiting an activities co-ordinator. We were pleased to find that one had been recruited and was liaising with residents to find out what they would like to be included in the activities programme.
The Reception/Foyer area was bright, fresh and decorated to a good standard. The Notice boards displayed showed information about the care home policies on various topics including Complaints Procedures, Health and Safety Advice etc. We were pleased to see that the home had now displayed the most recent CQC Report.
Other information displayed included an Activities Board, a Welcome to our Community Board. a Family and Residents Charter and an ‘Our Values’ poster. The area was spacious and it was evident that it is used by the residents to watch films as there was comfortable seating available and a large projector screen on the wall.
There was a sweets dispenser and the iPad system for residents and visitors to use to give feedback.
Situated off the main reception area was a room which was a facility for visitors (a family room).This room was being decorated and refurbished at the time of our last visit and it was disappointing to find that it had not been completed and was being used to store paint and other building materials.
The corridors were bright, wide and free from obstruction. Displayed on the walls were photographs of famous film stars. One area of the corridors was malodorous and the carpet in another unit would benefit from being replaced. Some of the flooring appeared to be dirty and a number of doors were marked.
Some dementia friendly signage was evident throughout the home and we noticed a ‘rummage bag’ in one of the corridors.
The lounges viewed were spacious with seating arranged around the perimeter.
We visited 2 dining rooms, one used by residents with dementia and one with nursing care needs. Both rooms had kitchenette areas which did not look clean and tidy.
We did not observe many staff providing one to one assistance to residents.
One staff member was assisting a resident with their meal but a number of residents appeared to need extra support.
A resident informed Healthwatch Authorised Representatives that they enjoyed their food but another started shouting and complaining about her food.
Another resident informed Healthwatch that the staff do not answer the call bells promptly and have to wait a long time for assistance. They also complained that they do not receive enough to drink during the day.
The bathroom viewed was well equipped, tidy and clean and there was some element of the introduction of a dementia friendly environment by the home using contrast colours for the seats and grab rails.
The resident’s room viewed was personalised and spacious with a call bell position within reach. However a number of rooms viewed from the corridor did not appear to have jugs of water available to enable residents to stay hydrated.
The laundry room was large and appeared to be untidy and a little disorganised.
We were informed that the incidence of loss of items is small and the home holds an amnesty on occasions to allow residents to locate missing items.
External areas and gardens
There was a pleasant garden area to one side of the home. This area had a pergola and garden furniture for residents to use.
The internal garden area, which was accessible for use by the residents had been improved since our last visit.
It was disappointing to see that items of furniture being disposed of during the refurbishment continued to be stored in a corner of the car park. We were informed that the home had requested a skip after our last visit and had been told that they are only able to order a skip when they have enough items to fill it and that when the skip was full it would be taken away immediately as fire safety good practice. Healthwatch Authorised Representatives felt that this practice may potentially become a hazard if items are left piled up in the area.
Healthwatch Authorised Representatives observed that several rubbish containers continue to be placed in an area that has been designated as a Fire Assembly Point and that the container nearest to the building was overflowing.
We did not observe many staff interacting with residents at the time of our visit but the few that we did see appeared to treat residents kindly and with dignity and respect.
Feedback (from Staff, Service Users, Relatives, Visitors, Carers)
At the time of our visit there were several members of staff in the staff room but few were seen working in the units.
A staff member informed Healthwatch that there are problems with staffing levels on occasions, particularly as the home has lost a number of staff who have gone to the Transfer to Assess unit managed by Four Seasons.
A number of staff reported that they would like a kettle and toaster for the staff room.
One resident reported that they receive good care at the home.
Another reported that they enjoy living at the home and that the staff are nice.
One resident said that there are not enough staff and that staff are always too busy.
Another said that they have to wait a long time before anyone answers the call bell.
- Residents looked clean and tidy
- Some areas of the home appeared untidy and dirty
- It was pleasing to hear that the home is continuing to participate and gain accreditation in the 6 Steps End of Life training
- It was concerning that the home has lost several members of staff. At the time of our visit a number of staff were in the staff room but we did not observe many staff on the units
Recommendations and Considerations
- Cleaning schedules should be revised as some areas in the home appeared untidy or dirty particularly in the kitchenette areas
- Make arrangements for the disposal of the rubbish stored in the car park
- Remind staff about the importance of good waste management practice ie not overfilling bins
- Continue to work on and implement the recommendations and actions from the last CQC visit
- Recruit further staff
- Increase staff ‘walk arounds’ to ensure that resident’s needs are being met
Post-visit supplementary feedback from the provider
Thank you for the report.
“Some areas of the home looked unclean and untidy and dining rooms where not cleaned”
Unfortunately the visit occurred just post dinner time and the cleaners had not had time to clean the rooms as they were in the staff room taking their lunch.
Staff have access to kettles and toasters when they require unfortunately they have recently broken both again but it has not been reported to management. We will replace both.
We have approached our estates department to move the bin shed fence in the car park to encompass rubbish that needs to be put in the skip that we are allowed on site for filling purposes only. As
explained on the day of your visit, our new regional MD does not like skips kept on site for fire safety reasons.
Staff have been informed about waste disposal practice and the importance of not overfilling bins.
We have recently had an inspection from CQC and are working closely with all appropriate agencies to increase the rating of the home.
Staff recruitment is a continuous process and we have recently recruited 34 permanent staff to our team.
Daily walkarounds are completed on each unit by nurse in charge and we have now put in a Care Champion of the day to look at the units and engage staff with residents.
Healthwatch follow-up action
Revisit in 2020
CADT – Central Advice and Duty Team
CSW – Care Support Worker
CQC – Care Quality Commission
DoLS – Deprivation of Liberty Safeguards
DNAR – Do not attempt resuscitation
MUST – Malnutrition Universal Screening Tool
NVQ – National Vocational Qualification
PEEP – Personal Emergency Evacuation Plan
RGN – Registered General Nurse
Distribution of Report
Healthwatch Wirral will submit the report to the Provider, Commisioner and to CQC.
Healthwatch Wirral will publish the report on its website and submit to Healthwatch England in the public interest.