County Homes Care Home
40 New Hey Road, Woodchurch, Birkenhead, CH49 5LE
Elaine Evans, Carole Battersby, Denise Williams, Brenda Shannon
Healthwatch Wirral would like to thank HC-One Ltd for welcoming Healthwatch Authorised Representatives who visited to view the facility and talk to staff, patients and visitors on 04/09/2019.
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
County Homes is a large care home situated in Woodchurch, Birkenhead. It is set in its own grounds and provides dementia nursing care for up to 82 residents.
Purpose of visit
To verify 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.
Enter and View visits are conducted in a way that works in accordance with Merseyside Safeguarding Adults 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
Discussion with Manager
Healthwatch Wirral representatives arrived at the home and a member of staff showed us to the reception area where we were asked to sign in and wait for the Manager. The Manager joined us and we had a discussion about the home and its policies and procedures. The Manager was accommodating and took time out to discuss the day to day running of the home.
We were informed that County Homes provides dementia nursing care for up to 82 people in single rooms, most having en-suite facilities, but some residents share toilet facilities. The home was not at full capacity at the time of our visit and currently had 76 residents. However, it was reported that the home has a waiting list of people interested in becoming residents.
Accommodation is provided over 2 floors housing male and female units, Chester, Lancaster and York. Each unit has a Manager and the units have their own lounge and dining areas.
Health and Safety
We were informed that the home uses the Personal Emergency Evacuation Plan (PEEP) A detailed personal evacuation plan is in place for each of the people living at County Homes and there is an individual plan for each unit. The maintenance team keeps records of regular checks and tests they carry out. Their monthly checks include water temperatures, profiling beds, emergency lighting and fire safety equipment. The home has contracts in place to check the gas, electrics, nurse call system, lifting equipment, passenger lifts and fire safety equipment.
It was reported that regular fire drills are held at the home.
The Manager reported that care plans are person centered and accurately reflect people’s needs and wishes.
Registration of residents with a GP – Most of the residents are under the care of a local GP who visits the home twice weekly, but some are registered with other GP practices as this is their choice.
Staff and Training
80 staff are employed at the home.
During the day the staffing levels are 4 registered nurses plus 12 health care assistants, Manager and deputy, 2 activities co-ordinators plus kitchen, cleaning and laundry staff.
At night there are 3 nurses plus 9 healthcare assistants on duty.
When staffing levels are lower due to sickness absence or unplanned leave, levels are adjusted up to ensure quality care for residents whenever necessary. The home tries to avoid using agency staff and prefers to use their own bank staff by being flexible, changing shifts or increasing overtime. The home assesses the dependency of people living in the home to help determine how many staff are needed.
Nursing staff are educated to degree level and care assistants have NVQ 2 or 3 qualifications.
All staff have induction when they commence employment and have an annual appraisal including 6 supervisions per year. Staff are required to attend mandatory training modules. Training is delivered online or face to face.
Other training available to staff include Dementia, Deprivation of Liberty, Safeguarding, Care plan writing, Mental Capacity, Medication, Nutrition and Hydration, and Tissue Viability.
Medication is managed and administered by trained nurses who are assessed for competency.
Healthwatch Representatives were supplied with a comprehensive training log for permanent and bank staff.
We were informed that there is a high turnover of staff as some staff leave when there are vacancies at the local hospital trust.
County Homes uses the Teletriage system which replaces the need for nurses or carers to call 111 in non-emergency situations.
Teletriage is remote clinical support provided by Wirral Community Health and Care NHS Foundation Trust to Wirral care homes to prevent unnecessary hospital admissions in non – emergency situations.
End of Life Policy
The home has completed the 6 Steps End of Life Training.
It was reported that a high percentage of residents achieve their preferred place of care at the end of their life and also the home includes the resident and their families in End of Life advanced care planning.
Medication is managed and administered by trained nurses who are assessed for competency.
Medicines are stored securely in locked clinic rooms on each unit and we were informed that temperatures of the rooms and medicines fridges were monitored and recorded to check that medication was stored safely. Controlled drugs were stored in a separate locked cupboard and it was reported that the balances were checked twice daily on shift handovers.
Nutrition and Hydration
We were informed that all residents are weighed on admission and their weight is recorded monthly in their care plan. Any problems are referred to the GP or dietician. Residents may eat in their own room if they wish to do so and are given a choice of suitable food to meet their needs or special dietary requirements. This home uses the MUST tool (Malnutrition Universal Screening Tool) and MUST training is part of the mandatory training. Staff are aware of the need for adequate nutrition and hydration and provide assistance to residents when required.
It was reported that all safeguarding alerts are investigated, documented and reported to the appropriate authorities.
We asked about the complaints procedure and if staff, residents or their relatives would know how to voice any concerns. We were told that County Homes monitors and records complaints. Staff, residents and their relatives are aware of the complaints procedure and any issues are usually resolved by talking to the complainant.
DoLS and DNAR’s
We were informed that all residents are assessed before admission and the home follows legal requirements and best practice guidelines. Residents are reviewed monthly and “best interest” meetings are held.
County Homes manages and prevents falls by using risk assessments, close observations, assistive technology, low profile beds and crash mats. Medication is reviewed and residents may be referred to the Falls Team. All falls are recorded and incidents/accidents are investigated by the Home Manager with the Unit Managers.
Pressure ulcers are managed and prevented by monitoring, hydration and nutrition, using body mapping, daily skin checks, repositioning and by using specialist equipment such as cushions, mattresses or profile beds.
Residents may also be referred to the Tissue Viability Service.
County Homes employs 2 Activities Co-ordinators, 1 full time and 1 part time. Residents can work with the co-ordinators on a 1 to 1 basis. The home has its own mini bus for taking residents on trips and outings. Many activities are available including crafts and games and other forms of entertainment. Local schoolchildren visit and talk to the residents.
It was reported that residents are invited to participate in activities but if they choose to decline their choice is respected.
After the discussion with the Manager, Healthwatch representatives were invited to look around the facilities.
The home measures the quality of the care that they provide by using internal auditors and conducting surveys.
The Reception/Foyer area was bright, fresh and decorated to a high standard. There was a visitors signing in book and notice boards displayed showed up to date information about the care home.
Hand sanitiser was available for infection control purposes.
The floor surfaces and coverings were good quality and free from trip hazards
The reception area appeared to be very welcoming and was designed to look like a café area with attractive high quality furnishings and drink making facilities. At the time of our visit the tables were set out for afternoon tea.
Corridors/hallways and stairs.
The corridors were clean, tidy and well lit. Hand rails were in place to enable residents to safely navigate around the home.
The décor in some of these areas appeared tired and needed refreshing. Signage was in various formats and each of the bedroom doors had a brass plate showing the residents name. Information boards, posters and art work were on display.
All of the entrance doors to various parts of the home were secured by keypads and the corridors were free from trip hazards.
One area had been decorated to look like a garden and a bus stop to provide a dementia friendly environment.
Some areas did not smell fresh and would benefit from a deep clean or a replacement of the carpet. This was particularly evident in the corridor on the upper floor. The Manager informed us that the carpets had been cleaned. We observed that there was a lack of ventilation due to the fact that the window would not open. This was reported to the Manager who said that she would arrange for the window to be replaced or repaired.
The York Unit on the ground floor had laminate type of flooring which had a repair across the join. This was reported to the Manager for infection control purposes. This area smelled fresher than some of the areas that had carpet flooring.
These were clearly small and cramped. They would accommodate a wheelchair and a laundry/food trolley but not a stretcher. Healthwatch Representatives felt that the lifts were not really fit for purpose as, if a resident is discharged from hospital on a stretcher, they would have to be transferred to a wheel chair on arrival at the home. This may not be appropriate for all patients.
The communal day areas on each unit provided a selection of seating including high seat chairs and ordinary armchairs as well as more complex seating for individual residents with specific needs. These areas were spacious and furniture was arranged well to give non – institutional feel. The television was on but many residents were asleep in their chairs. We did not see activities being provided at the time of our visit.
These appeared to be clean and comfortable. The tables were set but the lunch service was not yet in progress. We did not observe residents eating or being supervised at the time of our visit to this area. Menus were available in reception and dining areas. The Manager reported that staff did assist patients with nutrition and hydration when required.
We viewed an unoccupied bedroom known as a “showroom”. It was small and quite cramped and again décor was a bit tired. This room had its own toilet with hand washing facilities. It was reported that some residents have to share a toilet with another resident. The Manager said that they try to ensure that residents who share toilets are selected carefully. There were no en-suite bathing or shower facilities.
We were informed that risk assessments are done as some rooms are not suitable for patients prone to falls and bed rails are not used throughout the home.
It was reported that all rooms have Profile beds and residents are allowed to personalise their rooms.
We viewed a shower room which appeared functional but again décor appeared a bit tired.
Some of the communal toilets had recently been altered to replace the toilet with a urinal for male use. The light switch outside one of the toilets was not easy to locate. Healthwatch Representatives were unsure if residents would know how to find and use the switch. There were call bells available but were largely used by staff as the manager reported that residents generally did not have the capacity to understand how to use them.
We visited the laundry room and found that it was clean, tidy and well organised.
The kitchen had a five star food hygiene rating. At the time of our visit the kitchen and staff were busy preparing for the mealtime service but it appeared orderly and organised.
The large Activities Room appeared to be a little cluttered. Stored within this room were reminiscence items, dolls, cots, rummage bags and a sweet trolley.
We were also shown a room that had been authentically decorated and designed to look like a pub.
The room was clean and well equipped. We observed several residents having their hair done at the time of our visit.
External areas and gardens
The garden and car park at the front of the home was tidy and well kept. However, some of the courtyard gardens did not look very inviting with an untidy appearance and evidence of broken garden furniture.
The Activities Co-ordinator was very enthusiastic about her work.
As we walked around the home it was obvious that the Manager knew residents well and had a good relationship with them.
Staff appeared to be well presented and visible. They were observed treating residents with dignity and respect.
We were advised by the Manager that it was probably not appropriate to speak to some of the residents due to their cognitive state and mood.
Residents appeared to be appropriately dressed and were clean and tidy.
Some were mobile independently and others required assistance.
Many were sat in communal areas and some were asleep.
Feedback (from Staff, Service Users, Relatives, Visitors, Carers)
We spoke to a nurse who had been employed at the home for 9 years. She reported being very happy and confirmed that there had recently been a high turnover in staff as the local hospital had had a recruitment drive. She also stated that the training provided at the home was good and that this was a priority for the Manager.
Several other members of staff said that they enjoyed working at the home and that they felt supported by management.
- The residents appeared to be well cared for and safe
- Staff appeared to treat residents with dignity and respect
- Staff were offered an extensive training package
- The environment was clean and safe but some areas would benefit from redecoration
Recommendations and Considerations
Continue a programme of refurbishment of areas of the home to match the high quality redecoration of the reception area.
Although there were elements of providing a dementia friendly environment within the home this could be developed further.
Post-visit supplementary feedback from the provider
Thank you for the visit and your feedback.
There is a robust cleaning rota throughout the home with regard to carpets and other soft furnishings to reduce the odours. The window that would not open on the upper floor has been reported to our Help Desk and we await its replacement.
We have various activities available throughout the home and a time table is available on our Residents notice board and it is also written on a daily basis on the white boards on each unit – residents are encouraged to participate but are able to decline if they wish.
We have an ongoing refurbishment programme throughout the home with the Maintenance operatives responsible for decorating the bedrooms and en suite areas as they become vacant. Our communal areas are decorated via the Estates team. Furniture (both inside and outside) and soft furnishings are replaced when required.
HC-One has launched Harmony which is the new name of our Dementia Care and our memory care communities. The company is currently trialing new approaches in a selection of homes throughout the country across the areas of wellbeing and comfort , learning and development and the environment – we will be kept informed of the progress and any changes recommended will be implemented by the company.
Healthwatch follow-up action
Provide home with a copy of Healthwatch leaflet ‘Dementia Friendly Environment in a Care Home Setting’
COSHH – Control of Sustances Hazardess to Health
DNAR – Do Not Attempt Resuscitation
DOLs – Deprivation of Liberty Safeguards
EMI – Elderly Mentally Infirm
GDPR – General Data Protection Regulation
H&S – Health and Safety
HCA – Healthcare Assistant
MCA – Mental Capacity Act
MUST – Malnutrition Universal Screening Tool
NVQ – National Vocational Qualification
PEEPS – Personal Emergency Evacuation Plan
RGN – Registered General Nurse
SCA – Senior Care Assistant
SOVA – Safeguarding of Vulnerable Adults
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.