Inspection on 26/02/09 for Wayside Nursing Home

This is the latest available inspection report for this service, carried out on 26th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wayside Nursing Home 03/05/07

Wayside Nursing Home 06/02/07

Wayside Nursing Home 20/10/05

Wayside Nursing Home 10/05/05

Wayside Nursing Home 14/01/05

Wayside Nursing Home 22/07/04

Wayside Nursing Home 23/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wayside Nursing Home 25 New Road Bromsgrove Worcestershire B60 2JQ     The quality rating for this care home is:   two star good 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: Sally Seel     Date: 2 6 0 2 2 0 0 9 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. that people have said are important to them: They reflect the things 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 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Wayside Nursing Home 25 New Road Bromsgrove Worcestershire B60 2JQ 01527837774 01527872631 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Alpha Health Care Ltd care home 30 Number of places (if applicable): Under 65 Over 65 3 30 30 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Wayside Nursing home provides care and accommodation for up to 30 older people. The homes registration allows the home to offer all 30 placements for older people with physical disabilities and includes up to 3 placements for people who are over 65 years of age and have dementia. Wayside Nursing home is located close to Bromsgrove town centre. The home is a large detached period property with a mature enclosed garden and limited car parking. Accommodation is on three floors (ground, first and second floors), which can be accessed by a central passenger lift. There are a range of single, double and en-suite bedrooms. The home has several lounges, a dining room, a conservatory and a hairdressing room. Information regarding fee levels and what is included within the fee was not included Care Homes for Older People Page 4 of 35 Brief description of the care home within the Statement of Purpose or service user guide. The reader may therefore wish to obtain up to date information from the care service. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: One inspector undertook this fieldwork visit to the home during a nine hour period. The registered manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were twenty-four people living at the home on the day of the visit with six vacancies. Information was gathered from speaking to and observing people who lived at the home. Three people were case tracked and we partially case tracked a fourth person, this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the Care Homes for Older People Page 6 of 35 service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us a wealth of information with good examples about the home, staff and people who live there. Improvements and plans for further improvements have been taken into consideration. Regulation 37 reports about accidents and incidents that could affect peoples health and safety in the home were reviewed in the planning of this visit. Five completed surveys from people living in the home, their relatives and staff, and one completed survey from a professional who visits the home were returned to the Commission for Social Care Inspection, (CSCI). Information from all of these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking four individual peoples care provided at the home. For example, the people chosen consisted of both male and female and have differing levels of care needs. The atmosphere within Wayside is inviting and warm and we would like to thank everyone for his or her assistance and co-operation throughout the day we visited. What the care home does well: What has improved since the last inspection? Care planning has improved to ensure that peoples health and care needs are identified and met. The home has now employed an activity co-ordinator to make sure that people have the opportunity of social stimulation on a daily basis. Staff have commented that all people regardless of their abilities and mental health are encouraged to take part with support as needed. The environment within the home has improved, such as, appropriate lighting has been put in place and a replacement boiler to ensure hot water is delivered to all bedrooms so that people can be confident that they live in a well maintained, comfortable home that meets their needs. Staff training in fire safety has been addressed so that people living in the home can be assured that staff will have the knowledge to protect them in the event of a fire. Fire inspection records are all in order and where recommendations have been made Care Homes for Older People Page 8 of 35 these have now been satisfied so that people living in the home are protected. What they could do better: 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 35 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 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information about the home is provided to people considering living there. Preadmission assessments do not always have sufficient details about a persons care needs so that staff are able to follow these ensuring people receive care and support in a way that protects their health and wellbeing. Evidence: The statement of purpose and service user guide were shown to us and these give people information about what it would be like to live at Wayside and how their needs would be met. The service user guide is dated February 2009 which shows that all the information has been updated and reviewed since the last inspection visit. We were told that people are also able to visit the home to see if it is the right place for them and ensure staff can meet their needs. All information can be provided in large print so that all people are able to read and understand the contents of the statement of purpose and service user guide. Surveys received from people who live in the home Care Homes for Older People Page 11 of 35 Evidence: confirmed that they received sufficient information to make an informed choice about whether they would like to live at Wayside. Some people living at the home stated they had received a contract. There should now be some consideration made to include the fees charged if someone chooses to live at Wayside so that people are able to make informed decisions in relation to their financial situation prior to moving into the home. In the sample of care records that we case tracked we found preadmission assessments that show peoples needs. These were completed before people moved into the home so that staff know they are able to meet individuals needs. The statement of purpose also confirms, ensure all nursing and care needs are met to a high standard from the first day of their introduction to the service. To enable this to take place within all planned admissions, we perform a preadmission assessment, where medical/nursing/social histories are obtained. However, when the inspector and registered manager were looking around the home they found a person who had moved into the home that day who was distressed and reassurance was provided. This person stated that they felt some pain and wanted to get out of bed. The inspector asked to see this persons care records and found that their preadmission assessment did not confirm how this person walked and or whether any aids would be required for support. This was discussed with the registered manager who will now ensure that when a person is in hospital they will contact the hospital for an appointment. This will make sure nurses are on hand to confirm a persons needs in detail. Staff will then be able to follow preadmission assessments so that peoples needs are met safely and their abilities are known together with any risks that require managing. The registered manager instructed staff to contact the persons doctor and relatives. Staff told us in their completed surveys: We do meet the individual care needs accordingly by respecting each individual. I am informed of residents who have particularly poor vision so that extra lighting can be introduced should it be required. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 35 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 planning has improved to promote peoples health, social, psychological and emotional wellbeing. Further improvements to include individuals in decisions about their lives will give people greater control over how their care is delivered. Medication administration and practices are protecting the people who live in the home in maintaining peoples health and wellbeing. Evidence: We sampled three peoples care records and found a range of care plans and risk assessments to meet peoples individualised needs in hygiene, medical conditions, physical abilities, nutrition, oral hygiene, foot care, sleeping and expressing sexuality. These plans have improved since the last inspection. They now have some good details for staff to follow and prompt staff to ensure peoples dignity is maintained throughout any tasks that staff help people to achieve. Each plan had what the person was able to do independently and states what assistance is required from staff to meet peoples needs. Within care plans individuals preferences and choices were noted so that staff could follow these. For example, likes to have bedroom door shut while she is in bed Care Homes for Older People Page 13 of 35 Evidence: at night and another care plan said, has a bath every Wednesday. However, it was not clear in the care plans how these decisions are made or whether they are based on peoples choices and preferences. For example, in some plans there was no reference to the individual making choices and or relatives. We discussed this with the registered manager who acknowledged that care planning needs to be further improved so that person centred care planning is promoted. The Annual Quality Assurance Assessment (AQAA) also confirms improvement plans for the next twelve months, To involve our residents at the beginning with regards to their care and wishes. This improvement will ensure that individuals have the chance to say how they would like their needs met so that this is done with peoples preferences in mind. Each person has their own key worker who will get to know the individuals needs, dislikes and likes. There were life histories which provided staff with details about peoples past lives and interests. These will assist staff to have meaningful conversations with people and people can take part in stating the things that are important to them. There is evidence within care records that were sampled that care plans are reviewed and this is also a source of information that is supplied in the homes statement of purpose. Where appropriate, we were told that, family members are included in reviewing and or updating peoples care plans. This makes sure that people are confident that their needs will be met even if they change. Staff who completed surveys told us what they thought the home does well: Wayside staff are always happy and polite which the residents pick up on and in turn gives them a sense of well being. Care is of a high standard. The home is well managed, the manager is also approachable and supportive. Elderly care. Some people in the home experience dementia type illnesses and staff are now receiving specialist training to make sure that individuals receive the most appropriate care in a dignified way. We observed staff interacting with people, respectfully showing people the way when they appeared to be lost and using distracting methods when individuals became unsettled. The home is developing good relationships with external professionals, such as, doctors, physiotherapists and social workers. In one care record that we sampled a Care Homes for Older People Page 14 of 35 Evidence: training consultant has advised staff how to meet and respect a persons choice to maintain their hobbies whilst in their own bed. This person wants to continue to knit, crochet and sew which involves sharp instruments such as scissors. The plan of care provides staff with instructions, for example, ensure every time X gets out of bed or she is changed that a full search of the bed is made and ensure there is good lighting in Xs bedroom. Family have also been involved in these plans. This shows that this persons wishes have been respected and followed. There was information in respect of dental, optical and doctors visits, with outcomes. A survey completed by one professional who visited the home commented, Show genuine care for patients and are aware of their individual needs. Able to do blood tests etc. There were some good care plans and risk assessments in place for people who were at risk of falling. People had moving and handling plans so that staff knew what actions to take to prevent any injuries occurring. For example, in one care plan it told staff to refer to prevention of falls policy and procedures and complete fall risk assessment and review monthly. It was positive to see that within a persons care plan for falls there were instructions to remind staff that the person needed a lot of reassurance and frequently needed orientation guidance due to the individuals loss of memory and wandering behaviour. This ensures staff are regularly made aware of other risks where people have some mental health difficulties and to not forget the human elements of reassurance. Monthly reviews were undertaken for falling, nutrition and skin soreness. A survey received from one person confirms that they always receive the medical support that they need. Other people told us: Quick response to recent illness. In an emergency the support I receive is very effective. When there has been a problem the home have reacted accordingly. The management of medication was reviewed for three people who live at the home with a nurse who administers medication as part of their duties. All medication checked tallied with the medication administration records (MARS) and was signed appropriately by nursing staff. We were told that prescribed creams and lotions have the date when opened on their containers, we were shown one, but they do not have a description in relation to which part of the body staff need to apply these. Also one persons prescribed cream was kept in an unlocked drawer in their room and we confirmed with staff that all prescribed creams and lotions need to be kept in locked facilities so that other people living in the home are safeguarded by medication practices. The registered manager confirmed that she would now be discussing the importance of staff doing this to make sure all peoples health and wellbeing are Care Homes for Older People Page 15 of 35 Evidence: safeguarded. We looked at care plans that provided staff with instructions where people are unable to give themselves their own medication which could be due to limited mobility and or their dementia. For example, one care plan had good details about checking medication, administering it with lots of water, washing hands before and after to maintain good hygiene standards and to check for unusual side effects. This ensures that medication is given appropriately and any risks of errors is minimised so that people are not placed at harm by the medication practices within the home. As at the previous inspection the medication trolley is stored by the stairs in the home as there is no treatment room which as stated previously is not ideal for the size of the home. The management of controlled medication was robust. Medication is signed in upon receipt. Nursing staff are trained in medication administration and handling and audits take place to make sure people are safeguarded from any bad practice errors that could affect peoples health and wellbeing. Also the local pharmacist completed an audit of the homes medication administration and handling in the summer of 2008 but we were told that this has not been received as yet. Therefore staff contacted the pharmacist on the day of inspection and they confirmed that they were trying to locate this audit report so that it could be sent to the home. People appeared well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and person preferences. There is evidence that the registered manager routinely observes staff attitudes and practice relating to privacy and respect together with peoples views and experiences. We found after death wishes on care records that we sampled but there was no end of life care plans. Therefore some consideration needs to be made in sensitively writing end of life care plans with individuals and or their representatives. This will ensure people receive individualised care that meets their practical, physical, psychological, spiritual and emotional needs in the way they want. This is particularly important as some people who live in this home have varying levels of dementia and all care plans and risk assessments should be done in the individuals best interests with their representatives consulted as required. Care Homes for Older People Page 16 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are assisted to participate in a range of leisure and social activities, which are supportive in helping them, lead stimulating and meaningful lives. Generally daily routines are operated on the principles of choice and respect. Meals provided are wholesome and satisfying to people living in the home. Evidence: There have been some improvements made in ensuring people receive appropriate daily social stimulation and activities since the last inspection visit. This has been mainly due to the employment of a new activities coordinator. The home has internal activity plans which include aromatherapy, bingo, board games, jigsaws, movie time, outdoor games, craft work, cookery, gardening, painting, drawing, exercise, quiz, singa- long, clothes party and so on. Time is set aside for one to one, which means that people can have time on their own with the activity coordinator to ensure that they receive stimulation and continue any chosen interests. This may be for people who have to stay in their rooms or people who prefer not to join in larger group activities. People who live in the home and staff alike who were spoken with on the day of our visit confirmed that the home provides a range of activities. People who have mental Care Homes for Older People Page 17 of 35 Evidence: health difficulties are encouraged and supported to participate in all activities regardless of their physical and or mental health. This is also reflected in the detailed care plans which have been completed by the activities coordinator with individuals who live in the home. These show what people enjoy to do, what their past hobbies and interests have been and what activities they would like to try. One care plan states, Doesnt always enjoy joining in with group activities but enjoys one to one, he needs help with his mobility and encouragement. To bring to group activities to encourage and keep his mental agility and independence where possible for him to communicate with others. Plan of care, enjoys listening to the radio, TV and enjoys gardening, to take him out on trips. Reminisce only if he wants to. Needs encouragement to help gain confidence, sensory activities, feel, smell, sight, sound and taste. On the day we visited we observed people participating in making 3D paper daffodils and whilst this activity was going on we heard general exchanges of conversation between individuals and the activities coordinator. We saw people sharing with the activities coordinator how they were feeling and why the activity was particularly difficult for them to achieve on the day. For example, one person confirmed, Cant settle today. Activities coordinator responded, Dont let that despair you. Other people were asking about the daffodils and the significance of the 1st March being St. Davids Day. The activities coordinator said that they would bring in some daffodils for people to do some still life painting and to one person it was confirmed, I have got a little easel for you. The activities coordinator was seen throughout the day to go into the different lounges to ensure all people who lived in the home had some opportunities to participate in activities and social stimulation. They also asked for the poem by William Wordsworth to share this with people and its reference to daffodils. The inspector spoke with the activities coordinator and found that they were very knowledgeable about peoples abilities and interests. This ensures that people are listened to and have the opportunity to give their views on what activities should take place. The activities coordinator has already introduced people to Chinese food by making this a themed activity and is looking at bringing other food into the home for people to try. We were told that a trip has been organised to take people to the garden centre for a talk on birds and the next day people were having a clothes party. The mobile library visits the home and people are able to choose what books they would like to read. A hairdresser visits the home twice weekly and people can choose to have their hair attended to. The local vicar visits the home about once a month and people are able to participate in Holy Communion if they wish. This ensures that peoples spiritual and religious needs are maintained. Care Homes for Older People Page 18 of 35 Evidence: People told us in their completed surveys: Now have full 25 hrs coordinator about time. After a period without an Activities Coordinator (the last one was excellent) a new lady was started this week (1st week in October). We have already had an outing to Webbs Garden Centre so the situation is looking helpful. After many months with out an activities coordinator we now have one and are looking forward to what activities she does with us and outings arranged. My father is not really able to actively take part but seems to get pleasure from seeing others taking part. On the day of our visit staff were seen to check with people what meal they would prefer and people were seen to sit freely where they would like to be. The lunchtime meals were observed and the atmosphere was calm and unhurried. Tables were nicely presented and staff were observed to assist people whilst maintaining their dignity. For example, staff did not stand over people whilst assisting them to eat but sat alongside and showed patience so that individuals could eat their meal at their own pace. The menus are on display in the home and if a person needs a pictorial style menu these can be made available. This is so people are not disadvantaged when choosing their preferred meal option. The home produces a rotating four week menu and this consists of two options for lunchtime plus side dishes of vegetables for people to choose, a desert and teatime meal. An example of one days options:Lunch, Fricassee Chicken in tarragon sauce or mixed bean goulash. Side vegetable dishes, garden peas, cauliflower and garlic and herb potatoes. Desert, rhubarb and apple crumble. Teatime, Soup, exotic fruit salad with clotted cream. We were told that the portions of fruit and vegetables offered to people are not recorded to ensure that individuals are offered five a day as recommended. Therefore consideration should be given to recording what fruit and vegetables are Care Homes for Older People Page 19 of 35 Evidence: offered to people in order to promote a healthy diet. People told us: Good selection staff encourage eating. The teas are bland lots of sandwiches which get a bit monotonous. Beans on toast or scambled egg occasionaly would make a nice change. I like very plain food not always available. The food provided is very good and the staff make sure my father gets the food he likes and can eat. There is an open visiting policy, which means that people can see their visitors as they choose and maintain relationships that are important to them. This is confirmed in the AQAA, We offer residents a choice of how they would like to spend their day. We have an open visiting policy which means that any family members or friends may visit the home at any time. People were seen to visit throughout the day and could choose how they wished to entertain their visitors. One visitor said, You are made to feel very welcome here. Staff told us: Meals are of a high standard. Residents are encouraged to treat this as their home. Activities provided for residents are varied and fun. Care Homes for Older People Page 20 of 35 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. The home has robust policies and procedures in place so that people are comfortable and supported in expressing their concerns and reporting abuse to ensure that people are protected and have their rights upheld. Evidence: The home has received three complaints in the last twelve months which have been resolved in the appropriate timescales satisfactorily. The registered manager confirmed in their completed AQAA, Even though complaints procedures are in each room we need to ensure all relatives and visitors are aware of it. There is evidence in the homes statement of purpose and service user guide detailing the complaints procedure. There is also a Whistle Blowing policy to encourage people to act appropriately without fear of discrimination. People spoken with on the day of our visit confirmed that they were aware of how to make a complaint or voice their concerns with the registered manager or carer and other people told us in their completed surveys: All staff helpful. My daughter has on occasions had cause to write to Alpha on my behalf and her letters have always been answered. I have never had cause to speak to the staff here Care Homes for Older People Page 21 of 35 Evidence: about anything but should the situation arise I know who to speak to and am confident that any of my concerns would be listened to and acted upon. My daughters when they visit. The staff and manager are always available to listen to our problems. There was evidence that staff have received training relating to issues of abuse. Staff spoken with on the day of our visit provided a good response to what they would do if they observed any form of abuse within the home. The home has one ongoing safeguarding event at this time and this has been referred to the local authority to investigate. However, we were told that staff have been advised to take a statement from the person living in the home. This practice does not follow safeguarding procedures in relation to protecting evidence gathered by an impartial person who does not work at the home. The registered manager acknowledged this but we are confident that they will ensure staff are made aware and are referred to safeguarding procedures and policies as a reminder with any training where necessary. Staff told us in their surveys:I would advise that they contact the care home manager or if she is available ask her to meet with them. Deals well and forwards to the manager. Care Homes for Older People Page 22 of 35 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. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment is continually being improved to ensure that it meets the needs of the people who live there. Evidence: A partial tour of the home was undertaken with the registered manager; we looked at communal areas and some bedrooms on the invitation of people who live at the home. The atmosphere was calm, relaxed and friendly, there were no unpleasant odours. We found lounges and dining areas have been improved for people who live at this home since the last inspection. There have been a number of improvements to the decor together with new furniture, making it a comfortable and pleasing environment for people to live in. All chairs have been arranged to promote social interaction as far as possible. The AQAA confirms this, The home is safe and well maintained and meets the service users individual and collective needs. People were seen moving around the home as they chose to. In the hallways we saw some paintings but the decor could be further improved by ensuring that the visual displays are tactile and meaningful to people who may be experiencing dementia. In particular by individuals bedroom doors where memory boxes could be placed together Care Homes for Older People Page 23 of 35 Evidence: with name plaques and or a picture which represents a persons interests. This will ensure people are able to identify their own room as independently as possible even if they have some memory difficulties. As at the previous inspection no bedroom doors have locks so that individuals can choose whether they want to hold a key and lock their rooms. Therefore it is recommended that locks for bedroom doors are considered so that peoples privacy and respect is upheld. Bedrooms seen were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. In one bedroom we were shown a picture frame that held a letter from the persons family member which they could read if they felt alone and or sad at any time. There are a number of assisted bathrooms. In one bathroom on the ground floor a wall cupboard was left open and there was hairdressing equipment in this which included a hairdryer. We said to the registered manager that this cupboard must be kept locked to protect people living in the home from hazardous items. This is particularly important as some individuals who experience dementia wander in and out of rooms. We were told by the registered manager and the handyman that a new boiler has been installed in the home which goes some way to resolve the issues that were present at the last inspection when the hot water supply to an identified wash hand basin in a toilet took a long time to be delivered and then it ran very hot. People told us:Downstairs always fresh. Upstairs occasionally stale - would understand cannot always maintain. Good overall. We have had a series of cleaners - the latest one started this week. As at the previous inspection there continues to be a slope permanently in place to access some bedrooms on the ground floor and this could create concerns in people trying to access their room and or bathroom. The registered manager confirmed to us that there are further refurbishment plans to include redesigning the reception area of the home and to include a nurses station within this. We were told by the registered manager that there have been improvements in the storage of cleaning materials since the last inspection. All materials are now stored in Care Homes for Older People Page 24 of 35 Evidence: the cellar area of the home and we were assured these are now labelled and stored appropriately. The garden area is well kept and a pleasant area for people to sit in or walk around as they choose. The handyman is very proud of their efforts in relation to transforming the garden area. We were shown before and after photographs with the handy man still continuing to have further plans for improvement. The environmental health officer has undertaken a visit in December 2008 and awarded the home four stars for cleanliness and hygiene, this is a very good rating. This means that the home should have good hygiene procedures in relation to food handling and this will minimise the risk of any cross contamination occurring. Staff told us in their surveys:The home is clean and generally a very pleasant place to be. The home is clean. I personally would like to up grade the garden area more. I have since I have been here managed to bring new life and look to the garden but I would like to do so much more. A new and preferably bigger lift would be great. Care Homes for Older People Page 25 of 35 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. People have confidence in the staff that care for them as recruitment practices are robust. There have been some improvements in training for staff members to ensure that staff are skilled to be able to meet the needs of people. Evidence: There are currently twenty four people living in the home, all with a variety of dependency levels and diverse needs. Assessment of staffing rotas and talking with the registered manager demonstrates that the home continue to maintain staffing levels. The staffing rotas confirm that bank staff are used but no agency staff to ensure consistency for the people living at the home. In addition to care and nursing staff the home also employs kitchen, domestic, laundry, maintenance and administrative staff to ensure that all aspects of peoples needs are met whilst living in the home. However, as at the previous inspection we received a mixture of comments from staff in their completed surveys which state:I feel that staffing levels for care staff could be increased as the demands put on carers is increasing. I do not feel this is good health and safety practice. Very often we are short staffed in my opinion considering the heavy workload. Care Homes for Older People Page 26 of 35 Evidence: Having enough staff very well organised. But only 4 carers in the evening shift this is not enough to meet residents needs. As previously reported these perceptions of insufficient staffing levels need to be taken into account by the registered manager and providers. The registered manager demonstrates a strong commitment to staff training and development. The registered manager told us that they are working hard to achieve the recommended standards of 50 in relation to staff having gained a National Vocational Qualification, (NVQ), Level 2. This should ensure that a knowledgeable and skilled workforce can meet peoples needs individually and collectively. A sample of staff personnel files were reviewed and were found to contain all of the relevant information including two written references, POVA first checks (Protection of Vulnerable Adults), CRB checks (Criminal Records Bureau). Staff have been provided with job descriptions so that they are aware of their responsibilities. We looked at the training matrix and found that this now needs some work so that it reflects all training undertaken with dates and is easy to follow so that refresher courses are completed in a timely manner. Review of peoples training indicated that this has improved and staff are receiving mandatory training together with more specialist training. For example, COSHH, (Control of Substances Hazardous to Health), food hygiene, health and safety, emergency first aid, infection control, moving and handling, fire training, medication training, knowledge of dementia, adult protection, nutrition care, and so on. This should ensure that staff have up to date training in order to care for people living in the home. Staff spoken with were knowledgeable about the people who were living in the home and what care was required. Staff were seen to interact well with people living at the home and the atmosphere was calm, friendly and relaxed. People told us:Always pleasant helpful. Given that there is a constant shortage of staff on the whole the staff are supportive. The staff are always pleasant and helpful. Care Homes for Older People Page 27 of 35 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is working hard to improve services and has plans to focus on person centred thinking, with people who live in the home shaping service delivery. Practice employed by management and staff go some way to promote individuals health, safety and welfare. Evidence: Julie Carpenter is the registered manager of Wayside, she has extensive experience in respect of working with older people and mental health. In the time Ms Carpenter has been at Wayside, she has been supported by the area manager, in making sure that improvements happen so that people receive the best possible outcomes. The registered manager has undertaken and passed her National Vocational Qualification, (NVQ), Level 4 and Registered Managers Award, (RMA). The registered manager is clear about further changes she would like to implement in order to ensure that the home is run in the best interests of people who live there. Care Homes for Older People Page 28 of 35 Evidence: The registered manager was seen to have an open door policy with staff asking questions, seeking advice or sharing information about people who live at the home. Also the registered manager was seen to greet people as she walked by them and it was clear to see that she has rapport with people on all levels. Staff told us in their surveys:Since starting at Wayside 11 months ago I have found it a most pleasurable place to work. I often look forward to getting here each morning such as the atmosphere and working conditions. Regular health and safety meetings work plans. I work as a bank care assistant so it is difficult to meet regularly but we meet as often as possible. Manager gives good support and guidance well. She runs well this home very well. Well organised. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment, (AQAA), and returned it to us. This gave us comprehensive information about the home, staff and people who live there, improvements and plans for further improvements. Throughout this report the reader will find lots of examples of what the registered manager told us. Responses from people who live at the home and staff surveys, observations and discussions throughout this visit show there is strong evidence that the ethos of the home is open and transparent with the views of both staff and people listened to, and valued. People living in the home, staff and visitors spoken to feel the management team are approachable, supportive and people are able to air their views in an open manner. In the AQAA the registered manager confirms, We must continue to deliver a high standard of care and address any issues no matter how small as soon as possible. We were told that staff meetings are now beginning to be held regularly so that people have the opportunity to voice their concerns and suggestions for improvements. The registered manager confirmed that she is now ensuring that all staff are completing supervision sessions which is an improvement from the last inspection. The registered manager is doing all staff supervisions herself at this time and is hoping to begin staff appraisals so that staff performances and practices can be assessed and feedback given. This practice will ensure that people living at Wayside are cared for by staff Care Homes for Older People Page 29 of 35 Evidence: whose practice is regularly assessed and improvements sought where necessary. The area manager visits the home and completes Regulation 26 visit reports on behalf of the registered provider, and these report on the quality of service being offered at the home. The registered manager and the organisation have a number of audits in place to monitor the service provided. For example, questionnaires are sent out, the nursing staff complete monthly medication checks to make sure staff are following good practices so that people are protected from risks and good outcomes are sought. We did not fully inspect the arrangements for the safekeeping and financial transactions of peoples personal monies but these were inspected at the last inspection and the registered manager did not state that there were any difficulties in this area. We reviewed the health and safety and maintenance checks and found that these had been undertaken in the home to ensure that the equipment was in safe and full working order. These records were very well presented and the handyman has even developed a matrix so that all ongoing of checks can be easily monitored and at a glance you can see when checks need to be completed again. This ensures a well maintained environment where people are safeguarded by ongoing inspections in respect of electricity, gas and water tests. Maintenance checks are also completed on the fire system and equipment so that people should be safe in the event of a fire occurring. Accident records were reviewed and some of these were completed appropriately with action taken. However, we found some did not have what action staff had taken when a person had experienced an injury. For example, a small skin cut on left eye but no action recorded and another, graze to skin but no action noted. Staff must ensure that action is completed when a person experiences an injury so that people are being safeguarded by staff practices which highlight people receiving the appropriate care and attention. We discussed the completing of accident records with the registered manager and we are confident that they will now ensure that staff are completing these appropriately. The registered manager and staff at Wayside have demonstrated that they are open and transparent in relation to all practices that may affect the safety and wellbeing of people who live in the home. For example, the CSCI have received Regulation 37 notifications which are a legal requirement and tell us about any incidents that happen within the home which may affect individuals health and wellbeiing. Care Homes for Older People Page 30 of 35 Care Homes for Older People Page 31 of 35 Are 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 Care Homes for Older People Page 32 of 35 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 1 3 13 Preadmission assessments must be completed with all the persons care needs so that staff are able to follow these. To ensure that people are not placed at risk by staff who do not know what their needs are and or how to meet these in order to protect individuals health and wellbeing. 06/03/2009 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 1 1 Statement of purpose should detail date when reviewed together with the fees charged so that people can be assured that all information is correct and they are able to consider the costs of living at Wayside. The home should ensure that all people living in the home and or their representatives are consulted and involved in relation to care planning processes so that people are able to make choices in relation to how their needs are met. Page 33 of 35 2 7 Care Homes for Older People 3 9 All prescribed creams and lotions should have a description on their containers instructing staff on which part of a persons body these need to be applied so that people are protected by staffs practices in relation to safe administration of medications. All prescribed creams and or lotions must be placed in lockable facilities in peoples bedrooms or the homes medication cabinet so that all people living in the home are protected. End of life care plans are sensitively drawn up with individuals and or their representatives to ensure that when the time comes people can be assured that their physical, medical, psychological and emotional needs are met in a way they prefer. Consideration given to record the fruit and vegetables that are offered to individuals on a daily basis to maintain the recommended five a day for a health diet. All staff are reminded and training as required in respect of whose responsibility it is to investigate any safeguarding incidents and how to protect evidence so that people living in the home can be confident that their rights will be upheld whilst investigations are completed. To ensure that all cupboards in communal areas are locked if they hold equipment and or other items that may pose a risk to a persons health and safety. Consideration must be made in relation to providing locks on all bedroom doors so that individuals have the choice of locking these as they wish and their privacy is maintained. To continue with maintaining supervision sessions and bring in an appraisal system so that people living in the home can be reassured that they are in safe hands. Accident records need to consistently confirm the action taken by staff to a persons injuries so that peoples health and welfare is promoted and protected. 4 9 5 11 6 15 7 18 8 19 9 24 10 36 11 38 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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