Inspection on 11/06/07 for Waterside

This inspection was carried out on 11th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Waterside 14/06/06

Waterside 16/01/06

Waterside 08/09/05

Waterside 30/03/05

Waterside 16/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Waterside 40 Sumner Road London SE15 6LA Lead Inspector Alison Pritchard Unannounced Inspection 11.15a 11th June 2007 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterside Address 40 Sumner Road London SE15 6LA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company Name of registered manager Type of registration No. of places registered (if applicable) 0207 358 5780 0207 703 5206 marcia.forsythe@anchor.org.uk www.anchor.org.uk Anchor Trust Marcia Forsythe Care Home 48 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 48 service users aged 65 years and above, within the categories of OP and DE(E) 13th November 2006 Date of last inspection Brief Description of the Service: Waterside is a staffed home that provides residential care for elderly people who may also have dementia. The home was purpose built in 2003 and is divided into three units, each situated on a separate floor of the three-storey building. Each unit accommodates 16 residents and has a communal lounge and dining area. The ground and first floor units are for residents with medium dependency needs and the top floor is for residents with low dependency needs. There is adequate parking and access to bus routes. At the time of the inspection there was one vacancy at the home. The home provides an information pack about the service to any prospective resident and a copy of the most recent CSCI inspection report is available in the reception area on the ground floor of the home. Fees are £536.18 per week for residents with medium dependency needs and £510.10 per week for residents with low dependency needs. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over two days in June 2007. The inspection methods included observation of care practice, discussion with residents, relatives and staff, inspection of residents’ files and a range of other records. Care plans were checked on each floor of the home, and aspects of these residents’ care were examined by case tracking. A short period of time was spent observing residents in one lounge to understand more about life in the home. The inspector also observed a meeting during which information about residents’ progress and needs was handed between staff on different shifts. Involved professionals were sent survey forms so that they could contribute to the inspection process. The Inspector is grateful for the contributions of everyone who responded to surveys and all of the people who spoke to her during the inspection. A pre-inspection questionnaire was sent to the home prior to the visit asking for information. This questionnaire was returned to the CSCI. The CSCI also has access to information gathered through notifications from the home. All of this information has been taken into account in compiling this report. The Manager and other staff from the home facilitated the inspection visits; they were helpful and courteous throughout the process. The last key inspection of the home took place in June 2006; a random unannounced inspection took place in November 2006. This was to look at staffing arrangements and to review progress towards meeting some of the requirements and recommendations made in June 2006. In November it was found that progress had been made towards meeting the requirements and recommendations but there were some outstanding matters. Particular improvements which had been made were: • the appointment of a permanent manager of the home; • improved management arrangements throughout the week; • safer systems for dealing with residents’ money had been introduced; • there were no unpleasant odours in the home; • a wider range of activities was provided. These improvements have been maintained. What the service does well: The feedback received from residents, relatives and professionals about the home and the care provided was positive. Comments made by residents included: • ‘Complaints? What complaints? There is nothing to complain about.’ • ‘The staff are very good.’ • A comment about the manager - ‘she’s one of the best.’ Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 6 Comments made by relatives and friends included: • ‘I recommended this home to a friend.’ • ‘it is very clean.’ • Another person commented that when she visited she asked residents what they thought of the home, and they were all very happy there. Professionals commented that • The home makes appropriate referrals and takes note of the advice given. • The new manager has made a lot of improvements. Other things that were found to be strengths of the home were: • The information provided about the home for people who are thinking of coming to live there; • Staff respect residents’ right to privacy; • Residents were dressed well, appropriately for the weather and with regard to their dignity; • All of the bedrooms are single and have en-suite facilities; • The building is very clean, and the decorations and furnishings are homely and comfortable; • Residents’ clothes are individually laundered; • Medication is stored securely and staff have been trained in how to deal with medication safely. What has improved since the last inspection? There are four outcome areas that have had particular improvement since the last key inspection in June 2006. These improvements were noted to have begun in the random inspection of November 2006 and it is encouraging that this has been sustained. The improvements have been noted as follows: • A manager who is qualified and experienced for the job is now in post. She provides leadership for the home and during the inspection expressed commitment to improving standards of care there. A range of people expressed confidence in her work. • Procedures for dealing with residents’ finances have improved; • Residents expressed confidence that any complaints would be dealt with properly and records confirmed that this is the case; • Staff are now better supported in their work through regular supervision; • A senior member of staff is on duty in each of the three units during the day and a senior staff member is on duty between all the units at night time; • Repairs to the roof have been undertaken; • More staff have achieved NVQ2 and others are soon to begin training. Although the required standard of 50 of the care staff team holding the qualification has not yet been met, progress has been made towards this goal. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5. Standard 6 does not apply to this home as it does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential residents have enough information to make sure that they can decide about whether the placement is suitable. Assessments are carried out before a decision is made about the suitability of the home, but in some cases they not available on the residents’ files. Potential residents and people important to them can visit the home to assess whether it will be a suitable place for them to live. EVIDENCE: There is a service user guide and statement of purpose which describe the services the home provides and gives essential information to the potential resident. The document includes information about the fees payable at the home and the services residents can expect to receive for the payment. The written information provided to referrers and to potential residents is very clear about the range of needs the home can meet. The Manager confirmed that the home carries out its own assessments of potential residents and obtains copies of social work assessments to inform the Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 10 decision about whether they can meet the person’s needs. These documents need to be available to staff providing care as some files did not contain the information. Discussion with the Manager showed her awareness of the importance of considering residents’ cultural needs as part of the admission process to ensure that they can be addressed. Arrangements had been made for a newly admitted resident to continue attending a day centre which is appropriate for her culture. Residents who had recently been admitted and relatives and friends confirmed that they could visit before making a decision about moving to the home so that they could decide whether it was suitable. One person said she had spent some time on her visit talking to current residents and that had been encouraging as they told her they were happy living at the home. The contract includes a six week period which is a ‘trial period’ to ensure that the resident’s needs can be met and that the resident is happy with the services provided. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were aspects of care in this area which were satisfactory, particularly in the attention paid to residents’ privacy, to ensure that they are appropriately dressed, with regard to their dignity and in encouraging people to maintain their independence. However, improvements are required to the systems to tell staff about residents’ health care needs and to monitor that these are being met. The need for improvements in this area is long standing. A new care planning system is being introduced and should contribute to improvements in the recording of residents’ health, personal and social care needs. The systems to keep residents safe will be improved by ensuring that temporary staff receive sufficient information about residents and their needs. EVIDENCE: Residents and their relatives said that the care provided is good and that they are satisfied with the home. One resident compared Waterside favourably with her previous placement and said that she felt that her needs are well met. Anchor Care is in the process of introducing a new format for care planning in this and other residential homes. The new care planning format should bring considerable improvements. Four care plans were examined, three in particular Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 12 depth. The plans varied in quality and detail. The care plans covered an appropriate range of residents’ personal care needs and there was information that plans were being reviewed. Little information was recorded about residents’ social interests, needs and how they might be addressed. One file did not include a photograph of the resident, some details of residents’ family and social histories were included in files but these were fairly scant. All of the residents were well dressed, wearing appropriate footwear and their hair was neat. There is a hairdressing room in the home and a hairdresser visits regularly. Residents confirmed that they are assisted to be as independent as possible but that help was available when it was needed. The CSCI had been informed of an incident in which a resident had left the home alone although it had been judged unsafe for her to do so. A member of staff had seen the resident leave, and was then alerted to the risks by another resident. It was explained that the staff member was a temporary worker and was not familiar with the resident who had been admitted since the worker’s last shift. It is important that all staff receive adequate information about the residents’ needs, behaviour that may present risks and action to ensure residents’ safety at all times. Residents said that they are able to see the GP when they need to do, either at the doctor’s weekly visits to the home or at other times as necessary. In the file of a resident who had experienced a serious health problem there were full and detailed notes of liaison with health care professionals and the outcome of appointments. This indicated that careful attention had been paid to health care needs in this respect. However this was not reflected in another file, which had a gap in the recording between 14.3.06 and 20.4.07. A requirement, which has been in place for more than a year, is that there must be clear plans, to address residents’ health care needs and these must be monitored on a daily basis. There was evidence that residents’ health care needs, were not being adequately met. • In one file the ‘nutritional profile’ had not been amended to include guidelines issued by a speech and language therapist. These guidelines included the need for drinks to be thickened. The information about the new guidelines had not been shared properly to ensure that all staff were informed of this requirement. The product, which was said to be used for thickening drinks, was labelled with the name of another person and it was difficult to establish where spare stocks were stored. • This resident was said to have no dentures, as they had been lost when the person had stayed in hospital. Although the inspector was told that mouthwash was being used to attend to the resident’s oral care, none was available in the person’s room and the information given to the inspector was that none had been available for three days. • In another case a resident was noted to have diabetes, which was controlled by diet, so careful monitoring of the person’s food intake is Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 13 required. The inspector noted at a meal time that this person had eaten little. This was not included either in the daily notes made on the person’s file, or in the information passed on to staff at the handover meeting. The requirement remains in place and must be the subject of further attention to make sure residents’ health is promoted. These issues were shared with the Manager of the home who agreed to address them and ensure that action was taken to ensure residents’ safety and well being. Feedback from a health care professional was that the home makes appropriate referrals for assistance. The person also commented that they felt welcomed to the home, which was described as having a friendly atmosphere. On each of the three units medication is stored safely and securely. Staff responsible for administering medication have received training. A member of staff observed administering medication was seen to do so carefully, checking the instructions and ensuring that residents had a drink of water. Most medication is administered using a ‘blister pack’ system. A sample of medication and records on one floor was checked. Each resident’s record is designed to have a sheet including a photograph of the resident and a brief medical history. In some cases the photograph was missing and in some the medical history was incomplete or missing. One item of medication had an instruction on the administration record ‘as directed’. The member of staff who assisted the inspector could explain when the item would be needed, however there were no written details in the file about the circumstances in which the medication would be required. Residents were observed to be treated with warmth and respect. Residents confirmed that their privacy is observed and they are able to choose to spend time alone in their rooms if they wish to do so. Staff were seen to knock on residents’ bedroom doors and wait to be invited in before entering. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements in the range of activities available for residents. Further improvements are planned, particularly in the activities available for people with dementia. The menu is under review so that residents’ needs and preferences can be included. Improvements to the organisation of meal times will ensure that residents are enabled to make realistic choices. EVIDENCE: An activity co-ordinator is in post and an activity programme for the home has been established. A professional who responded on a survey commented that the range of activities is ‘much improved’. During the inspection a number of activities went on including a ball game, a game of quoits and a sing along session. Some residents said how much they were looking forward to a trip on the London Eye, which had been arranged for later in the week. A resident told the inspector that he enjoys helping to tend the garden of the home and his work at a local gardening project. Other activities include quizzes, bingo, topical discussions, reminiscence work and celebrations of special days, such as St Patrick’s Day. There was agreement that there is scope to develop further activities for residents who have dementia. Arrangements have been made for the activity Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 15 co-ordinators who work in the Anchor homes to have training and information from a Clinical Psychiatrist. It is anticipated that the new care plan format will also assist with this through having more information about residents’ social histories and interests. Southwark Library Services bring books, films and music to the home for the residents and there were newspapers and magazines available in the home. A member of staff was seen to put on a CD of music that a resident particularly liked to sing along to and this showed kindness and knowledge of residents’ interests. Staff were seen chatting to residents and showed that they see this as an important part of their work. Dial a Ride, a community transport service, has been arranged for residents to increase their ability to access community resources. There were plans to have more trips out for residents both in the local area and further, for example, to Kew Gardens. Residents are supported to follow religions if they wish. People from local churches come to the home, including the Church of England, Roman Catholic and Pentecostal churches. Some residents attend day centres which reflect their cultural needs and the manager demonstrated commitment to ensuring that these needs are addressed properly. Activities are discussed at the residents’ meetings which are held monthly. Other issues discussed include residents’ views of the laundry service, the menu and care issues. Relatives and friends can visit freely at all reasonable times. A range of people commented that they are made to feel welcome by staff. Visitors can, by prior arrangement, use the visitors’ room to stay overnight. An advocacy service has been involved with the home. Residents are encouraged to bring personal items with them to the home and the bedrooms reflected this. The meals are prepared according to a six-week rolling menu. A new chef manager has been appointed and the menu is under review. During the inspection a meeting was held with residents to discuss their preferences so that they can be included in the amended menu. The manager is keen to ensure that the menu reflects the range of residents’ preferences and needs, including those which arise from their culture, religion and health. Dietary restrictions, which arise from one resident’s religion, were noted in a document in the person’s file, but not reflected in a document called ‘nutritional profile’, and staff demonstrated inadequate awareness of these dietary requirements. There were a number of ways that the arrangements for meals prevented residents making choices. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 16 • • • • The menu includes alternative meals but the printed menu did not include meals which reflect residents’ cultures although it was reported that they are provided. It was unclear how residents are made aware of this. Menus on tables on two of the units had not been changed so the meals that were served did not match the menus displayed. At the evening meal residents were served soup, described on the menu as ‘soup of the day’. Although there was a procedure for the kitchen to inform care staff what kind of soup had been prepared this had not been followed and residents could not be given information to make a realistic choice. It was observed during the inspection that residents were not able to help themselves to gravy as it was taken round by staff in one large jug. This was raised with the manager who agreed that this was unsatisfactory and provided an assurance that individual jugs will be provided for each table. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies for complaints and dealing with adult abuse contribute to the protection of residents. EVIDENCE: The complaints procedure is clear and available in the home’s statement of purpose. Copies of the procedure are also displayed in the hallway of the home and on the three units. There were three complaints in the last twelve months, all of which were substantiated. Records of complaints showed that they had been responded to appropriately by the manager and action has been taken to address issues of concern. Residents are reminded about the complaints procedure at residents’ meetings. Some training has been undertaken in adult protection issues over the last year and further training is planned as there remain some members of the team who have not had formal training about these issues. The issues have been discussed both at team meetings and in supervision sessions. The home has co-operated with adult protection investigations. When short fallings in procedure and practise have been identified the manager has taken action to address the concerns. Residents expressed confidence that, if they had a concern, staff or the manager would deal it with properly. Staff are provided with information about ‘whistle-blowing’ and copies of a leaflet about adult protection issues are available on notice boards throughout the building. Employment contracts specify the standards of behaviour expected of staff including that they must not benefit from residents in the form of gifts or money. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All areas of the home are attractive, homely and comfortable for residents. EVIDENCE: The home is attractively decorated and comfortable. The facilities provided for residents are very good. Each bedroom is single with en suite facilities including a shower. Residents had been able to either furnish or decorate their bedrooms to their own taste. The standard furnishings provided are of good quality. There are plans to fit an ‘air-flo’ system to assist with cooling the building in warm weather. The layout of the home, with three separate units, each for 16 service users, allows a homely feel to develop within each unit. Each unit has a kitchen, lounge and dining area and there is plenty of space for residents. There are also rooms which can be used for activities for all residents to get together. There is a visitors room available which can, by prior arrangement, be used for visitors to stay overnight Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 19 There is a garden to the side of the home, it is equipped with garden furniture including sunshades. Residents have the opportunity to look after the garden and one resident said this is something he particularly enjoys. There is a roof terrace on the first floor of the home. The terrace is currently unavailable for use as repairs are underway. The Manager has undertaken a risk assessment of the area to ensure that, when the area can be available for use again, any risks to residents are minimised. One of the safety precautions to be taken is to ensure that residents are always accompanied by staff on the terrace. In the meantime the door to the terrace is locked and cannot be accessed by residents. The building is very clean and there were no unpleasant odours at the time of the inspection. A small laundry is available for any residents who wish to do their own washing. Residents’ laundry is done individually in a larger wellequipped central laundry. The inspector was told that changes to the systems for dealing with laundry have led to improvements and residents’ clothing is returned to the residents and incidents of clothes being lost are now rare. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall staff numbers are satisfactory although the use of agency staff can reduce the consistency of care. Although progress has been made in reaching an adequately qualified staff team the required standard is not yet met. There is commitment from the management of the home to continue working towards the goal. The staff numbers are generally adequate, but need to be monitored in one unit in the afternoon and evening to ensure that the residents’ needs continue to be adequately met. EVIDENCE: In addition to the Registered Manager the care staff team consists of a Deputy Manager, seven team leaders, six care co-ordinators, an activities co-ordinator and thirty-five care assistants. An administrator assists with general management duties. The ancillary staff team is made up of a chef manager and deputy, two catering assistants and a housekeeping team, including a handyman and one person who works in the laundry. The staffing levels are as follows: • On each of the two units providing care for sixteen residents with high care needs (Lavender and Bridgewater) there is a senior member of staff on duty throughout the day, accompanied by three care staff in the morning and two care staff in the afternoon and evening. • On Avon unit, which provides care for sixteen residents with a lower level of need, there is a senior member of staff on duty throughout the day, Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 21 • accompanied by two care staff in the morning and one care staff in the afternoon and evening. At night time there is a senior member of staff on duty, responsible for the whole building, accompanied by four care staff, all of these staff do waking night duty. There are some vacancies on the staff team which were not being recruited to by Anchor Trust. These gaps were filled by the use of bank staff and agency workers. Over an eight week period thirty six shifts had been covered by eight different agency staff. While efforts are made to ensure that the agency workers are given an induction to the needs of the residents and that familiar staff are booked for a number of shifts this does not aid consistency of care. At a lunch time meal it was observed that one permanent member of staff was accompanied on the shift by a bank worker, who had previously worked at the home, and an agency worker who was working her first shift. It was observed that the agency worker was given the task of asking residents which meal they would like to eat. Residents were not familiar with or to the agency worker and communication was hampered as a result of this. The shifts are arranged to ensure that there is adequate time to allow information to be passed between staff at a ‘handover meeting’. Observation of a handover meeting showed that, as noted above in relation to health care needs, further care should be taken to ensure that appropriate details are passed between shifts to allow consistent care to be provided. Eleven of the total care staff team are qualified to NVQ level 2 or above, this is 35 of the team and does not meet the standard required that 50 of care staff hold the qualification. Further NVQ training is planned for the coming year. The team have undertaken a range of training in the last year, including health and safety issues (including fire safety, first aid, back care and the use of chemicals) and care issues including dementia care, death and dying, adult protection, and leading an exercise group for older people. Further training is planned in adult protection, visual awareness, dining with dignity, managing continence, medication administration (refresher), dementia awareness and health and safety. A sample of three recruitment records was checked. Just one issue was identified as needing attention. One of the staff files did not include evidence that an Enhanced Criminal Records Bureau check was carried out. This was pointed out to the Manager who agreed to ensure that the matter was addressed. In all other respects the recruitment procedures and practise was satisfactory. New staff go through an appropriate induction and must complete a probationary period successfully prior to their appointment being confirmed. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management systems in the home have improved since the appointment of a permanent manager in November 2006. There are a number of effective quality assurance systems in place which take into account the views of residents and relatives. Health and safety is well managed in the home. EVIDENCE: The manager was appointed to her post in November 2006. The manager had applied to the CSCI to be registered under the Care Standards Act 2000 and was registered shortly before the inspection took place. She is appropriately qualified and experienced for the role. The manager has effected a number of positive changes in the home and this was recognised in the feedback received from residents, relatives, staff and professionals. One resident described her as ‘one of the best’, and a professional commented that the management team was respected in the Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 23 home. The manager demonstrated knowledge commitment to ensuring that their needs are met. of the residents and There are a number of quality assurance systems used to ensure to monitor the quality of the service. Senior managers from Anchor Homes visit the Waterside each month and complete a report of their findings. The visits include discussion with residents, visitors and staff as well as an assessment of the premises and examination of records. An annual survey of relatives and residents is conducted across all of the Anchor Homes. The results were published in a report made available to the CSCI. In addition a quality assurance system called ‘Hospitality Assured’ is used at the home. It includes a range of quality assessment measures including a monthly survey of residents’ views on the personal care provided; the approach of staff; catering and mealtimes; housekeeping and GP services. Relatives and other visitors are also asked to complete questionnaires. The monthly residents’ meetings are another important aspect of ensuring that the home meets their needs and preferences. The manager / owner does not act as appointee for handling the financial affairs of any of the residents. Residents may keep a small amount of money at the home and draw on it as they wish. The records of these are subject to regular checks by the manager. The procedure to be followed when staff use cash on residents’ behalf has been improved and is now safer. There is a system in place to ensure that staff receive a minimum of six supervision sessions a year. Care staff confirmed that supervision is arranged, that a range of issues is discussed, including training needs and that staff meetings are also a source of support and information. Records of these sessions were seen on staff files and the manager has a monitoring system to ensure that the sessions take place at the required frequency. Health and safety records were in good order and showed that appropriate checks are carried out at appropriate intervals. Improvements to the food preparation areas and systems recommended by the Environmental Health authority were made soon after their inspection. A fire risk assessment was dated 2nd November 2006; weekly checks of the fire system are made and the last fire drill was conducted at the end of March 2007. Further training in fire safety issues was arranged to be completed by the end of June 2007. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 4 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 3 Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(2) Requirement The Registered Person must ensure that staff have access to information about the residents’ assessed care needs. Preadmission assessment information must be available on residents’ files. Timescale for action 01/10/07 2. OP7OP8 12(1) (a)(b) The Registered Person must 01/10/07 ensure that clear plans are in place to address service users healthcare needs and that these needs are monitored on a daily basis. This is a restated requirement. Previous timescale of 31/12/06 not met. 3. OP7 OP8 OP15 12(1)(a) The Registered Person must 01/10/07 ensure that the nutritional needs of each service users are recorded and addressed. This must include the nature of any assistance required with eating a meal and any specific dietary needs such as diabetes. This is a restated requirement. Previous timescale of 31/12/06 Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 26 not met. 4. OP7 18(1)(b) The Registered Person must 01/08/07 ensure residents’ safety at all times. In order to do so, all staff, including temporary staff, must be given adequate information about the residents’ needs, behaviour that may present risks and action required in response. The Registered Person must 01/10/07 keep a record of all health professionals involved in the care of each resident. The Registered Person must 01/08/07 make sure that items to meet residents’ health care needs are available for use in sufficient quantities. The Registered Person must 01/08/07 make sure that information about residents’ health care needs is properly passed between staff so that they are aware of their needs and how to meet them. The systems to be improved include both written information on files and information passed on at handover meetings. This will make sure that staff have sufficient information to meet residents’ health care needs. The Registered Person must 01/10/07 ensure that staff maintain an accurate record of the outcomes of healthcare appointments in individual care records rather than in daily logs. The Registered Person must 01/10/07 implement a medication profile for each resident, listing the medication each resident is DS0000052132.V340975.R02.S.doc Version 5.2 Page 27 5. OP7 OP8 17(1)(a) sch3 para3(m) 12(1)(a) 6. OP8 7. OP8 12(1)(a) 8. OP8 17(1)(a) sch3 para3(m) 9. OP9 13(2) Waterside prescribed, what it is for, possible side effects, and action to be taken in the event of missed doses. 10. OP9 13(2) The Registered Person must 01/10/07 ensure that the medication files contain written details of the circumstances in which medication given on an ‘as needed’ basis will be needed. This will help to make sure that staff have sufficient information to meet residents’ health care needs. The registered person must 01/10/07 provide staff training in providing activities for residents with dementia. The Registered Person must 01/10/07 provide a range of activities that take into account the cultural interests of all residents the home. The Registered Person must 01/10/07 ensure that meals are arranged so that residents can make choices. The Registered Person must 01/12/07 ensure that a minimum ratio of 50 of care staff have an NVQ level 2 or equivalent. This ratio is inclusive of agency and relief staff. This is a restated requirement. Previous timescale of 31/03/07 not met 15. OP29 19(1) (b)(i) The Registered Person must 01/10/07 ensure that residents are protected by efficient staff recruitment procedures. All staff recruitment files must include DS0000052132.V340975.R02.S.doc Version 5.2 Page 28 11. OP12 18(1)(c) 12. OP12 12(4)(b) 13. OP15 16(2)(m) 14. OP28 18(1)(a) Waterside 16. OP33 24(1) evidence of satisfactory enhanced criminal records bureau checks. The Registered Person must 01/10/07 develop an annual development plan for the home, based on a systematic cycle of planning action- review, reflecting aims and outcomes for residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The registered person should consider introducing life story documents to enable staff to have a better understanding of leisure interests and past employment. This recommendation was not met. 2. OP19 The registered person should provide shading from the sun on the roof terrace and in the garden. The roof terrace is not in use currently. 3. OP19 The registered person should consider ways in which the first floor roof terrace, which is overlooked by the neighbouring housing estate, can be made into a more private area for residents to sit. The roof terrace is not in use currently. 4. OP33 The registered person should canvas the views of all stakeholders involved in the service. For example, the views of GPs, nurses and advocacy services. This recommendation was not met. Waterside DS0000052132.V340975.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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