Inspection on 12/06/06 for Waterloo House

This inspection was carried out on 12th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Waterloo House 01/08/08

Waterloo House 22/06/07

Waterloo House 29/11/05

Waterloo House 29/09/05

Waterloo House 23/11/04

Waterloo House 23/06/04

Similar services:

22 Sandown Road

The Highlands

Turret Villa Retirement Home

Dilston College Of Further Education

West View House

Moor House

Prince Bishop Court

Park View (15)

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

CARE HOMES FOR OLDER PEOPLE Waterloo House Waterloo Road Blyth Northumberland NE24 1BY Lead Inspector Carole McKay Key Unannounced Inspection 12th and 13thJune 2006 13:30 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 Waterloo House DS0000000639.V290239.R01.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. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterloo House Address Waterloo Road Blyth Northumberland NE24 1BY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01670 351992 01670 356328 Mr Sewa Singh Gill Mrs Brenda Nicholson Care Home 46 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (33) Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: Waterloo House is a two storey adapted building. The home does not have gardens, though a small sitting out area is located near the front entrance to the home. Parking for a small number of cars is available at the front of the home within a general amenity area. The home is well located, in walking distance of the centre of Blyth. Bedrooms and communal areas are distributed across both floors and the office/reception area is immediately inside the main entrance hallway. The home has a large established staff team of ancillary, care, and senior care staff plus one manager Waterloo House is registered to care for older people and people with dementia who are also over 65. Fees for the home range from £356.30 to £361.24. Hairdressing, newspapers, taxis and private chiropody are charged for separately. This information was given on the 4th July 2006. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Manager was asked to provide some information prior to the visit to the service. During the visits the records were examined, a tour of the building was undertaken, the manager, some of the staff and service users were interviewed. Service users’ surveys were sent out. What the service does well: What has improved since the last inspection? A new assisted bath is available now for service users to use. The Manager said that this has made it much easier for service users Some of the fire safety arrangements have been improved. Other improvements are being made. Some of the bedroom carpets have been replaced. The home now has a special machine for deep cleaning of carpets. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 6 The Manager has audited the records to do with care and medication and these are being updated. An action plan has been produced for improvement to the premises and equipment in the home. An action plan has been produced to address the recommendations of the infection control specialist. Some of these improvements have been made already. The reports form the visits by the provider of the service now contain summaries of discussions with staff, service users, relatives and friends. The Manager said that the support she receives from representatives of the provider has improved. 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. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 7 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 Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. Service users have their needs assessed before they come to live at the home and during the first few weeks of living at the home. The home does not provide intermediate care. EVIDENCE: Service users’ files contain assessments. Care managers have provided these and the home has its own assessment for new service users. An assessment is carried out before and during the admission period. The home’s assessment is thorough and covers all aspects of dependency and well-being. The Manager has recently identified that the home needs a better risk assessment for falls. The Manager told the Inspector that she would be addressing this. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. All service users have a plan of care, which covers health and social needs. The home supports and safeguards people in using medication. Service users’ health is monitored and privacy is respected. EVIDENCE: The Manager, Brenda Nicholson, has recently checked through every service users’ plan of care. This task has identified that every service users has a plan of care and which ones are due to be updated. The task of updating these was being undertaken at the time of the inspection. The Manager and the staff involved in this said that this had been a very useful exercise. Some of the service users’ plans are signed by the service us As part of the assessment process the food and fluid intake of each service user is recorded for a short period following admission. This is to ensure good health as well as identifying likes and dislikes. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 10 The service user plans are comprehensive and very clearly written out. The actions staff are expected to take to deliver care are clearly described. For example, where a service user neglects to self-care, the plan describes how the staff should support the person with this. Routine health checks are arranged and recorded. Brenda Nicholson has carried out a thorough check of the medication policy and procedures. This task has identified good practice and ways of dealing with problem areas that are beyond the control of the home. Procedures for ensuring the safety of service users to do with medication are better since the system of checking was introduced. Where service users are self-medicating this is clearly assessed and support is provided. The staff involved in administering medication said that they appreciated the support that checking of the system gave them. All of the senior staff have finished a three-month training event in caring for people with dementia. Two of the staff said that they had found this very useful and had brought some of the practice they had learnt to their work place, to the benefit of service users. This should be reflected in the service users plans in the future. In the service user surveys, all the people who returned a survey said that they always receive the care and support they need. Service users can hold a key to their rooms. Some service users lock their doors. Staff said that health care treatment is carried out in service users’ rooms. Care staff help visiting nurses to with these arrangements. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is excellent. This judgment has been made from evidence gathered both during and before the visit to this service. The home meets service users’ social needs and expectations. It supports service users to maintain contact with friends and family. Independence and choice is encouraged. Some improvements to the presentation could be made, but the home offers flexible mealtimes and these are valued as part of service users’ health and social well-being. Support with social contact and relationships is given in a sensitive manner. EVIDENCE: People who use this service are nearly all local people from Blyth or Cramlington and the surrounding area. The home has a relaxed and friendly atmosphere. Service users said that they could get up when they want to and can spend their time where they prefer. For some people this is in the main lounge, for others this in their own room or in one of the smaller, quieter lounges. One lounge is set aside for people who like to smoke. Service users are found using all of these areas at different times of the day. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 12 Personal and social relationships are encouraged and the staff support service users with this in a sensitive way. Service users’ plans include social care. The home has a social activity programme and special events are arranged for seasonal celebrations. For example, an Easter Fayer was arranged and birthdays are celebrated if service users want this. Craft activity groups take place weekly. The independence of service users is valued and supported. One service user who has a business background, often answers the phone in the hallway. Service users are encouraged to go outside within reasonable risks to their safety. The Manager has concentrated on updating the risk assessments for these situations recently. The home receives a steady flow of visitors throughout the day and the evening. Visitors know and greet the Manager and the staff by name, and do not hesitate to enquire about their relatives’ well being. Some service users regularly attend church and day services in the community. These outings are allowed for in the routine of the home, by, for example, meals being kept and served later. Service users usually enjoy meals. The menus are very varied and a second choice is offered at every main course. During the meal an alternative is offered to service users who are not very hungry, or dislike part of the meal. This encourages service users to eat a small amount rather than leave the entire meal. The meal served on the day of the inspection was warm and tasty. Presentation of meals is poor due to worn table coverings, glasses and cutlery. Assistance with eating is given in a sensitive manner by the staff. As part of the assessment process the food and fluid intake of each service user is recorded for a short period following admission. This is to ensure good health as well as identifying likes and dislikes. The cook has a record of the likes and dislikes of the service users and can describe suitable arrangements for people with special dietary needs. A birthday cake was made on the day of the inspection for one of the service users. Service users who responded to the survey said that they always, usually or sometimes like to meals. One person commented that the meals “ are A1” Service users are encouraged to keep control of their own monies, with the assistance of the home, when necessary, for the safe keeping of cash. Good procedures are in place for supporting people to use their money as they wish but a the same time safeguarding their interests. Service users who prefer to Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 13 have money held for them, know how their money is looked after and how they can access it. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The service has good procedures for the protection of service user and will implement these when necessary. The complaints procedure is clear but the service users’ understanding of this should be checked out. EVIDENCE: The service has a clear complaints procedure and record. No complaints have been entered in the record since December 2003. The Commission for Social Care Inspection has received no complaints since the last inspection. Service users who responded to the survey said that they always or sometimes know who to speak to if they are unhappy and always or usually know how to make a complaint. The Manager, Brenda Nicholson has recently up dated the home’s policy and procedure for the protection of vulnerable adults. All care staff have undertaken workbook training in adult protection. The Manager has responded to an allegation. This was done promptly and the correct agencies were contacted. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The environment is improving but there are areas that still need attention. Bathing facilities are getting better with some work still to be done. The home is clean and infection control advice is being acted on. EVIDENCE: The upkeep of the premises and the facilities is not consistent. The new shower room has been taken out of use because of problems with drainage. Some of the furniture in the smaller lounges is very worn and marked. The Manager has undertaken an audit of the premises and an action plan has been produced for addressing these matters. The cupboards in the kitchen and shelving in the food cupboard are very worn. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 16 An action plan has been produced to address the recommendations of the infection control specialist. Some of these improvements have been made already. The raised flowerbeds to the front of the home are looking untidy and the lack of a proper bin store spoils the appearance of the entrance drive, when disused items are left out for collection. At the last inspection by the fire service several recommendations and requirements were made. The provider has addressed some of these and has an action plan for the longer-term improvements. Service users who responded to the survey said that the home was always fresh and clean. The home now has a carpet washing machine. No odours were detected in the home. The handyman continues to undertake an ongoing programme of redecoration. Two of the bedrooms have been decorated to good effect. Two rooms are being redecorated. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. Staffing levels are good and there is a commitment to staff training. Recruitment procedures need to be followed more closely. EVIDENCE: The home has good staffing levels. A senior team of staff, who are long serving and well-trained supports care staff. Two of the senior staff have delegated responsibilities for overseeing the care planning and medication arrangements. The home employs a team of ancillary staff. This includes; one handyman, two cooks, one kitchen assistant, one laundry assistant and three domestics. Recently the home has employed agency staff to cover for a night senior vacancy. The Manager said that she was advertising the post but was experiencing problems recruiting for nights. Where it is possible the existing staff do extra hours to cover vacancies. In the past year seven staff have left. Staff turnover is normally lower than this. The Manager said that most of the staff left to take up better-paid work. The duty rotas are organised so the staffing levels are concentrated around the care needs of service users. Where it is possible extra hours are provided to cover for service users’ appointments. Senior staff are on duty at each shift. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 18 Through the day four care staff are on duty as well as the Manager. During the night three waking care staff are on duty. The home has a contract with a training provider for induction and all mandatory training and refresher training. This is provided through an ongoing programme. 75 of the care staff have a National Vocational Qualification to Level 2 or above. Opportunities for specialised training are also provided. All of the senior staff and most of the care staff have finished a three-month training event in positive caring for people with dementia. Two of the staff said that they had found this very useful and had brought some of the practice they had learnt to their work place, to the benefit of service users. Most of the staff have recently attended a course in Equality and Diversity. Other training includes challenging behaviour, mental health, and supervisory management. Staff files contain application forms, references and criminal record bureau checks. The procedures for making sure that the most relevant references and checks are received on time are not working. Some persons have been employed without written references. There are gaps in some of the employment history on application forms. The Manager said that there had been some slippage of late due to pressure to fill vacancies. Staff terms and conditions are signed and held on file. The Manager has copies of the General Social Care Council Code of Conduct, which she issues to new employees. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. Positive management relationships are growing. The home now has a quality assurance system. The home is more prompt to respond inspection requirements. Some matters need to be followed up to do with recommendations from other agencies and to ensuring safety. EVIDENCE: The Manager, Brenda Nicholson, has been employed at the home for several years. Brenda has undertaken The Registered Managers’ Award. Recently Brenda has begun a quality assurance process for the home. The provider delegates his monthly visits to his representatives. Brenda has developed positive working relationships with these people. Reports are produced from these visits. These identify service users’ and staff opinions, as well as areas for improvement. The service produces written action plans also. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 20 Service users are encouraged to keep control of their own monies, with the assistance of the home, when necessary, for the safe keeping of cash. Good procedures are in place for supporting people to use their money as they wish but, at the same time, safeguarding their interests. Service users who prefer to have money held for them know how their money is looked after and how they can access it. The home has contracts for routine safety checks of fire and lifting equipment. These are up to date and the certificates are available. Where these checks result in recommendations or requirements the home is not always prompt in its response. For example the servicing report on the shaft lift made recommendations in April 2006, but the Manager was not clear about whether this matter was to be addressed. An accident involving the lift doors closing occurred shortly before this. Brenda Nicholson has contacted the lift servicing company to clarify if the recommendation would avoid this happening again. The Manager has undertaken a health and safety audit of the building and has identified that some wardrobes are not secured to the wall. The handyman is attending to this. The Manager has organised for the handyman to have up dated competent person fire training. The handyman provides instruction to staff and fire safety checks of the building. A record is kept of these. Risk assessments are carried for the building and for use of hazardous substances. These are recorded and up dated. At the last inspection by the fire service, several recommendations and requirements were made. The provider has addressed some of these and has an action plan for the longer-term improvements. New carpets were fitted in the main corridors last year. These are rucked in places. These could present trip hazard if not remedied. Staff receive First Aid, Food Hygiene and Moving and Handling training with updates. This is part of an on going training programme through a training organisation. Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 21 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 4 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 4 2 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 22 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 OP16 Regulation 22(5) Requirement Timescale for action 31/08/06 2 OP19 3 OP19 4 OP19 The registered Manager must ensure that a written copy of the complaints procedure is provided to each service user. 16 The registered persons must (2)(g) submit an action plan with 23(2)(b) T timescales showing replacement of the kitchen storage cupboards 23(2)(o) The registered person must arrange for regular maintenance of the grounds and improvements to screen the bin store area. 23 The registered person must replace the furniture which is very worn and damaged 23 An action plan to be submitted to the Inspector showing how the shower room will be improved and brought into use, with timescales. New timescale. This is outstanding original timescale 31/05/06 not met 31/08/06 30/09/06 31/08/06 5 OP21 31/08/06 31/08/06 6 OP29 19(1)(a) The registered Manager must ensure that recruitment DS0000000639.V290239.R01.S.doc Waterloo House Version 5.2 Page 23 7 OP38 23(4) procedures include two written references and cross check all information supplied to ensure that the home employs persons who are fit to work at the care home. The registered Manager must arrange for: • The rucked carpets to be re-laid • The recommendation of the lift engineer to be addressed. 31/08/06 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 Manager should identify suitable social activity for people who are isolated by their dementia. The Registered Manager should look at ways of including the good dementia care practice into the service users plans. The Registered Persons should renew table dressings glasses and cutlery. 2 3 OP7 OP15 Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Waterloo House DS0000000639.V290239.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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