Inspection on 12/09/05 for Waterloo House

This inspection was carried out on 12th September 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Waterloo House 20/09/07

Waterloo House 07/06/06

Waterloo House 25/04/05

Waterloo House 06/09/04

Waterloo House 04/05/04

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOMES FOR OLDER PEOPLE Waterloo House Walesby Road Market Rasen Lincs LN8 3EX Lead Inspector Doug Tunmore Unannounced 12 September 2005 09:00 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 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 C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Waterloo House Address Walesby Road Market Rasen Lincs LN8 3EX 01673 842343 01673 842925 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Platinum Care (Lincoln) Ltd Mrs Isobel Elizabeth Sugden Care Home 35 Category(ies) of Dementia - over 65 yrs of age (DE(E)) 0 5 registration, with number Old Age (OP) - 30 of places Mental Disorder, excluding learning disability or dementia - over 65 yrs of age (MD(E)) - 5 Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The total number of service users in categories DE(E) & MD(E) together will not exceed 5. Date of last inspection 25 April 2005 Brief Description of the Service: The home is in a residential area of Market Rasen, within five minutes walking distance of the local shops and amenities. The home provides personal care for up to thirty five residents in the category of mental disorder/dementia (older people) and old age, over sixty five years of age. Bedrooms are located on the ground and first floors, with lounge areas being available on both floors and the dining room is located on the ground floor. The rooms on the first floor are accessed by a shaft lift. The homes statement of purpose makes reference to maintaining the privacy, dignity, freedom of choice, citizens rights and the fulfilment of each resident. The service users guide provides information of the services made available to residents at this home. Website Address: www.waterloohousecarehome.co.uk Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 9.20 am. The main method of inspection used was called case tracking, which involved looking at policies and procedures relating to maintaining the safety and general welfare of residents. Residents were spoken to as well as visitors, the manager and care staff and observations were made of care practices. A partial tour of the home took place. What the service does well: What has improved since the last inspection? What they could do better: Files seen showed that not all care staff have undertaken annual appraisals and that the format used for supervision needs to be formalised, addressing all those aspect required for the supervision and recording of this process. Not all hot water taps have thermostatic valves to protect residents from potential scalding. Emergency lighting has not been tested monthly to ensure that they are in working order in case of an emergency. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 6 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 C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 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 standard(s) The key outcomes were assessed at the last inspection. EVIDENCE: Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 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 standard(s) 10 Residents were seen to be treated with respect and dignity. EVIDENCE: The home has a personal care policy, which gives guidance to care workers when undertaking intimate care tasks with residents. The minutes of the last staff meeting were seen and showed that the homes policy on personal care was discussed with all those who attended. One care worker who was spoken to was sensitive to the more personal care needs of service users and described the best practice in ensuring that service users dignity is maintained when bathing or toileting. The inspector observed that staff gave support to residents during lunch with eating their food in a sensitive manner whilst also maintaining their dignity. Residents stated that ‘ all staff are very decent’; ‘all staff seem to be okay and get on and do the things that are necessary’. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 10 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 standard(s) 15 The food is home cooked and caters for individual residents dietary needs. EVIDENCE: The inspector joined service users for lunch who said that the food at this home is varied and delicious. The inspector found that on the day of the inspection that the food was well prepared, hot and tasty. Observations made by the inspector were that staff are at hand in adequate numbers to help and encourage service users to eat their food. Service users spoken to also said that liquid refreshments and biscuits are made available throughout the day. Dietary information on individual residents is made available to the cook for her information. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 11 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 standard(s) The key outcomes were assessed at the last inspection. EVIDENCE: Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 24, 25 & 26 Residents can keep their possessions safe in their rooms. The home needs to ensure the safety of residents from scalding by fitting thermostatic valves. The home is clean, comfortable and pleasant. EVIDENCE: Residents confirmed that they had locks on their bedroom doors and a lockable facility in their rooms to keep their valuables safe. Residents’ files evidenced that individual risk assessments had been undertaken relating to the safety of residents in the homes environment. Files seen showed that thermostatic valves have been fitted to a number of hot water outlets. However, three hot water taps were tested with a bathroom tap temperature being 53 Degrees centigrade. All hot water outlets must be controlled at a temperature of 43 degrees centigrade to protect residents from possible scalding. The home employs two cleaners and a partial tour of the home found that it was clean and tidy having a pleasant odour. A visitor stated that he had not detected unpleasant odours and ‘the vacuum cleaner is always busy cleaning the carpets’. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28,29 & 30 Residents are protected by robust recruitment practices. Residents benefit from a staff team who are well trained and work well together and compliment each others skills. EVIDENCE: Two personnel file seen contained CRB checks (Criminal Record Bureau), references, application forms and interview notes. All care workers have been given and signed for The General Social Care Council Codes of Practice, which sets out their responsibilities as care workers looking after vulnerable adults. The homes training record was seen which showed that, twelve care workers had NVQ (National Vocational Qualifications) level 2, four of these having NVQ 3, two workers are currently undertaking NVQ level 2 training. The registered manager has NVQ 3 and is close to completing the Registered Managers Award. Statutory training such as fire training, moving and handling and first aid are undertaken at this home. Other training undertaken included; food hygiene, first aid and adult protection. One care worker demonstrated a clear understanding of her role and responsibilities. She confirmed that she has undertaken NVQ training levels 3 and 4. The home more than meets the standard for 50 of staff to be trained to NVQ level 2 by 2005. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 14 Comments received during this inspection were that ‘when we use the call buzzer, they (the staff) come quite quickly’. The duty rota showed that adequate staff numbers are on duty to meet the needs of residents in this home. There are two waking night staff with a senior who can be contacted if required. A visitor stated that he feels ‘that there are enough staff on duty and has not seen anybody not attended to’. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35,36 & 38 Records seen show that residents’ health and general welfare and safety are promoted. The home ensures that that the residents have the opportunity to voice their views and opinions. Accurate records are kept of residents’ monies. All care workers have not had annual appraisals undertaken. EVIDENCE: The home conducts a quality assurance report. The 2005 report is available to residents and relatives/visitors as is the last Commission for Social Care Inspection report in the reception area of the home. The minutes of the last residents meeting held in August 2005 showed that residents are encouraged to voice their views and are actively involved in issues relating to the running of the home. Residents seen at lunchtime said that the manager is very approachable and they see her in the home every day. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 16 The home only deals with personal allowances of residents, which are kept at the home. All other monies relating to funding are paid into the homes bank account on a standing order by relatives. Residents’ personal allowances were seen and it was found that an accurate record is kept and receipts are available for any monies spent, with signatures also obtained from the hairdresser or the visiting chiropodist. A visitor commented that he dealt with his mother’s monies. One resident confirmed that she keeps her own petty cash and that she can get money when she wants it. Supervision of care staff are undertaken on a regular basis by the manager and other senior staff. Care workers files showed that supervision has been undertaken. However, not all workers have had their annual appraisals. These must be undertaken to ensure that agreed targets have been met. One carer confirmed that supervision is undertaken with the care manager or the deputy manager and that her appraisal has been completed. There are a range of policies and procedures available in the home relating to fire safety and fire risk assessments. There was also evidence that fire alarm, fire drills have been undertaken. However, emergency lighting checks must be carried out monthly the last test was carried out on the 4/07/05. Care staff also receive fire training as part of the homes initial training and as a regular training event. Certificates were available showing that the shaft lift, bath hoists and wheelchairs had been serviced. All wheelchairs seen on the day of the inspection had footplates, which were in use. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x 3 2 3 STAFFING Standard No Score 27 3 28 x 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 4 x 3 2 x 2 Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 18 no Are there any outstanding requirements from the last inspection? 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 25 Regulation 13(4) Requirement Timescale for action 15/01/05 2. 3. 36 38 18 4(a)(c) It is a requirement that domestic hot water oulets must be controlled at a temeperature of 43 degrees centigarde to avoid the risk of scalding of residents. It is acknowledged that a large number of valves have been fitted by the home. (Timescale of 25/03/05 not met). The home must carryout annual 15/01/05 appraisals on all staff as per their policies and procedures. The registerd person must 15/01/05 ensure that emergency lighting is checked to ensure the safety of 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 36 Good Practice Recommendations The home should have a formalised supervision form addressing all those aspects required for the supervision and recording of this process. Waterloo House C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Unity House, The Point Weaver Road, off Whisby Road Lincoln LN6 3QN 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 C53 CO4 S2470 Waterloo House V245712 120905 Stage 4.doc Version 1.40 Page 20 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!