Inspection on 14/07/08 for Waterside Care Centre

This inspection was carried out on 14th July 2008.

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

Waterside Care Centre 31/12/09

Waterside Care Centre 20/07/09

Waterside Care Centre 18/04/07

Waterside Care Centre 22/05/06

Waterside Care Centre 18/01/06

Waterside Care Centre 01/06/05

Waterside Care Centre 09/11/04

Waterside Care Centre 06/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Waterside Care Centre 60 Dudley Road Tipton West Midlands DY4 8EE Lead Inspector Yvette Delaney Unannounced Inspection 14th July 2008 09:30 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 Waterside Care Centre DS0000004824.V371972.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. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterside Care Centre Address 60 Dudley Road Tipton West Midlands DY4 8EE 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) 0121 520 2428 0121 520 2448 dalwoods@bupa.com www.bupa.com BUPA Care Homes (AKW) Ltd Mrs Frances Taylor Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2007 Brief Description of the Service: Waterside Care Centre is a purpose built Home, opened in 1997, which provides 60 beds for frail older people who require nursing care. The Home is located on the main road between Dudley and Tipton, with public transport and local amenities easily accessible. Accommodation is provided on two floors; all bedrooms are single and have en-suite facilities. There is a lounge/dining rooms on both floors and a number of small quiet sitting areas. The Home offers intermediate/rehabilitation care for up to ten residents. A team of professionals, which include Physiotherapists and Occupational health Therapists visiting each week to assess and assist this care. There are pleasant views of the Black Country canal at the rear of the Home and the Black Country Museum is approximately 300 metres away. There is car parking to the front of the Home and gardens and patio areas to the rear. The current scale of charges are £456 - £658.35 per week dependent on the needs and dependency of people admitted to the home. Hairdressing, newspapers, toiletries and the services of a Chiropodist are charged separately. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate outcomes. This was a key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. . Questionnaires were completed and returned by eight people living in the home, a relative and three members of staff, giving their views of the service. An annual quality assurance assessment (AQAA) was completed and returned by the manager in time for the inspection. Information provided in the annual assessment by the home manager has been used to inform this report. The inspection included meeting most people living at the home and case tracking the needs of three people. This involves looking at people’s care plans and health records and checking how their needs are met in practice. Other people’s files were also looked at in part to verify the healthcare support being provided at the home. Discussions took place with some of the people that live at the home in addition to care staff and the home manager. A number of records, such as care plans, complaints records, staff training records and fire safety and other health and safety records were also sampled for information as part of this inspection. What the service does well: Relatives and residents said: “Mum is cared for and is made comfortable.” “They treat my brother and residents with dignity.” “Yes the care given makes mom’s life more happy and comfortable.” People living in the home are actively encouraged and supported to maintain family contact, friendships and relationships. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 6 People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. What has improved since the last inspection? What they could do better: The care home must be conducted in a manner which respects the privacy and dignity of service users. Staff should be aware of how to talk to people in their care. There must be sufficient staff on duty at all times to ensure that resident’s needs are met safely. The management of people during the end stages of their life and at the time of their death must be reviewed to ensure that staff are following appropriate procedures and making decisions within their professional role. This will Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 7 ensure that informed decisions are made based on medical advice and in the best interests of residents. A review of activities in the home should be carried out to ensure that residents receive mental and physical stimulation that meets their individual needs and supports their enduring interests. 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 Care Centre DS0000004824.V371972.R01.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 Care Centre DS0000004824.V371972.R01.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 and 6 Quality in this outcome area is good. People who are considering moving into the home benefit from having information about the home and have their care needs assessed so that they can be sure the home can meet their needs. Designated staff provide skilled intermediate care maximising a persons opportunity for rehabilitation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide were seen and read at the time of the inspection. Copies of both documents are available in the home. Two residents had information about the home in their bedrooms. It was identified at the last inspection that the documents needed to be updated the manager and provider have reviewed both of these. Two relatives of residents spoken with said that they were well informed when making the choice for moving into Dudley Court. The pre-admission details for two of the residents followed through the case tracking process showed that a thorough assessment had been carried out Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 10 before they were offered a place in the home. The manager or her deputy carry out pre-admission assessments. Assessments completed showed that some of the areas assessed related to peoples ability to care for themselves. Assessments included mobility, eating, dressing and toileting. Additional information related to health, medication, enduring interests and family life was also recorded. All service users have either a placing agreement with their funding authority or a contract if they are privately funded. Information about living at the home is included with the service user guide and terms and conditions of residency are available for residents, copies of these are included in residents’ files. The home has an intermediate care unit. This service is a provided with the support of the local Primary Care Trust (PCT). People admitted under the intermediate care arrangements have their own facilities and a dedicated staff team. The team are supported and given training in rehabilitation from physiotherapists and occupational therapists who work for the PCT. Waterside Care Centre DS0000004824.V371972.R01.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, 10 and 11 Quality in this outcome area is adequate. The healthcare needs of people living in the house are identified and met. Procedures for the management of people during the end stages of life are not appropriately managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents observed during this inspection visit looked well cared for. Residents living in the home were happy, smiling and talkative. It was evident that the service is meeting their personal care needs. People were well presented and groomed. Resident’s clothes looked well laundered and the clothes they wore were suited to the time of year. Three people were identified for ‘case tracking’. One of the residents chosen had recently died. We decided to continue to review this person’s care for the time they spent in the home. This would allow us to look at the care they received leading up to and at the time of their death. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 12 Care files contain a lot of information and are not easy to access and follow. However each care file contained a profile about the person’s life history, interests and relationships, health and personal care needs and medical history. This is good practice and should help staff to understand the cultural and social background of individuals and assist them to give ‘person centred’ care. Care plans provided sufficient details for care staff on what action they needed to take to meet the needs of people in their care. The care plans examined at this inspection show that the staff have carried out a lot of work to update the care plans. All the residents had a care plan and these had been updated to contain a plan of care with information about the actions staff need to take to meet their identified needs. Care plans are based on the initial assessment of peoples’ needs and a further assessment when they are admitted to the home. There is evidence that this information is reviewed and updated. The service uses risk assessment tools for identifying the level of risk for people in relation to falls, developing pressure sores, mobility and moving and handling. A risk assessment had been completed for one of the people followed through the case tracking process. The resident has pressure sores and is identified to be at risk from further pressure area damage. A care plan had been completed identifying the need for a specialist bed that would help to relieve pressure, the dressings that staff should use to treat the pressure sores and how often the person should be turned. We visited the resident who was willing to talk and was a very happy person. Our observation and speaking with the resident showed that staff had followed the guidance. The resident was being nursed on a special bed and mattress, the resident said that staff came in to see them and changed their position every four hours records of the care given was recorded on charts and in the daily records. This is good practice and should identify risks to the health and well being of people living in the home. Care plans had been developed to minimise identified risks. Records examined showed that people are supported access to GP services, hospital out patient appointments, community nurses and optician. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 13 Staff working in the home told us that care plans are up to date and information about residents can be found when needed. They said: “The individual care plans are there to look at and gain useful information if a resident is unable to speak for themselves family and friends can help a lot and know their wishes. We get in touch with other professionals who help us with care and personal choices. There were occasions when staff did not always speak to people living in the home with respect. Listening to some conversations between residents and staff on the first floor of the home demonstrated that staff can be quite short with residents. A member of staff responding to a resident asking for the toilet said, ‘You’ve just been’ and ‘I’m busy.’ This does not show respect for residents in the home, which could affect their individual self worth. The majority of staff were kind, caring and attentive towards people living in the home. Residents and relatives speaking in their questionnaires returned to us said about the service they received: “My… (Relative) was in Waterside Care Home for 8 days only on Respite…he has told me that he was happy and comfortable there.” “We have not been informed via telephone of psychotic episodes or of antibiotics being given, but have discovered this when we have visited via other residents.” “We expected more rounded care from a BUPA home.” The contents of the care file for the resident that died in the home, caused concern. Written information in the care file showed that an initial assessment had been carried out by the nurse at the time of admission to the home and the person was very ill. The GP saw the resident the day following admission and their medication was reviewed. The resident showed some signs of improvement for a few days and then their health once again deteriorated. The GP surgery was contacted to ask if one of the resident’s medicines could be omitted as it made them drowsier. An end of life plan of care was developed with the family, the resident was unable to participate in any decision making. Fourteen days had passed since the resident had last seen a doctor. The person’s health continued to deteriorate but there was no evidence in the daily reports or care plan to show that medical aid was called to reassess the resident’s condition. The GP was not contacted again until the person died when the GP visited to certify the death. There was no evidence that a referral Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 14 was made to the coroner due to the fact that it had been fourteen day since the resident had last been seen by a GP. The care in the final days of this person’s life had been mismanaged. The contents of the care plan do not show that the decision to let this person die was based on information gained through medical advise and the outcome of an assessment carried out by a doctor. There was no information in the care file to show that the GP had been asked to visit to review the resident’s condition. There was also no evidence to show that consideration was given to the Mental Capacity Act when discussions were held with the family and the resident was unable to let their wishes known. These concerns about the management of the resident during the time leading up to their death were discussed with the manager. The manager had audited the care plan and had written on the audit sheet, expressing her concerns about the care the resident had received. The manager had spoken to a palliative care nurse from the PCT but an investigation had not been carried. The manager has been asked to formally investigate the care given to this resident and share the outcome with us. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 15 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 and 15 Quality in this outcome area is adequate. People living in the home are not actively supported and encouraged to maintain their independence, interests, and take part in activities taking place in the home which would enhance their quality of life. People benefit from a varied and nutritious diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an Activity Organiser who organises day-to-day activities such as bingo, cooking, crafts and cards games. At the time of the inspection she was preparing for the home’s annual summer fete. Some residents are reluctant to take part in activities and choose not to do so. The home has a nice garden area at the back of the home. The garden offers different forms of stimulation. One area displays reminiscence objects and another flowers are grown, some of which are scented. There is an attractive area by the canal where residents can sit and enjoy the view, watch the barges and people fishing. These areas in the garden would offer residents different forms of stimulation and could encourage socialisation. The weather has limited the use of the garden. Two family members were observed to take their relatives out into the garden. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 16 Families are encouraged to visit and attend social events that the home holds. Some families have actively taken part in planning the fete by donating items for selling. Trips are organised these include visits to the theatre and the Black Country Museum. Family members or their representative are made welcome at all times and they are involved in planning their relative care. The home is friendly and welcoming and visitors and residents are able to communicate well with staff. The relatives speaking in their questionnaires said: “The residents are clean and well fed. However there is little mental stimulus, and… (Resident) sits in ….chair all day. Perhaps some simple exercise to music could coax the timid residents to join in…. (Resident) uses a walking frame so energetic exercise is not an option… (Resident) can do simple knitting, which could be encouraged.” The home has a four-week menu that is seasonal and is changed winter and summer. The menus are displayed on a wall in the reception area of the home. A hot choice is available at each mealtime. Staff were observed to ask residents for their choice of meals for the following day in the afternoon. Dining areas have been identified in the lounges on both floors. The majority of residents were seen to eat their meals in their armchairs where they had been seated for most of the day. Meals were served on bedside tables; there were sufficient bedside tables for each resident. The manager told us that they have tried to encourage residents to sit at the dining tables but have had no luck. Staff explained that only one resident downstairs liked to have their meals at the table with the remaining residents choosing to remain in their armchairs. In the dining area on the first floor there were six residents eating at the tables. These were mainly residents from the intermediate care unit, admitted to the home for rehabilitation. As downstairs the residents preferred to sit in their armchairs. It looked like this way of eating their meals had become ‘custom and practise’ for residents. The situation is not helped by the size of the dining areas, which are cramped and do not provide residents with sufficient space for them all to have a meal at the dining table. Eating their meals at the dining table would encourage some residents to mobilise and encourage conversation and socialising. The presentation of meals has improved. Dining tables are laid with tablecloths and cutlery. Table napkins were not available. Residents enjoyed their meals and felt that the food offered had improved. Waterside Care Centre DS0000004824.V371972.R01.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 and 18 Quality in this outcome area is good. Complaints are taken seriously by the home and there are appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the reception area of the home. Copies are also available in the Service User Guide. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made in questionnaires received by us include: The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. Both answered appropriately. There is one ongoing adult protection investigation, which was referred to Social Services and is being investigated under local adult protection procedures. The majority of care staff have had adult protection training with Sandwell Council Adult Protection Unit. Waterside Care Centre DS0000004824.V371972.R01.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 and 26 Quality in this outcome area is good. The environment is generally well maintained providing homely place for people to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements continue in the home. Some furniture and furnishings provided by the home was showing wear and tear and in need of replacement. Various types of chairs are provided for the comfort and safety of residents. The manager told us that plans are to refurbish the entire home as part of the organisations wider maintenance plans. Refurbishment plans include replacing furniture and carpets and re-fashioning the entrance to the home. Some residents were able to move around the home freely. Walking aids, such as Zimmer frames or walking sticks were available to help residents to mobilise safely. Some of the bedrooms in the home were visited and these looked Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 19 homely, residents had brought some of their own small items of furniture and pictures into the home. Personal photographs and soft furnishings were used to help personalise the rooms. This practice helps the resident to settle into the home quicker and promote their comfort. Some bedrooms had small en suite facilities consisting of a toilet and a washbasin. On the day of the inspection, the home was clean and free from malodours. Most residents and relatives speaking in their questionnaires said that the home was always fresh and clean; some gave their response as usually. The kitchen was clean, tidy and organised on the day of the inspection. Records for cleaning and checking temperatures of fridges, freezers, food brought into the home and cooked foods had been maintained. The cook for the day knew what meals residents had ordered, was well prepared. Waterside Care Centre DS0000004824.V371972.R01.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 and 30 Quality in this outcome area is adequate. Staffing levels in the home are not consistently maintained to ensure that there are sufficient numbers of staff on duty to meet the needs of people living in the home. Robust pre- employment checks safeguards people from risk of harm from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager told us that the usual staffing levels for the home are: First Floor Shift Early Late Night 1 Nurse 4 Carers 1 Nurse 2 Carers 1 Nurse 3 Carers (Also cover Step Down) 1 Nurse 4 Carers 1 Nurse 4 Carers 1 Nurse 2 Carers 1 Nurse 1 Carer 1 Nurse 1 Carer Ground Floor Intermediate Care (Step Down) Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 21 Duty rotas examined for a four week period between the 4 July 2008 and 7 August 2008 show that staffing levels are not consistently maintained. Action taken to cover shifts on some occasions where staff were off sick did not demonstrate that the shifts were covered. For example the duty rota for the ground floor of the home showed that actual staff numbers were at times one or two staff less than suggested by the manager. The manager is supernumerary, but will cover shifts if she needs to. The majority of staff work twelve hour shifts. Laundry, domestic and catering staff are employed in the home this means that care staff numbers are not depleted to undertake other duties that would take them away from providing care to residents. Residents however consistently identified that they had to wait for staff to assist them particularly going to the toilet. Residents and relatives felt that all staff were very helpful, polite and friendly. Speaking in questionnaires relatives and residents said “They (Staff) have a nice caring nature and are all very helpful and are friendly and look after my … (Resident) well. Concerns were raised about staffing levels and comments received include: “…despite the willingness and hard work of the staff, there are not enough staff to cope…” Most care staff have completed a National Vocational Qualification (NVQ) level 2 in care. Staff files examined contained certificates to show that they had completed the training. Senior care staff have completed NVQ level 3. The personnel files of two recently recruited staff members were examined and they contained evidence that satisfactory checks such as Criminal Record Bureau (CRB), Protection of Vulnerable Adult (PoVA) and references are obtained before staff commence employment in the home. Robust recruitment procedures and pre-employment checks should protect the vulnerable elderly people living in the home. New staff confirmed that their induction period covered manual handling, fire policy and other areas connected with the job. The member of staff said that they felt that “…a new c/a should shadow a experienced member of staff for 4 weeks or more, this would be beneficial to all concerned.” Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 22 Staff training records demonstrate that staff complete an induction programme and receive mandatory training in Health and Safety, Infection Control, Fire Training, Moving and Handling, Abuse Awareness and Food Safety. The manager maintains a monitoring system, which identifies staff who require updates in their training, so that training can be arranged. Some staff said, however that training is all in house and is not varied. They also told us that staff are taken off the floor to attend training, which then depletes the number of staff and takes staff away from caring for residents. It is also worth noting that the majority of staff work long days so there is no extra staff at any time as there is no overlap of shifts. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 23 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, 33, 35 and 38 Quality in this outcome area is adequate. The manager is competent and fit to be in charge of the home. Policies and procedures offer a sound framework and safeguard service users’ interests and safety. De-motivated staff does not help the home to be run in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is a registered nurse and has worked for BUPA for a number of years as a manager. She has the necessary experience and training required to undertake the role. The manager has a working knowledge of the care needs of people that live in the home. The manager is keen to make improvements and since the last inspection had taken actions to address the issues identified in the last report. Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 24 One relative told us in their questionnaire that the home manager Francis was extremely helpful in every aspect during her relatives stay. The home has a formal quality system, which looks at ways of gaining the opinions of the people at the home about the service they receive. Staff feedback on the running of the home was received through questionnaires they had completed and returned to us. Conversations were also held with. Comments received show that some staff have a positive image about working in the home and some staff feel de-motivated. Similar concerns had been raised at the last inspection visit some of the concerns include: • • • • Concerns about the induction process and training. Shortage of staff High ratio of sickness Lack of regular staff meetings. There has been a number of concerns raised by all staff and completed questionnaires told us that the responses given are a combined view of a number of staff. These issues require further exploration by the Manager, which was a recommendation given in the last inspection report. If left these concerns could have an adverse effect on residents living in the home. The manager will be asked to formally address the concerns and inform us of the outcome. Some positive comments were made and some staff said that meetings are held with staff. One staff member told us that supervision often takes place with the unit manager and an open door policy to see the manger or the deputy is in practise. The organisation has introduced an employee recognition programme, which is a programme they can use to show that they value their staff. Residents, relatives, visitors and staff are encouraged to nominate staff working in the home for a recognition award. Staff receive a certificate and badge acknowledging a ‘Personal Best’ for excellent service carried out within their normal job. People’s personal monies are stored away safely and a clear record of expenditure is kept so that it is possible to check how people’s money has been spent. Health and safety and maintenance checks had been carried out to ensure equipment in use is safe and in full working order. Electrical equipment used in the home had been tested to ensure us it was safe to use and appropriately Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 25 wired. The ‘5’ year electrical certificate was available and current. Water temperatures checks had been recorded monthly and this assists in the prevention of people accidentally scolding themselves. Maintenance checks were completed on fire systems and equipment. Records were well maintained, organised and easily accessible. A record is maintained in the home of any accident or incident that happens to person using the service. The hoist was used as a form of transport while transferring a resident from a wheelchair to a chair. This is not safe practice as the resident is at risk of slipping from the hoist sling while being transported in this way Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 26 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 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 2 11 2 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 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP11 Regulation 13(1)(b) Requirement Timescale for action 15/07/08 2 OP27 18 3 OP38 18 The management of people during the end stages of their life and at the time of their death must be reviewed to ensure that staff are seeking medical advice when a person’s condition deteriorates, following appropriate procedures and making decisions within the limits of their professional role. This will ensure that informed decisions are made in the best interests of residents. Staffing levels should be 30/09/08 reviewed to ensure that sufficient numbers are on duty at all times. Attention should be given to peak times of activity in the home and when staff are required to attend training. This will ensure that residents care needs can be met safely at all times. Hoists must not be used as a 15/07/08 mode of transport when moving a resident from one area to the home to another. This will ensure the safety of people using the service. DS0000004824.V371972.R01.S.doc Version 5.2 Waterside Care Centre Page 28 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 2 Refer to Standard OP10 OP12 Good Practice Recommendations The care home must be conducted in a manner which respects the privacy and dignity of service users. Staff should be aware of how to talk to people in their care. A review of activities in the home should be carried out to ensure that residents receive mental and physical stimulation that meets their individual needs and supports their enduring interests. Efforts should continue to be made to encourage residents to sit at the dining tables to have their meals. This would involve people in a small amount of movement and encourage residents to socialise. Staff should not be taken off the floor to attend training, if this means that the level of staff needed to provide care for residents is depleted. This action could affect the safety and well being of residents. Systems should be in place to ensure that staff working in the home have the opportunity to have a say in the running of the home. This will help to promote the health and wellbeing of people living in the home. 3 OP15 4 OP30 5 OP33 Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI Waterside Care Centre DS0000004824.V371972.R01.S.doc Version 5.2 Page 30 - 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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