Inspection on 14/09/06 for Waterloo House

This inspection was carried out on 14th September 2006.

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

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

Other inspections for this house

Waterloo House 18/08/08

Waterloo House 25/02/08

Waterloo House 14/06/06

Waterloo House 10/08/05

Waterloo House 02/06/05

Waterloo House 11/08/04

Waterloo House 04/05/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Waterloo House Waterloo Road Bidford On Avon Warwickshire B50 4JH Lead Inspector Sheila Briddick Key Unannounced Inspection 14th September 2006 10:30 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 DS0000004260.V312166.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 DS0000004260.V312166.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterloo House Address Waterloo Road Bidford On Avon Warwickshire B50 4JH 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) 01789 773359 01789 774791 Alpha Health Care Limited Mrs Maria Cosgrove Care Home 35 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (20), of places Physical disability (1) Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered manager (MC) must complete the registered managers award or suitable management qualification by 30 December 2007. 14th June 2006 Date of last inspection Brief Description of the Service: Waterloo house is registered to provide personal care for 35 older people. The registration is for 20 older people, 14 with dementia and one person with a physical disability. The main house is a large Victorian house, which has been converted to house 21 service users. All bedrooms have en suite facilities. The first floor is accessible via a chair lift only. Avon Lodge is a purpose built building behind the main house and accommodates 14 people with dementia. There is a passenger lift to the first floor as well as stairs. The home is within walking distance of Bidford Upon Avon where there are shops, churches and a bus service to Stratford Upon Avon. Current fees for this home range from between £440 to £505 per week. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The inspection visit was unannounced and took place on Thursday, September 14th, 2006 commencing at 10.30am and concluding at 5.00pm. • • • • • The inspection involved: Discussions with the registered manager, four care workers and the cook. Discussions with three visiting relatives Observations at a mealtime. Four service users were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for service users. An inspection of the environment was undertaken, and records were sampled, including staff training, health and safety, rotas and complaints. • The inspector had the opportunity to meet most of the service users and talked to three of them about their experience of the home. The service users were able to express their opinion of the service they received. General conversation was held with other service users, along with observation of working practices and staff interaction with service users. A number of service users experience some degree of cognitive impairment or dementia and are unable to express their views or experiences of the service provided, therefore placing greater emphasis on observations and interaction. One allegation of abuse, involving two service users, has been received by the home since the last inspection. The allegation of abuse was referred to social services for investigation and in accordance with the local arrangements for the protection of vulnerable adults. Following an investigation into the allegation it was concluded that the service users involved did not have the capacity to give consent to the incident that took place and neither were to blame for what had happened. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There has been some improvement in staffing resources available to support the management of the home and this has included an appointment of a Team Leader, there are now two team leaders in place. The handover period at Waterloo House has management support and the manager is meeting with both Team Leaders at the beginning of each day for planning and discussion of the service provision. The manager has reviewed the staff teams and re-structured these so that there is a better skill mix at both houses. Service users each have a Contract and this is now kept on their main file in the office at Waterloo House, although it is advised that service users be asked if they want a copy for themselves. Care planning for the planning and evaluation of nutrition, is much improved and the day-to-day recording that needs to take place was up-to-date and informative. Service users living at Waterloo House have more opportunity to make decisions regarding activities in the home as the manager meets with them on a monthly basis to discuss this. One man is now supported to make choices for example, about drinks and food, by using pictures. Signposting around the interior of the house has much improved generally so that service users can easily locate the toilets and other areas. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 7 An activities coordinator has been appointed and although they were only in their second week of employment service users had already begun to have a variety of activities to participate in. People spoken with were pleased to have more to do during the day. Recruitment of staff is much improved and shows that the service is taking the necessary steps to ensure that service users will be protected from harm by the people caring for them. 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 DS0000004260.V312166.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 Waterloo House DS0000004260.V312166.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People coming to live in this home can be sure that they will not be offered a place unless a full assessment of needs has taken place so that the home can be sure they have the services and facilities to meet their needs. Information however to inform prospective service users of the services and facilities available is not yet available to them and without this they will not be able to make an informed decision about living in the home. EVIDENCE: Four care files were examined at this visit as part of the case tracking process, each file had a social services care management assessment of needs and risk assessment files when necessary. There was no evidence of the Statement of Purpose or Service User Guide in care files or in service user bedrooms. There was however information regarding the daily routines in the home displayed in service user bedrooms viewed. The manager said that steady progress was being made to amend the Statement of Purpose and Service User Guide so that these reflected the Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 10 service provision. The manager discussed their intentions to ensure the documents were in a format suitable to meet the needs of people with a dementia using the service by introducing photographs and other information symbols. Existing service users each have a copy of their Contract on their main file in the home’s office. A good practice recommendation was discussed with the manager regarding service users being asked if this were satisfactory with them or if they wished to have a copy for themselves. Waterloo House DS0000004260.V312166.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plan programmes are not being evaluated routinely to ensure that personal support and healthcare is consistent, reliable and responsive to changing needs. This is placing service users care at risk especially those with a diagnosis of dementia. Staff spoken with however demonstrated a good knowledge of the importance of providing personal care in a manner that promotes privacy and respect. The system for medicine management is not robust enough to ensure that all medication received into the home is administered safely as prescribed or is being stored safely. EVIDENCE: At the inspection visit of 14th June, 2006 the care of a sample of four service users was ‘tracked’ in order to see if the home was providing a service that was meeting their assessed needs. The care of the same four service users was also ‘tracked’ on this occasion to determine what progress had been made to improve care planning. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 12 The new care plan format being devised by the manager was also looked at and she discussed her intentions of how this will be introduced. The new format will ensure that staff have clear written guidelines to follow when meeting care needs and this will promote continuity of care, which is essential when supporting people with a dementia. With each care plan examined it was encouraging to find that comprehensive records are now being maintained of all food and fluid intake by service users. There had been concerns at the last visit for one service user’s dietary wellbeing as daily monitoring records, weighing charts and staff practice was not supportive of the risk management and advice given by the doctor. Examination of this service user’s care plan found that food and fluid intake records were up to date, the service user was being weighed regularly showing a steady increase in weight. Staff were observed to give appropriate support at lunchtime to the service user, which included 1 to 1 assistance with eating and providing the equipment necessary to aid independence. Daily records, including records of meals taken daily, were well-documented and up-to-date on the care plans examined however evaluations of care plans in three of the four examined had not taken place since June 2006. Without regular and consistent evaluation taking place and a record of the outcome recorded on the care plan the service cannot demonstrate that it is meeting the current needs of the service user. The manager said that one service user’s health needs have deteriorated considerably and she, and the staff team, are concerned about the service user’s well being. Daily records and health notes record prompt action had been taken to inform doctors, psychologists and family members of the health concerns and a specialist re-assessment of needs would be taking place week beginning 18th September 2006. The service user was met during the visit and was clearly distressed and confused. Staff were seen to attend to her needs as she would allow and she was being kept from possible harm in the activities she was choosing to do. The service users care plan however had last been fully evaluated on 19 June 2006. An entry recorded in August’06 on medical notes relating to the service user’s emotional health and well-being stated that the service user was refusing help with personal care and had some weight loss. Instructions to staff recorded as, just to monitor. There was no care plan in place for supporting the changed personal care needs or how the service user’s personal hygiene was to be maintained. The service user’s weight chart showed a steady weight loss this year and the care plan required weekly weighing to take place, the record showed that this was not happening. The last documented water flow assessment for the Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 13 service user was dated March 2006. The last date of a documented risk assessment was dated 18 November 2005. It was apparent through discussion with them that the manager and staff had concerns and had acted promptly in referring these concerns to appropriate specialists however, with out an up-to-date plan of care, that is being reviewed and reassessed as needs change the service cannot demonstrate appropriate care is being delivered to the service user to ensure that their health and personal care is being promoted and maintained. Without written guidance on their care plan of their current needs the service user cannot be sure that their needs will be met consistently by the people supporting them. Service users met with during this visit said they felt well cared for and visiting relatives said they were also happy with the care their family member was receiving. One service user had a concern regarding their personal care in not being able to have access to a chiropodist. Discussion with manager and examination of care plans showed that a chiropodist does visit the home and the service user’s concern was forwarded to the manager with their consent. Medication administration was checked, and this included observation of the administration of medicine at lunchtime. Medicine records were well organised and medicines were properly labelled, and secure. The staff member administering medicines explained to each service user as they did what the medicine was for which is good care practice.in promoting service users rights to information about care being given to them. A complaint had been received from a family member regarding finding seven tablets in their relative’s room and this had not been noticed by any staff member. The manager had addressed this by reminding staff of the importance of ensuring service users receive their medicines at the prescribed time and the serious consequences there could be in leaving medicine unattended. The manager however does not currently have a system for auditing medicine administration in the home, including staff competency or drug control and without this they cannot be sure that medicines are being safely administered or stored. The manager discussed their concern regarding the current dosage system and how this is not really meeting the services needs as it has room for errors and that they are considering a better system which would include the use of a monitored dosage system. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are aware of the need to plan routines and activities in a way which meets the choices and wishes of the people living in the home and service users are beginning to have opportunity to participate in leisure and social activities both in the home and local community. Service users say the food is good and mealtimes are unhurried however staffing levels over the lunchtime period may not be sufficient to meet the individual needs or preferred choice of some service users. EVIDENCE: An activities coordinator was appointed to work in the home two weeks prior to the visit being made and a regular programme of activities for service users at Waterloo House is currently being implemented. On the day of the visit a group of service users were participating in a reminiscence activity with the activities coordinator and a staff member. They were looking at, and talking about old local newspapers, photographs of Bidford on Avon and listening to music from the 1930s. During the afternoon some service users at Waterloo House enjoyed a ‘word game’ quiz. Service Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 15 users at Waterloo House talked about a cookery activity they had enjoyed the day before making cakes. Arrangements have also been made for a music and movement therapist to provide a regular movement activity for service users The activities coordinators hours of working are flexible to enable them to support activities in the home during the daytime and evening, for example, when a musician made arrangements that day to come and play to service users one evening the activity coordinator change their working hours so that they could support the occasion. The notice board in the lounge at Waterloo House displayed future activities, which included trips to concerts on a regular basis and an individual musical concert to be held locally. One service user had support from staff during the afternoon to go shopping and another service user talked about how they enjoy a walk locally with another service user when the weather allowed. The staff room at Avon Lodge has recently been adapted into a sensory room which service users can access easily as it is on the ground floor adjacent to their lounge. Staff said that service users use this although this was not observed during the visit. The time spent at Avon Lodge was over the lunchtime period and therefore social activities were not observed. It is intended that the activities coordinator will share her time between the House and the Lodge. There is more information displayed around both environments, (signage), to enable service users to locate areas of the home such as bedrooms, toilets and the kitchen. One service user now has flash cards to use as a communication aid with staff. A service user, of Polish descent, had recently come to live in the home and said they were generally happy about living there and felt well cared for. They also said I am soon to have Sky TV installed in my room so that I can receive Polish television programmes . The manager confirmed that this was being arranged. The lunchtime meal at the Lodge was observed. Eleven service user had their lunch in the dining room with one service user choosing to eat their meal in the lounge. One service user was unwell and in bed and their liquidised meal was taken up to them after service users in the dining room had eaten their lunch so that the staff could support them appropriately with it. There were three staff to support service users over lunchtime, including the service user in bed having the liquidised meal and a service user who was unable to decide whether they wished to have a meal. It was noted that staff offered appropriate support to the people eating in the dining room with staff sitting beside two service users to assist them. Service users were given sufficient time to enjoy their meal at a pace that was Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 16 satisfactory to them. Staff responded quickly and appropriately to requests from service users and encouraged conversation and involvement. Observation of the lunchtime activity and discussion with staff however indicated that the staffing levels at this time are not adequate to meet service users needs and other responsibilities the staff have during this time. For example, there were seven service users observed to be in need of 1:1 support during the lunchtime and only three service users were seen to have this need met when the dinner was served. Two service users were observed to require support of staff assistance so that they could eat their meal in a way that maintained their dignity, the service user in the lounge and the service user in bed had to wait until the main dinnertime activity was finished before that they could have their lunch and a service user at this time was also in need of emotional support so they could make a decision about whether to have lunch or not. The three staff were also responsible for serving the meals and washing-up crockery and utensils afterwards, for the administration of lunchtime medicine, providing personal care to service users after their meal and completing daily records before they next staff team come on duty. Staff said that the dishwasher in the kitchen was broken and they were having to wash the crockery and utensils by hand, which again was taking up time that should be spent supporting service users. Mealtimes at the Lodge were discussed with the manager who identified how extra staff support could be provided at lunchtime however a full review of the activity, including staffing levels against the needs of the service users, at this time is urgently needed to ensure that the health and well-being of the service users is maintained. This review should also consider whether sufficient time for comprehensive records to be documented on care plans is available so that staff coming on duty have up-to-date information necessary to meet the existing needs of the people they will be caring for. The menu for the day was attractively displayed at Waterloo House however there was no menu displayed at the Lodge, staff said that this used to happen. The meal for the day was gammon, mashed potatoes, mixed vegetables and parsley sauce with treacle sponge and custard for pudding. When finishing their pudding a service user at Avon Lodge said, that pudding was lovely when staff asked if she would like some more she said yes and this was provided promptly. A review of the food provision was undertaken by the manager following her recruitment to the home and changes made have included more provision of fresh produce, custard is made with milk and not hot water, fruit bowls are provided in lounges areas, more choice at teatime and not just sandwiches and homemade cakes and puddings. The teatime meal was Ravioli, a selection of sandwiches and home made jam tarts. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 17 The cook was met with and discussed the meal provision and how she is implementing a four week rolling menu with two weeks having been completed. The cook stated that she will ensure that Avon Lodge have copies of menus so that they can plan and discuss choices with service users. The cook was unaware of the preferred likes and dislikes of individual service users regarding food they liked or of the consistency in which they could manage their food. One service user was observed when eating their dinner at the Lodge to be unable to chew the gammon that was provided to him. Staff spoken with said this had been offered to him previously in a liquidised form but he preferred to have his meal provided this way however, he had not been offered the choice to have the meat in any other consistency such as finely minced. The cook said that with sufficient information she would be able to provide food in a consistency that was suitable to meet individual service users needs. There is little evidence on care plans to show that the support and guidance of Speech and Language services is sought when supporting people with a dementia and eating and swallowing difficulties. Staff did say that they understood the manager to be contacting therapists as a resource for support during the care planning. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home can be sure that their concerns will be listened to and acted upon. People are protected by POVA policy and procedures and supported by a staff team who are clear of their role and responsibility within this. EVIDENCE: The home continues to investigate complaints that are made, report adverse incidents and keep proper records. Service users are protected by a Protection of Vulnerable Adult, (POVA), policy and procedure and staff are clear of their role and responsibility regarding POVA. Staff confirmed that training in POVA policy and procedure had taken place the week prior to the inspection visit. On the 11/08/06 the home reported an allegation of sexual abuse concerning two service users and this was subsequently investigated through POVA. The allegation suggested that staff did not manage the incident appropriately, that risks had not been assessed and guidelines put in place to manage this. The male service user was given 48 hours ‘notice’ by the home. Examination of the care plan records of one service user involved evidenced that staff had monitored and made appropriate records at the time. The manager had recorded discussions she had with individuals concerned and this included service users involved regarding their developing relationship, they had also kept family members informed. There is evidence to demonstrate Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 19 that following the incident of alleged abuse the manager and staff took prompt action to inform appropriate people including, relatives, social services, mental health services and the Commission for Social Care Inspection. Action requested by the services and specialist services were implemented immediately by the home to keep people safe. It was determined by psychologists that the service users involved did not have the capacity to give consent to a full relationship with each other and neither were to blame for what had happened. The decision was made for one service user to live elsewhere and they have since done so. Staff continue to monitor the emotional health of the service user still living at the home. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 20 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, 22 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the environment is warm, clean and friendly and providing the people living there with a safe place to live. The manager and staff take prompt action in the event of emergencies to keep people safe and comfortable. EVIDENCE: This visit took place at a time when there was extreme rainfall activity in the area and several leaks were apparent in the corridors, three bedrooms and the kitchen at Waterloo House and in the conservatory at Avon Lodge. The manager was taking prompt action, which included, closing off access to the conservatory, providing one service user with temporary bedroom facilities and bathroom toilet facilities for a service user whose bathroom was affected by the damage. One-bedroom affected was not being used. The registered provider made arrangements for a roofing Contractor to attend to the flat roof where the damage was occurring. The Commission was told that work Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 21 commenced on 19th September 2006. Ceiling damage will have to be repaired following this work and carpets replaced. A service user affected by this occurrence was satisfied with the action taken by the home. Bedrooms viewed were clean and looked comfortable, bathrooms and toilets were generally clean and had sufficient supplies. Some areas of carpet in the hallways and corridors at Waterloo house are becoming worn and stained despite regular cleaning by the domestic. Carpet flooring in toilet ensuite facilities may not be appropriate to individual needs. The bedroom of one service user whose care was being examined was viewed. The bedroom was clean and smelt fresh; bed linen was in good condition and the bed offered appropriate support for the service user having a cot side with protective covering for safety. There was a door to the outside garden leading off their bedroom and a ramp from the door, which enables them to use their wheelchair and access the garden and patio area. The service user said they liked to do in the summer when family members visited. The service user had an ensuite facility, which included a toilet and shower facility. Staff said that the shower facility was not used, as all of these in service user’s bedrooms are more of a small sitting bath. The shower tray was quite high and requiring a person to step up to sit in this on a bath seat that is formed into the shower tray. The staff member said that service users only use the toilet and wash basin facilities in their rooms because of difficulties in getting in and out of the shower/bath. The service user said that they liked their bedroom and bathroom facility and it was meeting their needs. The manager and staff said that refurbishment of the kitchen facility at Arden Lodge is expected to commence shortly and that this will include replacement of the dishwasher, electric hob, new flooring and new units. There are satisfactory policies and procedures in place for keeping the premises clean, hygienic and free from offensive odours. There are some odour issues in areas however, the domestic cleaner has sufficient resources to manage this, including a carpet cleaner and odour control sprays. All areas of the home were generally clean and tidy. As mentioned previously the dishwasher facility at Avon Lodge was not in working order and this is also the case in the main kitchen at Waterloo House. Staff say that they have to hold the rinse button down and stand there for quite some time for this part of the washing programme. To be sure that dishes and utensils are washed to a temperature that will promote the control of infection in the home the dishwasher at Avon Lodge should be replaced and the dishwasher at Waterloo House repaired. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some progress has been made to address staffing levels so that the people living in the home can be supported appropriately to meet their assessed personal, healthcare and social care needs. The manager has a good understanding of how this can be improved upon and was able to indicate how this improvement will be resourced and managed. EVIDENCE: Staffing levels remain the same, which is adequate, however there are times when staffing levels at Avon Lodge may not be sufficient for the needs of service users at specific times. This inspection identified lunchtime to be one such time as recorded earlier in this report. The deputy manager for the home is expected to return from maternity leave in November 2006. A team leader has been promoted internally to start their role week beginning 18 September 2006. There has been some improvement at Waterloo House regarding handover arrangements and the manager is attending these. The manager however does not always attend the handover meetings at Avon Lodge but was clearly aware of service user changing needs at the time. This visit has found that a full staffing level review is necessary and must include the handover period at Avon Lodge to ensure that the time provided is sufficient for staff to maintain up-to-date records of the needs of the service Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 23 users and for discussion with the oncoming staff team of individuals service user needs. Currently staff at Avon Lodge feel that this can be a rushed process as the period is not part of their working time and dependent on individual staff member’s commitment to attending work early or late out of their working hours. The staffing morale at Avon Lodge was low, although staff working at the time of the visit were observed to be good listeners and communicators and demonstrated good care practices. Discussion with them however identified that they had concerns about their ability as a team to manage care planning, support service users appropriately as their needs changed and provide consistency of care. This was discussed with the manager and various options were considered of how this part of the service could be improved upon and determined that adequate handover time, leadership and management presence and specified time for team leaders to complete care plan evaluation and reassessment was necessary. The manager said that two team leaders had been appointed and supernumerary time had been offered to them to attend to care plan evaluation, she also meets with them each morning to discuss issues of the service. A review of the staff skills mix had been completed recently by the manager, which had resulted in a change of teams at Waterloo House and Avon Lodge which, the manager felt, could be contributing to the low mood amongst the team at Avon Lodge. Staff spoken with did identify that the change in staffing rotas was influencing the care provision and felt that this was not promoting consistency of care for service users. Recent staff training has included elderly abuse, (POVA) and manual handling. One staff member spoken with had almost completed their NVQ at Level 2. Staff confirmed that they do get paid when attending training. All staff are to receive training in dementia care and in preparation of this the manager has made arrangements for specific training in dementia care awareness during November 2006. She has also purchased a video for staff to review entitled Yesterday, Today and Tomorrow and is in the process of arranging for behavioural therapists to attend the home to talk with staff regarding dementia care. The staff file for a recently recruited member of staff was examined and found to be up-to-date and in good order, evidencing that the necessary checks had taken place prior to their working in the home, including Criminal Record Bureau and POVA checks and any reason for any gap in their employment record. Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 24 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has a good understanding of the areas in which the service needs to improve and demonstrated how this improvement was going to be managed by them. EVIDENCE: The manager’s application to the Commission for Social care Inspection to be the registered manager for the home has been successful. The deputy manager will be returning from maternity leave in November 2006 and in her absence two team leaders have been supporting the manager. There has been improvement in the management of the home and this is especially notable at Waterloo House and it was clear from discussion with Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 25 service users, staff, and relatives that an ethos of openness and transparency is being promoted. The manager was able to demonstrate a commitment to ensuring that requirements made at the previous inspection would be met and produced evidence to support this. The manager was also able to demonstrate, through discussion and providing documentation, the plans she has continuing development of the management of Avon Lodge and of the time that has to be spent there to do this. Alpha Care has a quality management system that includes seeking the views of service users and their relatives regarding the care provision at Waterloo House and Avon Lodge. The manager said that this had last been completed prior to February 2006 when she took up the post of manager at the home and it is her intention to carry out a further survey towards the end of 2006. The survey will include seeking the views of professionals as well as the service users and relatives. The outcomes of the survey will be examined at the next inspection. There are day to day systems in place for seeking the views of service users on an informal basis and includes provision of suggestion boxes at both houses and monthly meetings with service users at Waterloo House. The manager has previously lead these meetings however it is hoped that the activities coordinator will do this as part of their role in future. Health and safety management continues to be satisfactory with routine maintenance checks regularly taking place; this includes the testing of fire alarms and fire fighting equipment. Examination of staff files and discussion with the manager evidence that a programme of supervision has been identified whereby staff will have supervision at least six times per year although this may include two sessions of group supervisions. A good practice recommendation was discussed that these could be between groups of staff with similar roles and responsibilities, for example, Team Leaders, Care Staff and Senior Managers. Waterloo House DS0000004260.V312166.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 2 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 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 2 2 X X 2 X 3 Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4 Requirement The registered person must ensure that residents have access to the statement of purpose for the home. (Timescale of 01/08/06 not met.) The registered person must ensure that a copy of the service user guide to the home is given to each resident. (Timescale of 01/08/06 not met.) The registered person must ensure that every resident has a written plan for their care and that it is regularly reviewed. (Timescale of 01/08/06 not met.) The registered person must ensure that all records made about the care and well being of individual residents are evaluated regularly by a manager/supervisor and action taken on this information as necessary to promote their wellbeing. (Timescale of 01/07/06 not met.) DS0000004260.V312166.R01.S.doc Timescale for action 01/11/06 2. OP1 5 01/11/06 3. OP7 16 01/11/06 4. OP8 12 01/11/06 Waterloo House Version 5.2 Page 28 5. OP9 13.2 6. OP15 12 The registered manager must 30/10/06 make suitable arrangements for regular audits to take place of medicines held in the home to ensure that it is being safely administered, stored and disposed of. The registered person must 01/10/06 ensure that staffing levels at mealtimes and the food provision at Avon Lodge is reviewed against the needs of current residents. The registered manager must make arrangements for all rainwater damage to ceilings to be repaired and made good and affected flooring replaced with new. To ensure that dishes and utensils are washed to a temperature that will promote the control of infection in the home the registered manager must ensure the dishwasher at Avon Lodge must is replaced and the dishwasher at Waterloo House repaired. The registered person must ensure that staffing rosters are organised in such a way as to enable an effective handover of care after each shift. (Timescale of 01/08/06 not met.) The registered person must ensure that all care staff undertake or update their training in good dementia care practice. 30/10/06 7. OP19 23.2(b) (d) 8. OP22 23.2(c) 15/10/06 9. OP27 18 01/11/06 10 OP30 18 31/12/06 11. OP32 12.1(a)(b) The registered manager must ensure that the staff working at Avon Lodge receive clear leadership and direction so that the people with dementia who DS0000004260.V312166.R01.S.doc 01/10/06 Waterloo House Version 5.2 Page 29 12. OP36 18 are living there receive the necessary care to meet their assessed needs at all times. The registered person must ensure that one to one supervision of care staff takes place at least six times per year and that records are kept. (Timescale of 01/08/06 not met.) 01/12/06 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. 2. 3. 4. 6. Refer to Standard OP2 OP15 Good Practice Recommendations Each service user should be asked if they would like a copy of their contract and a record is made on their care plan of the decision they make. The support and guidance of speech and language and dietician services should be sought regarding care planning and the food provision in the home. Areas of stained and worn carpeting in the home should be replaced and this should include service user’s ensuite bathrooms. The existing shower/baths in service users bedrooms could replaced with more accessible shower facilities. Group supervisions could be with staff teams who have the same roles and responsibilities. OP19 OP21 OP36 Waterloo House DS0000004260.V312166.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 DS0000004260.V312166.R01.S.doc Version 5.2 Page 31 - 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!