Inspection on 18/08/08 for Waterloo House

This inspection was carried out on 18th August 2008.

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

Other inspections for this house

Waterloo House 25/02/08

Waterloo House 14/09/06

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 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Waterloo House Waterloo Road Bidford On Avon Warwickshire B50 4JH Lead Inspector Yvette Delaney Key Unannounced Inspection 18th August 2008 10:00 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.V370852.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.V370852.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 www.alphacarehomes.com Alpha Health Care Ltd Manager post vacant Care Home 35 Category(ies) of Dementia (35), Old age, not falling within any registration, with number other category (35) of places Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th February 2008 Brief Description of the Service: Waterloo House is situated within walking distance of Bidford Upon Avon where there are shops, churches and a bus service to Stratford Upon Avon. The home is registered to provide personal care for up to 35 older people. The home is divided into two buildings. The main house is a large Victorian house, which has been converted to accommodate up to 21 older people requiring personal care. Bedrooms are available on the ground and first floor of the home. All have en suite facilities. The first floor is accessible via a chair lift only. The other part of the home is called ‘Avon Lodge’. This is a purpose built premises located separate to and behind the main house. The house can accommodate up to 14 people with dementia. This building has 14 individual bedrooms with en suite facilities. There is a passenger lift to the first floor as well as stairs. Current fees for this home range from between £440 to £505 per week. Waterloo House DS0000004260.V370852.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. The manager completed and returned an annual quality assurance questionnaire, containing helpful information about the home in time for the inspection. Questionnaires were completed and returned by five people living in the home, eight relatives 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: “My mother received wonderful care and support.” “I found this to be an excellent home for my mum. The staff were caring, pleasant and always treated her with dignity. When she died they contacted Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 6 the doctor and funeral director for me and treated her body with gentle care. They allowed her to die with dignity and were a great support to me and my family. “When I visit my aunt all the staff seem very caring and have the interests of the residents at heart.” “The staff are very caring, I am always made to feel welcome. “ “The home is very clean.” “Nothing too much trouble.” Photographs of meals served in the home provide residents with memory problems with a visual picture of the planned meals, which will help them to make informed choices. Information in three residents care files showed that they had received a comprehensive pre-admission assessment. Carrying out this initial assessment should help to make sure that the specific care needs of each person are identified before being offered a place in the home. The home can then confirm to the people involved that they are able meet these needs. What has improved since the last inspection? The manager and staff showed during the inspection that they are keen to make improvements and since the last inspection have taken actions to address all of the issues identified in the last report. Care files show that residents have their weight monitored at a frequency appropriate to their individual assessed needs. This will allow timely action to be taken in the event of concerns about a person’s weight and protect the wellbeing of people living in the home. The management of residents who are losing weight has improved and the support and guidance of speech and language and dietician services have been sought for advice on providing suitable, nutritious and appropriate meals for residents. Observation showed that people living in the home were clean and suitably dressed for the time of year, hence protecting their dignity and wellbeing. The medicine management has improved to a safe standard. Staff have good knowledge of the new systems installed and were keen to maintain and improve them further. All seven requirements regarding medication from the last inspection had been met. Records show that aids and equipment used in the home are regularly serviced and maintained. This will make sure that they are fit for purpose and safeguards residents and staff from the risk of harm. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 7 Training records show that staff have received training appropriate to the health; personal and health care needs of the people in their care. This will help to make sure people who live in the care home are safe by receiving appropriate care. The Care Home Manager has worked for Alpha Care Homes for seven years. She has completed the NVQ 4 Registered Manager Award (RMA) qualification and is responsible for the overall day-to-day management of the care home. The manager and deputy manager were present on both days of the inspection. Both managers are knowledgeable about people in the home; both were very attentive towards the residents. What they could do better: Care staff must seek medical advice when they have concerns about nonprescribed treatment used by residents in their care. This is so that care staff make decisions within the limits of their professional role, which will make sure that people living in the home receive care that promotes their health and wellbeing. The management of people during the end stages of their life must be reviewed to make sure that staff are seeking medical advice when a person’s condition deteriorates. This is so that care staff make decisions within the limits of their professional role and will show that informed decisions are made in the best interests of people living in the home. Care staff must be trained to use safe and appropriate moving and handling techniques when helping people in their care to move or transfer from one place to another. This will help to make sure that residents are cared for safely and not at risk of injury due to poor practice. The Statement of Purpose should contain information on the size of rooms available for use by people wishing to move into the home. This will ensure prospective residents have all necessary information to enable them to make an informed decision about using the home. Two written references, including where applicable, a reference relating to the person’s last period of employment, which involved work with vulnerable adults must be secured. This will ensure that the home’s staff recruitment practices are robust enough to safeguard people living in the home. Written entries in resident’s care files should be dated, timed and signed with the person’s signature. This will ensure that a legible and effective audit trial is available to track the care given to people living in the home. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 8 The Home should see the prescriptions prior to dispensing and checks the medicine charts and medication in against a copy of these before they are administered. This is to ensure that the service users receive their medicines as the doctor intended. Locked cabinets should be installed in the medication cupboards to reduce access to medication stored in the home. A system should be installed to check all new service users’ medication with the prescriber at the earliest opportunity to ensure that they receive the current drug regime only. Staff should be trained to give appropriate support at meal times. This will help residents to enjoy their meal, improve their appetite and maintain their dignity. Food should be presented attractively to residents’ which will promote an increase in their appetite and help them enjoy their meals. Cleaning records in the kitchen should be kept up to date and the cleaning monitored to make sure that the cleaning has been carried out. This will promote the control of cross infection in the home. Work should continue to increase the number of staff with a NVQ level 2 (or equivalent) qualification in care. This will mean that people have safe and appropriate support at al times from staff that are competent and suitable to care for them. 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. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 9 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.V370852.R01.S.doc Version 5.2 Page 10 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 and 3, Standard 6 does not apply to this home as people are not admitted for immediate care. Quality in this outcome area is adequate. There is scope to develop information about Waterloo House further to make sure that full, accurate and up to date information is available to people. People have the opportunity to visit the home before making the decision about where to live. A comprehensive assessment of peoples care needs is carried out with their involvement before admission to the home. This will support people to make an informed decision about whether to move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the statement of purpose and service user guide were available in the home. Both documents showed that they were updated in February 2008. The Statement of Purpose did not include information about the size of rooms available to people who wish to use the service. This would give people who are involved in a decision about whether to move into the home additional information as to whether the size of the bedrooms would be suitable to meet their needs. For example someone who needs a wheelchair to help them Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 11 mobilise may need to know that the space available in the bedrooms was sufficient to help them manoeuvre their wheelchair without obstruction. Copies of both documents were available in some of the resident’s bedrooms. One family member confirmed that they had obtained copies of the documents when first looking round the home. A resident spoken with during the inspection visit said that she could not remember getting the documents. They said “At my age dear I can’t remember these things.” This response reflects the mental health condition of most of the residents living at Waterloo House who have problems in remembering due to dementia. A relative for this resident told us that they had received information about the home from both the Statement of Purpose and Service User Guide. The relative had also visited the home to look around. A family member said that they found information about the home very helpful, they told us in their completed questionnaire that “I visited the home twice before my… (Relative) moved in. All my questions were answered fully... Laura (Home Manager) came to visit … (relative) in the hospital and gave…lots of information about the home.” Information in three residents care files showed that they had received a comprehensive pre-admission assessment before being offered a place in the home. Each of the files examined contained information that identified all the person’s needs. The assessments identified people’s needs in relation to areas such as mobility, nutrition, dressing and toileting. Carrying out an initial assessment before offering someone a place in the home should help to make sure that the specific care needs of each person are identified. This information can then be used to help develop and write a care plan to meet the individual care needs of people admitted to the home. The outcome of a comprehensive assessment of potential residents also provides staff working in the home with information, which supports them in delivering appropriate care. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. The healthcare needs of people living in the home are identified. Medical advice is not always sought when care staff are concerned about the health and treatment of residents in their care. This practice does not make sure that the health and wellbeing of people living in the home is protected at all times. The manager and staff have worked hard to improve the medicine management in the home to a safe level. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents living in this home looked happy and were smiling and talkative with each other and their guests. People looked well presented and groomed. Care files for three residents living in the home were examined at this key inspection visit. Care files were chosen for residents with varying degrees of dependency. These include one resident recently admitted to the home, one resident who had a high level of dependency and the care file for one person who had recently died. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 13 Each care file contained plans for residents care based on information gathered during the pre-admission assessment. Other information used to support care plans for residents include a profile on each person’s life history and interests. This will help care staff to provide care based on the individual needs of residents. The last key inspection carried out in February 2008 identified that care plans did not always provide sufficient details for care staff on what action they need to take to meet the needs of people living in the home. This visit showed that there has been some improvement in the content of care files and that care plans are audited and reviewed monthly or sooner if the need arises. One family member told us: “We meet regularly with my mother’s main carer to discuss any concerns we may have.” Examples of improvements in care file documentation were shown for one of the residents followed through the case tracking process. The resident was observed by staff to be losing weight. A nutritional risk assessment had been carried out and a care plan had been developed based on the outcome of the assessment. The care plan identified the resident’s preferences for breakfast. Instructions were provided for staff and the cook on the need for the resident to have a soft diet. Written information in the care plan showed that the support of a dietician had been sought. The instructions given by the dietician had been written into the care plan following the visit. The advice given was based on increasing the resident’s calorie intake. Observation during the inspection showed that the advice was been followed. Information on the amount and what food the resident was eating was being maintained. Records available also show that the resident’s weight was checked monthly and their progress included in the daily report. The information in the care plan provided staff with sufficient guidance to meet the needs of the resident and provide appropriate care. Further risk assessments tools were seen in care plans. These show that residents are assessed to identify risks related to areas such as falls, developing pressure sores and a person’s level of mobility. Using appropriate risk assessment tools should help staff to identify the level of risk to the health and wellbeing of people living in the home. Care plans had been developed based on the outcome of risk assessments. This makes staff and residents aware of the actions they need to take to minimise identified risks. Written details in care files show that people living in the home have been seen by district nurses, a dentist, an optician and chiropodist. Residents are registered with a GP and are supported to attend outpatient appointments either by a member of their family or care staff working in the care home. However, there was evidence of times when care staff did seek the advice of the GP when they had concerns about residents in their care. An example of this was seen in one of the care pans examined in the case tracking process. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 14 Information in the care plan showed where staff had concerns about using ‘tubigrip’ an elastic tube bandage normally used to provide support for a limb. Staff were concerned about the resident using the tubigrip, which had not been prescribed by the GP or district nurse. Care staff had written in the care plan and discussed with the family that they were unsure how to use the tubigrip and also expressed their concerns about putting the tubigrip on the resident when its use had not been confirmed with the GP or district nurse. The family were asked to sign a disclaimer and the staff agreed to put the bandage support on the resident. There was no evidence to show that the matter had been discussed with the GP or district nurse. The action taken by care staff does not show that they put the wellbeing of the resident first. Care staff continued with treatment they were unsure about without seeking medical advice. Written daily reports in care files provided information on people’s day-to-day life in the home and provided details on their health and well being. Entries were not always signed, dated and timed by the member of staff making the entries. This practice does not support maintaining an accurate and informed audit trail on the day-to-day events of a resident’s daily life in the home. Dating and timing written details on residents would also be important if an investigation of the care of a resident had to be carried out. The pharmacist inspection took place on a different date to the main inspection. Five residents’ medicines, medicine charts and care plans were looked at to assess whether the medicines had been administered as prescribed. Two senior care assistants were spoken with during the inspection. The home had recently changed pharmacist and a new system had just been installed. Previously the senior care assistants used to see all the prescriptions prior to dispensing and then use these to check the medicines and charts received into the home. This practice had stopped as the new pharmacist takes control of ordering and collection of prescriptions. Due to this change the home no longer checks the prescriptions or the medicines received into the home or has ultimate control of what is ordered. We, the commission were assured they would revert back to their previous good practice. Staff do not confirm new resident’s medication with the prescribing practitioner at the earliest opportunity, which may lead to errors. Audits indicated that the majority of medicines had been administered as prescribed. The manager undertakes a weekly audit to check the medication has been administered correctly and occasionally assesses the individual staffs’ practice. This has lead to a vast reduction in drug administration errors that were seen at the last inspection. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 15 The care plans supported the medication that had been prescribed. Clear protocols had been written if a medicine was to be administered occasionally, supporting staff to administer these medicines only when actually required. The senior care assistants had a good knowledge and understanding of the residents’ clinical needs and what the medicines were for. All external healthcare professional visits were well documented and it was easy to track a resident’s clinical condition. People living in the home were seen to be treated with respect and their dignity maintained for example, people living in the home were being called by their preferred name. When talking to resident’s care staff spoke to them respectfully and made sure they looked at and acknowledged the person when speaking with them. A relative told us that there are sometimes problems with getting relatives dressed or dressed appropriately. Residents were noted to be dressed well and appropriately for the time of the year. The contents of the care file for the resident that died in the home showed that a comprehensive assessment had been carried out. An end of life plan of care was developed with the resident and their family. All care was given to provide appropriate pain relief and support to make the sure that the resident was pain free and comfortable. Macmillan nurses and district nurses were also involved in the care of the resident. Information on the ‘Doctors visit sheet’ maintained by the home and in the daily report showed that the GP had visited. A resident told us in their questionnaire “When … (Relative) was ill and later died the GP, district nurses and MacMillan nurses were fully involved. The home ensured that medical treatment and support was available at all times, even during the night. However, concerns were discussed with the managers for Waterloo House after reading a written report which showed that the condition of the resident had suddenly deteriorated. Information written describes the body of the resident as ‘flopped’, breathing through their nose and looking vacant. The carer reports that the resident was responding when they called their name. The carer made the decision not to refer for medical advice. The incident occurred at 07:05 am. The GP was called between 9–9.15 am. The resident died later that morning. The management of the resident during the time leading up to their death was discussed with the manager. There were no records to show that instructions had been given to care staff not to call the GP in the event of the resident’s health deteriorating further. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 16 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 actively supported and encouraged to maintain their independence, interests, and take part in activities which would enhance their quality of life. People benefit from a varied and nutritious diet; however the presentation of soft and liquidised meals does not support a resident’s appetite. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are planned activities taking place in the home during the day. Resident’s were seen taking part in the game ‘hangman’. On the second day of the inspection the hairdresser was visiting. It had been two weeks since her last visit and therefore she spent the whole day providing a service and doing as many of the residents’ hair as possible. A group of women were seen in the hairdressing room enjoying socialising and having their hair done. A programme of activities is displayed in the home and details of planned daily activities or events are identified separately for residents and their families. Care plans read for residents involved in the case tracking process gave details of the residents’ interests, family life and involvement. Notice boards in the corridors of Waterloo House display pictures of activities and events that have Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 17 taken place. The boards also show details of events that are being planned by the home. One of the rooms in Avon Lodge the adjacent building to Waterloo House is in the process of being made into a quiet room “Snoozalem”. Professionals are decorating the room to provide a night scene that can be seen when the lights are switched off. Displays in the corridors of Waterloo house provide points of interests for residents as they walk down the corridor. These include ‘texture boards’ that allow residents to feel materials of different textures as they walk down the corridor. A reminiscence board displays pictures from the twenties to the eighties to draw the eye of the resident and hopefully bring back memories to them of their earlier years. These displays act as a means of therapy for residents. The changes seen in the home will help to provide physical and mental stimulation therefore helping to promote the mental health wellbeing of people living in the home. Family members and friends were seen to visit the home freely to see their relatives. Family members were made welcome and visitors and residents are able to communicate well with staff. Family members were offered a cup of tea while they visited their relatives. Visitors were willing to speak to us during the visit. Residents were offered choice it was observed that staff asked both men and women whether they wanted to have their hair done. Staff also asked residents where they wanted to sit in the dining room at lunch time. Photographs of meals to be served have been taken and displayed on A4 size cards. This is good practice and helps residents make a visual choice of the meal they would like for the day. We observed the lunch time meal service in the dining room, which was served between 12.30 and 1 pm. The meal served was roast pork, broccoli, carrots and potatoes. Residents could ask for an alternative if they wish, such as jacket potatoes and salads. Some residents did not want their meal and were offered sandwiches, which they ate. Residents were supported to sit around the dining tables, which were laid, with table cloths, condiments and a small flower arrangement. The mealtime was a social occasion for some of the residents who are able to have a conversation. People said that the food is excellent and residents were observed to be encouraged to eat as much as they were able to. A resident was offered more food, which they accepted. Meals were brought to the dining room plated and on trays but the meals were not covered when they left the kitchen. This leaves the food exposed to get cold and at risk of contamination from infection while taking the journey from the kitchen to the dining room. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 18 Residents sitting in the dining room who needed assistance with eating their meals were given appropriate assistance. One care staff was observed to sit quietly with a group of residents and support them discreetly to eat and enjoy their meal. Another carer did not look comfortable or natural supporting the residents. Cutting up the food and making it look unappetising and standing at times to feed residents. A further concern during lunch time was the poor moving and handling techniques used by the carer. We observed that residents were held by the carer using their full hand under the resident’s arms to help them to the standing position. This is poor practice as holding the person under their arms could cause injury. One of the residents followed through the case tracking process was seen to be given a liquidised diet in a bowl. Their food had been left in their bedroom uncovered and getting cold. The resident had to wait for a member of staff to be free to feed them. Staff were unable to say why the food had been served before staff was available to help the resident eat their meal. The meal had been all mixed together. Presenting the food in this way means that the resident would not be able to tell what they were eating and be able to appreciate the different tastes. A member of care staff spoken with said that residents who required liquidised and soft meal always have them prepared and presented in this way. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 19 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. People using the service are confident that their complaints will be listened to, taken seriously and acted upon. Action is taken by the home to safeguard people from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home reported in their AQAA that they had received six complaints since the last inspection. The complaints had been appropriately investigated and resolved to the satisfaction of the complainants. Recording complaints received by the home will show how they are dealing with all complaints. The outcome of investigating complaints supports the home in improving the quality of the service it provides. A policy and procedure is available and a summary of how residents or their families can make a complaint is available in a separate booklet. We have not received any complaints about the home since the last key inspection. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made in questionnaires and during the inspection include: “With the present manager when I have had concerns they have always been dealt with to my satisfaction and reported back on what action has been taken.” Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 20 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. The home has made one referral to Social Services regarding the allegations of abuse. This has been investigated and satisfactorily resolved under local adult protection procedures. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Training records examined shows that protection of vulnerable adults training had been offered to staff. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 21 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, 21, 22, 23, 24 and 26 Quality in this outcome area is good. People live in a home which is maintained, homely, clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Waterloo House Care Home comprises of two buildings, the main house known as, ‘Waterloo House’ and Avon Lodge. Access to the front entrance of the home has been improved by cutting back the hedge. The home is presently undergoing redecoration and refurbishment. This has not compromised the living conditions for residents living in the home. Work is ongoing to make the conservatory adjacent to the dining room in Waterloo house accessible to all residents. Plans are to have a suitable ramp built making the conservatory accessible for the able bodied and people with mobility problems. The flooring in the corridor of Waterloo house is still uneven, which could present a trip hazard for residents. The manager and area manager told us that planning has started to decide what work is needed to even out the floor and make it safe for residents to walk on. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 22 The home was noted to be free of any malodour at this inspection visit. Bedrooms viewed looked homely and were furnished to meet the needs of residents living in them. Rooms contain some of the residents own possessions such as furniture, pictures and ornaments. Some bedrooms on the ground floor have access to garden area at the side of the home. A maintenance man is available full time to carry out ongoing day to day maintenance in the home. There are three bedrooms on the first floor all have access to one bathroom, which had suitable equipment. The manager told us that deciding which residents are accommodated on this floor forms part of the admission process to make sure that they are able to access the two steps which lead to the bathroom on this floor. Negotiating these steps would be difficult for residents with mobility problems. The toilets on the ground floor had been improved to address the issues raised at the last inspection to ensure that they were suitable to be used. The bed seen at the last inspection that was not working and the mattress with a dip in it had been replaced. Work had started on the cleaning and maintenance of extractor fans in the home. Work has started on improving signage in the home. For example signs on toilet doors are in large, clear lettering. These are specifically designed for the purpose of providing appropriate signs or labelling of areas in the home which are used by the people living in it. It was disappointing to note however that a handwritten notice on one of the toilet doors situated in Avon Lodge was not written clearly and would not be seen until opening the door. The notice was to warn people that the toilet was out of order and should not be used. The toilet door was not locked and we were told that the toilet had been out of order for approximately one month. The toilet was the nearest to the lounge and therefore easily accessible to residents using the lounge. This does not show that the best interests and safety of residents had been considered on this occasion. There is a well-organised food store (larder), two freezers and one fridge. Temperatures were taken of food received into the home and cooked meals served to people who live in the home. Cleaning records in the kitchen show that they are not consistently maintained. Completing the records will show when cleaning was last carried out; provide information for evidence when practices in the kitchen are monitored or an outbreak of infection is reported. The laundry is situated in Avon Lodge. The organisation of the laundry had improved and the room was noted to be tidy and organised at this visit. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 23 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. People do not have safe and appropriate support at all times from staff that are competent and suitable to care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Duty rotas examined for a four week period between the 4 July 2008 and 7 August 2008 show that staffing levels are consistently maintained. We were told in the AQAA received from the home that staffing levels have been increased to meet the changing needs of people living in the home. The majority of residents have varying degrees of dementia. The manager is supernumerary. The deputy manager is allocated some supernumerary hours to support the management of the home. The majority of her time is spent working shifts overseeing and providing care for residents. Following the last inspection visit laundry staff are employed daily between the hours of 8.00 am and 2.00 pm seven days of the week. We were informed that care staff do not undertake laundry duties outside of these hours. This means that care staff numbers are not depleted to undertake other duties that would take them away from providing care to residents. Other ancillary staff employed include domestic and catering staff and a maintenance man five days per week working from 08:00 am to 4:00 pm. The Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 24 home also employs an activity coordinator who works five days per week six hours per day and usually between the hours of 10:00 am and 3:00 pm. The activity coordinator does vary her hours of work from time to time depending on the activities taking place. Relatives commenting on staffing levels in the home said “There is always a member of staff on hand if you need to ask any questions.” Training records show that nine out of forty care staff employed in the home has a qualification in care at NVQ (National Vocational Qualification) level two or above. Information in the AQAA told us that a further ten care staff are currently working towards the award. This means that 22.5 of care staff in the home are qualified at NVQ level two or above which is well below the National Minimum Standard for 50 of care staff to have this qualification. Although there are a further ten staff completing the course, the percentage of staff with a qualification in care will still be below the minimum standard required (47.5 ). This means that the home cannot guarantee that residents are cared for by competent qualified staff at all times. Although training records show that staff have received training in moving and handling, observation of poor practice was seen at this inspection visit and these concerns are discussed under the ‘Daily Life and Social Activities’ section of this report The personnel files of three recently recruited staff were examined. The files showed that there was some improvement in pre-employment checks. Records show that Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) checks had been carried out. Evidence was available to confirm that staff did not start working unsupervised in the home until the receipt of a satisfactory CRB check. Two references were obtained for all staff. However steps were not always taken to ensure that references were being requested from the most suitable person. Ensuring consistent and robust recruitment procedures are followed before staff start working in the home safeguard people living in the home from the risk of abuse. One recently employed care assistant confirmed that pre employment checks were made before they started working in the home. Some family members commented that they have concerns about the lack skills of some care staff, due to problems with language barriers. There were members of staff whose second language is English working in the home on the day of the inspection. Care staff were observed to talk clearly and slowly to the elderly residents to help the residents understand them. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 25 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. People have confidence in the way the care home is being led and managed. Appropriate health and safety practices are not consistently carried out to make sure the health, safety an welfare of people are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Care Home Manager has worked for Alpha Care Homes for seven years. She has completed the NVQ 4 Registered Manager Award (RMA) qualification and is responsible for the overall day-to-day management of the care home. The manager and deputy manager were present on both days of the inspection. Both managers are knowledgeable about people in the home; both were very attentive towards the residents. The manager and staff showed during the inspection that they are keen to make improvements and since the Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 26 last inspection have taken actions to address all of the issues identified in the last report. The area manager was present on the first day of the inspection and for part of the inspection on the second day. There are clear lines of accountability within the home with the deputy manager reporting to the manager. The home now has good support from an administrator who helps in the day to day running of the care home. Staff spoken with said that the management team are always approachable. A member of staff told us in their questionnaire that the manager and deputy manager are both very good at motivating staff. “Staff work well together with excellent support from management.” The manager told us in the AQAA for the home that questionnaires are sent out to residents. The home’s Quality Assurance file contained evidence that management reviews the service provided in the home and identifies areas for improvement. Action plans are developed for making improvements and are reviewed to monitor progress against the objectives set. The personal monies of people living in the home are kept securely and accurate records of income and expenditure are maintained. Audits are carried out to confirm that residents’ monies are managed safely. Information sent to us in the AQAA tells us that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Evidence was sampled at random to confirm this. For example, hoists indicate they were checked in April 2008. Gas appliances were last checked in December 2007. A fire risk assessment and checking of fire equipment was made in August 2008. The fire alarm is tested weekly. Health and safety concerns identified at the last inspection visit are being addressed by the organisation. Work continues on reviewing and supplying suitable and safe access to the conservatory. The manager also told us that work is ongoing on reviewing the uneven floor in the corridors of the main home. Part of this work is deciding what is the most appropriate, safe and cost effective route to take. Evidence discussed in this report under the section headed daily life and social activities identified concerns related to health and safety. These relate to the way in which meals are transported from the kitchen to the dining room. Meals were not covered, which means they are exposed to the risk of contamination from infection while taking the journey from the kitchen to the dining room. A member of care staff was observed to use inappropriate moving and handling techniques when helping a resident to stand. A ‘grabbing’ technique was used, which means that the resident is at risk of being held tightly under their arms by the carer using their full hand. Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 27 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 2 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 3 X X X 3 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 13(1)(b) Requirement Timescale for action 30/09/08 2 OP8 13(1)(b) 3 OP29 18 Sch.2 Care staff must seek medical advice when they have concerns about non-prescribed treatment used by residents in their care. This is so that care staff make decisions within the limits of their professional role and make sure that people using the service receive care that promotes their health and wellbeing. 30/09/08 The management of people during the end stages of their life must be reviewed to make sure that staff are seeking medical advice when a person’s condition deteriorates. This is so that care staff make decisions within the limits of their professional role and shows that informed decisions are made in the best interests of people living in the home. Two written references, including 31/10/08 where applicable, a reference relating to the person’s last period of employment, which involved work with vulnerable adults must be secured. This will ensure that the home’s staff DS0000004260.V370852.R01.S.doc Version 5.2 Waterloo House Page 29 4 OP38 13(5) recruitment practices are robust enough to safeguard people living in the home. Safe care practices related to moving and handling must be used at all times. Staff must help a person to move or transfer by holding them under their arms. This includes: When helping a resident to stand or supporting a resident to move from one chair to another. These practices could result in injury to residents due to poor practice. 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose should contain information on the size of rooms available for use by people wishing to move into the home. This will ensure prospective residents have all necessary information to enable them to make an informed decision about using the home. Written entries in resident’s care files should be dated, timed and signed with the person’s signature. This will ensure that a legible and effective audit trial is available to track the care given to people living in the home. The Home should see the prescriptions prior to dispensing and checks the medicine charts and medication in against a copy of these before they are administered. This is to ensure that the service users receive their medicines as the doctor intended. Locked cabinets should be installed in the medication cupboards to reduce access to medication stored in the home. DS0000004260.V370852.R01.S.doc Version 5.2 Page 30 2. OP7 3. OP9 4. OP9 Waterloo House 5 OP9 6 7 OP15 OP15 8 9 OP15 OP26 10 OP28 11 OP33 12 OP38 13 OP38 14 15 OP38 OP38 A system should be installed to check all new service users’ medication with the prescriber at the earliest opportunity to ensure that they receive the current drug regime only. Staff should be trained to give appropriate support at meal times. This will help residents to enjoy their meal, improve their appetite and maintain their dignity. A review should be carried out on how meals for residents living in Waterloo House are transferred from the kitchen to the dining room. Meals should be covered. Consideration should also be given to meals that are served to people who choose to eat their meals in their bedroom or other room in the care home. This will help to make sure that the food served is not exposed to bacteria while being delivered to the resident. Food should be presented attractively to residents’ which will promote an increase in their appetite and help them enjoy their meals. Cleaning records in the kitchen should be kept up to date and the cleaning monitored to make sure that the cleaning has been carried out. This will promote the control of cross infection in the home. Work should continue to increase the number of staff with a NVQ level 2 (or equivalent) qualification in care. This will mean that people have safe and appropriate support at al times from staff that are competent and suitable to care for them. Family members should be given the opportunity at resident and relative meeting to discuss their concerns about language barriers. So that there are aware of the measures that the home has taken to promote effective communication between residents and staff whose second language is English. Work should continue on improving the access to the conservatory so that care staff are not tilting residents backwards in chairs to get in to the conservatory. This will ensure that people who use the services are protected from the risk of harm. The uneven floor in the corridors of the main home. Must be reviewed to level and safe for residents and staff to walk on. This will ensure that people who use the services are protected from the risk of harm. Notices giving instructions should be clearly written, appropriately placed and easily accessible. Areas of the home or rooms considered out of order should be locked or secured to ensure the safety of people using the home. DS0000004260.V370852.R01.S.doc Version 5.2 Page 31 Waterloo House 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 Waterloo House DS0000004260.V370852.R01.S.doc Version 5.2 Page 32 - 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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