Inspection on 16/01/06 for 2a Waterloo Street

This inspection was carried out on 16th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

2a Waterloo Street 24/05/07

2a Waterloo Street 24/06/05

2a Waterloo Street 06/09/04

2a Waterloo Street 07/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 2a Waterloo Street Cockermouth Cumbria CA13 9NB Lead Inspector Gordon Chivers Unannounced Inspection 16th January 2006 09:30 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 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 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 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 Adults 18-65. 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. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 2a Waterloo Street Address Cockermouth Cumbria CA13 9NB 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) 01900 827749 West House Mrs Elizabeth Marie Clements Care Home 10 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (10) of places 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Registered for 10 people over 18 years of age with a learning disability (LD), some of whom may be over 65 years of age (LD(E)). The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 24th June 2005 Date of last inspection Brief Description of the Service: West House are the Providers of the services and care at 2a Waterloo Street for ten people who have a learning disability and who may be older adults. The home is situated in a quiet side street near to the centre of the town of Cockermouth. The home blends into the surrounding community and there is level access to local amenities and facilities. 2a Waterloo Street operates as two units for five people on both the ground and first floors. Private bedrooms are situated on both floors and access to the upper floor is by either stairs or chairlift. There is a small garden to the rear of the home that includes a public footpath. There are car-parking facilities adjacent to the home. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over seven hours from 09.30 to 16.30, and took place in the presence of the manager Liz Clements. A tour of the home was undertaken, and a sample of case files and a range of other documentation was examined. Two members of staff were interviewed in private and some of the service users were spoken to. The inspection looked at those standards which had a requirement or recommendation made against them at the last inspection, and some of the standards which were not assessed during the last inspection. The inspector would like to thank the service users and staff for their welcome and cooperation throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: The admission process ought to be undertaken and recorded more thoroughly. Staff should receive accredited training in the administration of medication. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Adequate information about the home is available for service users. The home’s admission procedure is not thoroughly implemented. The service users have written contracts of their residency. EVIDENCE: The home has a comprehensive Statement of Purpose and Service User Guide in place, although these are to be updated to take account of recent and prospective changes of staff. The last admission to the home was in October, 2005. The service user in question moved from a temporary placement after having to leave his previous home. This was another ‘Westhouse’ home and so the organisation was acquainted with his needs. The service user was also acquainted with some of the service users already resident in the home and, coincidentally, a vacancy had arisen at the time. However, the process of admission to the home did not conform to the Standard, nor to Westhouse’s own procedures, in that the service user was only given one pre-placement visit to the home. The reasons given are that the service user was very unhappy and unsettled in the temporary placement, and that Cumbria Social Services put pressure on Westhouse to provide the service user a place in 2a Waterloo Street Nevertheless the service user did not have sufficient opportunity to assess the home for himself, nor the staff to fully assess the appropriateness of the proposed placement. The immediate need of the service user (to leave the temporary placement) was met, but there was insufficient evidence to indicate that his needs would be met over the long term. As it happens the service user has settled well into his new home and, due to the efforts of the staff, has not behaved in any of the ways which caused concern in his previous home. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 9 The Action Plan provided by the Service Manager as a result of the last inspection has yet to be implemented in that the process of this admission was not documented. This was discussed with the manager who demonstrated how she will ensure that the process of future admissions would be recorded in an appropriate section in the case file. All of the service users have contracts/ terms and conditions of their residency. These have been signed by the service users, but some of them have still to be signed by the manager. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,8,10 Service users are supported in participating on care planning and reviews. They are consulted on and are involved in all aspects of domestic and personal life. Personal information about service users is handled appropriately. EVIDENCE: The service users in the home are supported in the assessments of their needs and the development and reviews of their care plans by members of their family if they have any, or by independent advocates. There is evidence in the case files that staff supported the service users in making decisions for themselves, for instance regarding bed times, clothes worn, meals, bedroom furniture and décor, activities and leisure. All service users participate in drawing up the weekly menus. During the inspection there were various instances in which staff asked service users what the preference or wish was regarding specific issues. The information about service users is kept in filing cabinets in the office which is locked when not in use. The home clearly respects and protects the confidentiality of personal information. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14,16. Service users are involved in a range of leisure activities of their choice. The staff respect service users’ rights and support them to understand their responsibilities. EVIDENCE: The case files contain records of service users’ likes and dislikes and what they want to do. The service users engage in a range of leisure activities. These can include shopping, attending church, going to discos and local gatherings, sitting on the benches on the main street and watching the world go by, doing jigsaws and crafts. Staff are committed to respecting service users rights as a core principle of their work, and this is evident in the way in which they interact with them. They also support service users in recognising and understanding that they also have responsibilities which they have to take account of in their attitude and behaviour towards other people. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,21 Staff administer the service users’ medication correctly, although they do not appear to have received accredited training. Staff manage the aging, illness and death of service users extremely well. EVIDENCE: None of the service users administer their own medication. The home has two regulation medication cabinets in the office: one holds the medication and the other holds all the creams. The first has an inner box for controlled drugs. The MAR sheets are completed and signed appropriately. A separate record is kept of medication which is disposed of. A local pharmacist provides advice and guidance to staff but this is not accredited training. Westhouse are currently in the process of engaging a training organisation to provide staff with accredited training in the administration and safe handling of medication. The home has copies of the Westhouse policy and procedures on the administration of medication. Westhouse have engaged with a local advocacy service to provide independent support to service users in a variety of ways, including indicating their wishes at death. This is always a sensitive and difficult issue for some service users to understand and/or cope with. Most but not all service users have stated their wishes in this respect. It was suggested to the manager that a record should be kept of all attempts to support those service users who are either unable or unwilling to deal with this issue. In October, 2005 the home experienced the 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 13 death of a service user who had lived there for many years. The records of how the home cared for this service user in her final days and weeks of life show the level of care (and affection) with which she was treated. This service user had been bedfast for three years prior to her death and yet had never once suffered from bedsores. Quite a few of the home’s service users have reached old age and are suffering with long-term conditions. One middle age service user is now in the early stages of dementia. The staff are very aware of the long-term health implications and there is plenty of evidence in the health records and action plans that they are managing these issues as best they can. There is frequent contact with primary care and community nursing personnel. During the inspection the makers of a new mobility aid came to the home to demonstrate it to the staff who wanted to assess it for a particular service user. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home and Westhouse is in the process of providing training for all staff in order to ensure the protection of service users. EVIDENCE: Westhouse has records of the POVA and CRB checks which are undertaken in respect of all staff. Three members of staff who have not had any recent training on the protection of vulnerable adults are due to receive such training at the end of February 2006 as part of a current rolling programme being provided by Westhouse. Staff who were interviewed were aware of the issues involved in identifying and preventing abuse or neglect, and none had ever had cause for concern in this respect. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,30. The home’s risk assessments support the need for a barrier at the top of the stairs to ensure the safety of the service users. Every bedroom is personalised, homely and well appointed. The planned refurbishment of the downstairs bathroom will better meet the needs of the service users, and new mixer valves on the hot water taps will allow for the hot water to be set at the regulation temperature. The communal lounges and kitchens are very well appointed but the ground floor lounge does tend to become crowded outside of mealtimes. The home is very clean and hygienic. EVIDENCE: The manager has up-dated a risk assessment in respect of one of the service users who sleep on the first floor who sometimes rushes about and is prone to stumble. The home have retained the metal gates at the top of the stairs as a physical and psychological barrier because of this level of risk. Nevertheless the metal gates are somewhat institutional, and the manager agreed to consider whether a more homely alternative is possible. Every service user’s bedroom has been personalised to reflect their characters and is individual in décor and furnishings. The service users are supported in choosing these for themselves. Every bedroom is cleaned thoroughly on a weekly basis and service users are encouraged but not compelled to help. All 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 16 of the bedrooms are bight and cheerful and clean, with personal belongings, ‘nick-nacks’ and pictures on display. The downstairs bath is no longer effective in meeting the needs of the service users. It is due to be replaced by a walk-in, level-entry shower within the next month. This will better enable the staff to meet the needs of those service uses who are becoming increasingly infirm. At the same time mixer valves are due to be fixed to all the hot-water taps so that the fixed temperature gauge on the hot water tank can be correctly set to 60 degrees without presenting a hazard to service users. Currently the boiler temperature is set at 45 degrees to prevent the service users scalding themselves when using the hot water taps, but this in turn presents a danger of legionella. The hot water pipe in the downstairs toilet is not boxed in and as such represents a potential hazard. The manager has brought this to the attention of the landlord, Impact Housing Association. The health and safety notices have been removed as required by the last inspection. The door between the ground floor kitchen and lounge has been re-stained but it still bears marks through wear and tear. This is probably inevitable since this area is the social hub of the home where all of the service users tend to congregate outside of mealtimes. There is a well appointed lounge and adjoining kitchen on the first floor but these are not as well used as the downstairs lounge, even though it is only big enough for five or six people. This is a quandary for the manager with no obvious solution. One staff mentioned that ideally the whole of the home would be on the ground floor, although this is obviously unrealistic in this particular house. There is a noticeable lack of storage space in the home, and this will become more of an issue as the service users’ needs for aids and equipment increase as they reach old age. The carpet in the general corridor has been professionally cleaned and is now perfectly serviceable. The home is kept clean and hygienic in meeting the needs of all the service users. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,36 The service users are supported by a well qualified, well supervised and effective staff team. EVIDENCE: Of the twelve members of staff (excluding the manager), nine have qualified to NVQ level 2 or above, and the other three members of staff are currently undertaking the level 2 qualification course. Many of the staff have worked in this home or in other Westhouse homes for several years and therefore have considerable experience between them. Members of staff have occasional refresher training in aspects of health and safety as and when they are referred by the manager. Westhouse is aware of the additional needs of the current service users as they grow older, and has informed the Commission that it has raised this issue with Cumbria Adults Services. The home has recently offered jobs to two new support staff and if they accept the offers they will fill the two vacant posts. This will ease the pressure on the current group of staff. Some members of staff said that morale within the staff team had improved since last autumn when the home experienced a lot of changes. House meetings involving staff, and service users who choose to attend, take place every month. The manager has evidence that staff have formal supervision with her on six occasions in a year. One member of staff gave permission for her supervision file to be looked at. The manager is also about to introduce a system of annual appraisal for all staff. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,40 The management approach of the home focuses upon meeting the needs of the service users, and on supporting staff to do this. The home’s policies and procedures are well developed and guide staff in meeting service users needs fully and correctly. EVIDENCE: One support worker has recently been promoted to the new post of senior support worker. This post will ease the manager’s workload and will assist in the managerial and administrative duties of the home. This meets a requirement from the last inspection. The senior support worker is relatively new to the job and is still adjusting to it and her new working relationship with the other staff members. Staff considered the manager to be approachable and supportive, and that the central principle of the home was that ‘the service users come first’. The manager has yet to develop an annual Service Improvement Plan. The home has a comprehensive range of well developed policies and procedures to safeguard the service users and guide the staff. The staff are aware of these and know how to access them. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 X 3 X 4 2 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 3 X 3 x 3 X X x 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA4 Regulation 14,17 Requirement The registered person must ensure that their admissions procedure is complied with fully in the case of all new admissions, and that the process of admission is fully recorded. The registered person must ensure that all new placements are based solely upon the needs of the service users in home and are not influenced by any other factors. All staff who administer medication to service users must receive accredited training. Timescale for action 16/01/06 2 YA4 14 16/01/06 2 YA20 18 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations More homely alternatives to the metal gates at the top of the stairs should be considered. 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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 2a Waterloo Street DS0000022556.V279160.R01.S.doc Version 5.1 Page 22 - 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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