Inspection on 05/12/06 for Waterloo House

This inspection was carried out on 5th December 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Waterloo House 30/10/07

Waterloo House 25/01/06

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Waterloo House 3 Nelson Gardens Stoke Plymouth Devon PL1 5RH Lead Inspector Jane Gurnell Unannounced Inspection 5th December 2006 10:00 Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 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 DS0000066199.V290560.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 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. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterloo House Address 3 Nelson Gardens Stoke Plymouth Devon PL1 5RH 01752 567199 01752 567199 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) Vivacare Limited Vacancy Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (20) Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must only accommodate service users over the age of 30 Date of last inspection 19/01/06 Brief Description of the Service: The care home was purchased by Vivacare Ltd on 19/12/05. The home is a large terraced building, approximately 150 years old, on a small private road close to Stoke village in central Plymouth. A full range of amenities and facilities are within walking distance of the home. The home can accommodate up to twenty residents over three floors. There are two communal bathrooms and two communal shower rooms. There is a shaft lift providing access to the first an second floors. There is a large lounge to the rear of the building on the ground floor and this opens through patio doors onto a large enclosed garden. A further lounge room is provided on the first floor for residents who wish to smoke. There is only one shared bedroom in the home all the others being single bedrooms. Due to the age of the building all the rooms have high ceilings which help the rooms and the home in general to feel spacious. The service offered by the home is primarily for people with long standing mental health issues of various types. The residents group has a mixed range of abilities from highly independent to more significantly disabled. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on 5th December. Prior to the inspection, the Commission had sent surveys to the residents to enable them to respond anonymously and directly to the Commission regarding their views of the quality of the service they receive. Five surveys were returned and all said that they received the support they need and were satisfied with the overall service. The inspector made a tour of the building and spoke to 6 residents in detail as well as the care and ancillary staff on duty. Records relating the care and support of 4 of the 6 residents spoken to were examined, as well as medication records and staff personnel files. The deputy manager and her staff team assisted the inspector throughout the inspection. What the service does well: What has improved since the last inspection? One member of staff has the responsibility to organise an ongoing programme of training to ensure staff have the knowledge and skills necessary to support residents with complex mental health needs. Refurbishment and redecoration of the building continues to ensure Waterloo House offers a safe, warm and conformable home to its residents. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 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 Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home admits new residents appropriately so that both the home and the new resident can be confident that their needs will be met by the service. EVIDENCE: One newly admitted resident described that he had been able to visit the home and spend time with the staff and other residents before making decision to move in. He said that he had been made very welcome and felt he had made a wise choice of home. From the examination of his care plan it was evident that a detailed assessment of his needs had been undertaken by social services prior to his admission identifying the support necessary to meet his needs and ensuring that Waterloo House is an appropriate home. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning at the home is adequately managed enabling residents’ needs to be identified and met. EVIDENCE: From discussions with the residents and care staff it was clear that the residents felt well supported and that staff had a comprehensive knowledge of residents’ needs. All of the 6 residents spoken to at length said they were well supported and were happy living at Waterloo House. The care plans for 4 residents were examined however these did not reflect the same level of detail and provided only a brief description of care needs. For example, one resident’s care plan stated that at times he suffered with breathing difficulties. The care plan did not describe the circumstances under which it was known the resident suffered these difficulties, what action the staff should take at this time and whether medical assistance was necessary. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 10 The deputy manager said that she had made a start of reviewing each resident’s care plans to ensure that these contained a current description of their care needs. Advise was given to include information about how a resident’s physical and mental health condition affects their day-to-day living and the nature of the support required from staff. This is important, particularly for people with complex needs to ensure consistency in care and to identify if a resident’s physical or mental health condition is deteriorating. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The efforts made by the service to provide choice helps support the dignity and individuality of the residents, and helps the home to be run to meet the individual needs of the residents. EVIDENCE: Residents were seen coming and going freely from the home without any need to seek permission from staff. Residents were seen moving around the communal areas of the home, talking, eating and drinking as they wished. Some residents spoken to preferred to spend time away from the communal areas and this was respected. Some residents described the individual activities they participated in outside the home. Some residents commented on how they could do what they wanted when they wanted. All the residents have an assigned key worker who helps the resident develop a weekly activity plan. This plan is kept with their care plan and their activity is recorded in an individual daily activity record. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The administration of medication in the home is well managed ensuring that residents prescribed medication is effectively delivered and their physical and mental health needs are met. EVIDENCE: Residents said they were well supported by kind and caring staff. The inspector was able to observe staff going about their duties and interacting with residents in a respectful and friendly manner. The residents care plans, the records of medical professionals visits and information given by the deputy manager and care staff showed the considerable medical support being received by the residents. This information noted the input of Community Psychiatric Nurses, Psychiatric consultants, dieticians, the incontinence service, speech and language therapists, district nursing and GPs. Medication records were accurate and medication stored safely. Those with the responsibility for medication administration had received training from the local pharmacist to ensure that were aware of safe medication practices. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The welfare of the residents is protected through the proper management of concerns and complaints and thorough adult protection procedures. EVIDENCE: Prior to the inspection, the Registered Provider had received a complaint regarding restrictions placed upon a resident’s access to their bedroom. The Registered Provider demonstrated their commitment to protecting residents and appropriately investigated this complaint. The complaints procedure is displayed in the main hallway making it accessible to residents, their relatives and other visitors to the home. The home has a copy of Plymouth City Council’s Alerter’s Guide and staff have received adult protection training to ensure they have the knowledge and skills to respond appropriately should they suspect that a resident is at risk of abuse. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Waterloo House provides a pleasant, comfortable and safe home for its residents. EVIDENCE: The home was found to be very clean and tidy and the communal areas and bedrooms are comfortable and pleasantly decorated. At the time of the inspection the main hallway on the first floor was being decorated and a bathroom had recently been refurbished indicating the Registered Provider’s commitment to ensure the home is well maintained. A lounge room is provided for residents who may smoke. Residents’ bedrooms all have an individual lock to provide them with privacy and security for their belongings. Residents’ bedrooms have been personalised and decorated to different degrees. At the previous inspection the former Registered Manager stated that all the baths and sinks have been fitted with temperature control valves. These valves prevent the hot water temperature at hot taps becoming too hot reducing the risk of scalds. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are satisfactorily met by trained and competent staff. EVIDENCE: Residents said that they are well supported and feel there are sufficient staff employed to meet their needs. At the time of the inspection there were 3 care staff on duty and the deputy manager as well as catering, domestic and maintenance staff. Examination of the duty rota indicated that there were 2 or 3 care staff on duty each day during the morning and early afternoon and 2 care staff in the later afternoons and evenings. Care staff said that during the busy times in the mornings that 2 care staff were insufficient should a resident became distressed and need more staff time than usual. They were advised to discuss this with the Registered Provider. The deputy manager confirmed that a senior member of staff had the responsibility to organise an ongoing programme of staff training to ensure staff have the necessary knowledge and skills to support residents with mental health conditions: evidence was available that training had been planned for the New Year. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 16 Three care staff files were examined, one of which was for a member of staff who had recently been employed. Two files contained the appropriate information including an application form, 2 written references and a Criminal Record Bureau (CRB) disclosure ensuring as far as possible their suitability to be employed. The file of the newly appointed staff did not contain a copy of the references or evidence that a check had been made against the Protection of Vulnerable Adults (POVA) List which is the check that is required for someone to start working at a care home before the CRB disclosure is received. The deputy manager said that due to the home not having a Registered Manager, the company’s Responsible Individual oversaw the employment process and had the references and disclosures. The Responsible Individual is the person appointed by the company to ensure each establishment is managed according to company policy and the Care Homes Regulations. References and disclosures are strictly confidential and were held by the Responsible Individual to ensure confidentiality. The deputy manager gave assurances that she had been instructed by the Responsible Individual that this member of staff’s references and POVA check were satisfactory and she was able to start work at the home. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39,42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The deputy manager and her staff team strive to provide a homely, stimulating and safe environment that respects and protects residents’ rights. EVIDENCE: Both residents and staff said the home continues to be well managed despite the Registered Manager leaving some months previously. The home is being managed by the newly appointed deputy manager who is supported by her staff team and the company’s Responsible Individual. It is anticipated that the Registered Provider will review the management structure of the home and appoint a Registered Manager in the near future. Due to the home not having a Registered Manager this outcome group is being assessed as adequate and the management of the home will be reassessed at the next inspection. The Environmental Health inspection report, dated 16/01/06, required that ventilation in the kitchen be improved because the temperature in this room Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 18 could become too high during the summer months. This requirement will be follow up by the Plymouth City Council’s Environmental Health Department. The windows in those rooms examined by the inspector were fitted with opening restrictors reducing the risk of falls. The deputy manager was advised to check that all windows above ground level had been risk assessed for the fitting of a restrictor. As the deputy manager is new to her role, she is in the process of assessing the most appropriate manner of consultation with residents, relatives and visitors to the home. She is planning meeting residents individually, arranging group meetings and using questionnaires to assess the quality of the service being provided. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 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 X 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X X 3 X Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 20 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 YA6 Regulation Reg. 15 (1) Timescale for action Unless it is impracticable to carry 31/01/07 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of their health and welfare are to be met. The Registered Provider must ensure that each resident has a service user plan (or care plan) that accurately describes the resident’s current care needs and the action required by staff to meet those needs. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 21 No. Refer to Standard Good Practice Recommendations Waterloo House DS0000066199.V290560.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 DS0000066199.V290560.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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