Inspection on 06/02/08 for Waterside House

This inspection was carried out on 6th February 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Waterside House 30/05/06

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

CARE HOMES FOR OLDER PEOPLE Waterside House Moathouse Lane West Wednesfield Wolverhampton WV11 3HA Lead Inspector P Wells Key Unannounced Inspection 6th February 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 Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterside House Address Moathouse Lane West Wednesfield Wolverhampton WV11 3HA 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) 01902 738 124 01902 867 974 home.wlv@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Vacant Care Home 60 Category(ies) of Dementia (60) registration, with number of places Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must not fall below the following staffing levels: 1 full time Manager 37.5 hrs per week off rota. Early shifts (08.00 - 15.00) 2 x assistant managers/seniro care assistants 10 x care assistants Late shifts (15.00 - 22.00) 2 x assistant managers/senior care assistants 10 x care assistants 1 x shift per week Assistant Home Manager Assistant home manager Night shift (22.00 - 08.00) 4 x night care assistants 1 x senior/manager on call The home is registered to provide care for up to 60 service users with dementia. Up to 5 (five) service users aged 55 years plus, other service users must be over 60 years. 30th May 2006 2. 3. Date of last inspection Brief Description of the Service: Waterside is a purpose built residential care home which opened in November 2005. The home accommodates sixty older people with dementia type illnesses. The building is on two floors, which is serviced by a lift. All the bedrooms have en-suite facilities. The home is split into four units each with its own lounge/ dining area. In addition to there are themed lounges. The home has a large enclosed garden. The home is situated in a quiet residential area approximately one mile from Wednesfield shopping centre. The service is run by Methodist Homes for the Aged but welcomes people of any faith or culture. The responsible individual is Carol Artis and the registered manager was promoted within the organisation on 1st December 2007. The stated ‘philosophy of care is person centred and holistic, with the individual and their preferences at the centre.’ Waterside House DS0000065543.V356710.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 the people who use this service experience adequate quality outcomes. This was a full inspection of Waterside to look at how the home is performing in respect of the core national minimum standards (the report says which these standards are). This is called a key inspection and was carried out by two inspectors and a pharmacist inspector. Since the last key inspection in May 2006, another inspection had taken place on 22.11.06 following a complaint. There were two visits to the Home, the first was unannounced and the second was arranged with the temporary manager. The registered manager, left at the end of November 2007 to take up a new post within the organisation. Hence the temporary manager had only been at the home for a few days before the inspection commenced. The registered manager had completed a detailed Annual Quality Assurance Assessment for the Commission in October 2007. This information about the service was taken into account. We sent survey forms to a sample of people who live at Waterside or use the service for short stays (4), relatives (12), staff (10) and professionals (11) who know the service. Responses were received from 2 residents, 7 relatives, 1 staff and 2 professionals. We also heard from Wolverhampton Social Services who have a contract with the service for the majority of places. During the two visits the inspectors spoke with the manager, some residents, staff and visitors. There was a tour of the building and time was spent observing how people spend their days and what the arrangements were at lunchtime. Throughout the inspection there were opportunities to observe the contact and support people were given by staff. Documentation was checked, including the care records of people who live at Waterside, and some staff files. Copies of policies and procedures were made available. Information about the range of fees and additional charges was requested but this could not be located in the home or in documents. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home would benefit from a manager who stays to lead the development of the service. Detailed assessments need to be available for the staff before a person moves into the home. Care plans need to be easy to read, up to date and detailed so there is a clear picture of the person’s needs and daily routines and lifestyle. Care needs to be taken to ensure that people’s clothes do not go missing. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 7 Arrangements for the safe administration of medication need to be improved. There needs to be a more robust process for dealing with concerns, complaints and safeguarding individuals and their personal belongings. People would benefit from a level, secure, interesting garden with easy access from the home. Aspects of infection control need attention. Staffing levels need to be reviewed and maintained to ensure that staff have the capacity to support the complex needs of the individuals living at Waterside. All the staff should supervision and have training in safe working practices and dementia care, as well as the opportunity to take a qualification in care. The provider should review the mix of permanent and short stays on the four units and consider a unit specifically for respite care. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available for people considering moving into Waterside. The assessment process should be more detailed to ensure that an individual’s needs and lifestyle are known and can be met at the home. EVIDENCE: Waterside has a service user guide and statement of purpose that are available to people viewing the home, their relatives and professionals. These documents have been updated since the last inspection. The guide should include the range of fees, charges for extras, results of surveys and the home’s complaints procedure. The service user guide should be given to new residents and their families before or on the day of admission. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 10 Waterside has 50 permanent places and 10 respite places, the majority of which are filled under contract by Wolverhampton Social Services. The home has an established introductory and assessment process for planned admissions. This can include visits to Waterside prior to admission, a senior staff visiting the person in their own home or hospital and contact with relatives. Basic details about the person are recorded and could be more detailed regarding the individual’s circumstances, needs and lifestyle. The sample of admission records viewed (6) indicated the information varied and that Social services were always not providing the home with a full assessment just referring to ‘24 hour care needed’. For emergency and respite admissions information was limited. Without detailed information for a new person (with dementia) it is difficult for staff to know how to care and support them. People who live at the home permanently have a ‘residential care agreement’ and in this document the fee for the individual is indicated. Waterside does not have an intermediate care unit but provides emergency and short stay (respite) care for up to 10 people on any of the 4 units but does not have an intermediate care unit. Short stays have successfully led to some individuals deciding to live at Waterside. Comments received about choosing this home: ‘I was brought to view it and I liked it’. ‘I think it was a good move because I am quite happy here’. ‘I believe I received information before I moved to Waterside but I don’t remember. I still have the booklets’. ‘Information was not given to us. We found a care booklet in the bedroom which explained everything and should have been given to the family earlier’. ‘We are supposed to be given information verbally about a new client but this does not happen, you can find out by reading the care plan’. Waterside was originally chosen as they had respite. As the care will become permanent we have been happy enough with the care for provided for Mum to stay there’. ‘We are not given information about the service when our relative was admitted.’ Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are respectful and caring towards people living at the Home and work hard at providing good care but some aspects of care need more attention. People feel that they or their relative receive good attention from staff most of the time. The written care records need to be developed so that staff always have reliable and up to date information to guide them in giving each person the care they need. There needs to be a review of the laundry service to ensure that clothes do not go missing and each person has their own clothes. Arrangements for the safe administration of medication need to be improved. EVIDENCE: Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 12 Our observations were that people living at Waterside are looked after by caring, committed staff who are respectful to residents and know their individual health and personal care needs. Staff communicated in a patient, gentle manner with individuals – for example when assisting them with having a meal, walking, toileting or at times of agitation. Comments received from residents and relatives: ‘I have peace of mind knowing my relative is being cared for in a professional manner’. ‘Staff always treat me well in a polite way. They always ask if I need anything or help with personal care’. ‘The overall care given to Mom is good, she is well fed & looked after’. ‘The care to my relative at Waterside is 100 ’. ‘All aspects of care excellent’. ‘We are happy with the care my mother is receiving and hope it continues in this high standard’. ‘They are very caring and pleasant. My relative seems to be happy’. The staff are very supportive and seem genuinely to care’. The staff we met were knowledgeable about the individual needs of people. The organisation had introduced a new, detailed care planning system last year. Each person has an assessment following admission and a plan of care according to their individual needs and lifestyle. This included details of their health and care needs including risk assessments for example - nutrition, skin and mobility. A sample of 6 care plans were viewed. We also observed the support people received and spoke with the residents, carers and some relatives. Feedback indicated that the individual’s health and care needs were known and met. The care plans were regularly reviewed but in the new care plans it was difficult to obtain a picture of the daily routines and activities of individuals. Staff referred to ‘care plan 3 and 5 carried out’. For some when a new problem was identified, the follow up was not always clearly recorded. For example in a risk assessment for a person who had a high risk of falls it noted ‘walks with a stick’ but the person was walking around without a stick in sight. Another care record indicated ‘to have a pain in the bum’ but no follow up to this. For two people who went to hospital following falls there was not a clear record of the incident, check up and outcome. For a person who had been in hospital; the illness, treatment and return to Waterside were recorded in different places so it was difficult to follow in a logical manner. We viewed the care plans whilst checking how complaints had been addressed but a record was not evident in the personal records. The daily entries on occasions were unclear ‘Took part in activities to day’, ‘pully legs’, ‘doesn’t wear many knickers on her and pilling dresses on her’. An assistant manger explained that the staff had received one training session to implement the new care plans and that another session may be helpful. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 13 Three staff commented that sometimes you only hear about a problem and the outcome if you are on duty and difficult to pick it up in the care records. Concerns have been raised regarding clothing and shoes going missing. Residents appeared to be suitable attired at our visits although it was unclear whether a person liked to wear tights or have bare legs. A relative commented that a single shoe and walking stick in her mother’s room did not belong to her. We observed baskets of unmarked clothes including underwear and night attire in the laundry. It was said that on occasions this was re-used. Relatives also commented that this is a frequent problem: ‘Clothes are clean but go missing, sometimes returned’. Shoes/slippers go missing and need replacing’. ‘Sometimes when I go to collect my relative after 5 nights he is still in the same clothes. It would be nice if he came out in clean clothes’. ‘There are few problems when clothes go missing.’ The home is well supported by health professionals and people are encouraged to retain their own GP if feasible. At the inspection we met district nurses, the private chiropodist and had survey responses from an optician and continence advisor who all spoke positively of the service. The nurses visit daily for one person and, as and when needed for others. Comments received: ‘I recommend this home to people with dementia’ ‘I have always been impressed with the care and attention shown to the residents’. ‘The team appear to be willing to try new ideas and improve the service where possible. Although initial needs are acted upon, long term, individual programmes need to be completed. An increase in staffing levels and educational input to improve the service’. The pharmacist inspector visited the home on the 6th February 2008 as part of the key inspection and carried out an inspection of the medicines management systems being practiced within the home. The inspection comprised of examining the medication storage areas, examining the records kept and having discussions with the care staff. The findings of the inspection were then fed back to the deputy manager at the end of the visit. We found that on the whole the recording the receipt of medicines into the home was occurring. We found that medication held over from the previous month was in the main being taken into account, but the figures being stated on the new MAR charts were the quantities found in the home two days before the new MAR chart started. The reasoning given for this confusing process was that on the Sunday night when the new medication was changed for the old the home did not have enough staff to carry out the counting process required to accurately carry the quantities over to the new month. As a result of the adequate receiving process auditing of the residents medication was possible. The audit process showed that some people were not receiving their Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 14 medication as prescribed by their doctor. The audit process also showed that the Medicine Administration Record (MAR) charts had been signed when the medication had not been administered. We also found other poor practice issues with the MAR charts and these included a) gaps in the conformation of administration, b) undefined abbreviations (F and G), which meant that it was not obvious as to why the medication had not been administered, c) the attaching of additional dispensing labels to the MAR charts, d) where variable doses had been prescribed the records did not show what quantity had been given and e) a number of medicines were being administered on a when required basis when the prescribing information did not support this. We found that care plans were also lacking information about medicines that had been prescribed on a when required basis for the treatment of anxiety and aggression. We found that there was no mention of what medication was to be used, what behavioural triggers would result in the administration of the medication, what the maximum daily dose was and what intervals were required between doses. Concerns were expressed about the administration of medicines. The morning medication rounds were not finishing until about 11:30 am and the lunchtime round starting at about 1pm. Concerns were expressed about the length of time it was taking for this process to be completed and also that there appeared to be no safeguards for those residents that required minimum dosage intervals of four hours. Concerns were also expressed about the way senior staff were handing over medication to the night staff to administer and the fact that there appeared to be no confirmation by the night staff that they had administered the medication. Concerns were also expressed about the length of time antibiotic eye drops were being administered. Normally these types of eye drops are administered for a period of between five to seven days yet there were examples of where these drops had been administered for longer periods and there was no information in the care plans to support this action. The Controlled Drugs cabinet found within the home was breaching the Misuse of Drugs (Safe Custody) Regulations because it had not been properly attached to the wall. On examination of the Controlled Drugs register it appeared that the residents were receiving their medication as prescribed. The home had adopted the policy of checking the balances of the Controlled Drugs at every shift change and recording the results of the procedure in the Controlled Drugs register. The amount of entries made in the register far outweighed the entries for the receipt, administration and disposal of the Controlled Drugs. There was a real possibility that administrations of the Controlled Drugs may get missed due to the shear number of the checking entries. The home was asked to review the need for so many checks and where best to record the results of the checking procedures. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 15 We found that the residents’ current medication was being stored in two mobile drug trolleys, each of the trolleys storing medication for two of the living areas. The home had originally had four trolleys, one for each living area. Concerns were expressed about the number of times members of staff could not find residents medication even though the records would suggest that medication was available. The use of only two trolleys with them being over capacitated and disorganised may be a contributing factor to this issue. The maximum and minimum temperatures of the fridge were being recorded on a daily basis. The records of the maximum and minimum thermometer showed that the fridge was not being maintained at between 2 and 8°C and had not been maintained at the correct temperature for the last four months. We also found that a tube of Daktacort cream, which must be kept in the fridge, was being stored in the excess stock cabinet. We were informed that all of the staff who administered medication to the residents had received training on the safe handling of medicines and also all of the staff had undergone a competency assessment in August 2007. In light of some of the issues identified during the inspection the home was advised to review their training to ensure that the training meets the needs of the staff. The home was also advised to review their competency assessment programme to make sure that the assessment was rigorous enough to ensure the safety of the residents. The organisation has worked hard at preparing families and staff for the end of life of a resident. Some staff have attended a course, residents and relatives encouraged to discuss and complete ‘Final lap, my way’. The chaplain working at Waterside offers support to all at the end of life respecting individual beliefs and cultures. Waterside House DS0000065543.V356710.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Waterside are valued and treated as individuals. Enjoyable pastimes and a choice of good food are recognised as important elements of good care and progress is being made to develop the quality in both areas. How individuals prefer to spend their days should be recorded in their plan of care. EVIDENCE: We observed and heard that people who live at Waterside have their individual interests respected. They are encouraged to make choices about their daily routines and to have as much control over their lives as they are able. Those that wish can roam freely around the home. Visitors are welcomed and contact with friends and families is encouraged. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 17 The service have a full time activity organiser and two additional part-time posts have been identified for 8 hours weekly. A range of activities in and out of the home are planned weekly. Some residents commented that they liked going to the shops, on outings and walks, which is normally in small groups. The AQAA, organiser and chaplain commented on developing the pastimes so that people’s individual interests are recognized. The home has it’s own transport. Special events are arranged and relatives invited. They also attend the residents meetings. Two volunteers/relatives have been recruited to assist with activities. The chaplain is also involved in social activities and ensures that the residents spiritual needs are met. Residents’ links with their faith are promoted. The home has themed communal rooms – nursery, craft, games, films, nursery, quiet/prayer room, holidays and 2nd world war. These rooms appeared to be under used and need equipment installed. A resident and her relative did not know about the nursery lounge, which she would be interested in. Internally there are long corridors where some people like to walk up and down. Apart from the reception area there were few focal points such as pictures, interest stations, letter boxes. In the four unit lounge/diners music or television was on according to the interests and on occasions care staff observed in social interact with residents. People who liked to clean, tidy, prepare drinks etc were encouraged. Sweepers and dusters were available for residents to use and some commented they enjoyed doing a little housework. The spacious, secure garden is underused because it is extensive and uneven in areas. However work has commenced to have it landscaped with raised beds, allotment, sheltered areas, conservatory, extra paths and easy access out of the home. This is welcomed and completion date is August 2008. It would be beneficial if some of the areas could be completed earlier so that residents have a safe, garden area as soon as possible. The activities and daily interests of individual’s needs to be recorded in more detail so that staff know what they prefer to do and to ensure that every one has an opportunity to engage in activities if they so wish. Comments received from people who live at Waterside, use the service for short stays and relatives: ‘I make my own decisions each day and I sometimes seek advice from that staff if I am unsure’. ‘I am always given enough freedom to do whatever I want to do’. Some weekends the home organises trips to attractions and I make every effort to attend them’. ‘I provide my views and concerns at the residents meetings’. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 18 ‘We do attend meetings but sometimes we are not aware of the meetings until the last minute’. ‘She spends a lot of time looking out of the window, more persuasion skills is needed to involve them with activities’. ‘Every Sunday Mom’s church picks her up, and that is really important to her, the care staff support Mom every Sunday for her to go’. ‘Food is excellent, varied and imaginative’. ‘Something could be done to improve ready, unaccompanied access to the garden (or part thereof)’. ‘The service do well by not restricting residents to move about whenever they want to. Taken on outings, to the shops, relatives visit and can make tea, sing alongs arranged. Allow residents to have a choice’. People are offered choices at each mealtime of nutritious, wholesome food prepared by a catering team. Menus are available the day before for people, with support, to choose their meals. The catering manager has the meals in picture format for easy selection and is introduces new meals with samples. The main meal at lunchtime was observed and the staff were very attentive ensuring that every person ate. If a person did not fancy what they had ordered, other meals or snacks were offered. People could eat in their unit in the dining room, lounge or their bedroom. Drinks were continually served in the unit lounges/diners. Other mealtimes were leisurely with a variety of foods served as meals, finger foods or soft foods. Most people’s cultural preferences and dietary needs were recognized. Two persons and their relatives said they would welcome occasionally some of their cultural foods this should be taken into consideration. Waterside House DS0000065543.V356710.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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has complaints, whistleblowing and adult protection procedures in place and staff are aware of the importance of reporting abuse. This needs to be supported by all staff having training about safeguarding vulnerable adults and responding to a concern or complaint. There needs to be a more robust process for dealing with concerns, complaints and safeguarding individuals. People told us they can approach the manager or staff if there is something they are not happy with. EVIDENCE: The service has a feedback card – complaints, comments and compliments care homes which is colour coded. It did not have the addresses for the organisation or CSCI, as required. A complaints procedure for the home could not be located and was not attached to either the statement of purpose or service user guide. Policies and procedures for staff regarding complaints, whistle blowing and protecting vulnerable adults were in the home. Survey responses from residents and relatives indicated that people knew who to speak to if unhappy or wishing to make a complaint: Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 20 ‘My key worker if she is on shift or a senior on duty’. ‘If I get a minor complaint I contact the care staff or senior to resolve them’. ‘If we had any concerns we will take it up with management of Waterside’. There had been complaints about the service with recurring themes, which Wolverhampton Social Services had brought to our attention – clothes, monies and valuables going missing, a few people absconding, some medication errors and a few people having falls. At the inspection we followed these up but found it difficult as in most situations the records/responses were in different places and sometimes inconsistent. Also due to their mental state we could not ask residents what had happened or they were no longer at the home as their short stay had ended. It was apparent that the previous manager had investigated but the outcomes were not always recorded or known to key staff. In one situation the family had not wished to make a formal complaint, nevertheless the concerns needed investigating to ensure that the individual had been safeguarded. In another situation the complaint had not been upheld as the ‘missing’ money was in safekeeping and jewellery was found. The previous manager had written to the relative on every point. It became apparent that concerns arose more often when people had been placed in an emergency or for a short stay and little information was available about how to care and support them. In many situations action had been taken immediately to support/safeguard the individual - for example a cover had been placed over the front door release button so residents could not let themselves out alone, missing money and clothes found or replaced. The AQAA referred to 10 complaints being received and resolved since the last inspection but not all the records relating to these incidents could be found. The temporary manager concluded the ‘the complaints process is not transparent’ and assured us that this would be followed up with each incident logged, investigated and outcome recorded. Other comments received: ‘On occasions there has been a lack of communication so when concerns were raised others were not aware of it’. ‘More communication with each other’. ‘You’re scared to bring up certain issues as it may affect your job’. All staff need training in safeguarding vulnerable adults, the training records indicated that only 41 of the staff undertaken training. Families should be routinely given the service user guide and home’s complaints procedure, when their relative is admitted to Waterside. Waterside House DS0000065543.V356710.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is good providing people with a comfortable, safe and wellmaintained place to live in. The space and number of different communal areas provides people who are restless with an environment where they can move about safely. The gardens and grounds will enhance the overall facilities when completed. EVIDENCE: The home was purpose built in 2005 to provide appropriate accommodation to meet the needs of the residents. The home is maintained to a high standard and provides a very comfortable homely and safe environment. Each person Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 22 has their own single, ensuite bedroom and a picture them self or a pet for easy location. The home is divided into four units, each having a communal lounge/dining room with kitchenette, communal toilet and bathroom facilities. There are themed lounges throughout the home. The home having been opened for two years and now needs, in parts, a redecorating programme taking into consideration interiors for people with dementia. The activities organiser has identified that different colours would be beneficial and the well-used long corridors could be more attractive with interests stations, themes and pictures. The home has extensive gardens and grounds but these are currently unsafe for residents to go out alone due to the size and uneven areas. We were told about the plans to develop the garden and work had begun. This is welcomed and completion date is August 2008. It would be beneficial if some of the areas could be completed earlier so that residents have a safe, garden area as soon as possible. The majority of the home was clean but in some parts there was an odour and relatives commented that this does occur from time to time. There was a poor, strong odour in one of the units on our first visit and when brought to the attention of the temporary manager, the issue was addressed. For good hygiene and prevention of infection the following was noted: One relative commented that the lift often has a poor odour and we recommended a keypad be attached to the lift door so staff can monitor the use of the lift. Waste bins did not have lids in various rooms in the home; pedal bins would be more hygienic. In one toilet there were no towels, so residents and staff using this toilet could not wash their hands. The laundry was viewed and has suitable washing, drying and ironing equipment but was a busy and cluttered. We observed an iron unattended, baskets of unnamed clothes and a laundry worker not using gloves to pickup laundry for washing. Safe working practices in the laundry should be improved and the unnamed clothes disposed of unless claimed and marked with the person’s name. See page 13 of this report for comments about clothing. Other comments received about the environment: ‘The home is fresh and clean all the time although if residents make a mess sometimes but cleaned by staff soon when noticed’. ‘A new way of entering the building, sometimes it takes a good while before anyone knows your waiting to come in’. ‘The care home is clean and well maintained’ Waterside House DS0000065543.V356710.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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff group is hardworking and committed to their work and provide people living Waterside with caring and respectful support. Staffing levels need to be reviewed to ensure staff and managers have time to deal with the complexity of care needs that people have. Training needs to be provided to all staff and accurately recorded. EVIDENCE: Comments received relating to the care given by staff are listed on page 13 of this report, also: ‘The home is very well run with highly competent and enthusiastic staff at all levels’. Our observations, the survey responses and discussions with a sample of senior, care (day and night), laundry and catering staff that people are looked after by a committed, caring, hard working and enthusiastic staff. Many of whom have experience and training in caring for people with dementia. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 24 We observed how busy care staff were throughout the days of our visits. The senior staff spent a lot of their time dealing with medication that took this person away from direct care work. Some units seemed better staffed than others and we observed a lounge/dining room without staff where a resident was clearly distressed and unable to move away from the dining table without assistance. Care staff were working elsewhere in the unit but did not respond to her calls. We were pleased to hear that the home was fully staffed yet the rotas did not indicate that the minimum staffing levels, agreed when the home opened (see page 5, conditions of registration, were being maintained on some shifts, particularly at week-ends when there was less management cover. We also heard that the night shifts were busy and there was not senior member of staff at the home at night, just 4 care assistants. We considered that a specialist home of this size should have a person in charge at night to lead the night staff and monitor the night service. Now that the home is established and very busy caring for people with complex mental and physical needs with both permanent and short stay residents, the staffing levels need to be reviewed. The staff came across as friendly, caring and conscientious towards the residents and aware of their individual needs and routines. The care staff work on all the units, which accommodate permanent residents and people for short stays, and this can be demanding. We picked up on occasions that information sharing/communication has been difficult particularly if staff are not on duty when an incident occurs, and the records and follow up are not detailed in the care plan. Comments received about this are noted on page 21 of this report and from staff: ‘Shortage of staff so cannot meet individual needs and are rushed’. ‘The service would be better if there were enough staff to meet the needs of the residents, not enough time to listen to them’. Information about training for staff was received but records inconsistent and indicated that not all staff had received induction, training in safe working practices and protection of vulnerable adults. 46 had completed an Alzheimer’s Society Course on dementia. About 44 of staff had an NVQ in care or catering or housekeeping depending on the person’s job. A sample of staff files were viewed and indicated that the organisation has a suitable recruitment and vetting process. There were two application forms in use and the fuller form should be used to indicate an applicant’s full employment history. Some staff commenced work at the home after full checks and this is good practice to wait until the police check is returned. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 25 A member of staff commented that her vetting was thorough but that she did not have induction and had to find out about the service and residents herself (she was a carer with experience and training). Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 26 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, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs a registered manager to stay, lead and develop the service for the people who live at Waterside. Staff should receive regular supervision to support them in their jobs. All staff need up to date training in safe working practices. The arrangements for the safeguarding of people’s monies and valuables needed to be improved. All incidents and deaths in the home need to be reported to CSCI. EVIDENCE: Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 27 Waterside was without a registered manager because he had just been promoted. The organisation had arranged for their experienced peripatetic manager to manage the home temporarily. The home has had two experienced managers since opening two years ago and the service would benefit from a manager staying longer to lead the development of the service which has the potential to become a quality, specialist home. We understand that a manager has been appointed. Following the inspection the temporary manager immediately produced an action plan and has begun to follow up and address matters raised. The organisation has a quality assurance programme to audit the service and details were made available on request. The home had had an audit in the last year and surveys from staff residents and relatives had been analysised. However the results were not easily available to people in the service user guide or in the reception area. When looking at staff records it was apparent that staff were not receiving supervision regularly and this needs to be planned. The administrator keeps monies and valuables on behalf of the majority of people living at the home. These were kept safely and records kept for the monies but not the valuables. On occasions monies when the office is closed, monies are stored in the medicine cupboard, which is not appropriate. The form for recording each person’s monies indicates that two persons need to sign and this good practice but not always happening. There were a lot of valuables being kept safely but unidentified or recorded. The temporary manager agreed to immediately address this. A health and safety policy and procedure is in place, and there were good records to indicate that services and equipment in the home were regularly maintained. The fire log indicated that fire safety checks were being carried out, with the required frequency, fire drills were undertaken and there was fire risk assessment. There was outstanding recommendation from the Fire Service’s report of 14.09.07 regarding labelling the fire alarm panel and the temporary manger immediately followed this up. We identified that not all the staff had training in safe working practices and others needed refresher courses. The service keeps Accident Books and notifies CSCI, as required of an injury to a service user. However it did not appear that CSCI was being notified, as required of all deaths or serious illnesses of a resident. Again the manager has followed this up. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 28 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 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 2 x x 2 Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 15(1) Requirement Care plans must clearly indicate the current personal and health care needs and lifestyles of the person to ensure that these can be met. The records of the receipt, administration and disposal of medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” and “as directed” medication to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. Staff who administer medication must be competent and their practice must ensure that residents receive their DS0000065543.V356710.R01.S.doc Timescale for action 31/07/08 2. OP9 13(2) 30/04/08 3. OP9 13(2) 30/04/08 4. OP9 13(2) 30/04/08 Waterside House Version 5.2 Page 30 5. OP9 13(2) 6. OP18 7. OP30 13(6) 13 (4) (5) medication safely and correctly. Medication must be stored within 30/04/08 the temperature range recommended by the manufacturer to ensure that medication does not lose potency or become contaminated. To safeguard people, all staff 31/07/08 must receive training in protecting vulnerable adults. There must be programme for all 31/07/08 staff to receive training in safe working practices, dementia care and NVQ’s in care. Previous requirement partially met. 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 service user guide should be updated, include the home’s complaints procedure and be given to the new person and their relatives before or on the day of admission. Each person should have a full assessment before moving into the home or, for an emergency admission, within a week. All staff administering medication should undergo regular assessments to ensure their ongoing competency to follow the home’s procedures correctly. The fridge temperatures should be monitored on a daily basis, using a maximum and minimum thermometer to ensure that the fridge temperature is maintained at between 2 and 8°C. The medication storage areas should be kept clean and well organised thus increasing the chance of finding the medication and reducing the risks of picking the wrong medication. A review should be undertaken of the need to check the DS0000065543.V356710.R01.S.doc Version 5.2 Page 31 2. 3. 4. OP3 OP9 OP9 5. OP9 6. OP9 Waterside House 7. OP9 8. 9. 10. 11. 12. 13. 14. 15. OP12 OP12 OP16 OP16 OP19 OP19 OP26 OP27 16 17. 18. OP31 OP35 OP36 presence of Controlled Drugs on such a regular basis and the appropriateness of where the records of the checks are made. A review should be undertaken about the organisation of the trolleys, the administration practices and the subsequent length of time it takes to carry out the medication rounds. The care manager should ensure that the key workers compile a Life Story Book for each person. The activities in and out of the home should be developed so that people’s individual interests are recognized. There needs to be a robust process for dealing with concerns, complaints and safeguarding individuals. The home should have it’s own complaints procedure which includes how to contact CSCI, the manager and organisation. There should be a safe, interesting, accessible garden area as soon as possible. There should be a programme for redecorating the home, taking into consideration interiors for people with dementia. Aspects of hygiene and infection control should be improved. A review of the staffing arrangements at Waterside needs to be undertaken to ensure there is senior cover at the home at all times and so staff are able to respond to each person’s individual needs. The service should have a registered manager who stays to lead and develop the service. The arrangements for the safeguarding of people’s monies and valuables should be improved. Staff should have regular supervision to support them in their jobs. Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Waterside House DS0000065543.V356710.R01.S.doc Version 5.2 Page 33 - 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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