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Inspection on 25/05/05 for Saltways Cheshire Home

Also see our care home review for Saltways Cheshire Home for more information

This inspection was carried out on 25th May 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is being effectively and competently managed, and staff were very caring and considerate to residents, who were very complimentary about the staff team. The rights and interests of residents is clearly promoted by staff. The organisation, manager and staff work hard to maintain and improve standards within the home, which maintains positive environmental standards that are enjoyed and appreciated by residents. The staff team are well motivated and trained. This enables them to provide positive standards of care to people who have very complex and challenging care needs. The staff team work well with residents to engage them within the care process. Meals are varied, well-balanced and nicely presented offering choice and variety. Staff work well with residents to ensure that the meals provided are suitable to individual likes and preferences.

What has improved since the last inspection?

Staff within the home are working well to ensure that care records are improved, thereby underpinning and supporting consistency in the care provided to residents. The development of resident empowerment and ownership of service development has been clearly noted since the time of the previous inspection. This ensures that the service being provided by the home and the parent organisation is in accordance with resident wishes and choices.

What the care home could do better:

Although nursing staff provide a good level of care to and for residents, it is again noted that medication management needs improvement and closer scrutiny. Although the issues noted in relation to the recording of medication administration are relatively minor, the shortfalls could present and pose a risk to residents` health and well-being should non-permanent staff who are unfamiliar with residents have to administer medication to residents. This needs to be improved to ensure that all medication administered to residents is clearly and accurately recorded.

CARE HOME ADULTS 18-65 Saltways Cheshire Home Church Road Webheath Redditch B97 5PD Lead Inspector Nick Richards FINAL - Unannounced 25 May 2005 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 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 Stationary 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. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Saltways Cheshire Home Address Church Road Webheath Redditch Worcester B97 5PD 01527 452800 01527 544462 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Leonard Cheshire Foundation Mrs Marilyn Christine Briers CRH 24 Physical disability Physical disability - over 65 24 5 Category(ies) of PD registration, with number PD(E) of places Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3 January 2005 Brief Description of the Service: Saltways Cheshire Home is a single-storey building located in a suburban district of Redditch.The home comprises of four “wings” (or units), and provides 24-hour nurse care for people under the age of 65 years, who possess a physical disability and can also accommodate up to five people over the age of 65 years who possess a physical disability. Within the past five-year period, the home has been completely refurbished and upgraded. Environmentally, the home is fit-for-purpose. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours and was carried out to; (a) Assess how the home was performing against care standards, (b) Gain feedback from residents about the care provided and (c) Establish how effective care was during the morning period. A tour of the premises took place and training and care records were inspected. Three staff who were on duty and four of the twenty-three residents were spoken to. What the service does well: What has improved since the last inspection? Staff within the home are working well to ensure that care records are improved, thereby underpinning and supporting consistency in the care provided to residents. The development of resident empowerment and ownership of service development has been clearly noted since the time of the previous inspection. This ensures that the service being provided by the home and the parent organisation is in accordance with resident wishes and choices. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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 standard(s) 1, 2 and 3 The home ensures that residents and prospective residents are provided with the information necessary to ensure that an informed decision about admission can be made. Prospective residents are assessed to ensure that the home can meet their needs prior to arrival at the home. EVIDENCE: The admission procedure was satisfactory to guide staff on the actions to be taken to ensure that new residents’ needs are properly assessed and planned for. Individual records are kept for each of the residents, and inspection of the records for three residents had full assessment information recorded. Staff members on duty knew about the care needs of the three residents. The homes Statement of Purpose and Service User Guide are suitable – providing residents and prospective residents with details of the services the home provides, enabling an informed decision about admission to be made. One resident explained his appreciation and satisfaction with the home, by rating it “10 out of 10”. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9. The home ensures that residents are consulted regularly on their changing needs and are supported to take risks. EVIDENCE: Residents said that staff within the home consulted with them about their healthcare needs, and kept them informed about the care being provided. Residents were happy that staff within the home were providing them with the care they required. Care records clearly showed that residents and their representatives were being routinely consulted about the care provided, and were agreeing with the plans of care developed – thereby including and engaging the individual within the care programme. Documentation available showed that risk assessments were taking place, and action was being taken to minimise risk once it had been identified, while promoting, as far as possible, the independence of each resident. Regular meetings were taking place between staff and residents (usually at the instigation of residents), and the meetings centred around what residents wanted from the service, or wanted changed about the service. The minutes of Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 10 one meeting was examined, and showed how residents had discussed, developed and implemented a policy regarding “verbal abuse to staff” – thereby facilitating ownership by, and empowerment of the resident group. Other documents were examined that showed how residents had been consulted on food provision, and how the home was taking on board residents’ criticisms, and was attempting to implement change in response to the issues raised by people. One resident had been voted onto Leonard Cheshire’s “Service Users’ Representative Executive” (SURE) Committee representing residents from services in the Wales and West Region. The SURE Committee is a stakeholder group that influences Leonard Cheshire strategy and policy formation. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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 standard(s) 17. Dietary needs of residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and choices. EVIDENCE: A number of people living in the home were spoken to and everyone who commented on the food said how good it was and that they welcomed the daily choices offered. One person described the food as “lovely”. Menus were inspected and found to be balanced and interesting and mealtime arrangements are also flexible enough to accommodate individual preferences. Catering staff demonstrated a detailed knowledge and understanding of individual residents’ dietary preferences and requirements. The nutritional and dietary needs of people who required a softened diet were being appropriately met. In addition to a main, central dining area, the home also provides three additional “satellite” kitchens where residents can prepare their own breakfasts, snacks and drinks, and which were being used by residents and their visitors during the inspection. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 12 Residents explained that enough food was provided for them at mealtimes, and care records showed that weight loss due to insufficient food was not a problem within the home. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 13 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 standard(s) 18, 19 and 20 The health care needs of residents are identified, safeguarded and met. Medication management was impaired, and this could place residents at risk. EVIDENCE: Individual plans of care are available, and progress has been made to ensure that all aspects of health, personal and social care needs are identified and planned for. Plans were detailed, up to date and had been regularly reviewed. Significant events in the home had been recorded, daily entries into case records had been made and entries available gave an indication of the actual care given. Residents spoken to were happy to confirm that their care needs were being met by staff within the home in a dignified and respectful way. Staff were seen providing care sensitively and discretely to residents, and discussions with staff confirmed that they were aware of residents’ care needs, and how the care was to be provided. Medication records were generally well managed. However, there were occasions when nursing staff had not recorded information such as the dose of medication administered and the administration of medication. On some occasions, the frequency of administration had been misread by nursing staff. This could adversely affect residents’ health and well-being. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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 standard(s) 22 and 23 Complaints are handled objectively and residents are confident that their concerns will be listened to, taken seriously and acted upon. EVIDENCE: The home has a simple and clear complaints procedure. A copy of the complaints procedure had been given to all residents, and was available to visitors and relatives. Residents spoken to were confident that concerns could be raised with the home. The Commission has not received any concerns or complaints about the service since the time of the previous inspection. A procedure for responding to allegations of abuse is available, and staff had been given training regarding the recognition and reporting of abuse. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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 standard(s) 24, 25, 26, 27, 28, 29 and 30. Investment within the home continues to maintain a high environmental standard, creating a comfortable and safe environment for those living there and visiting. EVIDENCE: Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 16 All rooms within the home possessed a range of furnishings that were suitable for individual residents. Residents had been encouraged to bring with them items of their own furniture, furnishings and possessions on admission to the home, and bedrooms seen demonstrated the individuality, tastes, preferences and interests of individual residents. The home was clean, tidy and comfortable. Many residents were content to make use of their own personal space, but some residents were seen making use of the homes communal areas, which offered television, video, computer games and computers for residents to use for recreational, occupational and social purposes. One person explained how he liked to use the “Playstation” console available – and then expressed a preference for a “Playstation 2” (PS2) console. He then decided that the “Playstation 1” console was more favourable due to the prohibitive cost of PS2 games! The previous inspection identified some concerns about poor floor coverings. The registered manager said that an audit of floor coverings had taken place, six areas of carpeting had been identified as in need of replacement, and these were to be replaced within the current financial year. The size and layout of the home helped residents to access all areas of the home, and facilities within the home had been provided to maximise residents’ independence in the form of grab hand rails in corridors, overhead tracking hoists, assisted baths and hoists. All residents spoken to on the day of inspection confirmed that they were pleased with the environmental standards within the home. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 35. Staffing levels and competencies are suitable to ensure that residents’ needs are identified and effectively met. Staff morale is high resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. EVIDENCE: Staffing levels have stabilised within the previous six-month period, and there were a total of six nursing and care staff on duty to provide care and support for 23 residents. In addition to nursing and care staff, there were also ancillary staff on duty to support service provision. The home now employs a total of 11 registered nurses and 24 carers. This provides consistency of care for residents as agency usage has been minimised. At the time of inspection, the home had moved from carrying 7 staff vacancies (at the time of the previous inspection) to just a 20 hour shortfall which was predominantly covered by permanent or bank staff. The duty rotas confirmed that the staffing levels were stable, with little evidence of staff being absent through short-term sickness. Significant investment and emphasis had been placed on staff development and training, and this is commendable. A “Training Co-ordinator” is employed Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 18 within the home for 21 hours each week, and she has developed “Personal Development Profiles” for all staff. Training has been provided to staff, and includes infection control, first aid, moving and handling and disability and the law. Training was identified as a result of the needs of residents, to ensure that care delivered was appropriate to and in response to the needs of residents. Each resident spoken to made positive comments about the staff, and one person said that the best thing about the home was the staff. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 38 There is clear leadership, guidance and direction to staff to ensure residents receive consistent care, resulting in practices that promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: There is a registered manager, and she is competent and appropriately qualified and experienced to manage the service. Staff and residents spoke very highly of her, and significant diligence and action has been undertaken to maintain and enhance the quality of the service provided by the home since the time of the previous inspection. Residents clearly expressed their opinion that the home was being run in their best interests. One staff member rated the manager by saying “I’d give her 15 out of 10”. Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 3 3 Standard No 11 12 13 14 15 16 17 x x x x x x 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Saltways Cheshire Home Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x x x x x E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 21 No 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 20 Regulation 13 Requirement Medication charts must be signed when medication is administered to a resident, and the actual dose adminstered must be recorded when medication is prescribed on a variable dose basis. Timescale for action immediate and ongoing 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 Good Practice Recommendations Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 22 Commission for Social Care Inspection The Coach House John Comyn Drive Droitwich Road Worcester WR3 7NW 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 Saltways Cheshire Home E52 S4140 Saltways V224316 250505.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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