Inspection on 17/06/08 for Walm Lane Nursing Home

This inspection was carried out on 17th June 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walm Lane Nursing Home 19/06/07

Walm Lane Nursing Home 28/06/06

Walm Lane Nursing Home 17/02/06

Walm Lane Nursing Home 29/09/05

Walm Lane Nursing Home 09/03/05

Walm Lane Nursing Home 06/01/05

Similar services:

Ashlong House

Norbury Crescent (30)

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Henry Nihill House

Birchwood

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/11/2008.

CARE HOME ADULTS 18-65 Walm Lane Nursing Home 141 Walm Lane London NW2 3AU Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 17th June 2008 10:30 Walm Lane Nursing Home DS0000022945.V368164.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 Walm Lane Nursing Home DS0000022945.V368164.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. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walm Lane Nursing Home Address 141 Walm Lane London NW2 3AU 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) 020 8450 8832 020 8830 7426 Ibexbrook Limited Amanoollah K Juhoor Care Home 21 Category(ies) of Past or present alcohol dependence (21), Past or registration, with number present drug dependence (21), Dementia (21), of places Learning disability (21), Old age, not falling within any other category (21), Physical disability (21), Sensory impairment (21) Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Past or present drug dependence - Code D Past or present alcohol dependence - Code A Old age, not falling within any other category - Code OP Dementia - Code DE Learning disability Physical disability 2. - Code LD - Code PD Sensory Impairment - Code SI The maximum number of service users who can be accommodated is: 21 19th June 2007 Date of last inspection Brief Description of the Service: 141 Walm Lane is a nursing home that provides accommodation to 21 adults over 18 years. At the time of this inspection there were 2 persons with older person care needs 17 young adults in the home. The primary care needs of the older adults are nursing and personal care and those of the younger adults are dementia, mental health and alcohol dependency. The home is a large detached building on three floors. It is located close to Cricklewood Broadway and Willesden Green with good access to a variety of shops and local amenities. The home is about 5-10 minutes walk from Willesden Green underground station and is easily accessible by buses, which travel down Walm Lane. There is parking for about 3-4 cars in front of the Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 5 home. Walm Lane and most of the surrounding areas contain resident parking or parking meters. There is also a small area with shrubs and bushes in the front of the home and a large garden at the back of the home accessible to all residents. Accommodation for residents is found on all three floors and a mezzanine floor in 17 single bedrooms and 2 double bedrooms. There is a shaft lift but the mezzanine floor is not served by the lift. The home currently has 3 bathrooms and one shower for the 21 residents. There are 4 bedrooms, no bath and 1 small toilet on the second floor. The home has a smoking room with a kitchenette facility. The communal areas are on the ground floor and consist of a main lounge/conservatory and dining area. The home charges £850-£900 for younger adults depending on the needs of the residents and £800 for older people again depending on the needs. There were 19 residents in the home at the time of the inspection. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is the first key inspection for the period 2008-2009. The inspection was unannounced and started on Tuesday 17th June from 10:30-17:00, continued on Wednesday 18th June from 10:00-13:30 and finished on the 10th July from 11:30-14:00. The last inspection took place on the 19th June 2007 and there has not been any regulatory input into the service since then, except ongoing monitoring of the notifications that are sent by the home and contacts that are made with the Commission. As part of this inspection, we received an Annual Quality Assurance Assessment (AQAA), which had been completed by the manager. This has been used where possible to inform this report. We also received five comment cards from residents who completed ‘service users’ comment cards and three more comment cards from service users who used comment cards for care managers. We tried to use these where possible when writing this report. We checked a sample of records that are kept by the home, spoke to five residents and three members of staff and toured some of the premises. We also gave feedback to the manager and had a discussion about how well past requirements have been met. We would like to thank all the residents for a kind welcome to the home and the manager and all his staff for their support and assistance during the inspection. What the service does well: The home makes sure that people receive information about the service to enable them make an informed decision about moving into the home and also carries out a full assessment of their needs before they are offered a place in the home. Once admitted residents have a care plan addressing their identified needs that are drawn up and reviewed with them or their representatives. The care plans are also evaluated at least monthly to see how well the plans are being implemented. The home has an effective key worker system, when key workers work closely with residents to ensure implementation of the care plans and that residents Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 7 receive the necessary support to make decisions in their daily lives and to build independent living skills. Residents are offered choices about the meals that they want to have and receive nutritious and varied meals. They are able to sit in a congenial setting to enjoy their meals. Residents’ healthcare needs are in the main met in the home. They are referred to the relevant healthcare professionals as and when required. The home is on the whole appropriately maintained and there is evidence of ongoing redecoration. It was also clean and free from odours on the day of the inspection. Residents’ bedrooms are appropriately furnished and provides a homely environment. The home has a stable team of friendly and approachable members of staff who support residents in their daily lives. Staff are generally provided in appropriate numbers to meet the needs of residents. There are regular staff’s and residents’ meetings to offer them the opportunity to contribute their ideas to the running of the home. What has improved since the last inspection? The home has made attempts to meet a number of requirements that have been imposed on the home during the last inspection, but few requirements were only partly met instead of fully met. The service users’ guide has been updated to include information about the fees that the home charges to make sure that people are fully aware of the costs of moving into a care home. There has been some progress with the standards of care plans. The life history of residents was completed to a good standard to provide insight about their personhood. New residents tended to have comprehensive assessments of their needs. There has been some progress with regards to offering residents more privacy and opportunities to exercise choices. The doors to the bedrooms of residents have been fitted with locks to ensure the privacy of residents. The manager has also made attempts to refer residents to organisations in the community, which support people who are dependent on alcohol and substances. Staff have also been provided with awareness training in this area. The management of medicines in the home is carried out to a good standard to make sure that residents are safe. Appropriate lancing devices have been provided for blood sugar testing in cases of diabetes to reduce the risk of cross-contamination. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 8 There has been an improvement in the provision of disability aids to promote the independence of residents, such as by the provision of grab handles around toilets. Residents have also been provided appropriate wheelchairs according to their needs to promote their independence. The home has acquired a quality control system to ensure self-monitoring of the quality of the service that it provides. Some issues that were noted with Health and Safety have been addressed, such as carrying out risk assessment with regards to residents having access to hot water outlets and having an up to date electrical wiring certificate. What they could do better: Whilst there was evidence that the home has tried to meet past requirements, we noted that six requirements have not been fully met and therefore these requirements were not met within the appropriate timescales. The home must ensure that all requirements are met within the appropriate timescales as requirements are made following breaches of legislation and the Commission will take enforcement action to make sure that repeated requirements are met within the appropriate timescales. The contract/statement of terms and conditions must be made more comprehensive to address the possible issues that may arise while a resident is accommodated and cared for in the home, so that should these issues arise, people are clear about the position of the home on these issues. The home has the capability of making care plans comprehensive and useful documents as there are some very good care plans. Whilst there was a noticeable improvement in this area, more need to be done as there were still a few care plans that were lacking, particularly with regards to having a comprehensive assessment of the needs of the residents and addressing the fears, hopes and the aspirations of residents about the future. Risk assessments must be made more comprehensive to address the risks that residents face while they engage in the local community and while they are developing independent living skills. The risk assessments must be agreed and signed by the residents/representatives and where appropriate by a relevant healthcare professional. Recruitment of staff in the past has not been robustly carried out. All checks must be completed as required to ensure the safety of residents. Whilst there has been some training in the home, there was still a lacking with regards to the provision of statutory training in the home, particularly with regards to fire training. We could not access all the financial records of residents to look at the way their personal money was being managed on the first and second day of the Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 9 inspection. These were made available on the third day of the inspection, but all residents’ records must be made available when a person authorised by the Commission request to see the records. Inspection of the management of residents’ finances by looking at a sample of records showed that residents’ finances are safeguarded from abuse, but there are some recommendations that are made in this report to promote the rights of residents and to make the process more transparent and robust. We were able to easily disable a window restrainer and this was therefore not safe. The restrainers that are provided must be of a type that can only be disabled by a special key or tool. 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. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 10 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 Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 11 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): 1,2 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with the necessary information for them to decide if they would like to move into the home. Prospective residents’ needs are assessed to make sure that the home only accepts people whose needs can be met in the home. Residents receive a contract/statement of terms and conditions but this document must be reviewed to make it more comprehensive. EVIDENCE: The residents who are referred to the home are mostly publicly funded. Most of the residents are now younger adults (18-65). Following a referral to the home for admission, the prospective residents are visited by the manager who carries out a preadmission assessment. We were able to see two of the preadmission assessments that the manager had carried out. These were comprehensively completed and appropriately addressed the needs of residents. We also saw minutes of the Care Programme Approach (CPA) meetings for one resident. The minutes of the CPA meetings described the needs and the plan to meet the identified needs of the resident. The manager stated that the home also receives the assessments of the needs of the residents that are carried out by the funding authority if these are available. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 12 One resident said that he visited the home prior to deciding if he wanted to come to the home. The manager said that residents are provided with information about the service when he visits them to carry out an assessment of their needs or when they come for a home visit. The manager reported that all residents are provided with a service users guide (SUG) on admission. We looked at the SUG and noted that it also contains the home’s contract. According to the manager, the contract is signed by him and the resident or his/her representative. Two out of five people, who responded to comment cards, said that they have received a contract, two said that they did not receive one and one was not sure. It was not clear why some would say that they have not received a contract when the contract is in the SUG. There was a requirement during the last inspection that the SUG be updated to include information about the fees and another requirement with regards to making the home’s contract/statement terms and conditions more comprehensive. The manager provided an updated service users’ guide after the last inspection to show that it has been updated to include information about the fees that are charged by the home. The home’s contract/statement of terms and conditions has been reviewed in March 2008 according to a copy that was sent to us. We however noted little change in the document as compared to the previous document. The contract/statement of terms and conditions should be individualised for each resident reflecting his/her personal circumstances and funding (see regulation 5(2) of the Care Homes Regulations 2001 (amended 2006)). We also noted that the issues that we suggested for review in the contract during the last inspection have not been reviewed such as information about the personal contribution of residents, the method of payment (regulation 5A(2)(b), when these must be paid (see std 5.2 (iv)) and the circumstances when a contract can be terminated. The contract does not also make clear the equipment that the home will provide if required. For example it is not clear if the home will provide specialist equipment such as specialised chairs or pressure relief equipment for people at risk of developing pressure ulcers or if residents/funding authority will be responsible for these. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 13 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 and 9 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst some care plans were appropriately completed, a few still lack a full assessment of the needs of residents. As a result there is no guarantee that all the needs of residents are accounted for. Residents have the opportunity and receive support when necessary to make decisions about their daily lives. There has been some improvement with regards to the use of individual risk assessments, but not enough to fully address the risks that residents face while developing individual living skills. EVIDENCE: We looked at the care plans of four residents. These were kept in drawers in the office and were accessible only to staff. Residents are able to access their care plans if they request for these or during a review of these, when staff tended to involve them. We observed that residents or their representatives signed the care plans to say that they have agreed to these. Two residents who spoke to us said that they have seen their care plans. The manager Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 14 confirmed that care plans are reviewed every six months with residents/representatives or when there are changes with the care plans. He added that the care plans are also examined during external reviews and during Care Programme Approach meetings that he tends to attend to provide feedback about the care and support that residents receive. While looking at the care plans we found that two out of the four residents did not have an assessment of their needs. Whilst all new residents seem to have a full assessment of their needs, previously admitted residents do not seem to have had an updated assessment of their needs. As a result there was a danger that there may not be a record of all the identified needs of residents. We noted that the plans of care for all four residents were on the whole appropriately completed. These contained information about the action to take to meet the needs of residents and were evaluated monthly. Evaluation of the care plans was normally carried out by the key workers and clear information was kept about how well the plans were being implemented and what worked and what was not working. We were able to see that the home has a key worker system that works. Key workers work closely with residents and have discussions with them about aspects of their care and the support that they require to make decisions about their daily lives. The outcomes of these meetings are then recorded. Key workers are also involved in the implementation of care plans and the development of living skills by the resident. For example on the first day of the inspection we observed how a resident was planning to go out with his key worker. We thought that this was good practice. Whilst touring the premises and observing the daily life of residents in the home we found that residents were offered the opportunity to make choices about their lives. They were asked about how they wanted to spend the day and about their choices for their meals. Two residents who spoke to us said that they are able to dress according to their individual choices and that staff support them with making decisions. Minutes of residents meetings showed that residents were able to contribute to the management of the home and made choices about outings and the content of the menu. Staff informed us that some residents were able to go out independently whilst others go out with a member of staff. Two residents said that they are able to go out independently and they only have to inform a member of staff when they go out. Risk assessments were however not always in place to address residents going out in the local community and their safety, and other areas where residents were being encouraged to make choices and develop individual living skills. Such areas could include residents managing their own finances, shopping independently, cleaning their bedrooms and doing their laundry Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 15 We found that one resident was involved in maintaining the grounds of the home. Whilst he did an admirable job, a risk assessment was not in place to address this issue. Another resident had bed rails on his bed, we did not see a risk assessment in the care records. There has however been some progress in this area such as when residents use a kettle, fridge and microwave, but more progress is required to make sure that appropriate risk assessments are carried out to address the safety of residents with their right to take risks and to develop independent living skills. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 16 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): 12,13,15,16 and 17 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home makes every attempt to meet the recreational and social needs of residents and has a flexible approach to the provision of activities. The meals that are provided by the home on the whole meet the nutritional needs of residents. EVIDENCE: The home employs a part time activities coordinator. We noted during the course of the inspection that she was very involved with residents and that she encouraged residents to take part in activities or for them to choose the activities that they wanted to take part in, even on an individual basis. Out of five residents who commented on activities one was usually satisfied, one was always satisfied and three were sometimes satisfied. The manager wrote in the AQAA that ‘the home tries to overcome the reluctance of residents to be involved in activities’. The activities coordinator and another member of staff also commented about the motivation of residents to take part in activities. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 17 Two residents also mentioned that they did not always want to take part in activities and preferred to stay in their rooms. There was a programme of weekly activities available for inspection. We however noted that this was quite flexible and depended on the wishes of residents. We saw that some residents liked to read, other watched TV, some went for walks, a few stayed in their rooms and there were a few who were involved in drawing/art. There were also outings in the local community and the activities coordinator mentioned that outings to places of interests were also arranged. New residents had a section in their care plan about their life history, which provided information about their social and cultural backgrounds. These were appropriately completed and provided useful information about the needs of residents in this area. We also noted that care plans were in place addressing these needs. At the time of this inspection most residents in the home had younger adults’ needs and there were very few if any, who had older people needs such as incontinence, risk of developing pressure ulcers, cognitive impairments and poor nutrition. All residents are encouraged to come to the communal areas and one resident who had a wheelchair which he had some difficulty to propel, has been provided with an appropriate wheelchair after a referral was made to the wheelchair service. The manager stated that the key workers have discussions with residents about the things that the residents would like to do or areas where they would like to develop skills. Staff would then provide the necessary support to residents in meeting these goals. Two out of three residents who responded to this section in comment cards said that the home always supports them to lead the life that they chose and one said sometimes. At the time of the inspection, none of the residents were engaged in work or in attending courses. The manager mentioned in the AQAA that he has made attempts to support residents in this area and that it is difficult to find outside occupation even on a voluntary or part-time basis for younger residents. The AQAA stated that residents have the opportunity to practice their religion and that the home supports residents to celebrate their religious and ethnic festivals. The manager said that the priest regularly visits the home to see residents who are practising and who are willing to have communion. Two residents mentioned that they would like to live closer to their relatives. The manager is aware of the above but this is also an issue with regards to the placement authorities. We were informed that progress was being made with regards to moving one of the two residents closer to his relative. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 18 Both residents mentioned above, agreed that their relatives are always made to feel welcome when they visit the home. A third resident mentioned that his daughter is able to visit him in the home. The SUG says that residents can preferably have visitors between 10:00 and 20:00. No visitors were observed in the home during this inspection. We observed that residents were able to lock their doors when they go out. The home has provided locks to all the bedrooms’ doors. The locks are of a type that can be opened in an emergency by staff. We observed lunch being served in the home on the first day of the inspection. The dining area was appropriately prepared for residents to have their meals and most residents sat in the dining area to have their lunch. We noted that this was a lively time in the home and a good occasion for residents to interact with each other. The home has a four weekly menu. On that day the chef was not in and a member of staff prepare the meals. We noted that meals were served to the residents according to their choices. Lunch consisted of lamb chops, peas and boiled potatoes. Some residents had chicken instead of lamb chops. There was carrot cake for desert. On the day of the inspection the residents who were spoken to said that they enjoyed their meals. Two residents out of five who responded to the section about the meals in comment cards said that they usually enjoy their meals and three said that they sometimes enjoy their meals. So on the whole we think that residents’ nutritional status is being maintained in the home. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 19 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): 18-21 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is able to meet residents’ personal care and their physical, emotional and health needs to promote the welfare of residents. Care records lack information about the ageing, hopes and fears of residents about the future including death and therefore there is no guarantee that these needs would be addressed when they arise. The management of medication in the home ensures and promotes the safety of residents. EVIDENCE: Two out of three residents who responded to question in the comment cards said that the service always respect their privacy and dignity and one said usually. One resident said that he was looking forward to his bath and that his key worker normally assists him. He stated that he is satisfied with the way that he is supported with his hygiene needs and the privacy that he is offered. A number of residents are independent with regards to personal hygiene, but all those who spoke to us said that they are very well supported by staff and that staff are sensitive to their needs. Three out of five residents who responded to this question in the comment cards said that staff always listen and act on what they say and two said sometimes. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 20 The AQAA mentioned that all residents are registered with a GP who serves the home. The manager added that there is a very good working relationship with the GP and that residents normally go to the GP surgery if they require medical input as they are fairly mobile. According to the manager the GP only visits the home to see residents who are not well or those who find it hard to mobilise. The home takes a similar approach if residents need to see other healthcare professionals such as the dentist or the optician. Residents are encouraged to visit the healthcare professionals in their surgery/shop. Two out of five residents who responded to this question in comment cards said that they always receive medical support that they need and three said usually. The home has a range of risk assessments that are used to assess the needs of residents such as falls risk assessment, nutritional risk assessment, Waterlow risk assessment and manual handling risk assessment. These however were not used and reviewed consistently for all residents. It would have been helpful if the home had clarified its position regarding the use of these and if there was clear guidance on when to use the relevant risk assessment and the timescale for its review. When checking care plans we found that these appropriately addressed the healthcare needs of residents, including the mental health needs. There were charts in place to monitor the behaviour of residents, if that was required, and care plans were in place in cases where residents had aggressive behaviour. In the past we have asked the home to look at support that is available in the community for residents with regards to alcohol and substance dependency, particularly with regards to overcoming their dependency. The manager stated that he has approached a number of local organisations to ask what they could offer and has also spoken with residents about whether this was a service that they wanted. At the time of the inspection none of the residents in the home attended such a service. However this is an area where there are opportunities for health promotion that would benefit residents with regards to adopting healthier lifestyles and which the home should seek to promote at every opportunity. The manager stated that he has also been supporting staff understand addiction and substance misuse. He is a trained mental health nurse and has worked many years in the NHS and social services. He said that he has the necessary skills to offer staff an awareness course in this subject. Whilst this is appropriate, it would be good if more in depth and specialised training be provided to staff in this subject, as this seems to be the main speciality of the home. The care plans of some residents contained a section addressing whether residents would be able to go back into the local community in the future and Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 21 areas where the residents might require support to enable this. However the care plans did not always have information about the expectations, fears and hopes of residents for the future including information about end of life care and death. This is an area where more improvement can be made. We checked the management of medicines in the home. We found that this was of a good standard. All medicines were recorded when received into the home and signed when given to residents. Containers were dated when they were opened to provide an audit trail for medication. None of the residents have been assessed as able to administer their medicines and therefore all medicines were administered by the nursing staff. We found that previous requirements imposed on the home regarding medication have been met. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 22 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 and 23 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who move into the home can be confident that their complaints will be listened to and that their interests will be protected by the home approach to safeguarding adults. EVIDENCE: The complaints procedure is found in the service users’ guide and is offered to all residents who use the service. Two residents who spoke to me said that they would talk to the manager if they were unhappy about the service that they received. Four out of five residents who responded to comment cards asking if they knew who to speak to if they were not happy, said that they always or usually knew who to speak to and all four said that they knew how to make a complaint. There has not been any complaint about the service since the last inspection. The manager said that most issues are dealt with as they arose and resolved before these escalate to the complaint stage. The home has a policy for safeguarding adults and staff have training in this area. The manager stated in the AQAA that staff are aware of the whistleblowing policy since they receive a staff hand out about this. There has been one allegation of financial abuse about the service, which was still being investigated at the time of the inspection. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 23 We were unable to fully inspect the management of the finances of residents on the first and second days of the inspection because we could not access all the records about the finance of residents. We made an appointment to visit the home on a third occasion to look at the management of residents personal finances. We looked at the way the home manages residents’ personal money in line with guidance from the Commission in the report titled “In safe keepingSupporting people who use regulated care services with their finances” (see www.csci.org.uk), the guidance “Monies held on service users’ behalf by corporate appointees” also available on the CSCI website, and Regulation 20 of the Care Homes Regulations 2001. We found that the home has a procedure for the management of residents’ finances. This generally described the way that the home dealt with residents’ finances. To find out how the home manages the finances of residents we looked at the financial records that were kept for last year and this year for three residents. From the sample that we chose, we did not note any discrepancies to suggest that residents’ money was being misappropriated. We however did note that the proprietor had supported residents with claiming benefits that they were entitled to, to make sure that they were not financially loosing out. He also monitored the benefits payments that residents received and made sure that any queries that arose, were sorted out and that any underpayments by the benefits office were followed through. This is to be commended. We however have some recommendations to make, to ensure that the management of residents’ money is more transparent and robust: • That residents’ capacity to manage their personal finance be assessed. The document “Making decisions. A guide for people who work in health and social care” from the Department of Health provides useful guidance on this matter and suggest the use of Independent Mental Capacity Advocate (IMCA) or referral to the Court of Protection in cases where residents do not have capacity. That there is a care plan about the personal finances of residents or a financial profile of residents, to enable a person easily understand how residents’ finances are managed and if the home supports residents to manage their finances, then information about this process. That consent be established and recorded if the residents’ want the home to support them with managing their personal finances. That residents’ social benefits be paid directly into their accounts or joint (with the proprietor) accounts and not in the home’s main account to make sure that residents are able to receive interest as soon as the money goes into their account. • • • Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 24 • • • That the home invoices residents for any personal contribution that residents make in respect of their fees to provide a clear audit trail. That the home buys residents’ cigarettes on an individual basis and provides an individual receipt instead of billing residents an average amount every week based on the average that they smoke and buying cigarettes in bulk. In this way residents would also have a choice of the cigarettes that they smoke. That the home’s policy on Clients Financial Affairs be reviewed in line with the above, if any changes are made. The home should also review the point in the contract/statement of terms and conditions, which says ‘that the home cannot accept responsibility for the management of residents money’. However if the home accepts to manage the finances of residents, there is an implicit role for responsibility both from a legal and good practice perspective and also to safeguard residents from financial abuse. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 25 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 and 30 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a maintained and appropriately decorated environment for residents where their needs can be met. EVIDENCE: The grounds of the home both in front and at the back were maintained to a good standard. The exterior of the building was generally in good condition and the parking area was also clean and tidy. No particular areas were noted during this inspection, which required redecoration. The communal areas, the corridors, bathrooms and toilets were in an appropriate state of decoration. Most areas in the home including corridors and bedrooms of residents were painted in the same colour. In the past when asked about the opportunities for residents to choose the colour scheme of their bedrooms, we were informed that residents preferred to leave this decision to the management. We were informed that the home would Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 26 continue to encourage residents make decisions about the way that their rooms are decorated The communal areas were appropriately furnished and we noted that furniture for the lounge area and for the dining area were appropriate to meet the needs of residents. One resident who was noted wheeling himself with difficulty during the last inspection, now has a wheelchair appropriate for his needs in which he can wheeled himself easily. During the tour of the premises we visited many bedrooms. We found that the bedrooms of residents were appropriately decorated and maintained. Items of furniture were also appropriate. There are now locks on each door to the bedrooms of residents, which residents can use as required to maintain their privacy. Bedrooms of residents are on the whole appropriately decorated. We noted an ironing board and an iron in a resident’s room. The latter confirmed that these belonged to the home and that staff came into his room to iron residents’ clothes at night. He said that he did not mind that and that he liked staff to talk to him. However the manager and staff should review this practice by balancing the resident’s willingness to engage with staff with the residents’ rights to privacy in his own bedroom. During the last inspection, there was a requirement to make sure that toilets have grab handles fitted to promote the independence of residents with impaired mobility. We found that the handles were fitted to one side of the toilets but not to the other side. As people may have physical impairment on either side of the body, grab rails must be fitted to both sides of the toilets. We noted on the day of the inspection that the handyman was in the process of purchasing the grab rails to fit on both sides of the toilets. There were no odours in the home and we found that the standard of hygiene in the home was good. Staff informed us that the laundering of residents’ clothes was carried out on the premises and laundering of bed linen was contracted out. Staff were responsible for the laundering of residents’ clothes and for the ironing. The home has a sluicing disinfector for the appropriate cleaning and disinfection of urinals, bedpans and other nursing equipment as required. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 27 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): 32,34,35 and 36 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides adequate number of staff to care for residents. They do receive regular supervision and training for them to be skilled to care for the residents, but they do not always receive statutory training in a timely manner. Recruitment checks have not always been robustly applied to make sure that the right people are recruited to care for the residents. EVIDENCE: There has not been any change in the staffing levels in the home. There are one trained nurse and four carers during the day and at night there are one trained nurse and one carer. There are support staff including cleaners/housekeepers, a chef and a handyman. The home also employs an activities coordinator. Staff do take part in some non-care duties such as doing the laundry and some cooking (supper in the evening), but care duties seem to take precedence. Three residents out of five who responded to a question in comment cards if staff listen and act on what the residents say and whether staff are available Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 28 when they are needed, said that this is always the case and two said that this is usually the case. We noted that staff adopted a real team approach in the home with regards to looking after the needs of residents. On the first 2 days of the inspection, the chef was not in and care staff help to prepare the meals. The manager stated in the AQAA that ‘the rota is such that it makes up for unexpected staff absence’. However while talking to two members of staff, they said that there could have been more staff to cover for absences. During the inspection, the manager said that he would recruit more staff on bank to provide backup when shortages of staff arose. The staff team has been fairly stable and only one has resigned since the last inspection. The manager stated that he has already recruited a new member of staff to fill that vacancy and the prospective member of staff was waiting for the appropriate checks before starting work in the home. We look at the personnel files of two members of staff. One member of staff started work in the home in 2006. We found that the application form had not been filled comprehensively. There were gaps in the education and employment history of the applicant. We also did not find any evidence that the two members of staff could work in the UK. There was no copy of a passport or of a visa to show that they were eligible to work in the UK. As there have not been any new members of staff since the last inspection, we were not able to check on the induction that staff received when they start work in the home. However the manager mentioned that the home uses the common induction standards from Skills for Care for new care staff. There was evidence that staff receive regular supervision and appraisal. Members of staff who spoke to us also said that they receive supervision on a regular basis and that they feel that they are supported in their job. This is commended. We found from the training records that staff have had training on safeguarding adults, health and safety, mental capacity training and managing aggression. The manager said that he has been providing training to staff about substance misuse and alcohol and drugs dependency. During the last inspection we found that staff have not had manual handling training every year. The manager said that training in manual handling was planned for the 1st July. We also noted that fire training was last offered on the 30th January 2007 and therefore a number of members of staff were out of date with regards to that training. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 29 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): 37,39,41 and 42 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified and experienced to run the home to make sure that residents are supported and cared for to a good standard. The home has a quality management system based on feedback from stakeholders to ensure continuous improvement of the service. Health and safety issues are on the whole appropriately addressed to ensure the safety of all people who use the service. EVIDENCE: The manager has worked in the home for about six years. Prior to that he worked for social services and the NHS in managerial positions. He is a trained nurse and has completed the Registered Managers Award. The management team consists of the proprietor, the manager and a deputy manager. The proprietor is responsible for the physical and business aspect of the home and the finance of residents and the deputy manager leads on clinical issues. We Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 30 however noted that the manager did not have full access to the financial records of residents and was therefore not fully aware of how residents’ finances were being managed. Minutes of monthly staff meeting and of residents’ meetings were seen. It was positive to note that staff and residents were given the opportunity to express their views and contribute to the management of the home. The home has acquired the Blue Cross Quality Management System that has been drawn up by the Registered Care Homes Association. There was also evidence that the various audits have been carried out by the manager. Quality surveys had also been carried out. We found that the manager and staff were very supportive during the inspection and that most records that the home kept were produced for inspection when requested. We were however not able to access all the financial records with regards to the management of the personal money of residents on the first and second day of the inspection, as the proprietor was not in the home. Health and safety issues were on the whole addressed. There was evidence of all the necessary safety certificates (gas, electricity, lift and hoist). There were records to show that weekly fire tests were taking place as well as fire drills and monthly emergency light tests. A Fire Risk Assessment and an Emergency Fire plan were in place. There was also evidence that the health and safety risk assessment was reviewed as required. The health and safety risk assessment addressed the use of the mini kitchen by residents, access to water outlets by residents (since the taps in the basins were not fitted with thermostatic valves), use of irons and kettles by residents. While touring the premises we noted that the restrainer to a window on the second floor could be easily and manually disabled and the window fully opened. In fact the resident who lived in that bedroom showed us how the restrainer could be disabled. During the inspection in June 2006 a requirement was imposed on the home to ensure that risk assessments be carried out with regards to windows having restrainers in relation to the people who live in the home and that once a risk has been identified then control measures should be in place. The guidance from the Health and Safety Executives states: Restrictors should be types that can only be disengaged by means of a special tool or key. (HSE, Local Authority Circular, LAC 79/6. 2007. Falls from windows in health and social care settings. Paragraph 29) As a result of the above all windows must be checked according to the home’s risk assessment to make sure that they are fitted with a type of restrainer that Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 31 can only be disabled with a special tool or key as it is the responsibility of the provider to ensure the safety of residents who use the premises. The home does not fit thermostatic valves to the washbasins of residents, but according to the manager these are fitted to baths and showers. He stated that according to the home’s risk assessment and individual risk assessments of residents, these are not required. We observed a multi-way electric socket adaptor in the bedroom of a resident. We imposed a requirement on the home during the last inspection to make sure that these be removed, as these are associated with an increased risk of fire. The manager immediately replaced that multi-way adaptor when we pointed that to him and he stated that all of the multi-way adaptors have now been replaced. This requirement has therefore been met but it has not been in a timely manner. The kitchen has recently had a visit by an Environmental Health Officer and has been rated two stars out of five stars. There was therefore room for improvement in this area. Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 32 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 2 2 3 3 3 4 3 5 2 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 2 3 X 3 X 2 3 x Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 33 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 5 Requirement The contract/statement of terms and conditions of the home with residents/representatives must be reviewed to make it more comprehensive (Repeated requirement-timescale 30/09/07 partly met). The needs of residents must be comprehensively assessed and kept under review to ensure that all the needs of residents are comprehensively identified so that plans of care can be drawn up to meet the identified needs (Repeated requirementtimescale 30/08/07 partly met). The registered person must ensure that care plans and risk assessments address the promotion of the independence of residents, and the development of living skills as identified by the assessment of needs while focusing on the safety of the resident and of others through appropriate risk assessments. DS0000022945.V368164.R01.S.doc Timescale for action 30/09/08 2 YA6 14 (1,2) 30/09/08 3 YA9 13(4) 30/09/08 Walm Lane Nursing Home Version 5.2 Page 34 4 YA19 14(1,2) (Repeated requirementtimescale 31/04/06, 30/09/06 and 31/08/07 not met) In order that residents needs are 30/09/08 comprehensively assessed, the home should clarify its procedure for the use of the range of risk assessments in use in the home so that all nursing and care staff are clear about the risk assessments that need to be completed for individual residents and the criteria for determining the timescale for a review of these. The registered person must ensure that toilets are fully accessible to residents as per a risk assessment by ensuring that the appropriate physical aids are in place such as grab bars (Repeated requirementtimescale 30/10/06 and 31/08/07 partly met). All applicants who wish to work in the home must complete a comprehensive application form and must have a full work and education history (Repeated requirement-timescale 30/08/07 partly met). Evidence of the eligibility of care workers to work in the UK must also be kept in the individual personnel files of staff. All staff must receive yearly updates in statutory training such as manual handling and fire training (Repeated requirement-timescale 30/08/07 partly met). All residents’ records must be made available at all times by DS0000022945.V368164.R01.S.doc 5 YA29 23(2)(n) 30/09/08 6 YA34 17(1), sched 2 30/09/08 7 YA35 18(1)(c) 30/11/08 8 YA41 17(3)(b) 31/08/08 Walm Lane Nursing Home Version 5.2 Page 35 9 YA42 13(4) any person authorised by the Commission to enter and inspect the care home. The window restrainers that are 31/08/08 in use in the home must be of a type that can only be disabled by a special key or tool to make sure that they are not easily disabled and for them to serve their purpose. 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 YA19 Good Practice Recommendations Whilst the manager is able to offer staff an awareness course in alcohol and substance misuse, it would be good if more in depth and specialised training be provided to staff in this subject, as this seems to be the main speciality of the home. The following recommendations are made regarding the management of residents’ finances to ensure that the management of residents’ money is more transparent and robust: • That residents’ capacity to manage their personal finance be assessed. The document “Making decisions. A guide for people who work in health and social care” from the Department of Health provides useful guidance on this matter and suggest the use of Independent Mental Capacity Advocate (IMCA) or referral to the Court of Protection in cases where residents do not have capacity. That there is a care plan about the personal finances of residents or a financial profile of residents, to enable a person easily understand how residents’ finances are managed and if the home supports residents to manage their finances, then information about this process. That consent be established and recorded if the residents want the home to support them with managing their personal finances. DS0000022945.V368164.R01.S.doc Version 5.2 Page 36 2 YA23 • • Walm Lane Nursing Home 3 YA24 That residents’ social benefits be paid directly into their accounts or joint (with the proprietor) accounts and not in the home’s main account to make sure that residents are able to receive interest as soon as the money goes into their accounts. • That the home invoices residents for any personal contribution that residents make in respect of their fees to provide a clear audit trail. • That the home buys residents’ cigarettes on an individual basis and provides an individual receipt instead of billing residents an average amount every week based on the average that they smoke and buying cigarettes in bulk. In this way residents would also have a choice of the cigarettes that they smoke. • That the home’s policy on Clients Financial Affairs be reviewed in line with the above, if any changes are made. The home should also review the point in the contract/statement of terms and conditions, which says that the home cannot accept responsibility for the management of residents’ money. If the home accepts to manage the finances of residents, there is an implicit role for responsibility both from a legal and good practice perspective and also to safeguard residents from financial abuse. That the use of a resident’s bedroom for staff to iron residents’ clothes be reviewed so that this balances with the willingness of the resident to engage with staff and the residents’ right to privacy in his bedroom. That the decision process and the outcome about this be recorded. • Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Walm Lane Nursing Home DS0000022945.V368164.R01.S.doc Version 5.2 Page 38 - 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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