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Inspection on 22/08/06 for Waltham Hall Nursing & Residential Home

Also see our care home review for Waltham Hall Nursing & Residential Home for more information

This inspection was carried out on 22nd August 2006.

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

The inspector 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

What has improved since the last inspection?

This is the inspector`s first visit to this home. There were no requirements made at the last inspection for improvement. Staff themselves noted improvements in the way in which care plans were written. Policies in the home, which give information about how staff carry out their work, have been reviewed since the last inspection.

What the care home could do better:

It might be good if the daily care records could be made clearer so that they gave a better, more continuous picture how a service user is on an ongoing basis, which help to ensure their needs are met. It would be good if staff could advise all residents (and relatives where appropriate) of their right to see their records and be involved in care planning. All incidents, which affect the welfare of service users, must be reported to the Commission for Social Care Inspection under Regulation 37, Care Homes Regulations 2001 More detailed assessments for the use of bed rails and other such equipment should be carried out, which directly show why this aid is needed and in what way it will make an individual safer. The Registered Manager must ensure that service users` needs are properly assessed on an ongoing basis, and that any issues of concern noted are recorded. There were some errors and issues of concern noted about the administration of medication, and the manager must ensure that staff administer medication correctly to meet the medical needs of service users and keep them safe.Given the differing views of service users about social stimulation and activities, it would be good if attention could be paid to assessing whether service users would benefit if both lounges on both floors were used (facilitating with appropriate numbers of staff as required), and whether any service users have preference for different kinds of social stimulation from that currently offered. The Registered Manager could give consideration to further briefing staff as to action to take relating to incidents regarding safeguarding service users from harm, in order to ensure that prompt action is taken in future, where a concern is identified. It is recommended that cleaning materials are safely stored to prevent risks to service users. It is recommended that the provider looks at alternative options/adaptations to make baths safe, in order to be able to offer service users a choice about whether they would prefer a bath or shower. The proprietor should ensure that at least monthly visits are made to the home, to monitor the quality of service provided, and a report prepared of the outcomes of the visit, a copy of which should be sent to the Commission for Social Care Inspection. The recommendation remains from the previous inspection for the manager to look into how individuals` finances are managed and whether more appropriate alternatives might be found for people who wish it, that recognises individual needs/wishes/personal choice in how their money is held.

CARE HOMES FOR OLDER PEOPLE Waltham Hall Nursing & Residential Home Melton Road Waltham On The Wolds Melton Mowbray Leicestershire LE14 4AJ Lead Inspector Chris Wroe Unannounced Inspection 22nd August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waltham Hall Nursing & Residential Home Address Melton Road Waltham On The Wolds Melton Mowbray Leicestershire LE14 4AJ 01664 464865 01664 464881 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) Claregrange Limited Patricia Jane Groom Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61), Physical disability over 65 years of age of places (61), Terminally ill over 65 years of age (2) Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No one falling within category TI(E) may be admitted into the home where there are 2 persons of category TI(E) already accommodated within the home. Named Person To be able to admit the person of category LD/DE named in variation Application No. V28476. To be able to admit the person of category PD named in variation application number V29019. Named Person To be able to admit the named person of category PD named in variation application No. V31071 dated 31 March 2006 Date of last inspection Brief Description of the Service: Waltham Hall Nursing and Residential Home is situated in the Leicestershire village of Waltham on the Wolds and is registered to provide personal and nursing care to sixty-one persons over the age of sixty-five. Accommodation, which can be found on two floors, is accessible by two shaft lifts. Communal areas including dining rooms and lounges can be found on both floors. There are forty-eight single bedrooms with ensuite facilities, eleven single bedrooms without ensuite facilities and one double bedroom with ensuite facilities. There is a large garden to the front, side and rear of the building, which is well maintained and accessible to all residents, relatives and visitors. A large car park is available for visitor parking. The home enjoys pleasant views over the surrounding countryside. Fees charged range from £410 per week to £566 per week. Additional charges are made for other facilities, such as hairdressing, private chiropody and magazines and newspapers. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included a visit to the service. The inspector visited the home on 22nd August 2006 (10.30am to 4.45pm) and 29th August 2006 (10.15am to 3.40pm). The visit lasted for eleven hours and forty minutes in total. The Registered manager, Ms Jane Groom, assisted the inspector during the first part of the visit, and a member of the nursing staff during the second part. The main method of inspection used was ‘case tracking’. This means looking at the care given to residents in different ways. The ways this was done are: • talking to the residents • talking to staff and the manager • watching how residents are given support • looking at written records. The inspector spoke with eleven people who live in the home (two relatives spoke on behalf of service users with whom the inspector was unable to meaningfully communicate on this occasion). In addition, a sample of comment cards were sent out to ten randomly selected service users. Together with comments from people spoken with during the inspection, these form a sample of views. The views of people living in the home are given throughout the report. In the main, service users were happy about the care given by staff. They felt the home was comfortable and they mainly have what they need. All the key standards were checked during this inspection. The information below is based only on those aspects checked in this inspection. Individual detail has been kept out of the report, to make sure it is kept confidential. The term ‘service user’ is used in the report to refer to people who live in the home, since the terms ‘resident’ and ‘nursing care’ are used in the home to describe the different kinds of need of people. What the service does well: The admission process for someone moving into the home is good. Service users commented that they had received good information about the home and had a chance to visit and make a choice about moving to the home. Assessments are carried out to detail what care and support people need. Staff have a range of training to enable them to meet the needs of people living in the home, as identified when they move into the home. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 6 Contracts and terms of conditions are in place for private and funded service users. Care plans are in place for all service users, which give information about service users’ needs and how staff in the home will meet them. There was some evidence seen of the involvement of service users in care planning. Service users generally commented that they usually receive the care and support they need. Staff support service users with sensitivity. Skin viability assessments are carried out for service users, to make sure that they are protected from the risk of pressures sores, and staff spoken with were aware of good practice in prevention and treatment of pressure sores. All service users are linked with a GP, and good contact is maintained with GP services, calling someone out where a concern is noted. GPs gave positive comments about the home when consulted. Good attention is paid to continence – both by assisting people to use the toilet and by assessment and provision of aids if needed. Staff manage continence discreetly. Additional services, such as chiropody, and dental care are accessed for service users. Medical treatment and examination is provided in individual’s own rooms, and privacy is afforded to service users. There are risk assessments in place in the home, which give information about how to keep service users safe. Nursing staff carry out assessments to identify if someone needs support, for example through use of bed rails, whilst in bed. Medication systems and recording are in place. The storage and recording of controlled drugs is appropriate and safe. Service users are enabled to make some choices in their daily lives. Service users are enabled to have visitors, and relatives’ involvement is encouraged. Service users are able to bring personal possessions with them into the home. A public payphone is available in a communal area – service users may use a private phone in the office if they need to. Smoking is permissible in one part of the home. Some activities are provided in the home. There is an activities co-ordinator in the home and support staff, who provides individual stimulation through reminiscence, small games and puzzles. Books are available in the home, and links are made with the local library. Bingo is held weekly and other occasional entertainment includes musicians and singers, barbeques and picnics. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 7 Menus show that a nutritious and varied diet is given to service users. Discussion with the cook indicates that differing diets are catered for, and sensitivity is paid to people with particular dietary requirements. Food is freshly cooked on the premises. Nutritional assessments are undertaken and attention paid to diet if a need is identified. Complaints received by the home are investigated promptly and fully. There has been one complaint received by the Commission for Social Care Inspection since the last inspection, which was investigated by the Matron and resolved with the complainant. Issues in the complaint related mainly to infection control measures and, in part, to care of one service user. As a result of the complaint, but also because of good practice developments in the home, a programme of routine cleaning of wheelchairs and other equipment has been put in place in the home to control the spread of infection. Residents spoken with during the inspection confirmed that they felt able to talk to someone if they had any concerns. All parts of the home, which were seen, were clean and tidy and generally in a good state of repair. There were no offensive odours in the home. There are sufficient machines and systems in place for an effective laundry service. Safety checks are carried out in the home to ensure equipment is working properly and service users are kept safe, for example testing of fridge/freezer temperatures, and testing of water temperatures at service users’ sinks. There is a range of staff employed in the home, including registered nurses, care staff, cooks and kitchen staff and domestic and cleaning staff. There are waking staff on duty at night in the home, who check service users through the night to ensure they are safe and well. More care staff work at busier times, for example in the mornings to help people to get up and washed and dressed. Good training opportunities are offered to staff. Sixty percent of care staff have achieved National Vocational Qualifications in care at level 2 or above. Staff spoken with said that they felt well supported in the home through training. Recruitment processes appear thorough in the home. All required safety checks, including Criminal Record Bureau checks, and written references are collected in relation to employees. Staff receive induction, and ongoing supervision and appraisal of their work. The manager carries out her own regular audits in the home to assess how things are running. There are some good quality assurance processes, including questionnaires to service users and relatives, and regular residents meetings. A range of staff meetings are held regularly for different staff, and staff have ongoing supervision. Invoices are sent to service users monthly detailing charges owed for hairdressing, chiropody, fees and any other costs. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 8 Health and safety committee meetings are held regularly, showing that ongoing attention is paid to the health and safety of service users. What has improved since the last inspection? What they could do better: It might be good if the daily care records could be made clearer so that they gave a better, more continuous picture how a service user is on an ongoing basis, which help to ensure their needs are met. It would be good if staff could advise all residents (and relatives where appropriate) of their right to see their records and be involved in care planning. All incidents, which affect the welfare of service users, must be reported to the Commission for Social Care Inspection under Regulation 37, Care Homes Regulations 2001 More detailed assessments for the use of bed rails and other such equipment should be carried out, which directly show why this aid is needed and in what way it will make an individual safer. The Registered Manager must ensure that service users’ needs are properly assessed on an ongoing basis, and that any issues of concern noted are recorded. There were some errors and issues of concern noted about the administration of medication, and the manager must ensure that staff administer medication correctly to meet the medical needs of service users and keep them safe. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 9 Given the differing views of service users about social stimulation and activities, it would be good if attention could be paid to assessing whether service users would benefit if both lounges on both floors were used (facilitating with appropriate numbers of staff as required), and whether any service users have preference for different kinds of social stimulation from that currently offered. The Registered Manager could give consideration to further briefing staff as to action to take relating to incidents regarding safeguarding service users from harm, in order to ensure that prompt action is taken in future, where a concern is identified. It is recommended that cleaning materials are safely stored to prevent risks to service users. It is recommended that the provider looks at alternative options/adaptations to make baths safe, in order to be able to offer service users a choice about whether they would prefer a bath or shower. The proprietor should ensure that at least monthly visits are made to the home, to monitor the quality of service provided, and a report prepared of the outcomes of the visit, a copy of which should be sent to the Commission for Social Care Inspection. The recommendation remains from the previous inspection for the manager to look into how individuals’ finances are managed and whether more appropriate alternatives might be found for people who wish it, that recognises individual needs/wishes/personal choice in how their money is held. 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. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (Standard 6 does not apply at this time) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a good admissions procedure to the home. EVIDENCE: One person spoken with confirmed they had received information about the home before moving in, and said that someone came to see them, and they had a chance to visit the home and decide whether they wanted to move in. One relative spoken with said that the induction into the home was very good. Four people who responded in comments cards said that they had received enough information about the home before moving in to enable them to make a choice about whether it was the right place for them. Basic assessments are in place, completed by nursing staff, which tell about individual identified needs at admission to the home. Where someone’s move into the home is funded by the local or health authorities, additional assessments are in place. Staff have a range of training to enable them to Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 12 meet the needs of people living in the home, as identified when they move into the home. Contracts and terms of conditions are in place for private and funded service users, although three people who responded in comment cards said they had not received a contract. It might be good if the provider checked that everyone has received a copy of their contract/terms and conditions in the home. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some aspects of service users’ health and personal care are well looked after, but there are some areas in which individuals’ health and personal care could be put at risk. EVIDENCE: Care plans are in place for all service users, which give information about service users’ needs and how staff in the home will meet them. Daily records are made, but they refer to different parts of the care plans and so make it difficult to gain an ongoing daily picture of an individual’s well being. It would be good if the daily records could be made clearer so that they showed how someone is on an ongoing basis. There was some evidence seen of the involvement of service users in care planning, but one relative said spoken with said that they were unaware that were able to see care plan and be involved in care planning. It would be good if staff could advise all residents (and relatives where appropriate) of their right to see their records and be involved in care planning. Of those people who responded in comment cards, four said that they usually receive the care and support they need. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 14 Accident and incident records were seen – but there were some incidents which had not been fully recorded, and there had not been notification to the Commission for Social Care Inspection, as required, about a number of incidents - including regarding one service user who had fallen down the stairs and was taken to hospital by paramedics, and incidents of aggression by one service user against members of staff. All incidents, which affect the welfare of service users, must be reported to the Commission for Social Care Inspection under Regulation 37 Care Homes regulations 2001. Skin viability assessments are carried out for service users, to make sure that they are protected from the risk of pressures sores, and staff spoken with were aware of good practice in prevention and treatment of pressure sores. All service users are linked with a GP, and good contact is maintained with GP services, calling someone out where a concern is noted. GPs who provide a service for the home, were contacted by the Commission for Social Care Inspection for their views, as part of the inspection. They gave positive views about the service; one GP commented: ‘The care offered is excellent and particularly good with care of the dying… They treat relatives with respect and communicate well.’ Service users and relatives who the inspector spoke with were mainly satisfied with health care arrangements – although one relative commented that there had been times when communication following a GP visit had not been clear. Good attention is paid to continence– both by assisting people to use the toilet and by assessment and provision of aids if needed. Staff manage continence discreetly. Additional services, such as chiropody, and dental care are accessed for service users. Medical treatment and examination is provided in individual’s own rooms, and privacy is afforded to service users. There are risk assessments in place in the home, which give information about how to keep service users safe. Nursing staff carry out assessments to identify if someone needs support, for example through use of bed rails, whilst in bed. Risk assessments regarding bed rails are quite basic, and were found to not reflect the individual circumstances or needs of service users. They did not show why bed rails are most appropriate way to safeguard someone - for example regarding one service user, the assessment said the reason for use of bed rails was ‘deterioration in health, mental health problems, cardiac problems’ – but this gives no picture of why bed rails are needed – with the result that, in the absence of a clear assessment, the use of bed rails could look like restraint. More detailed assessments for the use of bed rails and other such equipment should be carried out, which directly show why this aid is needed and in what way it will make an individual safer. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 15 There were two individual issues of concern noted, which were taken up individually with senior staff on duty, and which cannot be explained fully in this report due to issues of confidentiality. Both incidents raised issues of lack of full recording in care records, lack of full assessment of the needs of service users, and lack of follow-up action. The Registered Manager must ensure that service users’ needs are properly assessed on an ongoing basis, and that any issues of concern noted are recorded. Medication systems and recording are in place. The storage and recording of controlled drugs is appropriate and safe. Some good safety measures have been put in place in the home – for example control of two staff signatures re administration of Warfarin to ensure safe, counting of balance of medication to ensure it does not go missing. One person said in comment cards that they always receive the medical support they need, two people that they usually do, and one person that they sometimes do. Some issues were noted in relation to medication administration: 1. There were two instances in which it was observed that staff left medication with service users in a dose cup, but did not stay to see if the medication had been taken – thereby causing a potential risk to the wellbeing of service users. 2. In one instance, the system of recording the balance of medication remaining showed a potential miscount of 12 tablets. No record had been made, and no investigation carried out as to the circumstances of this. Where a discrepancy in safety systems is noted, it should be investigated and recorded. 3. Records showed instances in which the home ran out of medication stock. Regarding one service user, nine doses of Procyclidine medication had been missed over a three-day period, because it was noted as being out of stock. Regarding another service user, sixteen doses of Salbutamol nebules had been missed over a four-day period, again due to no stock (matron explained that the pharmacy had no stock). These situations could potentially cause risk to service users. Arrangements must be made to ensure that service users received prescribed medication continually and consistently. 4. In discussion, the matron said that one service user often refuses medication, and it should be given on an ‘as required’ basis. This had not been discussed with the GP. Given that this service user is someone who sometimes presents challenging behaviour due to their mental health and is largely maintained in bed/reclining chair, the issue of correct medication could be important. Staff should refer any issues relating to individuals’ medication to the GP for review. 5. The matron and one member of staff said that sometimes other service user’s medication is used if the home does run out of medication – this is not appropriate. Service users should only receive medication prescribed and supplied for them. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 16 6. The dosage regarding one service user’s medication was referred to as ‘½ or 1 tablet twice a day’ – the member of staff was not clear about the circumstances in which one would give ½ tablet or 1 tablet and there were no clear instructions on the records or elsewhere. This should be clarified so that staff can be clear and consistent. 7. The Home does not yet dispose of medication for service users who receive nursing care via a licensed waste disposal service, as required under relevant legislation. This should be put in place as soon as possible. 8. Care staff apply prescribed creams for service users and then inform the nursing staff, who sign the medication administration records. It would be better if the staff who administered the medication signed the records. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally benefit from good attention to daily life and social activities. EVIDENCE: Service users are enabled to make some choices in their daily lives, such as where they would prefer to eat meals (for example, in the dining room or in their bedrooms). Service users are enabled to have visitors, and relatives’ involvement is encouraged. Service users are able to bring personal possessions with them into the home. A public payphone is available in a communal area – service users may use a private phone in the office if they need to. Smoking is permissible in one part of the home. Some activities are provided in the home. Instances were noted where stated needs in an individual’s care plan, regarding their particular need for social stimulation, have been followed up (for example one to one support to go out). There is an activities co-ordinator in the home and support staff, who provides individual stimulation through reminiscence, small games and puzzles. Books are available in the home, and links are made with the local library. Bingo is held weekly and other occasional entertainment includes Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 18 musicians and singers, barbeques and picnics. There are differing views on the quality of social stimulation. Of ten service users surveyed through comments cards, three people responded that there were usually enough activities, one that there sometimes were. One relative commented that upper floor lounge becomes very crowded – this was observed to be the case. On each floor there are two lounges, but only one lounge per floor is in use. The inspector observed that apart from moving for lunch (not everyone moved), some people generally stayed in lounge all day. One service user said that she was happy in the home, but would like to go out of the lounge more. Given the differing views, it would be good if attention could be paid to assessing whether service users would benefit if both lounges on both floors were used (facilitating with appropriate numbers of staff as required), and whether any service users have preference for different kinds of social stimulation from that currently offered. Menus show that a nutritious and varied diet is given to service users. Discussion with the cook indicates that differing diets are catered for, and sensitivity is paid to people with particular dietary requirements. Food is freshly cooked on the premises. Nutritional assessments are undertaken and attention paid to diet if a need is identified. Of those people who returned comments cards, two said that they usually like the meals at the home; one said that they sometimes do. Residents who were spoken with said they like the meals provided in the home. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are mainly protected from harm by complaints and protection procedures. EVIDENCE: Complaints received by the home are investigated promptly and fully. There has been one complaint received by the Commission for Social Care Inspection since the last inspection, which was investigated by the Matron and resolved with the complainant. Issues in the complaint related mainly to infection control measures and, in part, to care of one service user. As a result of the complaint, but also because of good practice developments in the home, a programme of routine cleaning of wheelchairs and other equipment has been put in place in the home to control the spread of infection. Of comments cards sent out, three people responded that they feel that staff listen to them, one responded that they feel staff sometimes listen. One person said they always knew who to talk to if they were not happy about something, two people said they usually knew, and one said they sometimes knew. Two people said they always knew how to make a complaint, two people said they sometimes knew. Residents spoken with during the inspection also confirmed that they felt able to talk to someone if they had any concerns. Whilst staff described that they were aware of the procedures relating to protection of service users from abuse or harm, issues noted during the Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 20 inspection relating to concerns about the behaviour of one resident, and the risk posed to herself and others should have lead the staff and matron to consider action under the procedures relating to protection of service users from harm. The service user’s social worker had not been involved, recording of incidents had not been carried out, and the home had not reported the incidents to the Commission for Social Care Inspection or other relevant agencies. The Registered Manager could give consideration to further briefing staff as to action to take relating to incidents regarding safeguarding service users from harm, in order to ensure that prompt action is taken in future. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users mainly benefit from a good living environment. EVIDENCE: All parts of the home, which were seen, were clean and tidy and generally in a good state of repair. Four service users who responded in comments cards said that the home was always fresh and clean – one commented that cleanliness in the home was ‘excellent’. Service users spoken with during the inspection also confirmed that the home was kept clean and tidy. There were no offensive odours in the home. There are sufficient machines and systems in place for an effective laundry service. Sluice rooms, which were seen, were clean and hygienic. On one sluice room a notice said that the door should be kept locked – but there was no lock on the door. Cleaning chemicals were contained inside. In addition, one cleaning room containing trolleys with cleaning chemicals in them was left open and unattended. It is Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 22 recommended that cleaning materials are safely stored to prevent risks to service users. Safety checks are carried out in the home to ensure equipment is working properly and service users are kept safe, for example testing of fridge/freezer temperatures, and testing of water temperatures at service users’ sinks. Most people have a shower in the shower room because of safety – the bath chairs do not fully support some people, who are more frail or have difficulty balancing. Staff said that some service users would prefer bath, but that the shower is used, as it is the safest method. It is recommended that the provider looks at alternative options/adaptations to make baths safe in order to be able to offer service users a choice about whether they would prefer a bath or shower. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users mainly benefit from staffing arrangements in the home. EVIDENCE: There are a range of staff employed in the home, including registered nurses, care staff, cooks and kitchen staff and domestic and cleaning staff. Care staff provide most of the personal care to service users, with nurses providing additional support and specialist care. There are waking staff on duty at night in the home, who check service users through the night to ensure they are safe and well. More care staff work at busier times, for example in the mornings to help people to get up and washed and dressed. Staff work a range of shift patterns to suit their circumstances, and proper breaks are given during the working day. Four people responded in comments cards that staff are ‘usually’ available when they need them. One carer, working with thirty service users on the first floor of the home, described that generally they try to have four members of care staff on duty, but that sometimes there are three. The member of staff described that the majority of people living on the first floor need the assistance of two staff to help them to move around the home and go to the toilet. Given the comments that have been made by people living in the home (see earlier in report) about their wish to move around more, or be able to sit in other parts of the home, it is suggested the manager look at how staffing levels could enable carers to meet differing needs of service users. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 24 Good training opportunities are offered to staff. Sixty percent of care staff have achieved National Vocational Qualifications in care at level 2 or above. Training provided to staff over the past twelve months includes fire safety training, manual handling, health and safety, first aid, palliative care, dementia care, nutrition, infection control, and reminiscence therapy. Staff spoken with said that they felt well supported in the home through training. Recruitment processes appear thorough in the home. All required safety checks, including Criminal Record Bureau checks, and written references are collected in relation to employees. Staff receive induction, and ongoing supervision and appraisal of their work. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in the home mainly benefit from good management and administration systems. EVIDENCE: There has been no change to the management of the home. The manager carries out her own regular audits in the home to assess how things are running. However there was no evidence of visits carried out by the proprietor. Regulation 26 of the Care Homes Regulations 2001 requires that proprietors, who are not involved in the home on a daily basis, visit the home every month and prepare a report, a copy of which should be sent to the Commission for Social Care Inspection. Given some of issues previously raised in this report, it is recommended that the proprietor carries out these visits to assess how quality is maintained in the home. There are some good quality Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 26 assurance processes, including questionnaires to service users and relatives, and regular residents meetings. A range of staff meetings are held regularly for different staff, and staff have ongoing supervision. Residents’ ‘pocket’ monies are held in one single bank account – this has been raised in a previous inspection, and recommendations made to arrange individual accounts. The administrator said they have been looking into alternatives but not yet made alternative arrangements. Some residents have a large amount of money held in the account – although interest is calculated annually by the home’s accountant on a pro rata basis. Invoices are sent to service users monthly detailing charges owed for hairdressing, chiropody, fees and any other costs. The recommendation remains for the manager to look into how individuals’ finances are managed and whether more appropriate alternatives might be found for people who wish it, that recognises individual needs/wishes/personal choice in how their money is held. Safety checks are carried out in home – for example water temperature testing at sinks, fire safety checks. Accident records are in place. Health and safety committee meetings are held regularly, showing that ongoing attention is paid to the health and safety of service users. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 37 Requirement It is required that all incidents, which affect the welfare of service users, must be reported to the Commission for Social Care Inspection. It is required that a safe system of administration of medication (including recording and handling) be implemented in the home by all staff. Timescale for action 20/09/06 2 OP9 13 20/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations It is recommended that more detailed assessments for the use of bed rails and other such equipment be carried out, which directly show why this aid is needed and in what way it will make an individual safer. It is strongly recommended that the Registered Manager ensures that service users’ needs are properly assessed on an ongoing basis, and that any issues of concern noted are recorded. DS0000001931.V308466.R01.S.doc Version 5.2 Page 29 2 OP8 Waltham Hall Nursing & Residential Home 3 OP12 4 OP18 5 6 OP19 OP19 7 OP33 8 OP35 Given the differing views of service users about social stimulation and activities, it is recommended that attention be paid to assessing whether service users would benefit if both lounges on both floors were used (facilitating with appropriate numbers of staff as required), and whether any service users have preference for different kinds of social stimulation from that currently offered. It is recommended that the Registered Manager give consideration to further briefing staff as to action to take relating to incidents regarding safeguarding service users from harm, in order to ensure that prompt action is taken in future, where a concern is identified. It is recommended that cleaning materials are safely stored to prevent risks to service users. It is recommended that the provider looks at alternative options/adaptations to make baths safe, in order to be able to offer service users a choice about whether they would prefer a bath or shower. It is recommended that the proprietor ensures that at least monthly visits are made to the home, to monitor the quality of service provided, and a report prepared of the outcomes of the visit, a copy of which should be sent to the Commission for Social Care Inspection (Regulation 26, Care Homes Regulations 2001). It is recommended (the recommendation remains from the previous inspection) that the manager to look into how individuals’ finances are managed and whether more appropriate alternatives might be found for people who wish it, that recognises individual needs/wishes/personal choice in how their money is held. Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX 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 Waltham Hall Nursing & Residential Home DS0000001931.V308466.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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