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Inspection on 06/09/08 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 6th September 2008.

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

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?

Medicines such as creams are now signed for when they are given. The residents and families are encouraged to use the complaints procedure when they have concerns. The privacy and dignity of the residents is being maintained. The residents are having meals that are appetising and presented attractively.

What the care home could do better:

The statement of purpose should contain all the required information and could include the results of the annual questionnaires sent to the residents and the families. The care plans could be written more clearly and arranged in an easier form to read. The care staff could be trained and encouraged to write in the care plans for the people who receive residential care. The medication could be obtained in an easier and safer method that would also give the staff more time. A dedicated activities person could be employed so that a wider range of activities could be arranged for the residents. The complaints book should be available at all times for the Nurse in charge to be able to complete if she receives a complaint. The complaints book should be in a form that shows the `trail` of the complaint from the date it was received until it is resolved. The front door must be kept locked at all times to make sure that the staff know who comes into the home to make sure that the residents are safe. The staff levels in the afternoons must be reviewed to make sure that the staff are able to give the residents the right care at the times that they want/need it. The staff files should have photographs of the member of staff on them to help with their identification. The residents` personal accounts and money should be available to the person in charge so that the resident can have their money whenever they want it. The resident`s accounts should have two signatures on each transaction to protect the resident and the staff. Money and valuables should be kept in a safe and not in the medicine cupboard. The registered provider must complete a Regulation 26 report form for the Commission for Social Care Inspection every month.

CARE HOMES FOR OLDER PEOPLE Waltham Hall Nursing & Residential Home Melton Road Waltham On The Wolds Melton Mowbray Leicestershire LE14 4AJ Lead Inspector Thea Richards Unannounced Inspection 8th September 2008 09:30 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.V371862.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.V371862.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 waltham-hall@tiscali.co.uk 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 Mrs Patricia Jane Fielder Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61), Physical disability (61) of places Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons 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 are within the following category: Old age, not falling within any other category - Code OP. Physical disability - Code PD. The maximum number of service users who can be accommodated is 61. 29th November 2007 2. Date of last inspection Brief Description of the Service: Waltham Hall Nursing and Residential Home is a large converted house in the Leicestershire village of Waltham on the Wolds. It is on the main road between Melton Mowbray and Grantham and is accessible by public and private transport. There is parking available at the front of the home. It is registered to provide personal and nursing care to sixty-one people over the age of sixty-five. Claregrange Ltd owns the home, which is managed by Mrs. Jane Fielder, who is a nurse and an experienced manager who has been in post for several years. The accommodation is on two floors and the first floor can be reached by the stairs or by the two passenger lifts. There are bedrooms, lounges and dining rooms on both floors. There are forty-eight single bedrooms with en-suite facilities, eleven single bedrooms without en-suite facilities and one double bedroom with en-suite facilities. There is a large, well - maintained garden to the front, side and rear of the house, which can be easily reached by the residents, relatives and visitors. The home enjoys pleasant views over the surrounding countryside. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 5 Fees are charged weekly and range from £424.00 to £655.00 and will be individually assessed dependent on the persons care needs. Additional charges are made for items, such as hairdressing, private chiropody and magazines and newspapers. The Statement of Purpose, the Service User Guide and the current Commission for Social Care Inspection (CSCI) report are available for residents and their families on request. The current registration certificate from the CSCI and the Employers Liability Certificate are displayed in the entrance hall. Waltham Hall Nursing & Residential Home DS0000001931.V371862.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 1 Star. This means that the people who use this service experience adequate quality outcomes. This was a key inspection of a care home for older people, which ended with an unannounced visit to the service. Before the visit we (throughout the report the use of ‘we’ indicates the Commission for Social Care Inspection), spent five hours reviewing information received by the Commission for Social Care Inspection (CSCI) since the last inspection on the 29th November 2007. The visit took place on the 6th and 8th September 2008 and lasted ten hours. During the visit we checked all the ‘key’ standards as identified in the National Minimum Standards. This was achieved through a method called ‘case tracking’. Case tracking means that we looked at the care provided to four of the residents. To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents and their families. With their permission the residents’ bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was looked at. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. We looked at the Annual Quality Assurance Audit (AQQA) that the home had sent to us. This describes the services provided at the home for the residents, how the home are hoping to improve services and statistics about the residents and the staff. We looked at the comment cards that we had returned to us from the residents, relatives and the staff. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 7 During the visit we spoke with the nurse in charge on the day, the residents, the staff and families and visitors to the home. What the service does well: What has improved since the last inspection? Medicines such as creams are now signed for when they are given. The residents and families are encouraged to use the complaints procedure when they have concerns. The privacy and dignity of the residents is being maintained. The residents are having meals that are appetising and presented attractively. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 8 What they could do better: The statement of purpose should contain all the required information and could include the results of the annual questionnaires sent to the residents and the families. The care plans could be written more clearly and arranged in an easier form to read. The care staff could be trained and encouraged to write in the care plans for the people who receive residential care. The medication could be obtained in an easier and safer method that would also give the staff more time. A dedicated activities person could be employed so that a wider range of activities could be arranged for the residents. The complaints book should be available at all times for the Nurse in charge to be able to complete if she receives a complaint. The complaints book should be in a form that shows the ‘trail’ of the complaint from the date it was received until it is resolved. The front door must be kept locked at all times to make sure that the staff know who comes into the home to make sure that the residents are safe. The staff levels in the afternoons must be reviewed to make sure that the staff are able to give the residents the right care at the times that they want/need it. The staff files should have photographs of the member of staff on them to help with their identification. The residents’ personal accounts and money should be available to the person in charge so that the resident can have their money whenever they want it. The resident’s accounts should have two signatures on each transaction to protect the resident and the staff. Money and valuables should be kept in a safe and not in the medicine cupboard. The registered provider must complete a Regulation 26 report form for the Commission for Social Care Inspection every month. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 9 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. Waltham Hall Nursing & Residential Home DS0000001931.V371862.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.V371862.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. 6 is not applicable in this home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ needs are always assessed before moving into the home and they have good information to help them make the right choice about the home. EVIDENCE: All of the residents who were ‘case tracked’ told us that they had seen the Statement of Purpose and had been given the terms and conditions. The Statement of Purpose and Service Users’ Guide should give people the information that they need to know about to help them make a decision about the home. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 12 The Statement of Purpose does not contain all the information that is required by the national minimum standards. Consideration should be made to include the results of the homes’ annual quality audit. This will give the prospective resident and their family a view on what people who use the service think about it. Providing a comprehensive Statement of Purpose & Service Users’ Guide gives the residents good information, making sure that they they can get the most suitable care. The manager or a senior member of staff always visits prospective residents before they are admitted to the home and there is a thorough pre admission assessment form in place. This was seen in the care plans looked at and confirmed by the residents and the families spoken with. This makes sure that that the manager and the staff in the home have the the right information before the resident is admitted, so that they can get the best care. It makes sure that the home can meet the residents’ needs and that the resident meets someone from the home who they can recognise. This makes the move into care easier to manage for them. The families spoken with confirmed that they were given the opportunity to visit the home before their relative came in and were able to have a meal at the home. Residents are given the opportunity of coming for a trial visit. Members of the staff spoken with said that they sometimes knew what the residents’ needs were before they moved in. The current registration certificate from the Commission for Social Care Inspection (CSCI) was displayed in the entrance of the home with an up to date insurance certificate. The latest report from the CSCI was available in the managers’ office. Waltham Hall Nursing & Residential Home DS0000001931.V371862.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff are not always able to meet the care needs of the residents, where they can, it is with privacy, dignity and respect. EVIDENCE: All of the ‘case tracked records were found to contain good individual evidence of the care being given to the residents and reflected the care that the residents needed. There was evidence that the residents and/or their relatives have been involved in planning the care. The residents and the families spoken with told us about the care that they needed and that they were happy that they received it. They told us that there was often a shortage of staff in the afternoons but that the staff that were there were excellent and did their best. There are records of the involvement of G.P.s, district nurses, chiropodist, Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 14 optician, dentist, dietician and speech and language therapist where needed in the care plans, showing that thorough health care is being provided for the residents. The residents and their families spoken with said that they could see the doctor and other health professionals when they needed to. Whilst the information that is needed was in the care plans it was difficult to find and some of the entries were not very clear. There was evidence that the care plans are regularly reviewed and the residents and the families spoken with confirmed that they had been involved and were aware of the care to be given and that they were happy with it. The daily record of care was up to date and contained details about the residents’ day. Fully completed daily records make sure that the residents receive the right care and the staff know what has happened to them during the day or night. The registered nurses complete all of the care plans, care staff should be encouraged and trained to make entries into care plans. This is particularly important for the residential people and for those that they are keyworkers for. We saw residents being treated with dignity and respect when staff spoke with them and undertook their care, particularly when moving them. They were seen to be knocking on the residents bedroom doors before they went into them. The staff sat down with the residents and spoke with them individually. Staff spoken with told us that they were happy at the home but often felt under pressure to give the residents the right care as they were short of staff, particularly in the afternoons. This could lesd to the residents needs being given to suit the staffing levels and not when they want it, for example going to bed earlier than they would like to. There are records of the residents meals and drinks that make sure that the residents are eating and drinking properly. There are records of the residents’ weight, which makes sure that they are not losing or gaining large amounts of weight. The staff spoken with were aware of the care needs of the residents and the residents and the families spoken with were happy that all care needs were being met. This was confirmed in the comment cards received by the Commission for Social Care Inspection and in the AQQA. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 15 The residents who had to stay in bed were well looked after and their care documented, this included being turned regularly to prevent damage to their skin. There were risk assessments in place to cover all the identified risks for the residents and how the staff should manage those risks. This makes sure that the residents and the staff are protected from any risks that have been identified, without restricting their activities. Comments from the residents included ‘ The staff look after us well ‘ ‘ The care is very good’ Medication records for the case tracked residents were in order. Medicines are given by the registered nurses who have regular updating in medicines. We saw that the medicines were administered individually and the residents were seen to be taking them. The medicines are supplied in their original packaging of packets and boxes, they also have to be ordered at different frequencies, with some coming monthly and some weekly. This gives the staff extra work to do and an approach should be made to have all the medicines on a monthly basis. The pharmacist could be approached to package the medicines into a ‘monitored dosage system’ where each tablet is in a separate ‘pop out’ card, a safer method of administration, which helps to make sure that the resident is always given the right medicines. This should reduce the amount of time that the nurses are spending on the medicine round. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. The manager carries out a monthly written audit of the medicines and the medicine sheets to make sure that they are correct. The controlled (dangerous) drugs and records were checked and found to be in order. Money and valuables were found being stored in the controlled drug cupboard. There was a self-medicating policy in place but there were no residents looking after their own medicines at that time. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome group is good. This judgement is made using available evidence including a visit to the service. The residents enjoy the activities that they want to and have their spiritual and nutritional needs metl. EVIDENCE: The staff were seen to be spending individual time with the residents. A resident told us that ‘The staff often sit and talk to me’ The T.V was on in the lounges, which the residents told us that they were enjoying. A member of staff was seen to be sitting with a resident talking to her about the programme and later a member of staff was watching the news with the residents and talking to them about it. Although we were told that there were regular activities such as, bingo, quizzes, sing-a-longs and exercise, there was no formal activity happening on the day of the visit. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 17 There was a notice board in the reception area that showed the more formal activities that were happening such as the church service and an entertainer coming in to the home. The staff, the residents and the families spoken with told us that they did have activities and that they were happy with the amount. They told us that they appreciated the monthly newsletter that included the activities that were going to happen. There was evidence in the daily records and in the care plans about the activities that the residents take part in. The activities organiser has left and the nurse in charge told us that they were looking for someone to replace her. All the families spoken with said that they were made very welcome in the home, which we saw whilst we were there. The residents spoken with said that the food was good and that they had a choice of what they had. The menus were varied and were discussed with the residents at residents meetings. Comments made by the residents included: ‘ The food is good and the staff look after me well’ We spoke with the residents during their lunch, which was served attractively and they told us that they were enjoying. The cook is supplied with the same meat that is provided at the providers other home so is limited in the choices of the main meal that she can offer. She always manages to provide another choice if the resident doesn’t like what is on the menu. Meals are provided for people with different needs such as vegetarian and diabetic. There are facilities for the residents to have meals with their relatives or friends either in the dining room or privately. The religious needs of the residents are met with regular services held in the home or with the clergy visiting the home to see individuals. The hairdresser visits for at least two days a week, which the residents said that they appreciated. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. There are systems in place to support and protect residents and staff are aware of the processes. EVIDENCE: There is a complaints policy in place which gives the details of how to complain and who to complain to in the home if they needed to. The contact details for Social Services are not in the policy. This could be made available in a large print and other languages if it was needed, which would make sure that as many people as possible could read it. The home has received one complaint since the last inspection on 29th November 2007. The Commission for Social Care Inspection has received one concern raised in this time that was checked on the visit and was found not to be a concern. The residents and the families spoken with were aware of the policy, of how to complain and who to complain to. They were happy that their concerns would be listened to and acted on. The staff spoken with were aware of how to handle any complaints. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 19 The complaints book was not available to the staff on duty, but kept in the administration office. This should be available to the nurse in charge at all times. We returned to look at the book, which could be improved to make sure that a proper trail of what had happened, the date and who had dealt with it. This would help the home to keep a good record that they had dealt with it appropriately. The complaints policy should be updated to include the contact details for the Social Services and the current details for the Commission for Social Care Inspection. The staff spoken with were able to describe how they would deal with an allegation of abuse, knew the areas where abuse could happen and could describe the process that they would go through if they suspected any abuse. They confirmed that they had had training in safeguarding adults and whistle blowing and the manager and the records seen supported this. The ‘in-house’ trainer showed us the training package that she was using to train the staff and the records of who had attended it. All of the staff have either got an NVQ at least at level 2 or have started the award, during which they receive training in safeguarding as well as the training given in the home. They were confident that the management would handle any issues correctly. We looked at the accident book, which had been completed correctly. These practices make sure that the residents are safe from any abuse and that any concerns are handled correctly. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, 26. Quality in this outcome group is good This judgement has been made using available evidence including a visit to the service. The residents are protected by the policies and procedures in the home to provide a safe environment. EVIDENCE: Waltham Hall is a large converted house in the village of Waltham on the Wold that is on the main road from Melton Mowbray and Grantham. On our arrival we were able to walk straight into the home, as the front door is kept unlocked. This could put the residents at risk if the staff were not aware of people coming into the home. The home was clean, homely and welcoming on our arrival. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 21 There are bedrooms, lounges and dining rooms on both of the two floors. The first floor can be reached by the stairs or by one of the two lifts in the home. The lounges and dining rooms were clean, bright and well decorated, with suitable seating for the residents. All of the bedrooms seen had been personalised and were found to be clean and well decorated. The residents spoken with were happy with their rooms and said that they were able to bring their own belongings in with them. There was evidence of equipment in the home to help the residents, such as wheelchairs, special mattresses and hoists. Hand- rails and ramps have been provided to help the residents get around the home. There was a good provision of bathrooms in the home and these were found to be clean and clear of any items that could cause a hazard for the residents. A new bathroom and vanity area on the ground floor has been provided for the residents. A recent environmental health inspection to the kitchen read ‘Excellent standards noted throughout’. There was a lovely patio area and beautiful grounds that were easily reached by the residents and made a pleasant place to sit and walk for them. The residents and the families spoken with were happy with the cleanliness of the home, and told us that the staff worked hard to keep it clean. There are staff employed to complete the cleaning in the home and they have had training in health and safety. The cleaning products are stored in a locked cupboard, which we saw. This was confirmed by the staff spoken with and by the manager. The residents and their families told us that there had been problems with the laundry and that they took their relatives washing home to do. The staff told us that they felt that the laundry service has improved since the home has a person who just does the washing and the ironing. The records for hot water testing were up to date and all the temperatures were within the recommended levels. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome group is adequate. This judgement is made using the available evidence including a visit to the service. The recruitment policy and the training meet the residents’ needs and protect their safety. There are not always enough staff to meet the residents needs properly. EVIDENCE: The duty rota reflected the number of staff on duty on the day of the visit, which were enough for the morning. The afternoon shifts did not have enough staff on duty for the residents needs. The residents, staff and families spoken with felt that there were not enough staff on duty in the afternoons and they sometimes felt that they were rushed or had to go to bed earlier than they would like to. They told us that the staff were very good and did their best. These comments were also received in the surveys returned to us from the residents, families and the staff. We looked at five staff files and the required information was complete in four of them. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 23 This included evidence of identification, adequately completed application forms, two written references, a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults check. The fifth file only contained one written reference, but the manager confirmed that she had the second one in a telephone conversation with us two days after the visit. The staff files did not have photographs of the staff member on them, which would help with their identification. The manager makes sure that all the required documentation is in place before an employee starts work. This was confirmed by the staff spoken with, who told us that they could not start until they had all the paperwork in place. We were shown the details of the ‘in-house’ staff training programme that included the induction training. The staff spoken with confirmed that they had received recent training in moving and handling, dementia, safeguarding of vulnerable adults and first aid. The residents and the families spoken with felt that the staff were well trained to do their job. Most of the care staff either hold a National Vocational Qualification (NVQ) at least at level 2 or are in the process of completing it. The National Vocational Qualification is a qualification for care staff to make sure that they receive training in the needs of the resident group whom they are caring for. The Registered Nurses are supported in keeping up to date to make sure that they have the right training and experience to keep their registration as nurses. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38. Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. The residents’ safety could be at risk with some of the practices in the home. EVIDENCE: The registered manager, who is an experienced manager and who has managed the home for many years, was not available during the visit, which took place on a Saturday and a Monday. The manager has completed the registered managers’ award and is registered with the Commission for Social Care Inspection. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 25 There are regular meetings held for the residents and for their families, to discuss activities and menus in addition as to how the home is meeting their needs. There is an annual quality questionnaire sent to the residents and their families and the questionnaires that we saw on the visit confirmed this. The families and the residents told us that they had completed the questionnaires. We received positive comments from the residents and the families at the visit and through the surveys sent to them amongst which were that the staff were very supportive of them and their relative. The residents’ accounts were seen and all in order, but did not always have two signatures on each entry. This would make sure that the resident and the member of staff handling the money were protected. We saw that receipts were obtained for purchases. The nurse in charge at the week -ends did not have access to the residents’ personal money, which could mean that a resident could not have their money if they wanted it. We were told that this is usually arranged in advance and that money is held in the controlled drug cupboard. Controlled medicines should be in a locked cupboard that is solely for their use, when we looked in the cupboard it contained many envelopes with valuables and money in it. There was very little evidence from the staff spoken with that they are having regular, formal supervision with their ‘line manager’. We were told that the records were unavailable, as the manager had taken them home. Formal supervision of the staff gives them and their ‘line manager’ the opportunity to discuss work and training issues and needs. There are regular staff meetings held, confirmed by records held and by the staff spoken with. The staffing levels in the afternoons, particularly at the week- ends, means that the residents could be at risk if a major incident such as a fire happened at the home. The registered provider is required to visit the home formally once a month and complete a report (Reg 26) for the Commission for Social Care Inspection (CSCI). These have not been completed or received by the CSCI. All the areas of health and safety such as hot water temperatures and fire drills and alarm testing were found to be in order. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X 3 3 X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 2 1 2 Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? None 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 OP19 Regulation 13 (4)(c) Requirement That the registered provider keeps the front door secure to protect the residents from intruders. That sufficient numbers of staff are employed at all times to be able to properly meet the needs of the residents. The registered provider shall make a formal visit and report on it in accordance with this regulation. Timescale for action 13/09/08 2. OP27 18(1)(a) 30/09/08 3. OP37 26(1)(3)( 4) 30/09/08 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. 2. Refer to Standard OP1 OP1 Good Practice Recommendations That the Statement of Purpose should contain all the information that is required in schedule one of the national minimum standards. Consideration could be made to include the results of the annual quality questionnaire into the Statement of DS0000001931.V371862.R01.S.doc Version 5.2 Page 28 Waltham Hall Nursing & Residential Home 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. OP7 OP7 OP8 OP9 OP12 OP16 OP16 OP16 OP29 OP34 OP34 OP36 OP38 Purpose. That the care plans could be written more clearly and better organised to make them easier to follow. That the care staff are trained and encouraged to complete care plans for the residential people. That the staff are at all times able to meet the needs of the residents. That consideration is made to changing the medication system to make it safer and to give the nurses more time to spend with the residents. That an activities organiser is employed to give the residents a better range of activities. That the complaints book is available to the person in charge at all times. That the complaints documentation has an audit trail of all the dates and signatures needed. That the complaints policy is updated to include the contact details for the Social Services and the Commission for Social Care Inspection. That the staff files have a photograph of the member of staff on them. That the residents’ personal accounts are made available to the person in charge at the weekends and that they have two signatures for each transaction. That any monies or valuables are kept in a safe and not in the controlled medicine cupboard. That formal staff supervision is completed at the required frequency. That there are sufficient staff on duty at all times to make sure that the residents are kept safe. Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Waltham Hall Nursing & Residential Home DS0000001931.V371862.R01.S.doc Version 5.2 Page 30 - 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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