CARE HOMES FOR OLDER PEOPLE
Waltham House Waltham House Louth Road New Waltham Grimsby North East Lincolnsh DN36 4RY Lead Inspector
Theresa Bryson Unannounced Inspection 9th January 2006 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 House DS0000057503.V277880.R01.S.doc Version 5.1 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 House DS0000057503.V277880.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Waltham House Address Waltham House Louth Road New Waltham Grimsby North East Lincolnsh DN36 4RY 01472 822864 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) Infinite Care Lincs Ltd Jane Elizabeth Robinson Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th June 2005 Brief Description of the Service: Waltham House is a large old property on the outskirts of New Waltham close to the town of Grimsby. It is set in mature gardens with car parking space to the front and side. The home is registered to provide care and support for eighteen older people over the age of sixty-five. The home has two storeys serviced by a stair lift, on the upper floor there are two sections that have further steps and therefore these areas of the home are only suitable for ambulant people. There are four bedrooms in the middle section where there are no steps to negotiate. There is one large sitting room, a dining room and a further sitting room, which leads to a conservatory. All of the communal rooms have open fires as well as central heating. There are adequate bathroom, shower and toilet areas. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over one day in January 2006 and was unannounced. To find out how the home was run and if the people who live there were pleased with the care they got, the inspector spoke to the manager, the Director of operations, some staff, some people who live there and some relatives. Records kept in the home were also seen to make sure checks were done to make sure staff employed are safe to work there. Records were also seen to make sure that the home and the things used in it were safe and checked often. The manager, Mrs.J.Robinson accompanied the inspector through out the visit. What the service does well:
The staff employed were friendly and appeared to have a good knowledge of the people who live there and their needs. The paperwork kept on each person living in the home was evaluated regularly and showed his or her most current needs. This will ensure their needs are always monitored regularly. The home provided a varied range of activities to ensure each persons individual and group expectations and preferences were being met. There was a robust system in place to ensure that the people who live there are protected from acts of abuse and staff are trained to recognise any types of abuse and know how to refer cases. The home was clean and tidy and care had been taken to ensure that equipment in each person’s room met their needs. The home has a good system in place to ensure that it audits all sections of running the home and it meets its quality assurance targets and checks to make sure the home is a safe environment to live and work in. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The manager must review the policy for caring for the dying person to ensure the staff are aware of how to respond to expected and unexpected deaths, so they can deal with any situation in a sensitive and respectful manner. The owners must ensure they produce a planned programme of maintenance and renewal to ensure all parts of the home are maintained to ensure the people who live there are in comfortable surroundings.
Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 7 The manager must ensure that all contracts of employment for staff are open for inspection and she is aware of the terms and conditions each person is employed under, to address any issues, which may arise during their work at the home. The owner of the home must have open for inspection a financial plan to ensure the CSCI can see that the company is financially viable. 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 House DS0000057503.V277880.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4 and 5. Staff are trained to meet the needs of service users and prospective service users have opportunity to visit prior to admission. EVIDENCE: The individual training records of staff showed that they had taken part on some service specific training through out the year. This included funeral awareness, stroke awareness and diabetes. This ensures they are kept up to date with latest information to enhance the practical delivery of care to service users. The manager encourages prospective service users to visit the home and even spend a day at the home. There is no charge for this service. This enables them to have a feel about the home and if the services provided and environment would be suitable for each persons needs. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 10 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): 7,10 and 11. A comprehensive care plan document charts the care of each individual person and staff were seen to approach each person with dignity and respect. Policies are in place to ensure that service users are treated with sensitivity and respect at the time of their death, but need reviewing to meet current guidelines. EVIDENCE: 3 care plans were tracked in depth at the time of the visit. Each care plan was very detailed and the inspector was able to track the delivery of care given to each person. The daily report sheets were in a separate folder and improvements had been made to the content recorded. This was a lot fuller and gave a good record of the actual delivery of care to each person. The manager is now reviewing these on a regular basis and making improvements in consultation with other staff members. There was accurate follow through with other documentation, such as accident recording.
Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 11 The records appeared to be up to date and ensured that all current needs of service users were being monitored. Staff were observed through out the day assisting service users in a variety of tasks in a dignified and calm manner. This was reinforced by the service users and relatives spoken to who all gave very positive comments about the attitude of staff. The home had a policy in place for looking after the dying person. This needs to be reviewed to ensure that it meets current guidelines and legislation. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 12 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 and 14. A varied programme of activities is offered to ensure that service users are able to fulfil their expectations and recreational interests on a daily basis. They are assisted to maintain as such independence as their medical conditions and circumstances will allow. EVIDENCE: The home does not have a separate activities organiser, but all staff take an active role in ensuring the recreational and social needs of service users are met. The social activities records were seen and showed a variety of events, which had taken place. The home also encourages service users to have visitors and others such as the local church and Pat-a-Dog scheme visits the home. 3 service users go out to regular events and clubs out side the home. The manager produces a regular newsletter with forth-coming events, birthdays, poems and articles. This is distributed to all service users and relatives. This ensures the service users can maintain contact with others and have a fulfilling daily life.
Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 13 Service users and relatives spoken to stated that they feel they can exercise control over their lives by a variety of methods, such as daily choices of meals, what they do each day and what events they wish to take part in and how they organise their bedrooms. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 14 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 and 18. Service users are able to exercise their civic and legal rights and a robust system is in place to ensure they are protected from abuse. EVIDENCE: The complaints procedure remains unchanged from the last inspection and was on display in the home. Relatives and service users spoken to stated they felt confident in the management team in ensuring their concerns would be looked into. There had been done recorded since the last inspection. All criminal investigation checks had been completed for all staff employed and the home had secured some training in the protection of vulnerable adults since the last inspection for staff. The policy on this subject had been reviewed in January 2006. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 15 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): 19,20,21,22,23,24 and 25. The home was clean and tidy and all maintenance issues had been completed for 2005, the new plan was not available on the day. This will ensure the service users are living in a safe and comfortable environment. EVIDENCE: The manager accompanied the inspector on a tour of the home, where all communal areas were seen, all toilets and bathrooms and some service users rooms. The assessment of furniture and fittings for each service users room has now been completed and was in each of their care plans. This ensures they have the correct equipment to meet their individual needs. The home was clean and tidy, but some areas are now looking very tired and are in need of redecoration. The Director of Operations stated that the company is intending to pursue its planning application to extend the home,
Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 16 but until this goes through the owners need to ensure that the main fabric of the existing accommodation is maintained. The maintenance and renewal plan for 2006 was not available on the day and must show actual work which is to take place in the forth coming months to ensure the service users are living in a safe and comfortable environment. A new display sign for the home had been purchased since the last visit, making for a welcoming frontage to the building. The gardens were tidy and all exits free from hazards. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 17 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): 28,29 and 30. The home employs staff who are safe to work with the service users and train them to understand their roles and to help them meet the needs of service users. EVIDENCE: Since the last inspection the manager has ensured that all criminal investigation bureau checks have been completed for all staff to ensure they are safe to work with this client group. All staff have contracts, the inspector was assured by the Director of Operations, these were not available as they are kept at the company head office and she was not aware of there content. These need to be open for inspection and the manager must ensure she knows the detail for each staff member to ensure they understand their terms and conditions and she knows the rates of pay, hours and holiday entitlement they each require. The home has reached its target of 50 of staff having obtained NVQ at level 2 or above. Some staff are still completing levels 2 and 3 and appeared more motivated to achieve this award, which they stated has helped them understand their role. The training records were much more organised and the inspector was able to track what had taken place for each person as well as how much mandatory and service specific training had taken place. A second session for fire training
Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 18 had still to take place, but all other mandatory training was in place. Service specific training such as stroke awareness, arthritis, diabetes; funeral awareness and aggression management had also taken place. This will ensure that staff are given the information to enhance their practical delivery of care to service users. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 19 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): 31,32,33,34,35,34,35,36,37 and 38. Service users live in a home which is maintained to a standard to ensure they are safe and their needs are taken in to consideration at all times. EVIDENCE: The manager has now completed her Registered Manager’s Award and feels this has enhanced her knowledge base to enable her to look after the needs of the service users and staff employed. A range of minutes of meetings were seen on the day. These included service users, staff and other stakeholders. The home has also recently surveyed a variety of people to ensure that it is giving a quality service. This included; district nurses, social services staff, community psychiatric nurses and visiting church people. All comments seen were positive about the home and its relationships with staff.
Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 20 The personal allowance records of service users were checked and appeared correct. The home had sent out a letter since the last inspection stating they could not allow accounts to go into the red and requesting families, who hold pocket money to ensure the home has the correct balance to enable the service users to fulfil their daily needs. Not to do so can be construed as fraudulent use of funds by the appointee and can be reported to the Benefits agency. The company still has to provide the local CSCI office with a financial plan for the forth-coming year, to ensure it is financially viable. The records for the supervision of staff have improved and showed that some have taken place, but it is unlikely it will reach its target for this year. The manager must ensure that all staff have some form of supervision each year and this must include ancillary staff such as the cooks and handyman. She will then be aware of how staff are fulfilling their job descriptions and if any action needs to take place to enable them to be fully competent and safe to work with the service users. The Director of Operations went over the quality assurance programme with the inspector, which showed how often various parts of the home are audited also showing the responses to questionnaires and audit tools. This ensures the home is safe, meeting the needs of service users and staff and that those employed are safe to work with this client group. The policy manual was in two folders and stated when each policy had been put in place and the date of the review. This ensures staff are working with the latest information, only one needed up dating as detailed in NMS 11. All records produced showed that service users were living in a safe environment and regular checks are made to ensure the home is safe and clean to meet their needs and that staff employed are safe to work with the service users. Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 21 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 X 3 3 N/A 2 3 3 3 3 3 2 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 X 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 2 3 3 3 3 Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP11 Regulation 24.1.a. Requirement The registered person must ensure that the policy for caring for the dying person is up to date. The registered person must produce a planned record of maintenance and renewal. The registered person must ensure that all staff have contracts of employment. The registered person must produce a financial plan. (Previous time scale of 02/09/05 not met). Timescale for action 30/03/06 2 3 4 OP19 OP29 OP34 23.2.b. 18.1.a. 25.1. 28/02/06 28/02/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Waltham House DS0000057503.V277880.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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