Inspection on 19/07/07 for Walton House Nursing Home

This inspection was carried out on 19th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Walton House Nursing Home 22/08/06

Walton House Nursing Home 14/12/05

Walton House Nursing Home 17/06/05

Walton House Nursing Home 22/11/04

Walton House Nursing Home 28/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Walton House Nursing Home Walton House 188 Chorley Road Walton-le-dale Preston Lancashire PR5 4PD Lead Inspector Mrs Vivienne Morris Key Unannounced Inspection 19th July 2007 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 Walton House Nursing Home DS0000025584.V337300.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. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walton House Nursing Home Address Walton House 188 Chorley Road Walton-le-dale Preston Lancashire PR5 4PD 01772 628514 01772 697200 mail@waltonhouse.eclipse.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) Walton Care Limited Mrs Jane Lyth Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 44 service users to include: Up to 44 service users in the category of OP (Old Age, not falling in any other category) 22nd August 2006 Date of last inspection Brief Description of the Service: Walton House is a care home providing both personal and nursing care for up to forty-four elderly people. The home is a purpose built two-storey establishment, being located on the main road through Walton-le-Dale, Preston and is situated near to shops, pubs, a post-office and other local amenities. A passenger lift provides easy access to the upper floor. There are car parking spaces available at the main front entrance and a garden area with flowerbeds, patio areas and seating to the rear of the home. The majority of bedrooms provide single accommodation. However, a number of companion rooms are available for those who wish to share. There are no en-suite facilities at Walton House. However, accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. There are lounge areas on each floor and the dining facilities are situated on the ground floor. Corridors are wide and fitted with grab rails. Other aids are provided to assist people living at the home with mobility problems. Information about the services that the home offers is provided in the form of a service users’ guide, which is available to existing and prospective residents and their relatives. The fees as of July 2007 ranged from £374.00 to £520.00 per week. Additional charges were incurred for hairdressing, chiropody, newspapers, magazines, personal toiletries and escort to appointments. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two regulatory inspectors from the Commission for Social Care Inspection conducted the unannounced site visit to this service over one day in July 2007. This visit formed part of the key inspection process. During the course of the site visit discussions took place with six people living at the home, a relative and five staff members. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. The inspectors sat in the communal areas of the home for periods of time observing the daily routines and activities, which took place. Comment cards were received from ten people involved with the service and their feedback is reflected throughout this report. The information provided by the home on the Annual Quality Assurance Assessment (AQAA) has also been taken into consideration when writing this report. There were forty-one people living at Walton House at the time of the site visit, when the inspectors ‘tracked’ the care of four of these residents, not to the exclusion of others. The total key inspection process focused on the outcomes for people living at Walton House and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection had not received any complaints about this service since the last inspection. However, one allegation against a staff member was referred by the home to social services under the safeguarding adults procedure. What the service does well: Residents were only admitted to the home when enough information had been gathered about them and the home was clear that their assessed needs could be met. In general, staff were provided with sufficient detail to ensure that they were able to meet the recorded needs of people living at the home. The plans of care were being followed in day-to-day practice, showing that written instructions were being carried out, in order to provide the care required. Care records showed that a wide range of external professionals had been involved in the care of people living at the home to ensure that, in general, health care needs were being met. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 6 Staff were observed speaking in a friendly but respectful manner to residents and any visitors to the home. Visitors were happy with the care, said they were always welcomed into the home and that staff were friendly and showed them respect. Records and discussions with staff and residents showed that staff tried hard to meet people’s diverse needs. Care plans included some social information, provided by residents or their relatives, about hobbies and interests. However, more information was provided through ‘life mapping’, which created a fuller picture of the lives of people. The home had their own transport that was used to take residents on occasional outings. An activity co-ordinator was employed to plan and organize leisure activities and some outside entertainers also visited the home. Visiting arrangements were appropriate for the people living at Walton House and it was evident that people were supported to access advocacy services if they wished someone to act on their behalf. Residents made varied comments about the food served. One said, “The food is varied and excellent”, another commented, “Meals vary from day to day” and a third agreed with this comment, adding, “But on the whole they are pretty good”. The policies of the home adequately safeguarded people living at Walton House. The complaints procedure was satisfactory and people living at the home were aware of what to do if they were unhappy about something. Resident’s rooms and communal areas were bright and comfortable. Some residents had brought in personal items to make their rooms more homely. Residents said they were happy with their rooms. The outside of the home was well maintained and residents said they enjoyed the gardens. Garden furniture, flower tubs, bird tables, water features and chimes were provided for residents’ enjoyment. The home was equipped with aids and adaptations to assist staff to meet residents’ needs. The layout and design of the home was suitable for the people who lived there. The home was well staffed with a competent, appropriately trained team of staff who were able to meet the diverse needs of the residents. The home used thorough recruitment procedures to ensure residents were safe and protected from unsuitable people. Systems were in place to monitor the quality of service provided and financial procedures adopted by the home adequately protected monies and valuables of people living at Walton House. What has improved since the last inspection? Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 7 There had been a lot of refurbishment and redecoration since the last inspection in order to provide a more comfortable place for people to live. The double-glazing units had all been replaced and several carpets had been renewed. The amount of staff training provided had improved since the last inspection and the induction process was thorough to ensure that new staff were competent to fulfil their role before working alone. Improvements had been made to fire safety since the last inspection, with the introduction of a fire risk assessment, staff fire training and regular fire drill practices. What they could do better: The home’s pre-admission assessment format could have been more detailed, showing the individual needs of each resident in order to promote person centred care. The care plans had not always been developed with the resident or their relative and did not always reflect all the information gathered before admission, to ensure that consideration was given to person centred care. The plans of care had not always been reviewed each month and did not always reflect any changes in care required, so that current up-to-date guidance was not always provided for staff. Not enough detail about how staff were to reduce or eliminate risks to residents had been included in the care plans, so that staff were fully aware of what action they needed to take to consistently keep people safe. The management of medications was poor. It was established that on the day of the site visit unacceptable practices were taking place, which placed those living at the home at risk. The management of meal times could have been better in order to create a more homely environment for people to dine in. The meals served record could have been maintained more thoroughly, so that an audit of food served could be easily conducted. A significant amount of people involved in the care of those living at the home felt that residents were not always listened to and their comments were not always acted upon. The system for the recording of complaints could have been better, so that a clear audit trail was evident in order for the registered manager to be easily able to monitor complaints received. Systems could have been implemented to ensure that people working at the home were familiar with the written policies of the home in relation to safeguarding adults. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 8 The standard of the environment could have been better, so that people lived in clean, safe and hygienic surroundings. The outcome of the quality monitoring systems were not always managed effectively in order to protect the health, safety and welfare of people living at the home. Some areas of serious concern were identified, which could have posed a risk for those living or those working at the home. 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. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 9 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 Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 10 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): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information had been gathered before people were admitted to the home to ensure that the staff team could adequately meet their assessed needs. EVIDENCE: The care of four people living at Walton House was ‘tracked’ during the course of the site visit to this service. Sufficient information had been gathered from a variety of sources about the needs of people before they were admitted to the home. This ensured that the staff team could adequately support each resident whilst living at Walton House. However, although enough information had been obtained collectively, the home’s pre-admission assessment format on its own was not always sufficient to ensure that the needs of people had been adequately assessed. This document consisted of a standardised checklist, which was sometimes limited in detail and was not always individualised to each resident living at the home. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 11 All five comment cards received from residents showed that they received enough information about the home before they decided to live at Walton House. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 12 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans did not always accurately reflect the assessed needs of those living at the home and did not always show that people were involved in choices and decisions about their care. However, people were treated with respect, their privacy and dignity being upheld. The management of medications was poor, placing people living at the home at risk. EVIDENCE: The Annual Quality Assurance Assessment (AQAA) submitted by the home provided a lot of useful information. It showed that residents were offered annual care reviews conducted by the manager on a 1:1 basis and that there was a key worker system and named nurse system in place, so that staff were familiar with the needs of people in their care. All comment cards received from relatives showed that they were kept up to date with important issues affecting their relative. One added, Even if they (the staff) cant get in touch with me, they will try to contact another relative, as agreed. The AQAA also showed that individual care was provided through life mapping, although improvements could be made by encouraging staff to be more aware Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 13 of this system. However, four care plans were looked at during the site visit, which did not consistently reflect all the assessed needs of people living at the home, as determined from the information gathered before admission, so that staff were aware of how to support residents in meeting all their individual requirements. In general, the information, which was recorded on the plans of care, was sufficient in detail and evidence was available to show that written guidance was followed through in day-to-day practice. However, any changes in the care needs of people were not always reflected on the overall plan of care, to ensure that up to date information was consistently provided. One relative wrote on the comment card, “My relative is taken care of well. If I ask any questions I get an answer right away. The AQAA showed that an audit of care provided was conducted and that residents or their relatives were involved in the care planning process. Records seen showed that eelements of the planned care had been agreed by some residents at the time of admission, indicating that they had been given the opportunity to be involved in planning their care. However, the overall care plan had not always been agreed with the resident or their relative to ensure that they were happy with the care being provided. Comments received from the people living at the home included, Unfortunately staff shortages make it difficult for staff to always help and Sometimes there is a delay when two carers are not available to respond to a call bell”. Photographs of some residents were available on their records, for identification purposes. However, this was missing for one person whose risk assessment showed that a photograph of them would be advisable in order to reduce the element of risk. Risks had been assessed although staff had not always included detail in the care plan about action to be taken by staff once a risk had been identified. Care plans had not always been reviewed on a monthly basis, to ensure that the information provided was current. However, there was evidence available to show that people were supported to receive healthcare from external professionals and that they were provided with specialist equipment. This was supported by information contained in the AQAA. Comment cards received from residents indicated that, in general they received the medical attention required. One relative commented, “My relative gets the intensive care she requires and it is comforting to know that we can place our trust in the home. The assessment for one person showed that they were prone to pressure sores and had previously developed one. However, the plan of care did not reflect this information and did not provide guidance about how to manage pressure care for this person or what type of pressure relieving equipment needed to be provided in order to reduce the risk of pressure sore development. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 14 At the time of the site visit the inspectors observed a medical emergency take place, which was handled very well by staff, the privacy and dignity of this person being protected throughout. One resident said, “The staff are very good. They are always willing to help me” and a relative stated, “The care provided to my relative is good. I have no concerns with that”. Comment cards were received from 5 residents, three of whom said that they always receive the care and support needed and two said that they usually receive the care and support required. The AQAA showed that medications were handled appropriately. Although, the requirement and recommendations, relating to medications, which were made at the last inspection had been addressed, we found that the management of medications was poor. When the Medication Administration Records were examined during the afternoon, it was evident that the lunchtime medications had not been signed for, indicating that they had not been given. Discussions with the nurse demonstrated that the lunchtime medications had actually been administered without any consultation of the Medication Administration Records and had been given purely on the nurse’s knowledge of the prescribed medications for each resident. The nurse had also failed to sign the Medication Administration Records to show that she had given the prescribed drugs. This practice is unacceptable and puts people living at the home at risk. The practice is also a breech of the Nursing and Midwifery Council Code of Professional Conduct. This issue of serious concern was discussed with the manager and an immediate requirement notice was issued at the time of the site visit. The AQAA showed that risk assessments were in place for self medication and that systems were in place to support people to self medicate if they so wished, to allow them some control over their lives. The AQAA also showed medication reviews were conducted by the pharmacist, although the home felt that improvements could be made by offering residents self medication more often, where appropriate. Hand written entries on the Medication Administration Records had not always been signed, witnessed and countersigned, to reduce the possibility of any transcription errors. The receipt of medications had been recorded on the Medication Administration Records and the Controlled Drug register was appropriately maintained to ensure that the amount of medication received into the home was monitored. There was no reference to privacy and dignity recorded in the care plans, to show that these principals of care had been taken into consideration when planning the care to be provided. However, there were no poor practices observed in relation to the privacy and dignity of people living at the home. We observed that people were able to have a rest on their beds during the afternoon, should they choose to do so. Staff were seen chatting with residents Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 15 when providing care and speaking in a friendly but respectful manner to them and any visitors to the home. Staff training included issues around privacy and dignity, so that they were aware of the importance of respecting people living at the home. One visitor said she was always welcomed into the home and that staff were friendly and showed respect. Walton House Nursing Home DS0000025584.V337300.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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home did not always meet residents’ individual needs, expectations and preferences, although they were encouraged to maintain contact with friends and family. Residents were offered a choice of menu, although the management of meal times could have been better. EVIDENCE: Social interests were recorded in a minimal way on the care plans seen. However, the registered manager explained that at time of admission each resident had a ‘life map’, which they filled in together with the help of relatives. This showed significant events in the person’s life and gave an insight into their life experience and lifestyle. The home employed an activities coordinator, who had compiled information about local attractions and events, around which trips out were organised in the home’s minibus. We were told that a picnic had to be cancelled recently, due to poor weather conditions. We were told that due to the number of people who could be living at Walton House the time that the activities coordinator could spend with people on an individual basis was sometimes limited. However, we noted one staff member providing 1:1 social care with a resident for a long period of time. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 17 Comments received from residents and staff indicated that people living at the home needed to be encouraged to take part in activities and that gathering information about each person’s interests and what they would like to do could lead to a wider range of activities and outings being offered. One relative stated, “There is good entertainment and therapy provided for residents”. One resident said, “I like the singers who come to the home, but I wouldn’t want them to come too often. I like to spend time in my room and sometimes the staff try to persuade me to join in with the others in the lounge, but I like to be on my own”. This comment showed that whilst people living at the home liked to have entertainment provided, it was important that staff members listened to residents and respected their choices. Some people living at the home indicated that the carers do not always listen to requests made by residents. Comment cards received from residents indicated that staff don’t always listen and act upon what residents say. The AQAA showed that the home felt that they could improve by talking to the people living at the home more when they are sitting in the lounge areas. One relative felt that a quicker response to the call bells could improve the service, and another said that there was easy access to the home, where people could walk into residents rooms without being challenged, which did not safeguard people’s belongings. Residents and relatives confirmed they were able to make choices about various aspects of their lives including routines, friendships, involvement, meals and activities. One resident said I never want for anything. At the time of this site visit some residents were observed enjoying a visit from a pat dog. Others were reading newspapers or books. Some residents were watching TV in their rooms. The views of people living at the home varied in relation to the provision of activities. Some felt that there were always suitable activities provided and that people were supported to live the life they choose, but others did not share this view. One person said, “There is not much going on in the way of activities. Outside entertainers visit occasionally and there are some trips organized but not much else. I sit in the garden in better weather”. The AQAA showed that the home felt that improvements could be made by encouraging staff to participate in social activities. One relative said that the TV in lounge was often left on loudly when no one was watching it and that personal TVs were also very loud, with bedroom doors open and so suggested that ear phones may be provided to reduce the disturbance. The AQAA showed that a new flat screen television had been purchased recently and that plans were in place for the home to purchase a music centre and a digital camera in the near future. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 18 The AQAA showed that choices and decisions of people living at the home were respected, such as, the time people preferred to go to bed and get up in the morning, the choice of food, access to magazines and newspapers of individual choices and people being supported to postal voting, if they so wished. Staff were seen spending time with people living at the home and there was evidence of a good rapport between some staff members and residents. One lady said that she really liked the staff and that she could have a laugh with them and that she thought they were helpful and friendly. The AQAA showed that clergy from the local churches visited the home on a regular basis and this information was supported by what people told us during the site visit. AQAA showed that open visiting was encouraged and that people living at the home were supported to access advocacy services to act on their behalf, if they so wished. Visitors spoken to said that they were always made to feel welcome and kept up to date with everything. Some people living at the home entertained their visitors in their bedrooms and others in communal areas of the home, showing that visiting arrangements were flexible and that residents were given a choice. One relative said, “I am made to feel very welcome when I visit the home. I am always offered a cuppa”, and another stated, “The home is very pleasant and I go in very often and I enjoy having a cup of tea and a chat with the staff. We were told that the home communicated well with relatives, by telephone or through quality group meetings, so that information is passed onto those involved with the people living at the home. One person said, “The staff are always friendly, polite and helpful”. Details about the availability of advocacy services were published through the service users’ guide and contracts of residence also included this information. The registered manager told us that two people living at the home accessed advocacy services to act on their behalf and an advocate being at the home at the time of the site visit supported this information. The AQAA showed that nutritious food was served and that the dietician was involved in meal planning, which is good practice. The AQAA also showed that some changes had been made in relation to meal times and beverages, as a result of listening to what people using the service had said and that further changes were planned in this area. Residents were always offered a choice of menu. The lunchtime meal looked nutritious and appetising and was plentiful. Special diets were catered for and staff were seen giving support to those residents who needed extra help. The record of what residents had to eat was not accurate or consistently completed, so that it was impossible to determine if people were receiving Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 19 adequate dietary intake. Records were maintained of a weekly kitchen audit, so that the catering services could be monitored. A mealtime was observed. The residents who had a soft diet were served first and their meals appeared attractive, with different tastes of food being presented separately on the plate. The management of meal times should be reviewed and consideration be given to creating a more homely and less institutionalised environment for people to dine in. We observed several areas, in which improvements could be made: Residents were wearing blue protective aprons, which were unattractive. No condiments were out on the tables, to allow people to help themselves. Juice was served in plastic glasses, which did not promote an enjoyable dining experience for people living at the home. Some carers were observed sitting with residents and assisting them with their meals, whilst independent eating was encouraged. However, a number of staff were observed standing over residents whilst helping people with their food, which did not promote a relaxed and homely setting. The AQAA showed that all catering staff had received basic food hygiene and 48 of care staff had received this training, which is good practice. One relative, when asked what the home does well felt that the meals were good and varied. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 20 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies, procedures and practices of the home adequately safeguarded the people living there and the management of complaints, in general, was satisfactory. EVIDENCE: The AQAA showed that three complaints had been received by the home in the last twelve months, none of which were upheld. A record of complaints was maintained, although this system could have been better so that an audit of complaints received by the home could have been easily undertaken. The registered manager was aware that improvements needed to be made in this area and explained that she intended to do this. It was evident that complaints were acted upon promptly. However, the outcome and detail of investigations were not always clearly recorded. Staff spoken to explained that if a complaint was made to them they would try to sort it out, or pass it to the manager if they were not able to do so. Residents and relatives knew whom to approach if they were unhappy about something. One relative said, “When I needed to raise a concern, it was dealt with quickly” and a resident commented, “I am quite happy living here. I have no complaints”. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 21 The safeguarding adult procedures were clear and contained relevant contact numbers for local agencies to ensure that a prompt and appropriate response to any suspicion or allegation of abuse was conducted. The manager demonstrated that she understood adult safeguarding procedures and had instigated these when appropriate. Staff spoken to had received training in Adult Protection matters, either through NVQ studies or through previously attended courses. They were able to explain what they would do in the case of suspected abuse, although were unsure if they had read the policies of the home. It would be advisable that all staff become familiar with relevant policies in relation to adult protection. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 22 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some parts of the home provided people with pleasant areas to spend their time. However, other areas were in poor condition and in need of improving, so that a safe, clean and hygienic environment was provided throughout for all residents. EVIDENCE: The AQAA showed that some improvements had been made to the environment since the last inspection in order to provide people with more comfortable surroundings to live in. Double-glazing units had been replaced in all bedrooms and all first floor corridor carpets had been replaced. The lounge had been redecorated after listening to the views of people who used the service and a walk in shower was planned to be installed in the near future. New garden furnitue had been purchased and some bedrooms had been upgraded, with carpets being replaced. New dining chairs had been purchased and the furniture had been renewed in Foyer. People living at the home had been involved in choosing the new furniture, which was considered to be good Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 23 practice. A tour of the premises supported the information provided in the AQAA. Resident’s rooms and communal areas were, in general bright and comfortable. Some residents had brought in personal items to make their rooms more homely. However, further improvements were necessary in order to provide a homely environment throughout for those living at the home. We found that some toilets and bathrooms were dirty and very unpleasant smelling, which did not provide a pleasant environment for those living at the home. The smells were created by the inappropriate disposal of clinical waste, the toilet bowls being in a dirty condition, clinical waste bins being uncovered and in one bathroom a soiled pad on the floor. This bathroom floor was also very marked and in need of attention. People spoken to felt that the home was not always fresh and clean. The floor in one bedroom was very dirty and the bedhead was loose, which did not provide safe and pleasant private accommodation for the person living in this room. There was a soiled incontinence pad on the floor behind another bed and the toilet seat in one bathroom was broken, which did not provide a safe and comfortable environment for those living at the home. A large number of soap dispensers contained liquid soap which had gone mouldy, presenting a health risk to those living at Walton House. An immediate requirement notice was issued at the time of the site visit for the registered person to ensure that the health and safety of people living at the home was protected. The general environment was ‘cluttered’ and in need of hoovering, so that a pleasant and homely environment was provided for those living at Walton House. One relative said, “The floors and skirting boards require more frequent cleaning in all areas. Also the toilets and bathrooms need to be cleaned more thoroughly”. This statement was supported by our observation of the environment. The AQAA showed that policies and procedures were in place in relation to infection control and that thirty three staff members had received relevant training. However, it was evident from the findings of the tour of the building that the policies and procedures of the home were not being followed in dayto-day practice. Some people had keys to their bedroom doors and the registered manager said that bedroom door locks would be fitted, if people required them, in order to protect personal belongings and to promote privacy. All rooms had call units in place and on the day of the site visit staff answered any requests for attention promptly, although one relative indicated on the comment card that call bells Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 24 were not always answered quickly. Screening was in place in shared rooms, so that privacy was promoted. The outside of the home was well maintained and residents said they enjoyed the gardens. Aids and adaptations to assist staff to meet residents’ needs were seen around the home. The layout and design of the home was suitable for the people who lived there. One person living at the home said, “I am quite happy with my own room. It is comfortable and it is cleaned regularly. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 25 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of people were met by the number, skill mix and competence of staff employed. Thorough recruitment practices adequately protected those living at the home. EVIDENCE: The duty rotas showed that the home provided staff in sufficient numbers and with different skills and experience to ensure they were able to meet the diverse needs of the individuals living in the home. The AQAA showed that agency staff were being used when necessary so that any shortfalls in staffing levels were covered. The AQAA showed that thirty five care staff were employed at the home, twenty one of whom had achieved a National Vocational Qualification, which provided the home with 60 of care staff having obtained a recognised qualification in care, which was commendable. Records and discussions with people working at the home showed that all staff were given relevant supervision, training and updates to help them to meet the needs of the residents in their care. Comments from those living at the home included, “Staff are friendly and helpful”, “Staff are on hand if needed” and “I’m quite happy with the care and with the staff.” The AQAA showed that all relevent checks had been conducted before people were emplyeed by the home, to ensure that those living there were adequately Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 26 protected. This was confirmed by examination of three staff employment files during the course of the site visit. However, application forms did not always give clear employment history, in one case an applicant had written ‘3 years now’ for the period with employer rather that the month and year. All gaps should be accounted for and to do this accurate detailed information should be gathered. Employment histories should include the month and the year of employment and any gaps in employment should be accounted for. Following a Criminal Record Bureau (CRB) audit the registered manager had been given some advise in relation to retention of the CRB disclosures, which she had followed to ensure that confidential information was being stored appropriately. The AQAA showed that staff were appropriately inducted to their role and that training had improved over the last twelve months with a wide range of courses now on offer, supported by the development of a training matrix. Improvements had also been made by providing training in accordance with identified needs of both staff and residents. Records seen and staff spoken to supported the information provided to the Commission. The AQAA also showed that the home felt that perhaps improvements could be made by promoting unity and retainining staff, although the number of bank nursing staff had increased during the last twelve months. One member of staff said, “I love working here. I like getting to know the residents and about their past”, and another commented, “I like working here and this is the first time that I have been encouraged to do training”. Staff records and care staff spoken with confirmed that they had completed a structured induction period. This included the completion of a checklist, which covered all aspects of health and safety and good working practices, including the six values of care. The training matrix covered all topics for training, both mandatory and training specific to the skills needed in the care environment. Comment cards received from relatives indicated that staff, in general, had the right skills and experience to meet people’s needs. One added, The staff are very good. They do a good job. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 27 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems were in place to monitor the quality of service provided, although outcomes for people living at the home were not always managed effectively in order to protect their health, safety and welfare. The financial procedures adopted by the home adequately protected monies and valuables of people living at the home. EVIDENCE: The registered manager of Walton House, Jane Lyth is a qualified nurse and has an appropriate management qualification. Staff felt that they were supported by the management of the home and were happy to raise areas of concern, in the knowledge that they would be listened to. The provider had submitted several reports to the Commission in relation to internal monthly audits, which identified some areas of concern and which Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 28 were looked at during the inspection process. Audit trails had been developed based on the findings of the home’s monthly reports, so that any areas of concern could be closely monitored. The AQAA showed that regular staff meetings were organised and that notices were displayed to ensure that knowledge and information was shared. The AQAA showed that a newsletter was also produced to disseminate information and that the home had been achieved two external quality awards. The home had a number of effective quality monitoring systems in place to make sure they were meeting people’s needs and expectations and to ensure that the health, welfare and safety of people was being promoted. The AQAA showed that internal audits were conducted to monitor support services, such as laundry, domestic and catering, which had produced favourable results. An internal quality audit system had been implemented and self audits completed by care staff indicated a good level of service. Residents and relatives said they attended quality meetings where they were able to make changes and improvements about areas that affected them. The minutes showed the home had responded positively to issues raised. Residents’ surveys were completed annually and the policies and procedures had been reviewed periodically. Clear accounting and financial records were maintained to protect resident’s financial interests. Resident’s monies, which were held and administered by the home, were kept in a bank account, which was non-profit making. A record was kept of all deposits and withdrawals. Receipts were kept for all transactions. Money was always available through the petty cash and the administrator settled the accounts. The Court of Protection was administering some resident’s finances, so that they were adequately protected. The AQAA showed that health and safety standards were maintained and risk assessments were in place in order to protect the people living at the home and the staff working at Walton House. The AQAA also showed that all appropriate checks had been done on systems and equipment to ensure it was in good working order and safe for use. However, on touring the premises we noted some areas of concern that needed to be addressed in order to promote the health, safety and welfare of those living at the home. We observed that hooks had been fitted to the top of bathroom and toilet doors, which prevented people using these facilities as they wished to do so and this situation could pose a risk to residents, by them being unable to freely exit these facilities. Several people living at the home were using bed rails, some of which were protected by padded bumpers, others were not. Daily checks of the bed rails were conducted and the findings recorded to ensure the safety of people Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 29 requiring them. All the checks seen had been signed on the day of the site visit., showing that the bed rails in place were protected, safe and suitable for use. However, on examination we found five residents with bed rails that were loose, poorly fitted or not covered, which posed a risk for those using them and which indicated that the checks were not being conducted sufficiently or accurately. An immediate requirement notice was issued at the time of the site visit for the registered provider to ensure that the safety of people living at the home was protected at all times. In one bedroom there were several containers of local applications on a bedside cabinet near an open door, which could pose a risk to those living at the home. Infection control policies were not being followed in day-to-day practice in order to protect the health of people living and working at the home. Strategies were in place in relation to fire safety, supported by a risk assessment, with staff having received appropriate training and with fire drills being conducted at regular intervals to ensure that staff were aware of what action to take should there be any suspicion of fire within the home. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 30 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 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 13(4)(c) 15(1) Requirement The registered person must ensure that the plans of care provide clear, up to date guidance for staff, as to how all the assessed needs of people living at the home are to be met, including details of any changes in care requirements and any interventions needed to reduce or eliminate risks to residents. (Timescale of 09/10/06 not met) The registered person must ensure that people living at the home or their relative are given the opportunity to be involved in the planning of care to enable them to make decisions with respect to the care they are to receive. The registered person must make arrangements for the safe management of medications. Medication Administration Records must be consulted when administering any prescribed medications to residents. The nurse responsible must sign the record immediately after the resident has taken their DS0000025584.V337300.R01.S.doc Timescale for action 31/08/07 2. OP7 12(1) 15(1) 30/09/07 3. OP9 13(2) 19/07/07 Walton House Nursing Home Version 5.2 Page 32 4. OP15 17(2) Schedule 4. 23(2)(d) 5. OP19 6. OP26 16(2)(k) 7. OP38 16(2)(j) 8. OP38 13(4)(a) medication, so that people living at the home are not placed at risk. The registered person must maintain a detailed record of food provided for residents. (Timescale of 09/10/06 not met) The registered person must ensure that all parts of the care home are kept clean, including toilet bowls and floor coverings in bathrooms and all bedrooms. The registered person must make arrangements to keep the care home free from offensive odours and make suitable arrangements for the disposal of clinical waste. The registered person must make suitable arrangements for maintaining satisfactory standards of hygiene in the care home, including attention to the liquid soap dispensers. The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety, including providing a ‘clutter’ free environment, removing the hooks from the outside of toilet and bathroom doors and ensuring that external local preparations are stored appropriately. Also to ensure that any broken or poorly fitted fixtures are repaired or replaced, such as bed heads, bed rails and toilet seats. 31/08/07 31/08/07 30/09/07 30/09/07 31/08/07 Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 33 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 OP3 Good Practice Recommendations The home’s pre-admission assessment format should consistently contain detailed information about the individual needs of people wishing to live at Walton House; to ensure that the staff team can meet all assessed needs. The plans of care should be generated from the information obtained before admission, so that all assessed needs are recorded on the initial care plan. The plans of care should be reviewed every month, or more regularly, if necessary, to ensure that information provided for staff is current. Photographs should be available of each person living at the home for identification purposes, unless the resident indicates otherwise. Any hand written entries on Medication Administration Records must be signed, witnessed and countersigned to reduce the possibility of transcription errors. The plans of care should include the need for privacy and dignity, particularly when providing personal or nursing care. The registered person should ensure that the people living at the home are always listened to and that their views are acted upon as necessary. It is recommended that the management of meal times be reviewed in order to create a more homely and less institutionalised environment for people to dine in. The system for recording complaints should be reviewed and improved, so that a clear audit of complaints received could be conducted. The registered person should ensure that all staff are aware of the home’s written procedure for safeguarding the people in their care. The registered person should conduct a full audit of the premises in relation to maintenance, safety, cleanliness and infection control, in order to identify issues needing to DS0000025584.V337300.R01.S.doc Version 5.2 Page 34 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. OP7 OP7 OP8 OP9 OP10 OP12 OP15 OP16 OP18 OP19 Walton House Nursing Home 12. OP29 be addressed. These should then be prioritised and an improvement programme developed based on the audit trail results, Completed staff application forms should include precise periods of employment history, so that any gaps in employment may be easily identified and explored. Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Walton House Nursing Home DS0000025584.V337300.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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