Inspection on 04/11/08 for Walton Manor

This inspection was carried out on 4th November 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walton Manor 09/04/08

Walton Manor 25/06/07

Walton Manor 09/03/07

Walton Manor 12/12/05

Walton Manor 09/09/05

Walton Manor 07/10/04

Walton Manor 14/06/04

Walton Manor 17/03/04

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 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Walton Manor 23 Luton Grove Walton Road Liverpool Merseyside L4 4LG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Garrity     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Walton Manor 23 Luton Grove Walton Road Liverpool Merseyside L4 4LG 01512981605 Telephone number: Fax number: Email address: Provider web address: waltonmanor@europeanwellcare.com Name of registered provider(s): Name of registered manager (if applicable) Jane Scarisbrick Type of registration: Number of places registered: European Wellcare Homes Ltd care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 11 of the 49 beds are for Intermediate Care of which three beds may accommodate a person under the age of 65 years old. 49 Nursing beds or 49 Personal Care beds in the overall number of 49. This service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. To accommodate one named female person under 65 years of age within the overall total of 49 Personal Care (PC). To accommodate one named male person under 65 years of age within the overall total of 49 (PC). To accommodate one named person under 65 years of age for respite nursing care. To accommodate one named person under 65 years of age for respite on a regular planned basis only within the overall total of 49 residents Care Homes for Older People Page 4 of 30 Over 65 49 0 Date of last inspection Brief description of the care home Walton Manor Care Home provides care services for older people with personal care and nursing needs. The home is a modern building and was built with the purpose of providing a care to older people. There are 45 bedrooms in total. The bedrooms are on two floors and are accessible by a passenger lift. The ground floor is spacious with a large lounge and conservatory. There are designated smoking areas within the home. Each floor has its own dining area. The home is situated in a residential area of Walton in Liverpool, close to local amenities and shops. The area is well served by public transport. Liverpool city centre is approximately a fifteen minute drive away. The building is centrally heated and has an enclosed private garden. There is a car park to the side of the building. Walton Manor has scaffolding around the front of the building. This is due to a fault located in the wall. A building expert has stated that this is not a risk to the people living in the home. Work is in progress to fix the wall. European Wellcare Homes Ltd home owns the care home. They own a number of homes that provide a wide variety of care provision. The manager has been in post for several years and is registered with the comission to be the manager. The home charges fees from 322 to 566 pounds and additional fee known as a top up. Fees for private individuals are dependent on their assessed needs. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was carried out over a period of one day. We, the commission, arrived at the home at 09.15 and left at 20.00. The visit involved a pharmacy inspector to look at medications, a lead inspector and a second inspector. The second inspector spent over an hour observing and recording staff contacts with people living in the home. This is known as SOFI. We spoke with 7 people who live in the home, 3 visitors, 5 staff, the manager and the programme manager. We completed the inspection by a site visit to Walton Manor, a review took place of many of the records available in the home and CSCI offices. These included individuals care plans, assessments, accident records, staff rota, staff files, maintenance records, menus, staff training, medications, activities records, information sent to CSCI by Walton Manor and a self audit completed by the home known as an AQAA. We followed a plan that was written before the start of the Care Homes for Older People Page 6 of 30 inspection to make sure that all areas identified in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report, additional standards were identified before and during the inspection these were also looked at and detailed in the report. Feedback was given to the manager and programme manager during and at the end of the visit. The programme manager was also given feedback via the telephone after the visit to the home. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. 10 Questionnaires were sent to the home to give to people living there. None were returned. What the care home does well: What has improved since the last inspection? What they could do better: Although the management of medications has improved there are still areas that are in need of further development in order to maintain the safety of people living in the home. This includes staff following the policy and procedure for checking medications when they are received by the home. Giving clear instructions to staff regarding creams and nutritional supplements. Risk assessments are not sufficient to safeguard people. Some risk assessments conflict information in others. We noticed that risk assessments were not always updated and in some cases not available. Additionally a risk assessment had been done by the home that identified that an individual was at risk of being trapped by their bedrails, no plan was in place to reduce this risk. This event did happen following the assessment and resulted in an injury to the individual. Care plans were confusing, not specific to individuals and gave unclear guidance to staff. Several of the care plans had not been updated and had not been written in consultation with the person living in the home or their representative. Daily records did not detail what care had been in place and prevented staff from monitoring the effectiveness of care and support given to people who live in the home. The Care Homes for Older People Page 8 of 30 management of personal allowances was unclear. Statements for people living in the home were confusing and imprecise. The policy and procedure available did not fully explain to people how their funds would be managed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to move into Walton Manor have the opportunity to look around the home before they move in. All people have their needs looked at to make sure that the service is suitable for them. Evidence: The AQAA for the home showed us that the home does look at individual needs before they move in. This is called a preassessment and is done by the home to determine if the service can meet peoples needs. We looked at four pre assessments available, all had been completed before the person moved in and had brief details about their physical needs. In some cases some information regarding mental health and social needs was also available. The AQAA also told us that people are offered an opportunity to look around the home before they move in. We spoke with people living in the home and their Care Homes for Older People Page 11 of 30 Evidence: relatives, they told us they came as a family to look around, and did look at a few in the area but like this one much better. Its nice and bright and the staff are very friendly, it was not an easy decision to make and was very hard to find a place we felt she would be happy living in, When we came here the staff were very welcoming, the bedrooms looked nice. We thought she would like it best here. The manager did talk to us about what we can expect and we felt that she understood my mums needs. I came to look around before I moved in and it looked like a nice home, is near my family and staff are very nice so its good enough for me. This showed that people have their needs assessed and are given the opportunity to see the home before they move in. We looked at information for people who live in the home that told them about the services that the home provides. A copy of this was available in large print for all the people who live in the home. We also noticed that a copy of this was available in every bedroom. Relatives and people who live in the home had seen this information, known as the statement of purpose and service users guide. These had been recently updated and gave an accurate description of the needs of people the service could meet. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of medications and meeting care needs has improved. There remains areas within both that are in need of further development in order to reduce any risks to people living in the home. Evidence: We looked at the care plans that detail to care staff how they are to support the people living in the home. AQAA from the home told us that each person has an individual care plan. Separate care plans were available for each person. Information in the care plans was repeated in several places and in other cases information was not available. Not all the care plans had been reviewed monthly or signed by the person for whom the care plan was written. In some cases directions were not followed and in other cases directions that need to be in place were not available for staff. We spoke to the people living in the home who told us, not seen a care plan, whats one of them, care plan not heard of it, and I did sign something about me, but I didnt read it staff are great and look after me well, why worry.We spoke to staff all of whom said that care plans were better organised. Staff also told us that they dont often read the plans Care Homes for Older People Page 13 of 30 Evidence: as thats the nurses stuff we dont have much to do with it. All staff need to have clear instructions that they follow at all times in order to provide support that meets individuals needs. Daily records that detail what care people have received varied in quality. Some records stated what support the person had recieved and others provided limited information. Daily records are a review of the care and support provide to people who live in the home. The records provide the opportunity for staff to monitor the care in place as such good records assist in making sure that staff are meeting individuals needs. Evidence of visits to and by GPs, Chiropodist, Dentist, Nurse Specialists, Dietician, Speech and Language Therapists and other health care professionals was seen, together with information given to the home by these professionals. The records completed by staff following these visits are clear and give full information and instruction for the staff team. People who live in the home told us if I need to see a doctor the staff make sure that I do and if Im ill the staff call the doctor. During the visit to the home the pharmacist inspector looked at how well medicines were handled to make sure that people living in the home were being given their medicines properly. At this visit to the home we saw that improvements had been made in most areas of medicines handling. We noticed that medicines were all stored safely and a new secure area for the storage of unwanted medicines had been made, so the risk of medicines being misused had been greatly reduced. The majority of records about medicines were clear and accurate and showed that most medicines could be accounted for. The records also showed that most medicines had been given as prescribed. The policies and procedures about medicines were not easily available to staff and could not always provide instructions. As an example there were no guidelines about how to check medicines for people moving in to the home or those who were returning to the home from hospital. If medicines are not carefully checked on arrival into the home individuals are at risk of being given the wrong medicines. There were some instances where medicines had not been given as prescribed. There were a number of reasons why medicines had not been given properly, for example some medicines had run out, and were not available to be given. Other medicines were not given properly either because staff did not follow the doctors directions or because the staff did not have full directions to follow. Sometimes it was difficult to tell if creams had been applied, as the records had not been correctly completed. Additionally there was limited instructions that informed staff how, where and when to apply the cream. When medicines are not given and recorded properly individuals health can be placed at risk. Care Homes for Older People Page 14 of 30 Evidence: People who live in the home can meet with their visitors in the privacy of their bedroom or in one of the communal areas as they wish. Staff were observed to speak appropriately to the people they support throughout the day. The majority of conversations between staff and the people who live in the home were positive in nature. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities for people living in the home to take part in group activities have improved. There remains a reliance of verbal communication about personal choices and preferences for people who live in the home. Evidence: The AQAA from the home told us that, there is a new activities coordinator employed part time enabling more external trips and one to one activities for residents. A mini bus is available to take residents out. The coordinator is recently in post and very keen to develop the role. We looked at the activities provided and noticed that these have improved since the last site visit. There is an activities programme available on a notice board. Unfortunately the notice board is not in an arae outside the nurses office. This would be better placed in an arae that the people in the home can access easily such as the lounge. The information on the board was difficult to read. We spoke to people living in the home who told us, that they had not seen the board and did not know what activities were available. There is some information in individual plans such as, likes reading, watching television and listening to music. This is not specific and does not say what kinds of music the person likes or what the home Care Homes for Older People Page 16 of 30 Evidence: will do to provide this as an example. People living in the home spoken with said that there is more to do and they get out more. Group activities have improved and provide a better choice for people living in the home. People who live in the home said that, food is okay, I like the food, always take what is offered, cook is very nice. The chef is keen to develop the menus and would like to receive training in developing specialised diets and include these on the menu choices. Menus are available but not in forms that are easy for the people who live in the home to access. Staff said they ask the people living in the home during the day what their choices are. We observed how staff communicated with people living in the home over an hour and fifteen minutes. There were examples of how staff supported people well taking the opportunity to talk to them. There were also examples of where staff had had very little conversation with people such as taking plates from in front of them without comment. The opportunity to make mealtimes a more social event was not taken. Two people living in the home told us that they are not aware of what is available at each mealtime until it arrives. This meal can be refused and another provided. Over lunch staff did take the time to make sure that the majority of individuals who could respond were asked what they would like to eat including what vegetables they would have on their plate. This is good practice and supported people to make a choice that met their preferences. Nutritional risk assessments are confusing as there are two systems are used they do give different determinations of risk. We noted that two people whose plans we looked at had directions to have supplementary drinks, but it was not possible to determine when and how these were to be given. During the day we noticed that an individual was given a supplementary drink when they refused their meal. Other people needed their drinks and food thickened, there was no clear written information to staff to make sure that they actioned this correctly. We spoke to three visitors during the day. They told us that they are made to feel welcome and able to visit when I want People living in the home told us, I have lots of visitors, they come and sit in my room, the kids bounce all over the bed. Its very nice to have them here. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home were confident that their concerns would be dealt with. Staff members have had the training and support they need to make sure that they would report any concerns they had. Evidence: The AQAA from the home told us that, records are kept about complaints received both at head office and at the home. There is a complaints procedure, which is displayed on the entrance hall wall. We have Let Us Know leaflets detailing complaints procedure and a complaints suggestions book available. A copy of how to raise concerns is available in the main entrance and a complaints and concerns book is placed in this area so relatives can write down any concerns they may have. We looked at concerns raised with the home and noted that one concern had been investigated by the manager and action taken place to resolve the situation. People living in the home told us, they were happy but if they had a problem they would talk to the staff, Not seen anything about complaints and The staff here are great I have absolutely no problems.There is information in each bedroom that tells him or her who to raise their concerns with. This has been updated and supports people living in the home and their relatives to raise concerns. The commission has not received and concerns or complaints about the home in the last six months. One bank (temporary) member of staff was working in the home without having been Care Homes for Older People Page 18 of 30 Evidence: properly checked as suitable. This action potentially places people at risk. Discussions with staff and their training records showed that staff understood how to raise serious concerns. This included potential allegations of abuse. Staff were able to demonstrate understanding as to who was responsible for dealing with serious allegations. The homes AQAA told us that staff have received training in dealing with any allegations of abuse in order to safeguard the people living in the home. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Several areas of the home have been redecorated and this helps make it a nicer place to live. In general the home is clean and well presented. More action is needed to make sure that offensive smells are removed. Evidence: The AQAA from the home told us that, all the dining room furniture has been renewed. The ground floor has been extensively redecorated and several chairs renewed. We looked around the home and noted that the lounge dining area is well presented with furnishings and decorations that are suitably maintained. Some of the corridors in the home were not properly lit due to some of the lighting not working. To maintain independence corridors need to be well lit for the people who live in the home. At present the home has twenty people living in it there are enough bedrooms for forty five people to stay in Walton Manor. The arrangement of furniture in the main lounge prevents several individuals from being able to see the television. A review of the home showed that the main areas such as dining area, lounge, bathrooms and corridors have been redecorated and present a more homely place to stay. Externally the home has a significant amount of scaffolding around the front of the building. Over two years ago a fault with this wall was identified. The home has Care Homes for Older People Page 20 of 30 Evidence: discussed the issue with the local council and structural survey has been done that details there is no risk to the people living in the home. Work has continued on this maintenance issue the manager anticipates that this will be fixed by the end of 2008. The intention at that time is to redecorate several bedrooms and corridors in the home when the work is finished. The kitchen and laundry areas were clean and tidy. We noted some offensive smells in the home in particular in the toilets and sluices, where waste is disposed off. These smells were noticeable in the main areas of the home. All of the bedrooms in the home are single occupancy, and most of the people who live in the home have personalised their bedrooms with pictures and ornaments. Individuals spoken with said, their room was very comfortable, they had all their things with them and they liked my room, comfortable, clean and staff keep it tidy. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff training continues to improve and to help provide staff with the opportunity they need to develop their skills. Not all staff are properly checked before they start to work in the home, this action places people in the home at potential risk. Evidence: Staff were observed during the day not to rush the people who live in the home and to have enough time to meet their needs. Staff spoken with all said that the home has improved over recent months and that they have received recent training in lots of areas such as eating disorders, challenging behaviour, basic food hygiene, moving and handling, dementia, first aid and food safety. Each member of staff has a file in place that identifies the training that they are too receive or have done. These had all been updated and included certificates of training. A training plan is also in place that shows what training people have had and when update training is due. Staff recruitment files were looked at. The AQAA from the home told us that, the staff had been checked before they started working. One member of staff working in Walton Manor that day had no records available to the manager regarding their recruitment. This was requested by the manager and received during the visit and showed that not all the appropriate checks had taken place and that an identified risk had not been dealt with. Care Homes for Older People Page 22 of 30 Evidence: The manager explained that the person had worked in the home previously and they had been shown around the home before they started work that day. There was no record to confirm that the person had had this basic orientation to the home. Without proper checks and information for staff, people living in the home may be placed at risk. The people, who live in the home, said that there is enough staff available most of the time. People living in the home made positive comments about the staff including I am happy here, staff are very good. They are like family now, I like the staff and nice bunch. Staffing levels are monitored by the manager and staff put into place to meet the needs of the people living in the home. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been improvements in medications and meeting health and care needs. The homes quality assurance systems are not being used effectively to improve the quality of the service provided to people living at the home. Evidence: The manager has worked in the home for several years, the AQAA completed by the manager told us that, she has over 20 years experience at a senior level. Staff expressed confidence in the manager. One member of staff said, the manager is very supportiveand things have improved, there is more training. The organisation that owns the home has a number of quality assurance systems in place designed to identify strengths and areas of improvement. These included audits for areas, such as medications, care plans and environment. The manager told us that she was changing the audits for care plans, as they did not show the quality of the plans. The certificates of insurance and maintenance of machinery, gas, electricity, fire equipments, lifts were in date and valid, including the home certificate of Employers Liability Insurance Care Homes for Older People Page 24 of 30 Evidence: Certificate. The maintenance man regularly looks at the emergency lighting, the call system and the fire alarms monthly. There are statements available for individual personal funds. These were recent and one a month is sent to the home. Receipts of individual spending were not available, but were detailed on the fund statements available. Statements were very confusing and difficult to work out what account the funds were in and what interest the money was earning. A new policy is in place that is available in the information in the home. This did not explain the interest that each individual was entitled to or how the transfers of funds would be managed. The manager was unaware of what each individual was entitled to and was not familiar with how funds were managed. There were some funds available in the home for people to have small amounts of cash, it was not clear what this limit each person can access was. Larger amounts need to be ordered from head office and depend on a member of staff being available to collect the funds. This was not explained to people living in the home and limits their access to their own funds. Risk assessments in the home for individuals are not always accurately completed by the staff. In one case the risk assessment had not taken into account the number of falls the person had had in the last 6 months. Other risk assessments included, pressure ulcers and poor nutrition. There were two different nutritional risk assessments which were confusing, they gave conflicting information. Risk assessments for bed rails and medication had no arrangements in place for monitoring if they assessment and actions remained suitable. One individuals risk assessment identified that they were at risk of being trapped by the bed rails. This event happened within weeks of the risk assessment being put into place and resulted in an injury to the individual. The manager told us that new equipment was put into place. This was not reflected in the assessment. The details in these were very brief and did not always identify the risk or actions as appropriate. It is good practice to identify risks, but were risks are identified the service needs to plan to make sure that actions are taken to reduce the risk. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 15 (1) (2) (a) People who live in the 09/05/2008 (b) (c) (d) homes care plans need to be reviewed to clearly identify the their needs and how to meet those needs. Consultation with individuals and/or their relatives needs to occur in order that all people who live in the home can be kept informed of how the their needs will be meet. Outstanding from 25/10/07 13(2) The service needs to make 09/05/2008 sure that all individuals receive their medications as prescribed. Medications need to be available for the residents at all times in order that they can be taken correctly. All medications as to how to give the medications written down for staff to follow. Outstanding from29/02/08. 09/06/2008 2 9 3 33 24 (1) (a) (b) A quality assurance system (2) (3) needs to be developed and put into place. This needs to include the expressed views of the people who live in the home a review of the services provided and identification of areas for development. A plan as to how the management Care Homes for Older People Page 26 of 30 intends to develop the quality of the service needs to be made available for all the People who live in the home and their supporters. 4 35 20 (1) (a) (b) The current arrangements for 09/06/2008 (3) the management of individuals finances and personal finances need to be reviewed. Clear information needs to be available that details the entitlement of personal allowances, where that money is kept, the interest earned and how that is distributed. 13(4) (a) (b) (c) Where risks are identified for 09/06/2008 people who live in the home, such as self-medication and falls, full assessments and plans need to be in place that are negotiated with the people who live in the home and detail any restrictions in place. These plans need to clearly detail the actions to be taken including any monitoring arrangements and review in accordance to the plan. 5 38 Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 18 All staff needs to have the correct checks in place before they start working. A copy of this needs to be available to the manager. Were risks are identified a proper risk management plan needs to be in place. In order to make sure that the people living in the home are properly safeguarded. 05/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Review the care plans which have a variety of different sets of paperwork and have resulted in confusing, inconsistant and sometimes inaccurate information. Daily records need to reflect the care give. Nursing and midwifery guidance regarding record keeping should be followed in order to make sure that best practice is maintained at all times. The opportunity to record individuals preferences in daily life such as activities and food should be taken This can be Page 28 of 30 2 7 3 12 Care Homes for Older People used to determine the activities and menus available. Information in these areas needs to be available to people living in the home to help them make choices that suits their needs. Care Homes for Older People Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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