Inspection on 09/04/08 for Walton Manor

This inspection was carried out on 9th April 2008.

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

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 Manor 04/11/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Walton Manor 23 Luton Grove Walton Road Liverpool Merseyside L4 4LG Lead Inspector Julie Garrity Key Unannounced Inspection 9th April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Walton Manor DS0000059447.V362016.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 Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walton Manor Address 23 Luton Grove Walton Road Liverpool Merseyside L4 4LG 0151 298 1605 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) waltonmanor@europeanwellcare.com European Wellcare Homes Ltd Jane Scarisbrick Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49) of places Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 49 Nursing beds or 49 Personal Care beds in the overall number of 49. 11 of the 49 beds are for Intermediate Care of which three beds may accommodate a person under the age of 65 years old. To accommodate one named male person under 65 years of age within the overall total of 49 (PC). 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 person under 65 years of age for respite on a regular planned basis only within the overall total of 49 residents To accommodate one named person under 65 years of age for respite nursing care. 25th June 2007 Date of last inspection Brief Description of the Service: Walton Manor Care Home provides care services for older people with personal care and nursing needs. The home also provides 11 Intermediate Care places. Intermediate care is a specialised care provision that is for people to gain independence before they return to their own homes. The intermediate care unit is staffed separately and is well equipped with rehabilitation aids, a domestic kitchen and communal sitting areas The home is a modern building and was built with the purpose of providing a care home. There are 45 bedrooms in total as although the home is registered for 49 residents, four bedrooms were converted to be used as additional facilities on the intermediate care unit, such as a kitchen. 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 the city centre is approximately a fifteen minute drive away. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 5 The building is centrally heated, has an enclosed private garden, which is not overlooked there is a car park provision. There is 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 residents living in the home. The care Home is owned by European Wellcare Homes Ltd, 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 CSCI to be the manager. The home charges accommodation and care fees in line with Local Authority fees plus and additional fee known as a “top up”. Fees for private residents are dependent on their assessed needs. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is no star. This means the people who use this service experience poor quality outcomes. The site visit was carried out over a period of one day. We (the commission) arrived at the home at 09:00 and left at 20:45. We spoke with 8 people who live in the home, 6 visitors, 7 staff and the deputy 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 rota, questionnaires, staff training, medications, information sent to CSCI by Walton Manor and a self-audit completed by the home. This site visit included discussions with people who live in the home, visitors, staff and management. We also received information from Social Services and this is also used within this report. We followed an inspection plan that was written before the start of the 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 deputy manager during and at the end of inspection. The programme manager was also given feedback relating to health and welfare section after the site visit. 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. What the service does well: Walton Manor has a stable staff team, this means the people who live in the home know the care staff well. The majority of the staff were observed to give the people in the home the time that they needed and did not rush them. Individuals spoken with were positive about the staff these included “staff attitude is very good”, “happy with the care” and “friendly, caring staff”. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 7 The Service has several different areas that individuals can choose to sit in. There is a smoking conservatory that allows those who smoke to make the choice of where to sit. The majority of individuals spoken with enjoyed the food that was available and said there was choices available. The people who live in the home can personalise their bedrooms as they chose. Some individuals have fridges and kettles in their bedrooms to maintain their independence. Individuals spoken with were positive about their bedrooms such as, “I really like my bedroom” and “I don’t like leaving my bedroom it’s very comfortable”. What has improved since the last inspection? What they could do better: There is no structured quality assurance in place that identifies the strengths and the weaknesses of the service and puts into place plans to address these. There service audits (looks at the quality) of a lot of different areas in the home such as medications, care plans. Despite these audits being done and identifying areas that need improving, these have not improved the quality the quality of the service. Information to individuals is inaccurate and does not explain what needs the service can meet. It gives an inaccurate impression of the daily life and routine of the people who live in the home. A variety of activities are written in the information that are not occurring and have not occurred for sometime. The lack of clear information that is inaccurate is misleading to individuals and could result in people moving into the service whose expectations may not be met.” Not all assessments for individuals wishing to move into the home are of sufficient quality to make sure that identifies his or her needs are clearly identified. A lack of a quality assessment that identifies individual needs means that individuals may be admitted to the home, whose needs the staff can not meet.” Medicines must be given to individuals as prescribed by their doctor. If people who live in the home get their medicines at the wrong dose, wrong time or not at all it can seriously affect their health and well-being. Accurate records of medicines arriving in the home, given to people who live in the home and disposed of must be made. Poor record keeping can lead to serious mistakes when giving medicines and put the people who live in the home at risk. Care staff need to be competent make sure they are able to deal with medicines safely. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 8 There is a reliance on verbal communication with written records being inaccurate or not having the full details of individual needs. This has impacted on the health and welfare needs of the people who live in the home. Attempts have been made to consult with the people who live in the home and to help them influence their own routines in the home. A lack of suitable activities for some people and staff making decisions for individuals without clearly understanding individual choices means that some people who live in the home do not have their choices and needs meet. Complaints and concerns are not always addressed, records regarding complaints are not always available. Information that explains what the manager will do to prevent this happening again is not available. This means that the manager will not be aware of individual concerns and does not always make sure that these situations are prevented from happening again. Staff training, amount of staff available and staff skills are of concern. Training records are incomplete, staffing levels are monitored on seven occasions in the last four weeks absent staff have not been replaced. The deputy manager explained that attempts are made to cover for staff absences. 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 Manor DS0000059447.V362016.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 Manor DS0000059447.V362016.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): Standards assessed were 1, 2, 3, 4, 5 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information in the home is not clear enough to make sure that people who live in the home or might like to live there can decide what services the home provides. All individuals have an assessment before they move into the home. The assessments vary greatly in quality and as such do not always support staff to make a proper decision as to whether they can meet individual needs. EVIDENCE: A relative said, “I looked at lots of homes, before I settled on this one, I came to have a look around and the staff were very friendly and welcoming. The staff said I could just go and look wherever I wanted, I liked this as it meant Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 11 they weren’t looking over my shoulder and trying to sell it to me they let me make my own mind up”. Information for people who live in the home that explained the services that the home provides was not generally available or easily accessible. None of the relatives, people who live in the home or care staff had seen this information, known as the statement of purpose and service users guide None of the relatives, people who live in the home or four care staff spoken with had seen this information known as the statement of purpose and service users guide. This information is not available in forms that meet the individual needs of people who live in the home and some of the language used is not plain English. The information in the documents mentioned above is out of date and unclear as an example it makes no mention of the “top up” on fees that needs to be paid and list activities many of which are not those undertaken in the home. The home has a unit that supports people who stay for a short time, this is for individuals who may not be ready to return home but hospital care is not needed. This is called intermediate care and has medical professionals involved such as physiotherapists. Two individuals spoken with said that they had not received any information before they moved in and no member of staff from the home had been out to see them before they came to stay. The home does receive full information from the professionals involved in the care of individuals who stay for a short time, however their own assessments are also essential in order for them to determine if they can meet individual needs. Five assessments for were looked at for individuals currently living in the home. All had assessments done by staff in the home. It was not possible to determine what training these staff had recieved in doing assessments and there was no policy or procedure shown to us that gave them guidance. The assessments seen concentrated on medical and physical needs and did not determine individual’s mental health or social needs. Of the five records seen none had copies of external professional assessments such as those from social services that inform the service of individual needs before they are admitted. The information was inconsistent in some instances large areas of the assessments were not completed. An example of this would be that of the five assessments seen, two contained information about medications three did not. Walton Manor DS0000059447.V362016.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): Standards assessed were 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some care plans do not have relevant information in them as to how to meet the individual needs. This means that staff are not always aware of the needs of the people who live in the home and place them at risk of receiving incorrect care. Medications are not well managed; people who live in the home do not always receive their medications in accordance with the prescriber’s instructions. This places people who live in the home at risk. EVIDENCE: We looked at five care plans in detail of those five viewed all had been reviewed every month and individual assessments that determined the risk for developing pressure ulcers, risk of falls and potential poor nutrition had been completed and reviewed every month. Two individuals were identified as high Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 13 risk of falls, but did not have a plan in place that detailed what action staff needed to take in order to reduce the risk. One other plan viewed showed that one person had fallen five times in one week but no plan had been put into place to reduce the risk. Of the seven care plans we looked at the deputy manager was able to supply additional information that was not in the care plans. This included one individual with a specific need. There was no care plan explaining this need or what actions needed to be taken. Daily records showed that for six days the person had symptoms of this condition. Staff had ceased giving a medication without finding out if the medication was needed at this time. They had not looked at what might be the cause of the symptoms or requested a doctor visit. As there was no care plan staff had not recognised that this needed to be addressed and had not responded to the change in the individual’s condition placing them at risk. Two care plans said that the individuals needed to have the fluid and diet intake monitored and recorded. One of these had been recorded occasionally and showed a low intake of fluids, no action had been taken, there was no plan in place that promoted their fluid intake or referred them to an external professional for further support. The other individual had not had their fluid and diet intake recorded despite their care plan saying that this must be done. The person had gained a substantial amount of weight in a very short period and had a diagnosis of a condition that if not managed properly could cause the person to gain weight. The individual had no records that a doctor had attended for 10 months, the care plan said that they were to see their doctor regularly because of this condition. Staff had not recognised the changes in these individuals’ conditions and had not taken action to bring these changes to the attention of external professionals. The care plans had not been changed to reflect the changes in the individual conditions and as such staff did not have up to date instructions that would support them to deliver care appropriate to the needs of the individuals. The deputy manager detailed behavioural needs of two individuals, one was inclined to drink to much water and another did not wish to leave their bed. This information was not available anywhere with the individual’s notes or care plans and as such staff did not have clear instructions as to how to meet the individual needs. Two individuals had pressure ulcers, records for these were unclear, and they did not detail what treatment was needed, consultation with external experts or what monitoring arrangements were in place. Records for both were unclear but showed that both wounds were not healing and in one case daily records written by the nursing staff indicated that the wound was improving but records did not agree with this. The lack of appropriate care planning and monitoring has resulted in changes in an individuals needs not being recognised our addressed. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 14 We looked at the medications for six individuals living in the home. In all cases errors with medications were identified. One person had run out of painkillers the day before and were without pain relief for over 36 hours. When spoken with the individual said that they did have pain but was aware that staff had run out of medicines and getting more. As this is a regular medication and can be bought from a chemist if necessary there should be systems in place that make sure that this is identified in advance and that individuals have the medications they need available. Another person had three inhalers available, one of these was not written on the medication records and as such there was no prompt to remind staff that the person needed this inhaler and no means to identify that it had been given as it should. The same person had been receiving anti-biotics initially in liquid form and then as a tablet. In both cases the records recorded more doses given then the home had available. Evidence showed that monitoring systems in place but were not being used to determine that people who lived in the home were receiving their medications, as they should be. One individual is supported to spend time with relatives and often goes to stay with them. The promotion of maintaining of family relationships is good practice. Staff were undertaking a practice known as “secondary dispensing”, they were putting the medicines that the individual needed in a kit for the family to give to the individual. It is good practice that they try to support the family. However the way that they support the family does not give them the information they need such as, what those medicines are, which may be essential if the individual needed medical care whilst away from the home. Dealing with medicines in this way maybe the best support for this individual and their family, but needs risk assessing in order to determine that this is in fact the safest method. A member of staff was observed to not follow the homes policy and procedure on giving out medications. Not following the homes own policies and procedures places the people in the home at risk of getting their medications incorrectly. Many of the medications were not stored appropriately either loose in the medicines room or not kept in the fridge, as it should be. One medication that must be kept in the fridge and thrown away after 14 days was not in the fridge and was undated as to when it was opened. One individual had refused this medication on several occasions as they felt it made them feel ill. Not storing medicines properly and not ceasing them after they have gone out of date places the people who live in the home at risk. Observations of staff during the day showed that the majority of staff maintained the dignity of individuals, this included speaking appropriately and making sure that personal needs were attended to discreetly. However one Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 15 member of staff was observed to enter two individuals’ bedrooms without knocking on the door. One family member said that their relative was “not always well turned out”. People who live in the home spoken with said, staff were very kind, helpful and polite”, “nice bunch of girls always happy to help” and “good staff”. Walton Manor DS0000059447.V362016.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): Standards assessed were 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. There is a lack of consistency and not all the people who live in the home have their individual choices found out or supported. Without proper determination of choices individuals prefer, that are kept up to date and readily available, staff will not be able to maintain individual choices. EVIDENCE: Some of the people who live in the home were asked when they were admitted about their lifestyle, choice of foods, and preferences of social activities. With help from a family member or a staff member, the individual completes a questionnaire. Several copies of these were seen in a file in the home, however they had not been passed on the chef or the activities co-ordinator to help them determine menus and activities. Although some staff spoken with have a good understanding of individual personal choices. Other staff were observed to be unaware of good ways to communicate with some individuals or to support their individual choices. One individual asked for something different than what was available, she did not receive her choice but was given a meal Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 17 by a staff member who did not tell her what it was. She ate a very small amount of this and it was taken away with no alternative offered. Another individual said that she did not want either of the choices available that day, but was told “have chicken, you like chicken”. A member of staff got her some sandwiches but did not offer her a choice about the sandwiches. On another occasion an individual asked for a cup of tea and was told one was on the way. After half an hour she still had not received a cup of tea. People who live in the home said that the food was “good”, “needed more choice”, “is bland” and “very tasty”. 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 individuals to access, staff do go around during the day and ask the individuals their choices. 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 meet their preferences. Those less able to respond verbally were not asked and the choice was made for them by the staff that said, “we know what they like”. There are no records readily available to staff that tells them what individual preferences are. Some people who live in the home have this information recorded in their care plans. Staff spoken with said that they did not read the care plans and therefore had no clear written that would help them support individual choices. Four care Staff spoken with said that they did not read the care plans and therefore had no clear written that would help them support individual choices. On the intermediate care unit choices and expectations of the individuals are to be looked at and the individuals are supported to regain and develop independent skills, such as cooking, cleaning etc. These are to be written in either the individual’s plan or the occupational and physiotherapy records. However daily activities were not reflected in the plans seen. During the site visit no individual seen to be undertaking any activities for the promotion of independent living skills. People spoken with said “staff do it all for me” No activities programme that would explain what activities were taking place was seen in the home. When individuals participate in organised activities, it is recorded in the activities records. This records what activities people have done. It does not look at the activities that the individuals would like to do. It does not look at what individual preferences might be and plan to meet those preferences. Several people who live in the home were spoken with said, “I don’t like group activities”, “the activities need to be looked at I would like more trips out” and “more trips out please”. The deputy manager said that the activities co-ordinator did 20 hours a week at present and is a relatively recently employed in this area. The service would like to increase the activities available and recruit another co-ordinator. There are plans to get a full activities programme in place. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 18 Visitors are encouraged in the home and people who live in the home can entertain their visitors, in the communal lounges, or in their own bedroom. Six visitors were spoken with during the site visit all but two said that they felt that their loved one was well cared for, happy and safe in the home. One relative said, “staff have a very good attitude”. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed were 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home feel confident to raise their concerns with the staff. There is a lack of clear documentation that supports the service to monitor any concerns and take appropriate action. EVIDENCE: A copy of how to raise concerns is available in the homes 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 these records and noted that three concerns had been raised with the home two of these had been looked at and actions taken and third one had no records detailing what action the home had taken. Additionally concerns that maybe confidential to individuals were readily accessible to all visitors. Individuals spoken with were not all aware of a complaints policy, but said that they would raise any concerns that they had with the staff in the home. Comments made included, Staff are nice if you have a problem just tell them” and “lovely girls, very caring, keen to help” Two relatives informed us that they had raised concerns with the manager on several occasion and these had not been resolved as their concerns continued. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 20 There were no records available regarding these concerns or how the manager had addressed them. The service has had several concerns of a serious nature raised both by themselves and external services. No records were available in the home that showed how the service had addressed these or what actions were to be taken in order to prevent them occurring again. Although staff training records were unclear about training that staff had received all care staff spoken with said that they had received training in this area and were able to detail what the appropriate actions they needed to take to make sure that it was dealt with. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed were 19, 20, 22, 23, 24, 15 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Some areas of the home have been redecorated. Many of the residents own bedrooms have been made personal to them, with familiar items and furniture. EVIDENCE: We looked the environment, the main corridors have been redecorated and the walls in lounge painted. Information from the home shows that the dining area has new tables available. There remains insufficient room for all the people in the home to be accommodated at anyone time with several individuals eating meals in the main lounge area from small tables. The furniture in the lounges remains in need of replacing with unmatched furniture and damaged chairs. 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 Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 22 main areas such as dining area, lounge, bathrooms and corridors are in need of redecoration and refurbishment. This includes carpeting that is beginning to stain, furniture that is worn and damage to radiators and bathing facilities that has not been addressed. The manager does do regular audits on the environment in order to make sure that the internal decoration can be identified. None of these could be located at this site visit. 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 discussed the issue with the local council and structural survey has been done that details there is no risk to the residents. This issue has progressed very slowly and there is still no date as to when the repairs will be done. There is no formal maintenance plan that would detail when or how the home will be redecorated or the needed repairs will be done. 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 memorabilia. Individuals spoken with said, “I don’t like to leave my room. I have everything that I need in the room. My family like this room as well, they brought all my things in from home”. The kitchen area was clean and tidy. A regular cleaning scheduled is in place to make sure that the kitchen staff can stay on top of all the cleaning and make sure that it gets done. Fridge and freezer temperatures are recorded and food stores are managed to make sure that food does not go out of date. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed were 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some of the staff do not have the skills that are needed to meet the needs of the people in the home and maintain their health and welfare. Staffing levels have been determined by the home, these are not always maintained and place the people who live in the home at risk. EVIDENCE: Staff were observed during the day not to rush the people who live in the home. During the day several staff were observed not to ask individuals less able to communicate what their choices were and on one occasion an individual requested something specific, without discussion a staff provided different choice and did not honour the individuals request. One member of staff was observed to not follow the homes policy and procedure with regards to safely giving out medications. On other occasions a member of staff did not request individual privacy and entered bedrooms without knocking on the door. Care plans and wound records were not consistent and not always of a good standard. The deputy manager of the home explained that she did not think that all the staff had good communication skills. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 24 Staff training records were inconsistent and it was not possible to determine whether all staff had received the training that was essential to their job role such as fire training. There was no training plan available that showed what training staff were to have or when. Records reviewed showed at least four individuals who had dementia care needs. Staff had in the past received training in this area from the records available at the site visit it was impossible to determine which members of staff had received training in this area. The information in the home states that they can support people with Parkinson’s, diabetes and other specific conditions, no training could be identified that showed that staff were able to meet these individual needs. The cook identified that he had not received training in catering for special diets, such as diabetes and was enthusiastic about wishing to develop skills in this area. We looked at records of newly recruited staff all had a basic induction in place and one had received moving and handling training before they started work. There were no other records that detailed what other training they had had. The deputy manager said that all new staff worked through an extensive induction process that covered a variety of areas. No records of this were available on any of the files viewed. Staff need training specific to the needs of individuals who live in the home, they also need to be competent in this area in order for them to properly support the people who live in the home. The deputy manager had developed and delivered two training sessions to staff a questionnaire was given to all those staff to determine if they had understood. One record of this was viewed on the files seen. The areas that the training was in were skin care and nutrition. This training and the determination of competency is good practice. The people, who live in the home, said that there is enough staff available in the home. They made positive comments including ““Staff are really kind.” “I like the staff here, “I think there is enough staff available” one individual said, “Not everyone speaks nicely to me”. Staffing levels are monitored and staff put into place to meet the needs of the individuals. This is based on the homes own system and staffing level are to be in place to meet the levels decided on. We looked records regarding staff in the home and noticed that in the previous four weeks there had been seven occasions when the level decided on had not been in place. Staff spoken with said that times there was not enough staff. On the day of the site visit it was noted that meals time were not supervised by a senior nurse, that the lounge did not always have a member of staff available and that escorts to external appointments such as hospital appointments took staff out the home that were not replaced. The home has determined that it needs this level of staff to meet the needs of people who live in the home and places individuals at risk if it does not have those levels in place. Each member of staff has a file in place that identifies the training that they are to receive or have received recently. These are out of date in the three records seen and it was not possible to determine what training all had Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 25 recieved including Protection of Vulnerable Adults, moving and handling training fire safety as examples. There was no training plan available that showed what training staff were to receive and when.The deputy manager explained that they had tried to make sure that they had recorded all training but had been unable to update the records. Two staff spoken with did detail training such as protection of vulnerable adults. Two others were unable to recall what training they had. One member of staff identified training needs that had not been planned for. Staffing recruitment files were reviewed had been significantly updated to make sure that all staff are recruited properly before they can work in the home. Induction records were unclear it was not possible to determine that all staff have received a full induction. The deputy manager said that all new staff had a full induction that was a large workbook for them to work through. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 26 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): Standards assessed were 31, 32, 33, 35, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s quality assurance systems are not being used effectively to improve the quality of service provided to people living at the home. EVIDENCE: The manager has worked in the home for several years a deputy manager has been recruited and is assisting in a number of management duties such as quality audits, staff supervision and training. The manager was not available for this site visit and it was conducted with the deputy, who was helpful, organised and open throughout the site visit. Staff expressed confidence in the Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 27 manager and deputy. One member of staff said, “they are very easy to work with and try very hard to make sure that the care is good.” 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, such as medications, care plans and environment. We looked at these audits, these were being done in a monthly basis and sampled various records such as medication records and care plans. Were issues had been identified and action plan to address these areas had not been put into place. The audits had not identified that care plans did not reflect individual needs or that medications were not always managed safely. Additional environmental audits could not be located. The home sends out questionnaires twice a year. These were located in a file and the deputy said that they had been returned within the last few months. In general positive comments were noted from the questionnaires. With the exception of two individuals who said that there was not enough activities outside the home available. There is no development plan in place that would inform the staff and the people who live in the home how the home intends to increase the quality of the service available. The home’s certificates of insurance and maintenance of machinery, gas, electricity, fire equipments, lifts were in date and valid, including the home certificate of Employer’s Liability Insurance Certificate. The maintenance man regularly looks at the emergency lighting in the home on a monthly basis, the call system on a monthly basis and the fire alarms. There are statements available for each individual’s personal funds. These were dared January 2008 and at the time of the site visit were out of date and did not provide individuals with information regarding the funds that they had available. Receipts of individual spending were not available, but were detailed on the fund statements available. It was not possible to determine if individual funds were managed appropriately because of the dated statements and a lack of records regarding individual spending. One individual had had a significant amount of money passed to family members. Records that detailed that the individual had been consulted with and given permission for their family member to manage these funds were not available. Risk assessment in the home for individuals are not always accurately completed by the staff. In three cases the risk assessments had identified a high risk of falls for individuals there was no plan as to how to manage this risk. Other risk assessment included, pressure ulcers, poor nutrition in three care plans a high risk had been identified and no plan into place. One of those identified at risk of developing pressure ulcers had developed a pressure ulcer since their admittance from the home. Risk assessments for bed rails and medication had no arrangements in place for monitoring if they remained suitable. The details in these were very brief and do not always identify the risk or actions as appropriate. One individual had been identified as low risk of Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 28 falls but had bedrails in place. 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. There were no records in place that showed that staff had received training in health and safety or of the actions that they needed to take to maintain individual’s health and welfare. The accident records were being monitored however one individual had fallen. The manager said this was to prevent injury if they feel out of bed. Risk assessments regarding the use of bedrails do not follow best practice to prevent injury to residents. Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X 2 3 3 2 2 STAFFING Standard No Score 27 1 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 2 X 1 2 Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 30 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 OP1 Regulation Requirement Timescale for action 09/06/08 2. OP3 (4) (1)(c) The information in the home (2) (3) (b) such as the statement of purpose needs to be updated to explain what support the service does provide. The criteria of admissions needs to be explained fully, including what support needs the home can meet. The service needs to make sure that this is in place in order that any residents wishing to come into the home can fully understand what support the service is able to provide. Outstanding from 30/03/08 14 (1) (b) The assessments in the home 09/05/08 (c) (2) (a) both before and after the (b) residents are admitted need to reviewed and take account of the statement of purpose that explains how the service will meet the resident’s needs. All residents health and welfare needs need to assessed in order to make sure that areas such as equality and diversity, daily routine, individual preferences, mental and psychological health needs can also be meet. Outstanding from 30/03/08 DS0000059447.V362016.R01.S.doc Version 5.2 Walton Manor Page 31 3. OP7 15 (1) (2) (a) (b) (c) (d) 4. OP8 12 (1) (a)(b) 5. OP8 17 (1) (a) 6. OP9 13(2) 7. OP12 16 (2) (i) (m) (n) Residents care plans need to be reviewed to clearly identify the residents needs and how to meet those needs. Consultation with residents and/or their relatives needs to occur in order that all individuals can be kept informed of how the residents needs will be meet and checked that the resident agrees to this action. Outstanding from 25/10/07 The service needs to make sure that all staff are aware of individual residents needs and take steps to meet their health and welfare at all times. This includes all information available on care plans is accurate and up to date and staff follow the instructions available in care plans. Not meeting resident’s needs in this area places them at risk. Outstanding from 30/03/08 Pressure ulcers and wounds need clear care plans and recording of the treatment. This needs to be done in order that any wounds can be identified and treated appropriately. Outstanding from 30/03/08 The service needs to make 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 Resident’s daily routines, personal preferences and choices need to be determined. This information needs to be readily available to influence the personal support of the residents and promote the routine of the DS0000059447.V362016.R01.S.doc 09/05/08 09/05/08 09/05/08 09/05/08 09/05/08 Walton Manor Version 5.2 Page 32 8. OP16 9. OP27 10. OP33 11. OP35 home. This is of particular relevance with resident’s menu choices and the activities available. Outstanding from 25/10/07 22 (1) (2) The current arrangements for (3) reporting complaints and serious incidence to the manager needs to be looked at. The management team needs to be made aware of all complaints in order that they can be dealt with. Staffs awareness of how to raise concerns and how different concerns will be dealt with needs to be increased in order to fully safeguard the residents. Outstanding from 25/10/07 18 (1) (c) Each member of staff must be (i) trained and competent to undertake their job role. Records that detail the training of each member of staff needs to be kept up to date and reflect their identified training needs and how these have been meet. Outstanding from 30/03/08 24 (1) (a) A quality assurance system (b) (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 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. 20 (1) (a) The current arrangements for (b) (3) the management of individual’s 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 DS0000059447.V362016.R01.S.doc 09/05/08 09/06/08 09/06/08 09/06/08 Walton Manor Version 5.2 Page 33 12. OP38 13(4) (a) (b) (c) earned and how that is distributed. Where risks are identified for 09/06/08 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. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations All care staff need to be involved in the care plans in the home and to regularly access and read them. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all residents Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. The registered person should review the current audits and policies and procedures in the home to make sure that they increase the quality of the service provided. These should also indicate what actions are to be taken from the findings of the audits. This will allow for quality areas to be identified and action taken to resolve any issues. A plan that identifies how to increase the quality of the service needs to be developed. 3. OP33 Walton Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Manor DS0000059447.V362016.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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