Inspection on 09/03/07 for Walton Manor

This inspection was carried out on 9th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Walton Manor 04/11/08

Walton Manor 09/04/08

Walton Manor 25/06/07

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 Mrs Julie Garrity Key Unannounced Inspection 11:15 6 and 9th of March 2007 th 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.V295295.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.V295295.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) 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.V295295.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. 12/12/2005 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 strength 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 only. There are 45 bedrooms in total as although the home is registered for 49 four bedrooms were converted to be used as additional facilities on the intermediate care unit. 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 (mainly buses); the city centre is approximately a fifteen-minute drive away. The building is centrally heated, has an enclosed private garden, which is not Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 5 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. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of two days. The inspector arrived at the home at 11:15 and left at 16.40 on the first day. One the second day a pharmacy inspector was also included. The inspection started at 9:30 am and the inspector left at 16:30. The inspector spoke with 11 residents, 9 staff and the manager. The inspector 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 care plans, accident records, medication records, staff rota, staff files, maintenance records, menus, information sent to CSCI by Walton Manor and a pre-inspection questionnaire completed by the home. This site visit included discussions with residents, visitors, staff and management. The inspector followed an inspection plan written before the start of the inspection to ensure 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. Feedback was given to the manager during and at the end of the inspection. There were several areas of concern identified at this site visit. The manager attended a meeting in CSCI offices and was asked to produce an improvement plan to cover the management of medications, dealing with health and welfare issues if residents and the competency of staff. The manager was asked that it be produced by 22/04/07. 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: The manager of Walton Manor is able to deal effectively with any concerns as they arrive. She takes a proactive approach to any concerns in order that they can be addressed. This good practice is recognised by the residents and their families said that the manager was ““knowledgeable”, “skilled”, “reliable” and “very approachable”. Staff demonstrated a very caring attitude through out the site visit. Observations showed that they spoke to the residents in respectful manner on all occasions and were keen to make sure that they meet the resident’s needs. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 7 All the residents spoken with were complimentary about the care that they received. Comments included “lovely girls, kind caring, so good”, “one of the best care homes” and “ very nice staff”. Residents are able to make their bedrooms their own space and they are encouraged to bring in items that make it feel like home. Residents spoken with said “I love my bedroom, its bright, I’ve got all my pictures and bits its great”. Residents spoken with said “I love my bedroom, its bright, I’ve got all my pictures and bits its great”. The intermediate care unit, has a service that is specific to helping the individuals return to their own homes. The home has made adaptations in the building to make sure that this can be achieved at that residents on this unit have a dedicated staff team who promote their independence. What has improved since the last inspection? What they could do better: Following this site visit several areas of concern were identified. Of major concern was the unsafe practice regarding medications. Some of the residents were not receiving their medications in a safe manner that meet the health and welfare needs of residents. Records in the home such as care plans, risk assessments and assessments did not always identify the needs of the residents and how to meet them. The lack of clear instructions to staff had resulted in some of the residents not having their health and welfare needs fully meet. Following the site visit, these concerns for three residents were referred by the manager to Social Services for further investigation under the Local Authorities Protection of vulnerable adults policy. This was appropriately undertaken by the manager and is good practice that she took this proactive approach, it is unfortunate that the systems involved in the home had failed to identify these concerns prior to the site visit. Other concerns included the further development of individual daily activities for the residents taken from their choices to make sure that they receive the activities of their choosing. Further development is needed in making sure that residents who have a special diet have the information that they need available and that hot foot is always available on the second floor. There are areas in the home that need redecoration and refurbishment. This includes the scaffolding around the home for a fault found in the building. Whilst a structural report has sated there is no risk to the residents there is still no date as to when this work will be completed. A plan that details when and how the improvement in the environment of the home is not available. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 8 CSCI has held a meeting with the home and an improvement plan to address the major concerns identified in this report has been requested. The home will receive another site visit following the receipt of the improvement plan in order to make sure that the home has meet its obligations. Failure to meet the regulations and the improvement can result in enforcement action being taken. 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.V295295.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.V295295.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 3, 4 and 6 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents are given the chance to see if the home is where they would like to live. Changes to residents needs are not always known and this will affect the homes ability to meet all the needs of the residents. EVIDENCE: All potential residents for nursing or personal care have their individual needs assessed by a nurse before they move in. One residents family spoken with spoke about how “kind the staff were” when their relative visited and “been welcomed by the staff”. All assessments are done to make sure that the residents’ needs can be recognized and the staff can determine if Walton Manor can meet the individual’s needs. Potential residents are able to visit the home or have an overnight stay before they move in. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 11 It is the policy of the home that no resident can move in until the staff have received the assessment of the residents needs from any other professionals involved such as a social worker. A copy of the social workers assessments was available on all but two residents care records, of the six sets of records looked at. Both the residents had lived in the home for a number of years and it is possible that these assessments have been misplaced. One of the residents care and support needs have changed over the years, the opportunity to contact social services to make sure that the residents needs were still being properly met was not taken. The manager had discussed the residents needs with a relative and consulted an external healthcare professional, however the home had not revisited its own assessment in order to determine if they could still meet the residents needs. The manager did contact the social worker following this site visit and a new assessment from the home and social worker is planned for the near future. However the changes in the residents needs had not been recorded in the individual’s records. The same resident was admitted with a specific condition, the assessment undertaken at the time did not detail how this condition impacted on their needs. The residents who stay on the intermediate care unit are assessed by a social worker and healthcare professional before they come to stay. The home has a specialised intermediate care unit for eleven residents. The Unit contains equipment and facilities to help deliver treatment to residents to help them to return home. These facilities are separate to those available for the permanent residents in the home. The Home converted four bedrooms to provide this service in order that this facility would meet the needs of the residents staying on the unit. Walton Manor DS0000059447.V295295.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 7, 8, 9 and 10 were reviewed in this area. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff do review care records but do not clearly identify changes in the resident’s condition or have care plans and assessments that meet the needs of the residents. Instructions to staff are not always clear and in some cases not available. This means that staff will not be able to meet the entire resident’s health and welfare needs. The management of medications is unsafe and has resulted in some residents not receiving their medications as prescribed by the GP. The health and wellbeing of residents is at serious risk of harm, as medications are not given properly. EVIDENCE: All residents in the home have an individual care plan, which is meant to detail what their needs are and how to meet those needs. Of the six care plans viewed, five had had regular reviews with one plan not having been reviewed Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 13 for 3 months. The plans are in different styles as the home is currently changing the way it records and manages resident’s care needs. This is very confusing, with information in the care plans being difficult to find and has resulted in very large amounts of documentation that staff do not read and residents and their families cannot access easily. Of the six plans viewed, one had been signed by the resident and the others had not been discussed with the residents. Two residents spoken with had not seen a care plan and one said, “I wouldn’t know what was in that”. Although five plans had been reviewed, changes in the residents needs had not been included in the plans. The accidents records for one resident detailed that in the last 4 months they had had 6 falls. The assessment for the resident’s falls risk assessment had been signed every month and detailed as unchanged, the aspect of the 6 falls had not been included. This would have shown that this resident was at risk of falls and no care plan had been put into place to meet this residents health and welfare needs. This meant that the staff were not able to maintain the health and welfare of this resident in this area. A resident who had needed additional care due to behaviour changes had, some of this included in their plan. It did not contain specific instructions to staff as to how to manage these needs, nor did staff have training in this area. It was also noted that this residents medications had not been given in accordance to the prescription and there was no instructions to staff that detailed when medication was to be given as needed, should be done. The resident had been prescribed painkillers for pain that was detailed in their assessment. There was no plan for pain for the resident that would have indicated how this resident expressed pain and how to give the pain relief medication. This meant that the staff were unable to provide suitable care to meet this residents needs. Additionally the pain relief medication had been given rarely over the last few weeks and it was not possible to determine how many were given or why they were given. The poor management of this resident’s medication has impacted on the residents health and welfare needs. The daily records of this resident showed that the resident was distress on several occasions particularly over night. The manager has since arranged for a Doctor to visit the resident and review their medication. Prior to this healthcare professionals had visited this resident on three occasions including a consultant. There were no records as to the instructions from these professionals or how staff were to carry this out. This meant that the home were not able to make sure that were professional advice was sought that this was put into action and the residents health and welfare needs met. Where specific tasks such as using creams, diet supplements were needed, these were not included in the care records and it was not possible to determine what they were to be used for, where and how. An example of this included “thick and easy”, which is a powder used to thicken foods and drinks Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 14 for residents with swallowing difficulties. This was located in the kitchen and is a prescribed to the resident by their GP. Care staff detailed that they use this and follow the instructions on the box. However there is no way to determine if this is the correct usage, staff have not received instructions for this, no written instructions are available in the home nor is this monitored to make sure that staff are undertaking this correctly. If the fluids were not at the correct thickness for this resident, they would be at risk of this impacting on their health. The intermediate care unit uses different plans than the rest of the home, these are designed to act as short care plans as the residents on this unit are only intended to stay for a maximum of 4 weeks. One resident has been on the unit for several months and the staff have kept the relevant professionals informed of this. A regular meeting is held for these residents on a Monday and this involves, doctors, staff social workers, occupational health and physiotherapists as needed. Decisions as to the progress of the resident and if they are ready to go home are discussed at this time. The site visit commenced on the 6th of March 2007 at that time a number of discrepancies with the medications being given by the nursing staff in the home were noticed. A further date of the inspection was arranged for 9th of March 2007 when a pharmacy inspector also visited the home to give advice and guidance and to review the medications. By this time the manager had taken a number of steps to address the concerns that had been raised. A sample audit of Medication Administration Record charts (MARs) showed 5 examples of medication that had been signed for, but not given and 4 examples of medication that could not be accounted for. In two cases it was impossible to check if the medicine had been given correctly or not. An injection due had not been given, even though there was one available in stock. One resident was receiving their medication once a day instead of twice daily as prescribed by the Doctor. This meant that some residents were not getting the medications they needed. Staff did not always say why a medication was not given. Tablets that can be one or two depending on the needs of the resident were not recorded properly, nor were the reasons for the decision reached by the staff member recorded. Additional there was no information in the residents care records that would guide staff as to how to make this decision. This meant that some medication was impossible to audit, to find out if they had been given or not. Accurate record keeping is essential to protect the health and wellbeing of residents. Residents are at risk of not getting their medication properly if records are unclear. Staff did not always have enough information to give medication safely. One resident had had a dose change recently. Different doses were recorded on the medication labels and on the record and it was impossible to confirm what the Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 15 current dose should have been. Staff were not able to know if that they were giving the medications properly. Medication was stored securely, however the trolleys were untidy and it was not easy to find medication for each resident. The actual temperature of the medication fridge was recorded daily. However when the fridge temperature was too high nobody took action to fix it. The health of residents may be at risk if they are given medication that has not been kept at the correct temperature. Discussions with staff showed that they were not aware of the proper storage of medicines. One member of staff said that an injection was not given because she did not find it in the fridge. This is an incorrect place for this item to be stored and had it been given straight from the fridge is likely to cause the resident discomfort. Some medication was supplied in packs intended for use in individual’s homes. More than one type of medicine was present in each blister. These packs were badly labelled and it was not possible to identify each medication before being given. Residents’ health and wellbeing is at serious risk if nurses are unable to identify medication before giving it. Medication was not being disposed of in line with current waste regulations. Staff need to receive training on current regulations so that they can record and dispose of all waste medication appropriately and maintain the secure storage of these items before being stored. Records showed that all residents in the home could access dentists, opticians, and chiropodist. Care staff will accompany residents for hospital or clinic appointments. GPs visit residents when needs arise. On the site visit a GP had been requested for a resident and was in attendance at the time. General observations of the staff and their interactions during the day showed that they spoke with the residents in a warm and friendly manner. Privacy and dignity is included in the staff training when they start working in the home and is discussed at staff meetings in order that this be maintained at all times. Care records detailed the name that residents like to be addressed by, however in one case this was no accurately recorded. This will result in staff addressing a resident by an incorrect name. All the residents spoken with were complimentary about the care that they received. Comments included “lovely girls, kind caring, so good”, “one of the best care homes” and “ very nice staff”. Walton Manor DS0000059447.V295295.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 12, 13, 14 and 15 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can choose how they spend their day in the home. Leisure activities are available that meet the needs of some of the residents. Families are welcomed into the home in order that they can maintain good contact with the residents. Residents have a choice of meals and they enjoy the food available. However some residents are getting food that is on occasions cold. EVIDENCE: Residents in the home are asked on admission, about their lifestyle, choice of foods, and preferences of the social activities they would like to participate in. With help from a family member or a staff member, the resident completes a questionnaire, which is used to provide staff with a history of the resident. This information could not be found in the majority of care records looked at. The manager is trying to develop the care records further and has included an approach known as person centred planning which details how the residents choose to live their lives. However this was not available in all the residents’ Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 17 records and those that were seen did not contain much information. Residents spoken with said, that apart from mealtimes “I can basically do what I want” and “in the morning they come and ask if I want to get up, I do most times, but if I don’t want to that’s okay”. Staff spoken with have a good understanding of residents personal choices. Information that is discussed and not written down runs the risk of being inaccurate this is particularly relevant for those residents who can not say when asked how they wish their routine to be. On the intermediate care unit choices and expectations of the residents are looked at and the residents are support in the approach of the service to regain and develop independent skills, such as cooking, cleaning etc. These are written in either the resident’s plan or the occupational and physiotherapy records. Staff on the unit read these daily and discuss them weekly with other healthcare professionals and the resident. There is currently a vacancy for an activities co-ordinator. One of the care staff has extra time allocated to take on this role and has organised several activities. A notice board is available that is completed on a daily basis that details what activities are available that day. When residents participate in organised activities, it is recorded in the activities records available in the lounge. This records what activities residents have done. It does not look at the activities that the residents would like to do or how to provide individual activities for residents that don’t wish to do group activities. Several residents were spoken with two said, “I don’t like big groups of people, I’d rather do my own thing”, another resident said, “the entertainment is okay, but not my cup of tea really”. However two other residents said, “there’s lots to do” and another said “I love a good game of bingo and enjoy it when we play”. Visitors are encouraged in the home and residents can entertain their visitors, in the communal lounges, or in their own bedroom. Several visitors were spoken with during the site visit all said that they felt that their loved one was well cared for, happy and safe in the home. One relative said “its near to us, I can visit easily and like to make sure that all is okay. It’s a nice home, with lovely staff” The menus in the home show that a good choice of different foods is provided. Residents spoken with confirmed this comments such as “I always get a choice” and “I enjoy the food its very good” were made. The chef has spoken with the residents on several occasions and has used these conversations to decide on the contents of the menus. A copy of the menus is available on each of the dinning tables and is also written on a chalkboard in the dinning room. The chef is keen to make sure those special diets such as soft diet and diabetic diets are catered for in the home. There is no information regarding this on the menus and residents who need these choices do not have this information available to them. Presentation of food in the home was viewed and the opportunity to make sure that the meals look nice is taken. This includes Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 18 liquidized meals where the chef makes sure each item is dealt with separately so that the residents can enjoy their food. One resident detailed that her meals were regularly cold and that she heats these up in a microwave in her room. Staff on the intermediate care unit confirmed that this happens and has been happening “for years”. The manager detailed that this had been identified in a recent residents meeting but had not yet been fixed. Since the site visit the manager has put temporary arrangements in place with the intention of making sure that all residents receive their meals at a good temperature level. Walton Manor DS0000059447.V295295.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 16 and 18 were reviewed in this area. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents feel their views are being listened to and acted upon. The home has a policy and training programmes for protecting adults that protects the homes residents from potential abuse. The manager makes sure that issues in this area are dealt with. EVIDENCE: The manager keeps a records of all concerns raised and investigates these correctly this is then used to make sure that the issue is fixed and stopped from happening again. Records in the home showed that all the complaints formally received had been investigated. Following this site visit the manager referred a number of concerns that needed to be dealt with by social services. Residents spoken with are aware of how to raise any concerns they have one said, “ if there’s a problem I just let one of the girls know it gets fixed”. Regular residents meetings also support residents to raise their concerns, a copy of how to raise concerns is available in the homes main entrance. When concerns are raised these are acted on and addressed in the nest meeting. They are also recorded in the complaints records available in the home. Staff spoken with know how to raise concerns but are not aware of who is responsible for dealing with more serious concerns or how the home would deal with it. All staff had received training in protecting vulnerable adults and Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 20 in recognising signs and symptoms of potential abuse. This was seen in the training records and in the staff also discussed the training they had recently had. All said that it had made them think about their job roles and how to make sure that they protected the resident’s rights. Walton Manor DS0000059447.V295295.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 19, 23, 24 and 26 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and tidy. Residents can make their bedroom space their own and are supported to do so by the home. There are areas of the home that need to be redecorated and the manager is aware of these. There are no formal plans in place to make sure that the work is to be completed in the near future. EVIDENCE: The home is clean and tidy and efforts are being made to make the home feel comfortable. Some areas have been redecorated and there are plans to repaint much of the home. Many areas are starting to show signs of wear and tear examples of this include peeling paint in the corridors, carpets beginning to stain in the corridors, stained lift and a toilet without a lock on the door. The manager does do regular audits on the environment in order to make sure that Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 22 the internal decoration can be identified. Externally the home has a significant amount of scaffolding around the front of the building. Nine months 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. However 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. The homes laundry is generally managed well by an individual with a lot of enthusiasm for her job role. Recently new machines such as tumble dries have been put in the laundry. This has made her job significantly easier to manage. The laundry is well organised and gloves and plastic aprons are available to make sure that potentially contaminated laundry is dealt with properly. All of the bedrooms in the home are single occupancy, and most of the residents have personalised their bedrooms with pictures and memorabilia. Residents spoken with said “I love my bedroom, its bright, I’ve got all my pictures and bits its great”. 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.V295295.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 27, 28, 29 and 30 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels in the home are at levels to meet the resident’s needs. Staff receive training to undertake their jobs, not all the staff are competent to do their jobs in order to meet the residents health and welfare needs. Recruitment arrangements are in place however the manager has no administration support and staff files are disorganised. This does not support the manager to be sure that all the staff in the home are suitable to work with the residents. EVIDENCE: The residents, relatives and staff said that there is enough staff available in the home. Residents said “sometimes you wait for something, but love they can’t be everywhere at once can they”. Staff said that they were occasionally very busy in the mornings but “that’s normal, there’s a lot to do in the morning”. Records viewed detail the amount of staff available in the home each day. Where staff are not available other staff such as agency staff can and do work in the home, this is not a frequent event as the staff in the home prefer to meet any shortfalls in staffing themselves. Staffing levels are monitored and staff put into place to meet the needs of the residents. This has recently resulted in more staff being available everyday and is very good practice. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 24 Each member of staff has a file in place that identifies the training that they are to receive or have received recently. These are very well organised and show how staff are being given the training that they need in order to do their job. Supervision is also in place. However a review of medications and health and welfare identified that there are issues around the staff’s ability and competency to provide care that meets the residents needs and safeguards them from harm. These have not recognised or addressed despite the systems in place from the organisation and the home at a local level. Staffing recruitment files were reviewed, these were very difficult to look through as the manager does not have any administration support and does not have the time to maintain these. Looking through these files it was difficult to find all the relevant checks for staff and to make sure that staff all were legally able to work in the UK. A number of Visa’s to work in the UK could not be located. On the second day of the inspection the manager stated that these were now available. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 25 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 31, 32, 33, 35, 36 and 38 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is aware of her role and responsibilities. She makes sure that all residents, relatives and staff are supported. Where issues or concerns are raised she makes sure that they are addressed as fast as possible. Regular audits are done to identify areas in need of improvement, but these audits do not detect areas of unsafe practice. Health and safety checks on the maintenance of the home are in place. However risk assessments for individual activities of residents are not always sufficient enough to make sure that the resident’s health and welfare needs are meet. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 26 Residents are given clear information on how their individual funds will be dealt with and good records are in place that makes sure that the resident’s money is safeguarded. EVIDENCE: On the first day of this site visit significant shortcomings in the management of medications and the competence of staff to do the medications were identified. By the second day of the inspection 3 days later the manager had put into place a plan to address these issues. A staff meeting with the relevant staff had been done, all staff had been given best practice guidelines and the manager had looked more closely at the medicines and identified further issues that she wished to address. She had consulted with colleagues and asked for relevant support and arranged for a new deputy manager to start a lot sooner in order that this and any other issues good are addressed. This is good, prompt and effective management in order to resolve an issue. The manager has been in post for many years. The residents, relatives, staff and other healthcare professionals spoken with said that they had “ a lot of confidence” in the manager, they found her “knowledgeable”, “skilled”, “reliable” and “very approachable”. Where there have been incidents in the home such as complaints and protection of vulnerable adults that the manager has responded appropriately to these. Following this site visit the manager made sure that social services and relevant family members were contacted regarding the issues identified in this report. Regular residents, relatives and staff meetings are held and the minutes of these meetings are available for those who are interested or need this information. 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 a regular sample audit of medications that was not sufficient enough to identify the serious concerns noted at this visit. This was evident in the usage of audits in medications that failed to identify unsafe practice and poor competency of the staff, in the environmental audits of the home that have as yet not action areas that need fixing such as the scaffolding and painting and decorating. If audits are to be used they must be good enough to identify and fix the areas identified. The organisation has a meeting where all the managers get together and look at best practice and at the policies and procedures in place. As identified with medications some of these need to be reviewed, as they do not reflect the practice within the home. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 27 All staff in the home have supervision six times per year, however as the staffing files were not well organised it was difficult to determine that this was occurring regularly. Staff spoken with said that supervision did occur but they were not sure how often, they did find it of value as it looked at what training they might want. Supervision determines if staff need further training but does not review if they are able to fulfil their current job role. Where possible, residents look after their own financial affairs. Families of residents are consulted as regards bank accounts of their relatives. The resident, family member, and EuropeanCare (the owners of Walton Manor) agree on a written contract on how the interest on small bank accounts of residents are utilised. Records for the funds held by the home were viewed. There is no float available for residents to access small amounts of money as they needed it and larger amounts must be ordered from the head office. The management said that this can be arranged quickly and if necessary someone would go that day to get some money. At the weekend this cannot be done, as the head office staff are not available. The home’s certificates of insurance and worthiness for 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. The fire alarm system has not been done on a weekly basis, advice should be sought from the fire authority about this. There is a fire risk assessment in place for the home as a whole and staff have been involved in fire training including a fire drill in the last six months. Risk assessment in the home for individual residents are not always accurately completed by the staff responsible in one case vital information that identified that the residents risk for falling had increased had not been identified or used within the assessment. Risk assessments regarding the usage of bedrails do not follow best practice guidelines. The home is advised to contact the medical device agency and the HSE (health and safety) for guidance regarding the best assessment for the use of this equipment. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X X 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 2 x 3 3 x 2 Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) (2) (a) (b) (c) (d) Requirement Residents care plans must clearly identify their needs, be kept up to date to reflect their needs and have clear actions described for staff to follow. The care plans should be written to include residents and/or their relatives’ comments. All residents must have their health and welfare needs recognised and appropriate action taken to make sure that staff are aware of how to meet those needs. All medicines received into the home and administered to residents, and those medicines leaving the care home require full and accurate records to be kept. In order that staff can be aware of the medications that they are to give and how to give them safely to residents. Prescribed medication records for residents must include the correct dose and instructions for administration. Timescale for action 09/04/07 2. OP8 12 (1) (a) 09/04/07 3. OP9 13(2) 09/04/07 Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 30 4. OP9 13(2) All medication must be identifiable. Medication that is not identifiable must not be given to residents as this runs the risk of them being given the wrong medications. Waste medication must be recorded and disposed of appropriately. This is to help make sure that the manager can check that medications have been given properly and to meet current legislation regarding the returns of medications. The concerns raised regarding food being cold to residents on the second floor must be investigated. Action must be put into place actions that make sure the residents receive food at a temperature that suits them. The home must be reviewed to determine the maintenance, redecoration and refurbishment needs. A plan that details how and when the quality of the environment will be improved must be developed. In order that the residents can be aware of the redecoration and refurbishment and that these will be dealt with as needed. All staff involved in the administration of medications and the planning of care must be competent to do so. Staff must have the skills they need in order that they can give residents the care that they need safely. Individual residents risk assessments must be accurate and kept up to date. Risk assessments need to provide staff with the methods that they need to take to reduce potential risks to residents. DS0000059447.V295295.R01.S.doc 09/04/07 5. OP9 13(2) 09/04/07 6. OP15 16 (2) (i) 09/04/07 7. OP19 23 (2) (b) (d) 09/05/07 8. OP30 18 (1) (a) 09/04/07 9. OP38 13 (4) (b) (c) 09/04/07 Walton Manor Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The registered person should make sure that health care professionals assessments are requested and available as appropriate. The assessments used by the home should be reviewed to make sure that where needs are indicated that this is also covered by the assessment. In order that these can be recognised at the home can decide if they can meet or continue to meet the needs of the residents. The registered person should support all care staff to be involved in the care plans in the home and to regularly access and read them. All staff need to know how to care for the residents in writing to prevent staff misunderstanding the residents needs and not relying on verbal instructions. The registered person should review medication policies and procedures in line with Royal Pharmaceutical Society of Great Britain guidelines to cover all aspects of medicines management. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. A second member of staff should witness/countersign all hand written entries on Medication Administration Record charts Verbal dose changes and new medication should be accurately entered onto Medication Administration Record charts with staff signature, date and authority where appropriate. Verbal dose changes should be confirmed in writing by the prescriber Medicines must be stored at the appropriate temperature. A record of temperature must be maintained for all areas where medicines are kept (max/min temperature of fridge should be monitored daily). Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 32 2. OP7 3. OP9 4. OP12 5. OP18 6. OP33 7. OP35 In order to assist in the safe management of medications. The registered person should make sure that a record is kept of residents personal preferences regarding their daily activities and choices of food is kept. This record should be used to develop activities that suit the residents personal preferences and menus that detail special diets. These should be regularly up dated. This is particularly relevant for residents less able to express an opinion and who need additional support in order that their choices can be identified and put into action. The registered person should make sure that staff are aware of the Local Authority policy and procedure called No Secrets and the homes own policy and procedure that details how POVA investigations will be dealt with. Staff need to have this information in order for them to understand how this works and can take appropriate action. The registered person should review the current audits and policies and procedures in the home to make sure that the increase the quality of the service provided. Consideration should be made to developing audits for care planning and accidents. 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. The registered person should review the current arrangement in the home for residents to access their money and put into place the means for them to know what they have available and access it as easily as someone not living in a care home. Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Walton Manor DS0000059447.V295295.R01.S.doc Version 5.2 Page 34 - 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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