CARE HOMES FOR OLDER PEOPLE
Waterside 60 Dudley Road Tipton, West Midlands DY4 8EE Lead Inspector
Richard Eaves Announced 1 June 2005
st 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 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. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Waterside Care Centre Address 60 Dudley Road Tipton West Midlands DY4 8EE 0121 520 2428 0121 520 2428 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ashbourne (KW) Ltd Francis Taylor Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 6th July 2004 Brief Description of the Service: Waterside Care Centre is a purpose built Home, opened in 1997, which provides 60 beds for frail older people who require nursing care. The Home is located on the main road between Dudley and Tipton, with public transport and local amenities easily accessible. There are pleasant views of the Black Country canal at the rear of the Home and the Black Country Museum is approximately 300 metres away. There is car parking to the front of the Home and gardens and patio areas to the rear. Accommodation is provided on two floors, all bedrooms are single and have en-suite facilities. There are large lounge/dining rooms on both floors and a number of small quiet sitting areas. The Home offers intermediate / rehabilitation care in up to 10 of its beds, with a team of professionals visiting each week to assess and assist this care. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and was undertaken at the end of May 2005 and involved a full tour of the bedrooms, communal rooms and service areas. The Standards not inspected on this occasion will be included in the next inspection. The inspector had opportunity to speak with most residents and those able to communicate their views were positive regarding all aspects of the home and care provision. Other information was gathered by observation, meeting with staff and examing records. Twelve relatives and thirty two resident comment cards were received prior to the inspection taking place. Residents responses were, overall very positive with just one indicating that they did not like living at the home and one other that privacy was not respected. There was more division in regards to the provision of suitable activities where 8 said ‘no’ and a further 8 only as ‘sometimes’. Five indicated that they would not know who to speak to if unhappy with their care. All other responses were positive regarding the home and care provision. Only two made additional comments these were; ‘No choice of food for me’ and ‘why can’t there be a shower unit on the upper floor’. Comments made by relatives included both positive and negative, the positive all reflecting on the staff, while negative views were of meals and mealtimes, that those on special diets have no choice or are repetitive e.g. ice-cream for pudding 5 times in a week, more effort should be given to taking service users to the table for meals. The other main concern was on the limited level of activities and trips out. Three General Practitioners returned comment cards and notably were not happy that the home communicated clearly or worked in partnership with them, neither were they happy with medication management. 2 indicated that they were not happy with overall care. While maintaining anonymity all comments received by the inspector either before or during the inspection were brought to the attention of the manager and will guide the new manager towards identifying priorities for change and improvements. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection?
Since the previous inspection a manager and deputy have come into post replacing a long-standing acting arrangement, this has stimulated a good deal of progress in aspects of management of the home such as introducing supervision, developing and implementing a training programme to meet mandatory and developmental requirements. The Statement of Purpose and Service Users Guide have been reviewed and amended with the guide issued to all service users and the statement of purpose actively promoted. Resident and relatives meetings have been established and surveys of their views undertaken with an action plan to address shortfalls. Care planning has greatly improved with plans of care available for all service users and these were found to be completed to a good standard. The format and layout of the care plans have been modified to make them more user friendly for the staff. A system of team nursing with named nurse and key-worker has been implemented and a senior carer role established, each of these events having the benefit of identifying individual responsibility and accountability. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 7 What they could do better: 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. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 - 6 The homes statement of purpose and service user guide are excellent sources of information providing details of the service, enabling service users families to make informed decisions about admission to the home. This decision is enhanced by visits to the home prior to admission. A pre-admission assessment is undertaken and confirmation given that service user needs can be met. The staff group are stable, well established and collectively have the knowledge and skills to meet the assessed needs of current service users. Designated staff provide skilled intermediate care maximising the opportunities for rehabilitation. EVIDENCE: The new in post manager has subjected the statement of purpose and service users guide to review and amendment and is actively promoting them to service users and their relatives. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 10 All prospective service users are subject to pre-admission assessment and confirmation given that their needs can be met at the home including those service users admitted under the intermediate care arrangements. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 &10 Health care needs of service users are fully met. Care plans provide the basis for the delivery of care and detail the actions required of staff to meet the identified needs. There remains scope to further develop the direction to staff and be more informative. Medications are well managed all facilitating the promotion of service users health. Service users are treated with respect and their privacy upheld. EVIDENCE: Care plans were randomly inspected in the three areas of ground and first floor and those admitted under the intermediate care arrangements. Overall the care plans were derived from extensive assessments of needs and individually assessed risks and were well completed and provided good direction for the delivery of care. One care plan for the management of diabetes mellitus would benefit from a contingency plan, another plan for epilepsy had good contingency guidance. The incidence of pressure sores are monitored and a plentiful supply of pressure relieving mattresses and cushions are available and preventative care
Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 12 plans well developed. There is a need to increase the number of height adjustable beds for the nursing care of service users who are restricted to bed. Pad storage is currently in service users own rooms and detracts from the general appearance of rooms and requires a solution to be found. Medications are well managed at the home although storage remains problematic with the room ambient temperature being at or about the maximum despite air conditioning. subject to monitoring may require a higher capacity cooler. Re-sheathing of used hypodermic needles was observed on the ground floor this practice presents a significant hazard to staff undertaking this practice. Staff were observed to interact well with service users showing respect and using the preferred terms of address, they were seen to be sensitive to protecting the service users dignity in dress, toileting and cleanliness. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 The systems for service user consultation about activities is good with evidence that their views are sought and even minority views are acted upon. The home has an open visiting policy to maintain service user contact with family and friends. The meals in this home are good offering both choice and variety and catering for special dietary needs EVIDENCE: Activities in the home are led by a co-ordinator who works 10 until 4 each weekday providing a programme of activities that is displayed on the notice board. One relative that returned a comment card directly to the Commission for Social Care Inspection identified that they didn’t feel that appropriate trips and activities were sufficiently available at the home. The service users were split in their views of the provision of activities with 14 ‘content’, 8 who consider them ‘sometimes suitable’ and 8 who did not consider them suitable. Those service users who responded in conversation said they enjoyed the activities particularly trips out. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 14 Regular meetings have been established between the manager and service users and this includes seeking their views on events they would like at the home. The topic of activities is also included in the in-house quality assurance the most recent identifying that the range of activities was excellent or good 53 while the remainder found them to be average. A number of trips are planned for over the summer starting with a canal boat trip, a summer fete is also planned and provision of a mobile shop is well progressed. Other activities include crafts, baking, movement to music, gardening, board games, dominoes, card games and reminiscence. A church service is held monthly and church visitors come to the home on a weekly basis. A member of staff is a lay preacher and provides spiritual support in the home. Service users are able to maintain contact with family and friends and there were some visitors to Waterside Care Centre at the time of inspection. The home has an open visiting policy. There are quiet rooms available for service users to receive visitors in private should they so wish. Service users were largely very satisfied with meals provided at the home with 28 responding that they like the food or sometimes. Meals are provided from menus that include choice and cooked option at the three main meals. The 4 week rotating menu is also changed for each season and provide good quality well balanced and nutritious diet. One service user (anonymous) stated he didn’t have a choice but gave no indication why. A relative noted that persons on diets such as soft or puree received ice cream 5 times in a week for evening pudding, this was not verified from recent records. The homes own survey of satisfaction identified considerable dissatisfaction at 21 identifying meals as ‘poor’. As a result further consultation and revision of the menus is being undertaken. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 & 18 The home has a satisfactory complaints system with some evidence that complainants views are acted upon. Arrangements for the protection of service users from abuse are safeguarded by the training of staff achieving good levels of knowledge and understanding. Service user rights are protected. EVIDENCE: The home has an appropriate complaints procedure that is displayed in the reception area of the home. An inspection of the home’s complaint log found that complaints are appropriately investigated and responded to the satisfaction of the complainants. Service users of longstanding are able to participate in forthcoming elections either by postal vote or attendance at the polling station. The homes adult protection policy and procedure make reference to both Dudley and Sandwell Local Authority policies. Staff training in adult protection is mandatory and included within the foundation period following employment. Currently an allegation is under investigation. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The environment within this home is good providing an attractive, comfortable and safe place for those living, working and visiting there. The home is clean, free from odours and hygienic. EVIDENCE: A good deal of progress has been in placing the maintenance and decoration of the home on a programmed basis having completed an extensive decoration of the first floor. Maintenance and monitoring is organised to ensure timely completion in a systematic way. The exterior is well maintained with attractive garden areas with ample seating and imaginative garden decoration. Internally the all-single en-suite accommodation is pleasant in appearance and individually personalised. The communal areas consist of a large lounge diner and two small lounges on each floor providing a range of facilities that are bright, comfortable and homely.
Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 17 Monitoring arrangements of services is of a good standard although a number of recommendations are made to further ensure safety management of hot water. These include recording the return temperature of circulating hot water to show that it remains above 50 degrees centigrade, recording each mixing valve adjustment when the temperature has been outside the safe range of the standard of 43 degrees centigrade. It is also recommended that each hot water mixing valve is subjected to an annual anti scald test and service and recorded in such a way as to present the full history of each valve. On the day of inspection the home was found to be clean and free from odours and tidy with corridors free from obstructions. Hand wash facilities were all well stocked with good evidence of frequent use demonstrating good progress since the previous inspection. The home is provided with a well-fitted laundry that meets all requirements for managing soiled and infected articles. Sluicing disinfectors are provided on both floors. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 In general, there are sufficient numbers of staff to meet service user needs. The home has a well-motivated and consistent workforce providing continuity of skilled care, following safe work practices and ensuring good care to service users. Recruitment and selection processes are to a good standard, protecting vulnerable people. EVIDENCE: The home is consistently staffed with appropriate numbers and skill mix of Nurses and carers over the 24 hour period. Staff are allocated in three teams these being ground floor, first floor and intermediate care, being 3 nurses and 13 carers in the morning, 3 nurses and 7 carers afternoon and 2 nurse and 5 carers at night. While these numbers meet the requirements to meet the assessed needs of the service users a considerable number of relatives commented that in their opinion more carers were needed. The manager is recommended to assess the afternoon and early part of the night shit to identify if there are sufficient staff to provide a presence in the communal areas at peak activity times. Care staff are well supported by an appropriate number of ancillary staff. Staff met and spoken with were enthusiastic and those who were recently employed received formal induction that meets TOPPS standard. The standard of 50 of care staff being trained to NVQ level 2 standard has been achieved and continues to be increased with 6 carers currently enrolled.
Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 19 A random selection of staff files were inspected and these show that recruitment and selection processes are completed to a good standard and supervised by the Human Resource Department. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 & 37 The manager and senior staff have a clear vision for the home and communicate this and are responsive and inclusive of service users, relatives and staff views, ensuring the home is run in the best interests of the service users. In addition staff benefit from regular supervision, which prepares staff so that they will safeguard the rights of service users. EVIDENCE: The manager is recently in post and at the time of inspection has yet to complete the registration process however she comes with a proven track record with the same company and is very active in establishing meetings to enable service users, relative and staff to express their views. A survey of service users views undertaken during March of this year has resulted in a report and action plan which is well progressed in its implementation. The manager also undertakes regular topic satisfaction surveys and feeds back the findings and actions resulting to the service users meetings.
Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 21 Arrangements for staff supervision is well established and applied in a relevant process covering all aspects of practice, philosophy and career development. An inspection of records required by regulation and listed in the schedules show these to be maintained, up to date, accurate, kept secure and used in accordance with the Data Protection Act. The home has been subject to a health and safety audit by the company advisor which covered all areas of the home with good standard found. Full inspection will be undertaken at the next visit but in inspecting other standards findings show good staff training in health and safety, fire training, satisfactory provision and testing of fire equipment and good environmental monitoring. The kitchens have a hazard analysis and critical control points in place with records of monitoring and cleaning schedules. The manager is recommended to review the Health and Safety policy and sign as the responsible person. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 4 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 3 x x 3 3 x Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 23 No Are there any outstanding requirements from the last inspection? 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) Requirement The registered person must ensure that care plans take account of contingency planning for specific conditions. The registered person must take necessary action to eradicate the practice of re-sheathing used hypodermic needles by staff The registered person must continue to seek solutions to an apparent dissatisfaction with the meals served at the home. Timescale for action 31.7.2005 2. op9 13(3) 31.7.2005 3. op15 16(2)(i) 30.9.2005 4. 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. 3. Refer to Standard op7 op7 op19 Good Practice Recommendations The manager should seek appropriate storage for individual supplies of continence products. The manager is recommended to increase the numbers of height adjustable beds available at the home. The manager must make arrangements for the annual servicing and anti-scald testing of all hot water mixing valves and present the monitoring records in a format that shows the history of each valve.
E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 24 Waterside 4. 5. 6. op19 op27 op38 The manager should monitor hot water return temperature and maintain a record of each required adjustment of the hot water mixing valve. The manager should seek ways to ensure the visible presence of staff in the communal areas at peak activity periods to increase confidence in the availablity of staff. The manager is recommended to review and sign the health and safety policy. Waterside E55 S4824 Waterside V227274 300505 Stg 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Mucklow Office Park, West Point Mucklow Hill Halesowen B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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