Inspection on 20/07/09 for Waterside Care Centre

This inspection was carried out on 20th July 2009.

CQC 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 CQC 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

Waterside Care Centre 31/12/09

Waterside Care Centre 14/07/08

Waterside Care Centre 18/04/07

Waterside Care Centre 22/05/06

Waterside Care Centre 18/01/06

Waterside Care Centre 01/06/05

Waterside Care Centre 09/11/04

Waterside Care Centre 06/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Waterside Care Centre 60 Dudley Road Tipton West Midlands DY4 8EE Lead Inspector Karen Thompson Key Unannounced Inspection 20th July 2009 08:30 DS0000004824.V376530.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterside Care Centre Address 60 Dudley Road Tipton West Midlands DY4 8EE 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) 0121 520 2428 0121 520 2448 dalwoods@bupa.com www.bupa.com BUPA Care Homes (AKW) Ltd Mrs Frances Taylor Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) 60 The maximum number of service users who can be accommodated is: 60 14th July 2008 Date of last inspection Brief Description of the Service: Waterside Care Centre is a purpose built Home, opened in 1997, which provides 60 places 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. Accommodation is provided on two floors; all bedrooms are single and have en-suite facilities. There is a lounge/dining rooms on both floors and a number of small quiet sitting areas. The Home offers intermediate/rehabilitation care for up to ten people. A team of professionals, which include Physiotherapists and Occupational health Therapists visiting each week to assess and assist this care. 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. The scale of charges were not included in the Service User Guide documents so we advise readers to contact the service directly for this information. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate outcomes. This was an unannounced inspection; the home did not know we were coming. It was carried out by one Inspector and one Local Area Manager who were there for one day. The focus of the inspection undertaken by us is upon outcomes for people who live in the home and their views of the service provided. The process considers the care home’s capacity to meet the regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to this fieldwork visit taking place a range of information was gathered to plan the inspection, which included notifications received from the home and an Annual Quality Assurance Assessment (AQAA). This is a questionnaire that was completed by the manager and it gave us information about the home, its staff, people who live there, any developments since the last inspection and their plans for the future. We were supported throughout the inspection process by the management team of the organisation. The Registered Manager was not present for the inspection and subsequent to the inspection we have been informed that the manager has now left the home. At the time of inspection forty-seven people were living at the home. Information was gathered by speaking to and observing people who lived at the home. Five people were “case tracked” which involves discovering their experiences of living at the home by meeting or observing the care they receive, looking at medication and care files and reviewing areas of the home relevant to these people in order to focus on outcomes. Case tracking helps us understand the experiences of people who use the service. Staff files, training records and health and safety files were also examined. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 6 What the service does well: Visiting is flexible and visitors are made to feel welcome. People living at the home have access to a range of Health and Social Professionals to ensure that any health care needs are met. People who live at the home are able to personalise their bedrooms to reflect their individual taste, age, gender and culture so that they feel comfortable in their surroundings. Money, which is held on behalf of people at the home, was accounted for and there were good systems in place to ensure that people’s finances were protected. What has improved since the last inspection? What they could do better: Public information needs to be accurate to help people make an informed decision about moving into the home. The medication management must improve to safeguard those people that live at the home. All the systems must be improved to ensure that all the medicines are administered as prescribed and that the records reflect this. Care planning records must be an accurate reflection of the care being provided. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 7 Communication between the staff teams and within teams needs to improve to ensure that persons living at the home have their needs fully met. Management systems need auditing to identify those that are failing. Activities must be available so that people living at the home lead a stimulating and fulfilling lifestyle that meets their tastes and interests. The arrangements for Care Plans need to improve in order that all new and emerging care needs are identified, assessed and addressed in the documentation. The home must then ensure that care plans are implemented as working documents to guide all staff so that the overall care delivery can be improved to make sure all people’s needs are met. There needs to be a review of the training provided to ensure that staff have the skills and knowledge to meet the needs of people living in the home. Staffing levels and deployment of staff need to be reviewed across the home to ensure people living at the home have their needs met appropriately at all times by people who know them well. The employment procedures did not demonstrate that all the appropriate checks had taken place before staff had commenced employment and that people living in the home were safeguarded. A review of bathing facilities should be undertaken and appropriate action taken to ensure there are sufficient working baths and showers to meet people’s needs. The home needs to ensure that staff have taken part in a fire drill and have the knowledge and skills to deal with a fire in the appropriate manner to maintain the safety of people living in the home and themselves. Systems for ensuring the return of clean clothes to people living in the home need to be reviewed to ensure clothing is not lost. Arrangements must be in place so that any bed safety rails in use are fitted safely to prevent any possibility of harm. The home needs to improve the way that it provides care for people living in the home and ensure this is individualised and dignified. The dining experience for people living at the home should be reviewed so that people have the choice of where they eat and they receive food and drinks that meet their nutritional needs. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 8 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Waterside Care Centre DS0000004824.V376530.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 Waterside Care Centre DS0000004824.V376530.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6. People using the service experience adequate quality outcomes in this area. Information about the service needs to be valid and correct to enable people to make an informed decision about the suitability of the service for them. Assessment processes for both continuing and short term care need to be improved upon to make sure those people’s needs will be met if they move into this service. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 11 We asked to see the services ‘Service User Guide’ document. A copy was given to us by the interim manager who confirmed that that was the most recent. We also saw copies of the same document in bedrooms of people who use the service. The document did not contain current and valid up to date information. For example, the weekly charges for care from this service were not included, the staffing information was incorrect as at least two of the staff named no longer work at the service and the dates for ‘residents meetings’ were for 2007 not 2009. This means that people are not being given up to date information to enable them to make a decision about the suitability of the service for them. Since our last key inspection of July 2008 concerns have been raised about this service by a number of agencies. The provider initially volunteered to suspend admissions to the home but due to ongoing concerns Health and Social Services decided they would suspend their contract. As a result no new people are at present being funded by Health or Social Services to go to this service, which includes intermediate and ‘step down’ care. In future, the needs of people must be fully assessed to demonstrate that the service can meet people’s full needs before they are offered a placement. This is to make sure that they will be cared for adequately and that they will be safe. We did look at the pre-admission assessment of three people admitted to the home prior to the suspension. The assessments had been completed and care plans had been written in relation to people’s needs and met the standard. We did speak to a number of people during our inspection that had relatives who had been living at the service for some time. Two relatives told us that they or another family member had visited the service before decisions were made about admission. One told us; “We chose this home ourselves. I did not want him to go anywhere. I did come and look around before I chose”. Intermediate care was being provided for two people living at the home at the time of our visit. A dedicated area within the home has been set aside for intermediate care. This service is supported by the local Primary Care Trust (PCT). People admitted under the intermediate care arrangements have their own facilities and a dedicated staff team. Waterside Care Centre DS0000004824.V376530.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.11. People using the service experience adequate quality outcomes in this area. The arrangements for meeting people’s health and personal care needs including medication are not always being adequately, consistently and appropriately met which may put them at risk of harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The care records of five people living in the home were looked at in detail and other records sampled. Care plans outlined the needs of people living at the home and the action required by staff to meet their needs. There was also a range of risk assessments that highlighted potential risks and the action required to minimise them. The care plans were being reviewed on a monthly Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 13 basis but in some instances changes were not leading automatically to a change in the care planning instructions. There was evidence that people’s fluid and food intake was monitored on a daily basis and that they were weighed regularly. One of the care records looked at was for a person referred to a dietician for poor dietary intake. It was recommended that they be weighed weekly and that a food and fluid diary be kept. This person was still being weighed monthly not weekly as recommended. The records in relation to food intake demonstrated three meals a day were being offered but there was no evidence of snacks in between meals. The fluid charts demonstrated poor fluid intake and in some instances the fluid chart had no recordings on them at all. Sufficient fluid intake is important as this ensures the person’s well being. Lack of drinks can mean the person feels unwell and then doesn’t want to drink. We asked a trained member of staff at the beginning of the inspection whether anyone exhibited challenging behaviour and we were told that no-one did. However, we found evidence in the daily records that one person did exhibit behaviour that challenged, but that they did not have a care plan to meet this need. Care staff also confirmed that this person did occasionally exhibit behaviour that challenged. This person did not have a care plan in place for behaviour that challenged, meaning their behaviour was not being assessed or monitored. This means both the person concerned, other people living at the home and staff are left in a vulnerable position and their well-being compromised. The needs of people with behaviour that challenged were not being met. Everyone living in the home was registered with a local general practitioner (G.P). People had access to other health and social care professionals as required including dieticians, chiropodists, speech therapists and opticians. The input of these people helps to ensure people’s health care needs are being monitored adequately to promote their well-being. We looked at records for the frequency of bathing and showering and also talked to staff. We found that bathing or showering was not occurring as often as their care plan stated it should do. Staff told us “(It’s) not being done, only one bathroom in use on the first floor... shower totally useless, never worked up here (first floor) not enough pressure, only one bath accessible to service users, the (bubble) bath we’re not able to get service users into”. Records confirmed that five people on the first floor had had a bath in one week out of twenty-one people. However, six people living on this floor could not get out of their bed and so had been given a bed bath. Bathing will be discussed again in the section on Environment in the report as it was found that not all equipment available was working correctly. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 14 We observed a significant proportion of people being nursed in bed at this home throughout the day. This was only an observation, but one that was discussed with the management team. They themselves had also made this observation and could not, like ourselves, initially offer an explanation. Bed safety rails were observed on a number of people’s beds along with alternatives such as crash mats. These are generally used to protect people who are at risk of harming themselves by falling out of bed. The use of bed safety rails needs to be based on a thorough assessment. Care plans had restraint forms in place for the use of bed safety rails. The restraint form has a section to indicate who has been involved in the decision making process but we found on one of these forms that it was evident that only the trained nurse and the family had been involved in the decision making process. The form guides staff to consider input from the multidisciplinary team. A multidisciplinary team decision ensures that people who live at the home have their rights balanced against risks. We tested a bed safety-rail for correct fitting and found it had a gap which allowed for possible entrapment. This was brought to the attention of the management team. The medication rooms on both floors of the home were visited. The medication room on the first floor was found to be too hot according to the home’s thermometer. Staff recorded the temperature of the room on a daily basis. The homes medication temperature records demonstrated that for the month of July there were seven instances where the temperature was not recorded and of the twelve other recordings only six were within an acceptable range. Staff informed us that the “gate” type security door on this medication room had been put on to allow air to circulate into the room. Whilst this demonstrates action has been taken to reduce the temperature in the room it has not been effective. The organisation will need to revisit this issue to ensure the home is storing medication at the right temperature and in compliance with their product licences. The home’s medication system consisted of pre-packed pharmacy boxed medication and a boxed system with printed Medication Administration Record (MAR) sheets supplied by the dispensing pharmacist on a monthly basis. The home has copies of the original prescriptions (FP10’s) for repeat medications so they were able to check prescribed medication against the MAR chart when it entered the home. We found medication from the previous month’s cycle was not being carried over to the current medication administration chart and consequently could not audit the medication properly. We also found gaps on the MAR chart and audits demonstrating that people were not always receiving the medication that had been prescribed to them. There were also issues with timings of medication. We observed the morning medication round beginning at 9 am and not finishing till after twelve midday on the ground floor, meaning the gap between medication rounds was less than four hours. This practice can lead to harmful effects in people as medications can interact with each other in the body and cause harm. We were informed by one trained nurse Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 15 that they receive regular medication updates and only trained nurses give out medications. We did find the medication knowledge of the nurses to be weak in some instances which could impact on the well being of people living in the home. Information was available on medication for staff to refer to. Practices varied in relation to maintaining and promoting dignity. During the course of the inspection we did observe good interaction with people living at the home and their representatives. Choice however was not always being promoted, for example people were not being asked whether they wanted to eat at a particular table or where and when they had a bath. Lack of choice does not empower people and impacts on their self esteem and dignity. The care plans demonstrated that people and or their representatives were discussing wishes in relation to end of life care. This ensures people living at the home have some feeling of control and input into the way the end of their life is dealt with. Waterside Care Centre DS0000004824.V376530.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience adequate quality outcomes in this area. People using this service are not actively enabled to be fulfilled regarding their leisure and stimulation needs. People are encouraged to maintain contact with family and friends. Meal times and meals could be improved upon to better meet people’s nutritional and social needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service’s most up to date Statement of Purpose document states; “We actively encourage service users to engage in social activities, hobbies and leisure interests “. The services most up to date completed AQAA says; ‘we have a structured activities programme with a dedicated organiser. We encourage a weekend Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 17 activities programme’. Evidence gathered during this inspection told us that this information is not correct and people’s activity and stimulation needs are still not being met even though our last inspection report of July 2008 highlighted that their was a shortfall concerning activity and stimulation needs. We do acknowledge that the activities co-ordinator at the time of this inspection had been off work and that another staff member had been put in to bridge the gap but provision is still inadequate. We observed the lower ground lounge from before breakfast time to midafternoon and apart from the deputy saying hello to each person early in the morning and drinks being given out, there were long periods when the people in there were left alone with no interaction or stimulation. We looked at activity records for two people we had ‘case tracked’ on the ground floor between the dates of 15.6.09 to 16.7.09 and there was only one entry to show that one of these people had been involved in an activity and this was only once. We also found similar findings for people living on the first floor. We spoke to a staff member and asked about the activity needs for one of these people and we were told, “Don’t know much about (them)... likes to go in the garden for a walk. We observed the person who was restless and confirmed that they were bored. A relative told us; “Not enough stimulation, not much going on”. One person living in the home confirmed that there was very little stimulation and they were bored. We observed the daily routine for people who were in the lounge on the ground floor. Each person was brought into the lounge early in the morning and sat in a chair which was where they remained for the day, even at lunch time. We found that visitors are welcome at any time and we have never been informed that there is a problem with the visiting arrangements. This means that people using the service can have contact when they want to with friends and family. One relative told us; “We can visit anytime. I come here everyday”. Another visitor told us; “We visit whenever we want”. A relative also confirmed that they were able to make themselves a drink in the kitchenette area of the home. We looked at people’s bedrooms and saw that each had some of their own possessions, such as pictures and ornaments which made rooms feel more personalised. A visitor confirmed that their relative did receive postal voting papers. These examples show that the service is trying to ensure that people do retain some control over their lives when living at the service. In response to comments made in our previous inspection report dated July 2009 about inadequate systems being in place for meal times ‘Efforts should be made to encourage residents to sit at the dining tables to have their meals, this would involve people in a small amount of movement and encourage residents to socialise’, and the services completed AQAA said; ‘We encourage residents to sit at the table for their meals’. However, our observations at Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 18 breakfast time and lunchtime showed that this statement was not correct. No person was asked if they wanted to sit at the tables for their meals, let alone be encouraged to do so. We saw that all people on the ground floor lounge sat in the same chair all day, even for their meals which does not promote physical movement, or orientation to tell people that is it now lunch time or tea time, for example. A staff member working on the ground floor told us: “No-one uses the tables, they stay in the chairs they are sitting in”. We were told by another member of staff on the first floor of the home: “only people on step down eat at the table”. (Step down is the term used for people who are only staying at the home for a short period of time before returning to live in their own home.) A relative told us: “Staff do not ask people if they want to sit at the table”. We were told by another person working at the service: “Somewhat institutional feeling about some practices”. We did see some good practice at breakfast time on the ground floor which does mean that the service does try to meet the nutritional needs of those people. We observed a staff member feeding one person and encouraging them to eat. Visitors are allowed to help feed their relatives if they want to. We saw that choices were given at breakfast time with people able to have what they wanted from a range of cereals and cooked options such as tomatoes or egg on toast or bread. We were informed that people choose their meal the day before. At lunch time we asked what happens if someone changes their mind in relation to the choices they were offered yesterday. Alternatives such as jacket potatoes and salad were, we were told, available to change to, but it was not possible to provide other alternatives. We were told by the cook that the trained nurses have a key to allow them access to the kitchen so they could obtain snacks for people living at the home when the kitchen was closed. Waterside Care Centre DS0000004824.V376530.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the service experience good quality outcomes in this area. Although some improvement could be made concerning complaints processes, in general people can be assured that their concerns will be listened to and acted upon. Processes are in place which are aimed at protecting vulnerable people and help to keep them safe. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service told us in their completed AQAA that they had received 18 complaints since our last inspection of July 2008. Information from external agencies told us that they had, in the 12 months leading up to December 2008, received 35 complaints. Our last inspection report dated July 2008 rated this section as being good in that complaints are listened to and are acted upon and that processes are in place aimed at protecting vulnerable people who use the service. We saw that a complaints procedure was on display in the front entrance hall and was also included in documents given to people using the service. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 20 With the exception of one, we saw that in general all complaints are logged and a response sent to the complainant following an investigation. A relative did tell us that she would complain if she needed to. A person who uses the service also confirmed to us that he knew how to make a complaint. We raised the issue with a senior manager for the need for the AQAA to be completed more accurately. The AQAA told us that there had not been any safeguarding referrals but looking through the complaints folder we identified that there had been at least two, so information in the AQAA regarding protection was not correct. Staff training information was very sketchy in all areas. A senior manager told us that they had already identified problems with the recording of training and this was being dealt with, including staff safeguarding training. We saw that a copy of Sandwell Council’s safeguarding procedures was available on a shelf in the office for staff to access if they needed to. A relative told us: “I have never seen anything concerning, if I did I would report it”. A staff member told us: “No real concerns, all things like that staff would report and we would deal with or refer”. Waterside Care Centre DS0000004824.V376530.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19.21.25.26 People using the service experience adequate quality outcomes in this area. The home was pleasant, clean and comfortable but some improvements are needed in the bathing facilities provided to ensure they are working and meet the needs of people living in the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 22 Some people we saw were able to move around the home freely. Walking aids, such as Zimmer frames or walking sticks were available to help people to mobilise safely. Some of the bedrooms in the home were visited and these looked homely. People had brought some of their own small items of furniture and pictures into the home. Personal photographs and soft furnishings were used to help personalise the rooms. This practice helps the person to settle into the home quicker and promote their comfort. Some bedrooms had small en suite facilities consisting of a toilet and a washbasin. The kitchen was clean, tidy and organised on the day of the inspection. Records for cleaning and checking temperatures of fridges, freezers, food brought into the home and cooked foods had been maintained. The cook for the day knew what meals people had ordered, and these were well prepared. The cook on the day of our visit had received an order of items such as jugs and crockery. The bathing facilities we found to be problematic on the first floor of the home. The shower would not work and carers told us that when it did work they did not use it as the temperature was unpredictable, running either too hot or too cold. The “bubble bath” on the first floor we were told was not used as staff were ‘unable to hoist anyone in and out of this bath and they didn’t have a plug’. This meant only one bathing facility on this floor was available for all. The lack of bathing facilities impacts not only on people’s ability to be and feel clean but also on their privacy and dignity as facilities would not be within easy reach for everyone. The laundry is located on the ground floor. We were informed that all washing machines and tumble dryers were working by the laundry staff. Paper towels and liquid soap were available. Clean laundry is returned to people’s rooms daily. We were informed by people living at the home that clothing did go missing. We observed a large box of clothes in the laundry area. We were told these items had no names on so they could not be returned. We looked at eight items of clothing in the box of which two had names. Clothes are important possessions that not only tell people who we are but promote our self esteem. Waterside Care Centre DS0000004824.V376530.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 People using the service experience adequate quality outcomes in this area. People living in the home are not always supported by suitably trained staff in sufficient numbers to meet their needs. Recruitment processes need some improvement so that people can be assured that they will be fully protected from harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The staff rota indicated there were four care staff on day and one trained nurse on duty for each floor of the home. The step down unit was being staffed by one trained member of staff and one carer. The night staff consisted of two trained members of staff and four care staff. One relative informed us that there were not enough staff and that people in the lounge seem to have to wait a long time for care. One member of staff also informed us that there was ‘not enough staff’. Observations during this inspection visit demonstrated that care practice is task-orientated and that the staffing levels or deployment of staff does not meet the individual needs of people living in the home. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 24 We examined a number of files for new staff members which did not meet the standard in relation to references and the availability of an intact Criminal Records Bureau check (CRB). The home was able to demonstrate that a CRB had been obtained, but there was not all the information one would normally see as the upper part of the form had been cut off. The management team is aware of the issues and have taken steps to rectify the situation. The services completed AQAA informed us that seventeen members of staff had left in the last twelve months. We asked for a breakdown as to why so many staff had left. The majority of staff were bank staff and if they do not work for a long period in the home they were classed as left. The AQAA told us that seventeen of the thirty-seven members of care staff had completed a National Vocational Qualification (NVQ) 2 or above in care. The AQAA also stated that a further seven care staff were in the process of obtaining this qualification. The NVQ ensures staff have a recognised qualification in care to give them a core of skills and knowledge to meet people’s needs. There was an induction training programme available and this meets the standards of the Social Skills Council. Carers undertake a three-day induction programme where they are supernumerary for a minimum of one day when they commence employment and gradually work through a training booklet over a 12 week period. Staff confirmed that training took place. The management team confirmed that training had slipped in a number of areas for staff and this had been identified by recent audits they had carried out. On the day of our visit moving and handling training was being delivered to a number of staff. Staff confirmed that training was planned for the future. Waterside Care Centre DS0000004824.V376530.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. People using the service experience adequate quality outcomes in this area. People cannot always be assured that the service is being run in their best interests. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The registered manager was not working at the service at the time of our inspection. The interim manager from another service was filling in, supported by a quality manager and the senior manager for the service. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 26 We told the senior manager that we felt that management of the service was ‘slack’ in that things we had found and have detailed within the report should have been identified and addressed by them. We were told, “Processes have not been followed as they should have been that is why we have been doing deeper audits”. We have highlighted in different areas of the report, that the services completed AQAA gave us incorrect information in some areas, which does not give assurance that the service is being run as it should. The service does have a quality assurance process and regular audits are carried out. We discussed this with the senior manager highlighting that if quality assurance processes had been followed then there should not be so many shortfalls. The service manager told us; “Regular audits were carried out and on the surface these looked alright but with us looking into things more deeply we have found that they were not”. We looked at the money being held in safe keeping for some of the people we case tracked. The administrator for the home was able to tell us clearly about the process and access the information we asked for. Little money is held on the premises. People’s money it is put into a joint bank account but individual money for each can be identified at all times. Records looked at were correct against balances. People can choose how they want their money managed, either they can put some for safekeeping which is receipted or in the case of hair or foot care they can have this done then they are invoiced by the service. Generally systems in place mean that people’s money is safe. We randomly looked at records for maintenance and found these to be in order regarding the lift, hoists and testing of fire equipment. We did note that there were gaps in staff fire drill training which need to be explored so that the service can be sure that in the event of a fire all staff know what they have to do to keep risks to people reduced. Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 27 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 x 2 x x 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x 1 x 3 x 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement Staff must ensure that people living in the home receive their medication as prescribed and records demonstrate this. To ensure that people receive their medication as prescribed. At least four hours must elapse between medication rounds to reduce the risk of potential overdose. The quantity of all medicines received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed All medicine must be stored in compliance with their product licenses. This is to ensure their stability. The home must review the bathing facilities available in the home and ensure that they are working and suitable to meet peoples needs DS0000004824.V376530.R01.S.doc Timescale for action 30/09/09 2. OP9 13(2) 30/09/09 3. OP9 13(2) 30/09/09 4 OP9 13(2) 30/09/09 5 OP21 23(2) 30/10/09 Waterside Care Centre Version 5.2 Page 29 6 OP38 13(4) Staff must attend fire drills twice a year to ensure the safety of everyone in the home. 30/11/09 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 OP1 Good Practice Recommendations The Service User Guide must be an accurate reflection of the services and facilities provided in the home. This will ensure people and or their representative have a clear account of what they can expect on moving into the home Care plans must be based on a though assessment of needs and show how care is to be delivered. Care plans must be accessible to staff delivering the care being given. Care plans must be reviewed and amended at the point where a persons needs change or routinely and incorporate external health professionals recommendations and systems must be in place to ensure staff are made aware of these changes. Food and fluid charts should be completed and from this the appropriate action taken to ensure people are supported to receive adequate nutrition. There should be a documented protocol available which describes the care to be given to residents who could become agitated or aggressive. This must include details for the administration of medication prescribed ‘when required’ for behaviour management.( recommendation made at Sept 2008 random visit) Trained staff working at the home should re-familiarise themselves with the NMC Standards of Medicine Management to promote and protect the health and well being of people living in the home. People living at the home should have a choice in relation to where they have their meal and when and where they can have a bath or shower. Efforts should continue to be made to encourage residents to sit at the dining tables to have their meals. This would involve people in a small amount of movement and DS0000004824.V376530.R01.S.doc Version 5.2 Page 30 2 OP7 3 4 OP8 OP9 5 OP9 6 7 OP14 OP15 Waterside Care Centre encourage residents to socialise. .( recommendation made at July 2008 key inspection visit) 8 OP10 The care home must be conducted in a manner which respects the privacy and dignity of service users. Staff should be aware of how to talk to people in their care. ( recommendation made at July 2008 key inspection visit) A review of activities in the home should be carried out to ensure that residents receive mental and physical stimulation that meets their individual needs and supports their enduring interests.( recommendation made at July 2008 key inspection visit) Shortfalls identified in training needs must be addressed in the appropriate learning style so that learning embeds. This will ensure that knowledge and practice mirror and meet the needs of people living in the home. Systems should be in place to ensure that staff working in the home have the opportunity to have a say in the running of the home. This will help to promote the health and wellbeing of people living in the home. ( recommendation made at July 2008 key inspection visit) Issues identified in the quality assurance system should be address appropriately and monitored on a regular basis to ensure positive outcomes for people living at the home. BUPA training package in relation to bed safety rails should be shown to all staff working at the home. 9 OP12 10 OP30 11 OP33 12 13 OP33 OP38 Waterside Care Centre DS0000004824.V376530.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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