Inspection on 17/12/07 for Waverley House

This inspection was carried out on 17th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Waverley House 04/07/07

Waverley House 16/05/06

Waverley House 28/09/05

Waverley House 07/06/05

Waverley House 11/11/04

Waverley House 29/07/04

Waverley House 14/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Waverley House 27 Victoria Road Grappenhall Warrington Cheshire WA4 2EN Lead Inspector Wendy Smith Unannounced Inspection 9:30 17 December 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 Waverley House DS0000026997.V351632.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. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waverley House Address 27 Victoria Road Grappenhall Warrington Cheshire WA4 2EN 01925 602453 01925 210736 residentialpar@btconnect.com 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) PAR Residential Homes Ltd Mrs Pam Roberts Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (1) Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 30 service users to include:* Up to 30 service users in the category of DE(E) (Dementia over the age of 65 years) * 1 named service user in the category of OP (Old age, not falling within any other category) * Up to 3 named service users in the category of MD(E) (Mental disorder over the age of 65 years) Date of last inspection 4th July 2007 Brief Description of the Service: Waverley House is a care home providing personal care for up to 30 people over 65 years of age, predominantly people with dementia. It is situated in Grappenhall, a residential area on the outskirts of Warrington. The home was first registered in 1984 and is an adapted Victorian building with a purpose built extension. The fees range from £326 to £460 per week. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 17th December 2007. It was carried out by four inspectors, including a pharmacist inspector. Before the visit, Commission for Social Care Inspection questionnaires were provided for residents, relatives and staff to find out what they think of the home. During the visit the inspectors spoke with staff and residents. One inspector used the Short Observational Framework for Inspection (SOFI) methodology, which involved spending two hours observing residents in a lounge. Note was taken of their state of wellbeing, whether they were taking part in any activity or interaction with others, and the quality of their interactions with staff. One inspector checked all of the staff records. One inspector had a tour of the premises accompanied by the home owner/manager. The pharmacist reviewed the arrangements for ordering, storage, administration and recording of medicines. Care plans relating to a number of residents were looked at. The last key inspection was carried out on 20th July 2007 and a number of requirements were found to be outstanding from previous visits, including compliance with the regulations in relation to residents’ medicines. A Statutory Requirement Notice was sent to the provider on 13th August 2007 and this set out four areas where the home was failing to comply with the Care Homes Regulations. A meeting was held with the provider on 19th September 2007 to discuss progress in complying with the legislation. A Random Inspection of the home was carried out on 18th October 2007 to find out whether the Statutory Requirement Notice of 13th August 2007 had been complied with. It was found that seven residents, who had been admitted to the home between April 2007 and October 2007, did not have any plans for how their care needs should be met. For three of these people, no assessment of their care needs had been recorded since their admission to the home. At least five other residents had care plans dated January 2007 that had not been reviewed since then. New care plans had been written for nine of the 30 residents. The requirement regarding the care of a particular resident had been partly complied with. The requirement regarding medicines was also partly complied with. The requirements regarding the recruitment of new staff was complied with. A meeting was held with the provider on 9th November 2007 and following this, a simple caution was issued on 21st November 2007 by the Regional Director regarding the failure to comply with Regulation 13(2) and Regulation 15(1) and (2) of the Care Homes Regulations 2001. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Senior care staff have put a great deal of effort into writing new care plans for all of the residents. The new care plans give a detailed account of the care needed by each resident. There have been significant improvements to the way that residents’ medicines are managed so that residents and their families can be sure that medicines are always given according to the doctor’s prescription. An activities organiser has been employed since the last inspection. A life history section has been added to the care plans so that staff can know more about each resident and what their interests are. A new carpet has been fitted in the ground floor corridor. The flooring in the lift has been replaced. All staff working at the home have a criminal records bureau disclosure, or have a POVA first check and are awaiting return of their CRB disclosure. A system of staff supervision and appraisal has been introduced. Some monitoring and auditing is taking place. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their relatives were confident that the home met their needs, however this was not always supported by documentation to show that residents’ needs had been assessed. EVIDENCE: Commission for Social Care Inspection comments cards were completed by nine relatives and five residents. They all confirmed that they had received sufficient information about the home before admission, and they were all satisfied that the home was able to meet the needs of the resident. Ten care plans were looked at and a number of these did not have an assessment of the resident’s needs. This is an area where further improvement is needed. The staff should have access to information that will inform them why each resident has been admitted to the home and what their individual needs are. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan that details the care that they require and records the care that is given each day. Residents’ medicines are handled safely. EVIDENCE: Since the random inspection in October 2007, senior care staff have spent much time and effort in writing detailed care plans for all residents and in general the standard of record keeping was much improved. The care plans were much more individualised to the resident. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 11 However there is still room for improvement, and the progress so far needs to be maintained and further developed. Some of the care plans had been written without first recording an assessment of the resident’s needs. Some new forms had been added to the care plans and these are not really necessary and make extra work for staff. This was discussed with Mrs Roberts and she said that she would have a look at the care plans and make sure that staff are not being asked to fill in unnecessary forms. Two frail people were being cared for in bed; they did not have a handling plan to tell staff how to move them safely. Charts in the bedroom showed that both of these people were being repositioned regularly to prevent pressure sores but only one of the two had a care plan to tell staff about the pressure care she needed. Another resident had a chart for staff to record any episodes of challenging behaviour, however she did not have a care plan about challenging behaviour. Another resident has on-going difficulties due to constipation but did not have a care plan about constipation. The care plans showed that residents’ health needs are monitored and visits are made to the home by doctors and district nurses as required. One resident had recently been seen by a dietician. Equipment, including adjustable beds and pressure relieving mattresses, was provided to meet the needs of residents. Staff were observed to have a pleasant and positive attitude towards residents. Comments made by relatives included: my relative is very frail but is looked after with dignity and great care: care staff have the right qualities patience, kindness, compassion, love for the residents: all residents are treated fairly, residents with special needs are given the time needed for their individual care. A CSCI pharmacist inspector inspected the medicines because medicine handling has been poor at previous inspections. There are policies and procedures for managing medicines. These contain useful guidance but we discussed some inaccuracies and points for clarification that the proprietor assured us would be altered. Generally the standard of handling and recording medicines had improved a lot. The medicine storage room was well organised and all medicines inspected were recently prescribed and in good condition. Controlled drugs were handled and recorded fine. Medicine records for 15 residents were fine. There were a few unexplained gaps in the records of giving medicines and occasions where the dose of a medicine (like a painkiller) where the dose may vary was not recorded. Also some record sheets had no dates included. Records of returning waste medicines to the pharmacy were fine. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 12 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 11, 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to remain as independent as possible but they would benefit from more social stimulation. Residents receive a good standard of catering. EVIDENCE: Residents are able to move freely around the ground floor of the home and have a choice of places to sit. A new activity organiser has been appointed and she had been making Christmas cards with some of the residents. Sometimes staff take residents out for a walk if the weather is fine and musical entertainers visit the home every six weeks. A life history section has been added to the care plans and this will help staff to understand residents as individuals. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 13 Observation of the morning routine in the main lounge showed that there was little for residents to do. The television was on but only about half of the people sitting in the lounge could see it. There is room for further development of social stimulation for residents, which does not have to be organised games or activities. This was discussed with Mrs Roberts, and she said that she was encouraging staff to initiate conversations and discussions with residents in the lounges. There is open visiting to the home and visitors can see residents in the privacy of their room or use any of the lounges or the garden, if the weather is fine. All of the visitors who completed comments cards confirmed that they are kept informed of any changes to their relative’s health and well-being. Residents spoken with said they were happy with the quality and the variety of food. The chef is aware of all residents’ likes and dislikes. Residents can take meals in their own room or in the dining room. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to deal with complaints and to protect residents from abuse, however not all staff have received training about abuse. EVIDENCE: The home has a satisfactory complaints procedure, which is in the service user guide in every room. Mrs Roberts said that there had been no complaints since the last inspection. There are satisfactory policies and procedures for abuse, adult protection and whistle blowing, however not all of the staff had received training about this. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable, clean and well-maintained and equipment is provided to meet residents’ needs. Residents may be at risk from hot radiator surfaces. EVIDENCE: A tour of the premises was carried out which included communal areas, bathrooms and bedrooms. There are two lounges and a conservatory, giving residents a choice of places to sit. The middle lounge, where a lot of the residents sit, is rather cramped and residents have to sit very close to one another. The television is situated in a position where half of the residents sitting in there cannot see it. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 16 Some bedrooms are carpeted and others have washable flooring that is more practical for some residents who have continence difficulties. One bedroom had a wrinkled carpet that needs to be repaired or replaced as it is a trip hazard. All areas were clean and in general well-maintained. There is an ongoing programme of redecoration. The carpet in the downstairs corridor has been replaced since the last inspection. Chairs in the conservatory had been cleaned and the flooring in the lift had been replaced. The radiators in some bedrooms and in a corridor were very hot at the bottom, and this could cause a serious burn if a resident were to fall against the radiator. This was discussed with the owner/manager who said that she would ask the maintenance person to bleed the radiators and if this was not effective she would consider fitting protective covers. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Enough qualified and experienced staff are provided to meet the needs of the residents, but not all staff have received training this year. EVIDENCE: All staff files were looked at, including staff that had recently been employed at the home. Protection of Vulnerable Adults (POVA) first and Criminal Record Bureau (CRB) checks were in place for staff who had been in post for some time and new staff had POVA first checks, whilst waiting for the return of CRB disclosures. However, two staff members had commenced employment without written references being obtained from the last employer. In discussion with the manager, she stated that she had telephoned to obtain a verbal reference for the staff members but there were no notes to confirm this. The home has a basic induction programme in and there was evidence on file to show that each staff member had completed an induction within the first few weeks of commencing work at the home. Staff who completed survey forms commented that they had learned by working with experienced members of staff. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 18 Formal supervision and appraisals of staff have been commenced recently, however the format being used for supervision was very detailed and time consuming. It was discussed with the manager that a more user-friendly form could be devised for supervision and the detailed form be used in conjunction with the induction programme to ensure new staff are supported and guided by the more experienced staff at the home. Some staff training has taken place with regard to dementia care and challenging behaviour, moving and handling, and safeguarding vulnerable adults. At least half of the staff working at the home have received this training and more study days are to be booked to enable all staff to attend to ensure that residents diverse needs are being met. Other training which had taken place included first aid, activities management, oral health, continence, nutrition, food hygiene, and medication. Four of the 22 staff employed at the home have achieved NVQ level 2 in care and three have achieved level 3. Six more staff are at present working toward this qualification to enable the home to achieve the government target of 50 per cent of care staff having a qualification. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 19 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 31,33 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home has improved over recent weeks, but a more thorough and regular system of monitoring is needed to ensure that improvements are maintained and built upon. EVIDENCE: The registered manager is also the owner of the home. She is a registered nurse with 30 years experience and holds a Certificate in Institutional Management. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 20 Monitoring systems have either not been in place, or not effective and this resulted in some serious concerns about care plans, medicines and staff recruitment in 2007. Improvements that had been made in the past had not been maintained. These concerns have now been addressed by the manager and the senior staff, however robust monitoring will be necessary to ensure that standards are maintained and the home continues to move forward. Satisfactory arrangements are in place for looking after residents’ personal allowances. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 21 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 N/A 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X X X X Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Timescale for action Ensure that there is a written 31/03/08 assessment of each residents’ needs and that this is kept under review, to ensure that staff providing care are fully informed about the person’s needs. The registered person must 31/03/08 consult residents about their social and recreational needs and provide a programme of suitable recreational activities to fulfil their needs. Timescale of 30/09/07 not met in full Arrange training for all staff who 31/03/08 have not already received training about the protection of vulnerable people from abuse. Ensure that all staff receive 31/03/08 training in the care of people with dementia to ensure they know how to meet the residents’ needs. Establish and maintain a system 31/03/08 for reviewing and improving the quality of care provided at the home to ensure that the home is run in the best interests of residents. Timescale of 31/10/07 not met in full DS0000026997.V351632.R01.S.doc Version 5.2 Page 23 Requirement 2 OP12 16(2)(n) 3 OP18 13(6) 4 OP30 18(1)(c ) 5 OP33 24(1) Waverley House 6 OP38 18(1)(c ) 7 OP38 13(4)(c) Ensure that staff receive training 31/03/08 in moving and handling and annual training updates to ensure they can move residents safely. Outstanding requirement from the last inspection Make sure that residents are not 31/03/08 at risk of burns from contact with hot radiators. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP28 OP29 Good Practice Recommendations Continue to support care staff to achieve a national vocational qualification in care. Ensure that two valid references are obtained before new staff start working at the home. Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Waverley House DS0000026997.V351632.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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