Inspection on 28/11/07 for Waverley Lodge Nursing Home

This inspection was carried out on 28th November 2007.

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

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

Other inspections for this house

Waverley Lodge Nursing Home 20/11/08

Waverley Lodge Nursing Home 12/02/07

Waverley Lodge Nursing Home 29/11/05

Waverley Lodge Nursing Home 03/08/05

Waverley Lodge Nursing Home 21/12/04

Waverley Lodge Nursing Home 18/08/04

Waverley Lodge Nursing Home 07/05/03

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Waverley Lodge Nursing Home Dunwood Manor Nursing Centre Sherfield English Romsey Hampshire SO51 6FD Lead Inspector Sue Kinch Unannounced Inspection 28th November 2007 10:45 X10029.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 Lodge Nursing Home DS0000011423.V356088.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 and Care Homes for Adults 18 – 65*. 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 Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waverley Lodge Nursing Home Address Dunwood Manor Nursing Centre Sherfield English Romsey Hampshire SO51 6FD 01794 513033 01794 519700 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) www.sentinel-healthcare.co.uk Sentinel Health Care Limited Mr Neil Young Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (26), Physical disability of places over 65 years of age (26), Terminally ill (26), Terminally ill over 65 years of age (26) Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The number of persons for whom accommodation and nursing care is provided at any one time shall not exceed 26 General Nursing Care: Elderly persons 60 years plus, Convalescent care, Respite care and Terminal care all 18 years plus. Specialist Nursing Care: Physical disability and Palliative care both 18 years plus 12th February 2007 Date of last inspection Brief Description of the Service: Waverley Lodge Nursing Home is located in Sherfield English with a sister home on the same site. The establishments are both owned by Sentinel Health Care Ltd. The home is registered to accommodate twenty-six service users in the categories of old age and adults from 18 years and older people in the categories of physical disability and terminal illness. Waverley Lodge was purpose built and shares some service facilities with the sister home such as laundry and kitchen. The home has two floors and accommodation for residents is located on both of them, and a passenger lift and stairs provide access to the first floor. All bedrooms are singles and twenty-four have en-suite WCs. There is level access to landscaped gardens and there is a hydrotherapy pool on the site that is used by the home as well as by the three other care homes operated by the company. The home is situated approximately three miles from Romsey. A minibus is available to enables residents to access the amenities in the local community. The current fee charged is £725 -£750 per week. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included: a review of the file held at the CSCI office including information received about the home since the last inspection; consideration of information in an Annual Quality Assurance Assessment (AQAA) document completed by the manager before the site visit; conversations with six residents, four staff, two relatives, the manager and a representative of the responsible person, and a health professional who visits the home regularly; a viewing of some records and care plans held at the home; observations of interaction between staff and residents and a consideration of aspects of the environment during an unannounced site visit on 28th November 2007. The visit started at 10:45 am and took seven and a half hours to complete. The service provides care for people in the older and younger person categories. This inspection therefore was carried out in conjunction with the National Minimum Standards for Care Homes for Older People and Younger Adults. What the service does well: What has improved since the last inspection? In relation to the requirements made in the last inspection report of February 2007 improvements had been made in the medication processes and better records are kept of the receipt of medication into the home and of Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 6 administration. Medication is provided to the person it is prescribed for and the manager had a system for monitoring that staff members adhere to the procedures required. The home has an ongoing plan of improvement and aspects of this are referred to in the report below. 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 Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,6 and 2 YA Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from their needs being assessed before they move into the home. EVIDENCE: In the AQAA the manager said that all the paper and processes for admission were in place. This was found in the records sampled when case tracking took place for two people recently admitted to the home. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 9 One resident spoken with about admissions had not been able to visit before moving in for personal reasons but a family member had and had also provided support. They had been, consulted about needs before the admission and, provided with information. Since admission the resident felt that their needs had been met with no suggestions for improvement. Records demonstrating a pre-admission assessment had taken place were in the home. Another person had also chosen not to visit before being admitted but the manager had visited to assess needs. This person felt that on the whole support they get the support needed although would like more activities. A care plan was held in the office for this person who was familiar with it and agreed with the areas of it discussed at the inspection. In the AQAA the manager said ‘All service users have a copy of their contract and terms and conditions of residency. Some have chosen to keep them in their rooms others in their files in the matrons office.’ Findings were satisfactory at the last inspection asnd was not followed up at this inspection. In the AQAA the manager said that they had made improvements to the admission process and had provided the service user guide and statements of purpose in large print and on coloured paper. These are detailed documents. Service users guides are available with the care plans and some of these were seen in people’s rooms. A copy is also available in the front hall of the home. Further improvements are planned by the manger with an intention to address the issues relating to the Mental Capacity Act in pre admission assessments. The service does not provide intermediate care. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. 6,9,16,18,19,20 YA Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are encouraged to be involved in the planning of their care which takes account of risk, dignity, choice, health, social and emotional needs. They are benefiting from an improved management of medication. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 11 EVIDENCE: A sample of three care records was seen as part of case tracking. This demonstrated that as found at the last inspection risk assessments are undertaken and care plans are in place to show how the service users’ needs are to be met. Risk assessments and care plans were detailed and contained a range of information to inform practice. These included areas such as personal care, communication, moving and handling, dietary needs and fall risk assessments. In the files viewed there was evidence of regular reviews of information held. Some residents spoken with have been encouraged to be involved in the care planning to varying degrees depending on ability and interest and they are able to choose whether to keep the care plans in their rooms or in the office. One resident spoken with had chosen to see seen some of care plan and had signed it. Areas of care, such as personal care and mobility, were discussed and the resident agreed that he received the support recorded including health needs. The one issue raised was that there was not enough stimulation. Care was discussed with another resident who said that the care was good. They said that help was provided with personal with attention to dignity and privacy. The care plan was in that person’s bedroom. They had seen it and said that it was fair and that they could contribute to it. There was evidence in the folder also that health needs were supported including visits to the doctor as needed, dentist and optician. Another resident agreed that dignity and privacy is promoted when support is provided and that staff knew their needs. Examples were given of staff being attentive and meeting her social, emotional and health needs. At the last inspection it was noted that there were a number of residents that required PEG feeding and treatment for these were prescribed. Comments were made that the care plans would benefit from more details about the feeds regime in order to inform practice. The responsible individual had said that this would be rectified. At this inspection it was discussed with the manager for one person and recording sheets had been put in place that were bring completed by staff. A relative agreed that a regime was in place. The manager had also introduced some fluid balance charts and was planning to provide staff with clearer guidance for their completion. At the time of the inspection the manager was responsible for the medication administration for the shift. Medication was discussed with her and compliance with the requirements made in the last report was assessed. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 12 A sample of records was viewed to see if receipt of medication was recorded and that the date of administration was maintained. This is now done regularly. The manager explained the system for recording medication coming into the home. A sample of stocks checked against the records at the inspection, was accurately completed. The manager checks that supplies are recorded. There had also been a requirement to ensure that medication prescribed is only being administered to the named user. No evidence was found to suggest that it was shared. The manager said that monitoring systems are in place and there was evidence that medication processes were discussed with the nursing staff responsible for medication in a staff meeting on 15/3/07. The manager said that checking has improved and referred to action taken following an error in storage and recording picked up by the checking process. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 and 12,13,15,17 YA Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being supported to make decisions about their lifestyles and choices in activities and use of the community are supported but also work is planned to develop this to meet the needs of younger people better. Residents enjoy the variety and choice of food provided in the home. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 14 EVIDENCE: Residents are encouraged make choices and pursue their own interests. One person spoken with was doing this and felt adequately stimulated. In the AQAA the manager said that there ‘is a planned programme of activities for the service users. The home has its own minibus and single person vehicle thus supporting our service users to maintain links with the local community and participate in a variety of leisure activities such as football matches, theatre trips and days out.’ Varied views about activities were discussed during the inspection visit but it was confirmed by residents that these activities do occur. One resident said that there was enough stimulation provided in the home. Some residents were out shopping with both activity co-ordinators on the morning of the inspection visit and another residents was at hydrotherapy. Another person spoke about having been to a football match. Other residents were involved in activities at the home with the co-ordinators in the afternoon. Less favourable comments were received from one person who was bored and another said that they mostly watched television. A relative commented that external activities cost money and that residents could be taken out for shopping more. In the AQAA the manager stated an intention to take into account catering for the needs of younger residents and provide more activities. There is space in the home for activities. There is an activity room, formerly the dining room, on the ground floor. The manager said that it was changed as a result of consultation with some of the residents who were finding it difficult to concentrate when activities were carried out in the lounge. There is also a second activity room on the first floor. An activity co-ordinator is available each day during the week with two twice a week. Meeting the diverse needs of residents was discussed with one of the coordinators who said that the role included some support on an individual basis and sited an example of foot massage provided to one of the residents. She also said that they consulted residents about the programme of activities, which was posted around the home. The home welcomes visitors. It has areas where service users can meet with relatives, friends, professionals and not be disturbed. One professional said that the staff are helpful and friendly and that the resident being visited is able to decide where to receive visitors. One relative said they visited very regularly and felt welcomed by the staff and the manager and were offered cups of tea. A third visitor was less positive, and although said that the senior staff are nice, had concerns about the attitude of others. However, they were going to raise issues with the manager who they felt could be approached. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 15 Food is cooked in another registered home on the same site and is brought to Waverley Lodge at mealtimes. Residents said that they are always given a choice and that this is checked on the day before the food is provided. Particular needs are considered and one person said ‘I am fussy–he (the chef) tries his best to organise it – today I had a good lunch, an omelette’. Another person said that they like the food and that it is always warm. Food provided at lunch during the site visit was varied and equipment was used to meet the varied needs of residents. Staff supporting residents with eating were doing this sensitively and were statutory enforcement notice sitting with the residents. It was noted that the dining room furniture was organised so there was insufficient space for all of the residents in the area to eat at the same time. Although residents spoken with did not complain, staff and residents spoke of a second sitting. This means that some people have to wait in the lounge area of the room. One member of staff said that some people who need help with feeding had to wait. Another said it was not always the same people who had to wait. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 and 22,23 YA Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are confident that their complaints would be listened to. Adult protection procedures are used and ongoing training ensures that the residents are protected. EVIDENCE: Most residents spoken with during the inspection said that they felt able to raise issues with the staff or the manager if they needed to although not all were sure about the formal complaint procedure. One person said ‘they listen to me most of the time’. A staff member said that residents are able to say if they are not happy about something and gave an example of this happening in connection with food. A relative said they could raise issues if necessary. Another relative was planning to raise an issue when spoken with but felt able to raise it with the manager or senior staff. Copies of complaints procedures have been provided to residents and were viewed in files in some bedrooms. Two files were also noted to be prominent in Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 17 the front entrance to the home .One holds the Service User Guide and the other and Statement of Purpose and these include the complaints procedure. A complaints logbook is held and recorded complaints made to the home as identified in the AQAA. Where complaints had been substantiated a records of action taken had been entered. A policy for safeguarding adults is held in the home. Records of complaint included an incident of adult protection since the last inspection, which had been reported through the local adult protection procedures. In AQAA manager had said that staff had been, and were receiving training in adult protection. There was evidence of training having taken place including on 16/2/07 and 25/8/07 with further training planned that newer staff will be able to attend. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26 and 24, 30 YA. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a clean well-decorated and well-maintained environment and adaptations are provided but attention is needed to some elements such as use of space and provision of keys. The infection control procedures are good and protect the people living in the home. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 19 EVIDENCE: The manager stated in the AQAA that ‘accommodation is provided in a warm and homely environment, furnishing of a good standard and appropriate to meet the needs of the service users. There is an ongoing refurbishment programme in place.’ All the comments from people during the assessment of the service supported this statement. They said that the home is always clean and warm. Some of the shared areas of the home and five bedrooms were viewed during the visit to the home. All were clean and well decorated with no major signs of wear and tear or of hazards to the people living there. In the AQAA the manager stated that replacing the carpets had brightened corridors and that three bedrooms and the dining room had been decorated. Adaptations were discussed with some of the residents who said that those needed were in place. One person wanted to have their bedroom re–arranged and was confident that the staff would sort this out. Residents asked also said that things were fixed if broken and one mentioned a broken toilet seat in their en-suite bathroom. This was being replaced later in the day by the maintenance person. The manager said that people are offered keys to their room. Two people were asked about keys. One said that their room could only be locked from the inside and another that keys had not been offered for the room or an area within the room. Later in the inspection a resident complained to the manager about something missing from their room. The dining area is commented on in the section on daily life and social activities. In the AQAA the manager stated that ‘We use the department of health guide Essential Steps to assess the homes infection control management.’Updated policies on protective clothing and handwashing were also reported to have been provided for staff . Staff showed an awareness of infection control and said they are provided with gloves and aprons and yellow sacks for disposal of soiled waste. New sluice facilities have been provided. Full hand-washing facilties were provided in the shared toilets areas viewed and in ensuite bathrooms. One resident agreed that there were no smells and that incontinence was dealt with discreetly. A regular visitor confirmed that gloves and aprons were always in use and used pads had not been seen in the home. The laundry facilities were not assessed, as they were good at the site visit in February 2007. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 and 32,34,35 YA. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current skill mix of staff that is not sufficient to ensure that the needs of all people living in the home are met safely due to several not having been trained by qualified trainers in moving and handling. The home’s recruitment process is good and ensures that the people living in the home are protected but more attention is needed to the checking of agency staff. EVIDENCE: On the day of the inspection the staffing was reported by the manager to be slightly different to usual. She was fulfilling the registered nurse role, on duty for the day. The home normally has two on duty. The manager said that she felt it was sufficient nursing input on the day of the inspection .The rotas Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 21 sampled supported the manager’s view of nurse staffing levels. A member of staff said that it was very unusual for one nurse to be on duty. A new registered nurse is expected to start work at the home just before Christmas. On the day of the inspection four carers were on duty in the morning and the manager said that the shift was one carer short. However, it was noted that both activity workers were at work and had taken some of the residents out. The duty rota however showed that normally five carers are on duty. At night the rota indicated that one registered nurse worked with two carers as stated by the manager. Comments were received from a resident about the home never being up to it’s staff level and it consequently being difficult to get a rapport with them. Changes to staffing were discussed with the representative of the responsible individual and separately with the manager. They agreed that there had been staff changes with some new staff to the home. In addition some agency staff were working because one resident needed 1-1 care in the day and another at night. On the day of the inspection there were three relatively new staff undergoing induction and an agency worker on duty. Records were viewed for two of those staff who had relevant previous experience. Observation of the rota and discussion with the representative of the responsible person showed that some of the longer established staff were on sick leave although were due to be working again in early December. Discussions were held with some staff and some records sampled. Some of these new staff members have had relevant previous experience and reported support and induction into their new post excluding moving and handling. Most views about the staff attitudes were very positive. One person said that the staff were good with ‘okay’ attitudes. A visiting professional said that staff were good advocates and knew the residents well. Another said their attitudes were good. It was noted that in the AQAA it stated that 50 of the workforce are not yet trained in NVQ 2 or above and that the manager is considering ways to achieve this. She also said that they plan to ‘ensure new staff complete their skills for care within 3 months.’ Staff spoken with talked of their induction training that they had just started. A rolling programme of training is available for staff to take part in and includes two sessions a month. In the AQAA the manager stated that the staff had received ‘proper recruitment checks’. A staff member asked about checks agreed that they had been carried out before working in the home. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 22 A sample of recruitment records was viewed and supported this. However, the letter from an agency, confirming that recruitment checks are taken and that staff provided are given moving and handling training, was three years old, and confirmation of this continuing was needed. The home did not have any information about individuals provided by the agency. The representative of the responsible individual agreed to address this. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 and 37,39,42 YA Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home reviews its services to ensure that improvements are made to meet the needs of residents but the training of Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 24 staff in moving and handling needs prioritising to ensure that residents’ safety is maintained. EVIDENCE: At the last inspection it was noted that the home did not have a manager and that one of the nursing staff was acting in this role. Since then a new manager has been recruited and an application to register with CSCI has been made. All people spoken with during the inspection spoke well of the support and openness of the current manager who one resident said they could talk to if necessary. A staff member described her as ‘fair’ and ‘treats all the same’. In the AQAA the manager says that she makes sure views of people are included by the use of quality assurance questionaires. Evidence that the home carries out an annual survey of residents was viewed and this was last completed in July 2007 since the last inspection and included responses from some relatives. People living at the home were consulted on various aspects of care provided including involvement in decision-making and individual care. The eleven responses, (out of twenty questionnaires sent out) were analysed and most showed full satisfaction with the service. The manager said that staff were also surveyed but the results were not at the home for viewing. Residents meetings are also still held four times a year. Records are held and were sampled and showed that people living in the home had influenced the use of the dining an activity space. The manager confirmed that the representative of the RI monitors other aspects of the service and this includes medication and care plans. Throughout the AQAA it was demonstrated that areas of the home have been considered and areas of improvement identified for the coming year. Finances were discussed with some people living at the home who said that they managed their own finances. Money is held for some residents in the office of the sister home on the same site. At this inspection records were not checked again as they had been found to be in order at the inspection of February 2007. The manager said that money could be accessed from this other home when needed. Health and safety is managed at the home and most servicing of equipments was reported in the AQAA to have been carried out with the exception of fire and gas checks. However records were available at the inspection and showed that checks were carried out within the correct timescale. Risk assessments had also been recently reviewed. The training of staff in moving and handling was discussed with the manager and staff. An immediate requirement notice was left at the inspection in light Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 25 of three staff on shift not having received moving and handling training from a qualified instructor. Following the inspection a letter was received from the home in response to the notice on 30/11/07 to say that training had been planned for 6/12/07 and 12/12/07. The home was asked also to inform us about what would be done to ensure that new staff recruited to the home in the future are appropriately trained. Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 26 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 x 2 x 3 3 4 3 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 ENVIRONMENT Standard No Score 19 4 20 x 21 x 22 x 23 x 24 3 25 x 26 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 2 34 x 35 3 36 x 37 x 38 2 Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 27 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 OP27 Regulation 18(1)(i) Requirement Timescale for action 30/11/07 2. OP38 13(5) You must make arrangements for all staff moving residents to have received training from a qualified trainer in moving and handling as soon as practical. You must also ensure that in 28/12/07 future you train new staff or they provide evidence to you of having received the training, before moving and handling residents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Waverley Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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 Lodge Nursing Home DS0000011423.V356088.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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