Inspection on 23/03/08 for Waverley Nursing Home

This inspection was carried out on 23rd March 2008.

CSCI found this care home to be providing an Adequate service.

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 Nursing Home 08/12/08

Waverley Nursing Home 09/10/08

Waverley Nursing Home 07/05/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Waverley Nursing Home 14/16 Waverley Road Liverpool Merseyside L17 8UA Lead Inspector Julie Garrity Key Unannounced Inspection 23rd March 2008 10:00 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 Nursing Home DS0000068442.V358501.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 Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waverley Nursing Home Address 14/16 Waverley Road Liverpool Merseyside L17 8UA 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) 020 8531 5737 Daughters of Mary Mother of Mercy ****Post Vacant**** Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to service users of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. One named service user who is under 65 years old within the overall total of 20 The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief Description of the Service: The Waverley provides nursing care and personal care For a maximum of 20 individuals. The home is a converted building on four floors, there are two lounges one on the lower ground floor and one on the ground floor. Bedrooms are located on the ground floor, first and second floors. There are gardens at the rear that are accessible from the main building and parking to the front and the side. The Home is located in a residential part of Liverpool near to the shopping areas of Lark Lane and Sefton Park area. There are frequent buses to this area and a train station within 15 minutes walk. Fees are charged in the home in accordance with those paid by Liverpool Social Services. Private clients fees are based on their individual assessment and the support that they need. There are several areas not covered in the fees such as hairdressing and newspapers. Waverley Nursing Home DS0000068442.V358501.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 one star. This means the people who use this service experience adequate quality outcomes. The site visit was carried out over a period of one day. A specialist pharmacy inspector also took part in this site visit. We (the commission) arrived at the home at 10:00 and left at 16:55. We spoke with 5 residents, 6 staff and the acting manager. We completed the inspection by a site visit to The Waverley and a look at the building. Written records in the home were looked at and these included, care plans, assessments, staff files, staff training, staffing rotas, cleaning records, GP visit records, information to residents and daily record. Information supplied from the home such as a completed questionnaire, reporting of incidents and correspondence was also reviewed as part of this inspection. Additionally we looked at information received from social services and the primary care trust in the Liverpool area. We followed an inspection plan written before the start of the inspection to ensure that all areas identified were covered. All of the Key standards were covered in this inspection, additionally other standards identified were also reviewed at the inspection, and these are detailed in the report. Feedback was given to the acting manager during and at the end of the inspection. Contact was also made with the new manager due to start working in the home 4 days after this site visit. Feedback was given to them and they provided additional comments. Before the report was completed following the site visit further information was provided to us from social services, this has also been included in this report. The arrangements for equality and diversity were looked at during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support residents to make informed decisions in line with their individual choices. What the service does well: The Waverley has a care staff team who have worked in the home for several years. Feedback from social services described the care staff in the home as “exceptional”. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 6 There is an activities organiser who makes sure that a number of “days out” occur at regular basis. The people who live in the home enjoy these days out. On the day of the site visit several people where going to the local circus. Those that went said that they had “really enjoyed it” and it had been “ a nice change”. As a small care home there is a welcoming atmosphere. All the people who live in the home spoken with were pleased with the care that they receive in the home comments such as “staff are lovely” were made by the residents. All the care staff spoken with were enthusiastic and wanting to supply a good service to the residents. They demonstrated a genuinely warm and caring attitude in keeping with their roles as care staff. What has improved since the last inspection? What they could do better: There is a need to look at the individual choices, needs and preferences of the people who live in the home, such as meals, activities and information. This will allow a service that meets the individual equality and diversity needs. Individuals need to be given the opportunity to influence the way that that the home is run. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 7 There are several people living in the home for which staff do not have the training to support and observations on the day showed that not all staff were able to appropriately support the residents individual needs. The management of medications in the home is in need of development as not all staff are following the policies and procedures in the home. The acting manager has done some work to determine staff’s competency and identify training, however there are still a number of areas of staff skills that need to be increased. Many areas of the home are in need of redecoration and refurbishment as they are worn or stained and do not present a comfortable and safe environment for the residents. This is also impacted on by the prevention of the spread of infection in the home with equipment to aid in this not being used. Arrangements for the management of residents own finances need to reviewed in order that residents receive the correct amount at all times. 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 Nursing Home DS0000068442.V358501.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 Nursing Home DS0000068442.V358501.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who wish to move into the home are not given enough information to help them decide if the home can meet their needs. The service does make sure that all individuals wanting to come and live in the home are assessed before they are offered a place. The assessment arrangements are not of good enough quality to make sure that individual needs can be established. The lack of properly organised assessments means that the service is likely to admit individuals whose needs they cannot meet. EVIDENCE: All individuals should receive an assessment before they are admitted. This is done in order that the staff can know what the needs of residents are before they move in and arrange support to meet their needs. The assessments viewed of a recently admitted individual contained very brief details, it did not determine many areas such as medications, social needs or wound care. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 10 Assessments need to be reviewed and updated regularly as individual needs change. Several assessments in areas such as moving and handling, risk and needs had not been reviewed. The service does not always make sure that they have copies of professional input such as social services or district nurses. There are several individuals with psychological needs, these were identified on the assessment but the behavioural impact was not assessed. The staff have not had training in this area have found it difficult to fully support the individuals with psychological needs in particular an individual who has on several occasions has physically injured the care staff. There is no information that informs people of what services the home provides or how it intends to support those who live in the home. Without good clear information that explains the home to individuals it will be difficult for them to make a choice to decide if the home is for them. The people who live in the home that we spoke with could not recall seeing any information. They choose to live there for a variety of different reasons, “a nice small home” being one. The majority of the individuals have lived in the home for several years and in that time the owner, the manager and several members of staff have changed. Individuals need to be aware how these changes impact on the services that the home provides. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improving, the variable practice regarding the planning and delivery of care and medications means that all residents cannot be sure that their health and personal care needs will be fully met. EVIDENCE: Five individual care plans were viewed, these are kept up to date, were an individual need has been identified a plan as to how to support the resident was in place. All the plans are looked at monthly. Staff spoken with say that they look at the care plans regularly and are asked for their point of view when they are changed. It is good practice that all the residents needs have clear advice to staff that details how to support the residents and means that all staff will be able to support the residents in the same way. None of the plans seen had evidence that individuals or their relatives were involved in the plan. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 12 In two cases needs identified did not have a care plan in place. In other care plans information was very brief and did not describe to the staff how to meet the needs of the individual. There was inconstant practice with some care plan having good information in them that included plans of activities and social needs. Daily records varied in quality with very clear details as to care that had been given to “uncomplaining”, which is a phrase that does not preserve the residents dignity or describe how they are that day. Two individuals had wound care needs. The care plans did not detail what dressing were needed, and the monitoring of wounds did not meet best practice guidance such as photographs, monitoring of the size with a technique called wound mapping or a measurement of the degree of damage know as a grade. There were no records available that a specialist nurse had been contacted for advice and guidance. A recently admitted individual had a pressure ulcer no attempts had been made to confirm with the doctor or the district nurses what treatment was in place. Staff are not in a position to make sure that they are dealing with this aspect of care in a manner that promotes healing and prevents a deterioration in condition. Similarly, staff had not checked and confirmed that all currently prescribed medicines had been brought into the home at the beginning of their stay. These checks should be made to ensure people receive the treatment they need. Administration of medicines was observed. This was done with care and the records were signed immediately after the medicines were given. However, the actual time was not recorded when medicines were given much later than the time pre-printed on the medicines record. This is particularly important for medicines prescribed more than once a day; to make sure doses are not given too closely together. Although people had warm drinks, water was not offered during the medicines round, a cold drink (water) should be offered to help people take their medicines. A sample of medicines was counted and compared with the records to check that they were given at the prescribed dose. We saw that medicines had mostly been given correctly but that records for the application of creams were often missed, so it was not possible to tell whether they had been applied or not. There was no written information about where the creams should be used, or for how long. We also saw some ‘gaps’ in the record keeping, when medicines had not been given, making it impossible to tell why the dose had been missed. To help ensure medicines are safely administered as prescribed, records need to be completely and accurately maintained. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 13 As previously seen, medications such as analgesic’s that were to be given on a ‘required needs’ basis had no written instructions as to when to give or in what circumstances. This information is needed to help ensure consistency in the use of these medicines. We saw that where people administered their own medicines either at, or when away from the home, assessments had not been completed and there was no information about how they were supported to manage these medicines safely. Assessments need to be completed and kept under review to help ensure people always receive any support they may need with their medicines. Records for communication with doctors were mostly good and most changes to medication could be tracked. The home had arrangements in place so that non-prescribed medicines for the treatment of minor ailments could be given. This means people can receive treatment for conditions such as minor pain without delay. But, sometimes these medicines were used for longer than allowed by the home’s medicines policy; sometimes this was because the person’s own prescribed supply had ‘run out’. Better systems are needed for ordering medicines that are needed outside the normal delivery to ensure people do not ‘run out’. Medicines were safely stored but the controlled drugs cupboard felt too warm this needs to be addressed to protect the quality of medication stored there. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have little or no information on which to base resident’s choices and rely on discussions amongst themselves. The opportunity to fully explore and record each individual’s choices, preferences and daily routines has not been taken for all the residents and this will mean that not all residents’ wishes are respected or met. EVIDENCE: A menu is available that does not detail alternative diets or choices of meal, the menus were only available in the kitchen and were not distributed to the people who live in the home to see for them to see. The cook said that the he did try to alter menus if he noted items were not getting eaten. He also explained that there is no limit on the budget so he can buy what ever the individuals wish to eat. Several individuals need a special diet and in general even though not on the menu staff try to make sure that they receive these diets. One individual had been identified on admission as having kidney problems. This usual involves a low salt diet, there were no records in the home that this was in place or a dietician had been contacted. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 15 The acting manager did contact a dietician after this site visit to make sure that if needed the diet would be available. The menu is reviewed in a very informal way with little evidence that individuals are consulted about their choices. One care plan was noted to contain a list of individual likes and dislikes but this was not available for all the people who live in the home. Those that can express an opinion are consulted with and asked on a daily basis what they would like. These records showed that a choice was offered. On the day of the site visit a member of staff had ordered items for an individual that was in conflict with their health and welfare needs. The cook had recognised this as an issue and made sure that they individual was asked to choose something suitable to their needs. Those less able to express a choice have their choices made for them. Those individuals spoken with generally found the food “tasty”, “enjoyable” and “of good quality”. Without the opportunity to make sure that all staff are aware of individual choices and menus that meet individual needs it is likely that individual needs and choices will not be supported. The activities co-ordinator keeps records of the activities that individuals have done. There are no records that detail the routines of the individuals like such as when they like to have a drink or eat a meal. One care plan does detail an activities programme and what they look to do. Without good understanding of individual it is difficult for staff to understand individual preferences and to support these preferences. Two residents said that they were not aware of what activities were available or what choices of food there were. On the day of the site visit several individuals went out. Trips out do frequently occur, but are limited by staff and the mobility of the individual. On-going activities for those less able to take part in bingo or a trip out were not seen to be available. Two individuals were in their bedrooms without any stimulation staff arrived to attend to their physical needs. When spoken with staff explained that they preferred to stay in their rooms and did not want a television or radio. There was no records to support this point of view or any determination of alternatives such as time spent with staff as an example. There are no records in the home that detail personal choices, preferences or individual cultural needs. Restrictions such as smoking were detailed in care plans but were not always fully explained one example was two people were restricted to 10 cigarettes a day but there was no explanation for this. The manager detailed that this was due to a lack of finances however this was not detailed in the plans or discussed with the individuals. If individual rights are restricted an explanation and explorations of alternatives is essential in order to meet individual needs. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home have the confidence to report any concerns that they may have. Staff have not received the training and the policies in place the home are out of date or not available. This means that not all concerns or complaints can be recognised by the staff team or dealt with properly. EVIDENCE: Training records show that not all staff have received training in dealing with concerns regarding the protection of adults. Staff did not recognise when to make sure that social services were aware of issues of this nature and a recent admission was referred to social services at the prompting of the inspectors at the site visit. Policies and procedures in this area have not been reviewed for three years and as such do not provide staff with guidance as to how to deal with complaints or serious concerns. Two staff spoken with were able to detail what they thought should be reported to the manager. Neither of the staff members knew that investigations of a serious nature, were a suspicion of abuse had occurred, were not to be investigated by the manager. Both would have started an informal investigation, speaking to other staff before they raised concerns with the manager, this action would mean that the situation could not be properly investigated. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 17 The manager detailed that he had identified in a recent situation that the night staff were also unaware of whose responsibility it was to undertake investigations. A policy regarding complaints is available, however not all residents are aware of this. Of the three spoken with regarding this none had seen a complaints policy. All said that they had no problems but if they did they would tell the staff. There were no records regarding the concerns raised in the home by Social Services and the commission in the last 12 months. The manager did not realise that it was good practice to keep records of all concerns raised in order to monitor them. Staff said that they resolve any concerns as they arise, as there is nowhere particular for them to record concerns. They may write it in the daily records, the diary, leave a note for the manager or discuss with the nurse on duty. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The decoration and maintenance of the home is not of a good standard. Several areas are in need of redecoration and do not make the home a comfortable and welcoming place for the people who live there. People who live in the home feel that they can make their bedrooms their own space and make those areas more to their individual taste. EVIDENCE: The building is on four floors, there are two lounges one on the ground floor another in the basement area next to the managers office. There are no dining facilities, people who live in the home eat at tables in front of their chairs or in their bedrooms, and the choice of eating at a table is not available. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 19 A number of areas of the home were looked at most were in need of redecoration or refurbishment this included, two bathrooms, the main corridors, five bedrooms, both lounges and the furniture in the main lounge on the ground floor. There is no maintenance plan that details what needs maintaining and when. There is a list of things to be redecorated but this does not start until February 2009. There are no regular audits that determine the areas that need redecorating. Two residents said, “used to look much nicer” and “I like my bedroom”. Several of the bedrooms viewed had been personalised and included individual’s own items such as ornaments. Several other bedrooms viewed were bare and had no items of a personal nature. People who live in the home will feel more at home with familiar items around them. The home was not clean and tidy on the day of the site visit, corridors were in need of hoovering as an example. The home does not have a cleaner everyday of the week and on the days that their no cleaner care staff do cleaning as part of their duties, this is limited to basic cleaning only and does not include things like vacuuming. This was particularly applicable to the kitchen were a storage area has not been in use for several months and the cook has to store cleaning items next to timed food items. It was noted that contaminated items such as pads had been placed in normal bins and not in the specialised bins that are needed to dispose of contaminated items. Other areas of the home that deal with handling bodily fluids such as the laundry did not have items available that would protect the staff’s uniforms and prevent them from spreading infection to the people who live in the home. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not sufficiently trained or skilled to undertake their job role. Plans to improve this area are in place but as yet not started. Communication and team working between the staff groups such as care staff and nursing has started to improve and this may make sure that all staff have a better understanding of the needs of the people who live in the home and how to meet those needs. EVIDENCE: Three staffing files were looked at in all, the file for the acting manager had limited information he was recruited from an agency to act as a temporary manager until a permanent one could be recruited. Information from the agency that all proper checks had been put into place was not available in their staff file. Other files viewed were better organised than at the previous inspection, attempts had been made to identify gaps in work history and to make sure that all checks were up to date. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 21 A list of potential staff training was available, there was no plan as to who was to have what training or when. This does not detail staff training for needs of the individuals such as dementia, depression, tissue viability, medications, care planning, diabetes etc. The opportunity to determine if the training that staff have had and their skills are sufficient for them to complete their job role has not been taken. An example of this is there is no assessment of competency for staff giving out medications. Records in the home showed that staff were not managing care planning, medications, moving and handling, dealing with aggression or diets appropriately. Instructions and training was not available to help them to develop the necessary skills. Staff spoken with were clearly able to detail many but not all of physical needs and behavioural needs of some of the people who live in the home. With regards to one resident three staff said that they found the individuals behaviour difficult to deal with a times and were unsure of how to respond. There were records that showed that the person had hurt staff on several occasions. The acting manager explained that staff did not always approach the individual in the correct manner and that staff had not received training in dealing with behavioural needs. A review of staff training showed little to no evidence that staff had received training in essential areas such as fire safety, moving and handling and the recognition and prevention of abuse. Staff spoken with were unsure what training they had received or when. Staff observed during the day showed a genuine enthusiasm for the job that they do. Most have worked in the home for several years. All the staff spoken with were keen to be more involved in determining and planning the care of people who lived in the home. In general staff would welcome more training all said that they would like to increase their skills and understand their job much more. The staffing rota detailed that staffing levels altered daily with different amounts of staff available each day. There was no explanation for this other that staff shift patterns. When staff were absent or sick another member of staff was brought in most of the time but not always. No formal records of monitoring staffing levels were available. Staffing levels have not been determined that they are correct to meet the needs of the people who live in the home. At present there are eleven people living in the home and staff levels have remained the same as it is likely that this is sufficient to meet the people who live in the homes needs but not monitored by the home. The day before the site visit one of the care staff undertook cooking duties as one of the cooks was on leave. There was no evidence that the individual doing the cooking had received training in food hygiene as a minimum. Staff need to be trained and skilled to undertake the tasks that they do. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 22 Four residents spoken with had positive comments about the staff. “lovely, kind staff”, “I like living here staff are very good” and “there’s plenty of staff available, I don’t often have to wait”. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home are happy and settled. The opportunity to develop the quality of the service in the home is not in place. This has resulted in areas of the service not being of a good standard. A changing management team has meant that the quality of the service could not be maintained or remain in place. The recent acting manager did improve areas and the permanent manager should also make sure that the quality of the service is improved. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 24 EVIDENCE: The service has not had a stable management team for the last 12 months. In that time there has been three different managers. Social Services and the local PCT have been making regular visit to the home as there were significant concerns raised about the quality of the service. Both PCT and Social Services have reported that they can identify improvements in the service, there still remains many areas of the service that are in need of improvement. The improvements have been possible as an acting manager was in post for several months and they had worked hard to increase the quality of the service. A new permanent manager was due to start four days after the site visit. A permanent manager in place will lead to a more stable service and enable the staff to recognise areas of the home and their practice that are in need of improvement. There is no evidence that any quality assurance system is in place that looks at the views of individuals who live in the home. On previous occasions the manager gave out questionnaires to the people who live in the home and their relatives to determine the quality of the service. This has not happened for sometime and meetings in which individuals can influence the service have not taken place. Policies and procedures had not been reviewed for over three years and as such many are now out of date and do not reflect the needs of the people living in the home or changes in best practice advice. Without good guidance staff will be unable to make sure that they can maintain a good quality service. General checking by the manager on the quality of the service has also not occurred, this has resulted in weak practice being seen in the management of medications, care planning for individuals and recording of wound care as examples. The acting manager said that audits on medications and care plan had been done, but was unable to locate the records. Good auditing processes would identity areas that need improving and allow the acting manager to improve the quality of the service. A clearer system is in place for the management of individual funds “pocket money”. A breakdown of what each individual is entitled to is available. Receipts were available for spending. However were multiple items had been purchased for more than one individual it was not always possible to find out whose spending was whose. This is poor practice and means that individuals may not always have their full funds available to spend. The service had recently opened a single bank account for all the individual funds. They had no system in place to make sure that interest on the funds was allocated to the individuals fairly. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 25 There had been no consideration for the people who live in the home to have their own bank accounts and be support to maintain their independence. Records for fire testing and general checks were all in place such as emergency lighting, fire alarms. However no records were available that staff checked that fire doors were closing properly or that the call system was working. This was needs to be on a yearly basis to maintain safety. The people who live in the home spoken with said, “I am happy here”, “the staff are very nice” and “I’m happy, it’s easy for my family to visit and I do like the trips out”. Waverley Nursing Home DS0000068442.V358501.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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 1 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X 2 2 2 2 2 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 2 2 1 2 Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 27 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 OP1 Timescale for action 4 (1) (a) Information in the home such as 27/09/08 (b) (c) (2) a statement of purpose and a (3) (a) (b) service users guide needs to be written and readily available in a format to suit the individual needs of people living in the home. 14 (1) (a) (b) (c) All residents need to have a full 27/03/08 assessment that determines their needs and supports staff to plan on how to meet their needs before they are admitted to the home. Outstanding from 16/02/08 It is essential that residents 27/04/08 health and welfare needs are recognised and staff have clear written instructions that supports them to be aware of and meet the residents health and welfare needs appropriately. This includes up to date care plans that provide staff with clear instructions on how to meet resident’s needs. Regulation Requirement 2. OP3 3. OP7 15 (1) (2) (a) (b) (c) (d) Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 28 Care plans for the residents need to be reviewed and monitored in order to determine that they fully respect the support that is to be provided by staff. 4. OP16 22 (3) (4)(5) Outstanding from 16/02/08 A record of any complaint made, 27/04/08 details of any investigation, action taken and outcome must be kept at the home in order to make sure that all concerns are fully addressed and prevented from happening again. Outstanding from 31/10/07 Medications must be 27/04/08 appropriately managed to maintain the safety of the residents. Staff need to give out medications in accordance with the homes own policy and make sure that they follow the prescription given by the GP. Outstanding from 31/10/07 The opportunity to explore, find 27/04/08 out and put in place actions to meet residents personal preferences and choices. This is of particular importance for residents less able to voice an opinion whose equality and diversity needs are not being explored or addressed. Outstanding from 31/10/07 5. OP9 13 (2) 6. OP14 16 (2) (m) Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 29 7. OP26 13 (3) The lack of good practice to 27/04/08 prevent cross infection and the usage of equipment is insufficient to prevent the spread of disease. This will need to be reviewed and appropriate measures taken such as audits of environment, correct equipment, policies and procedures and staff training put into place. Outstanding from 31/10/07 Staff training is not sufficient to 27/05/08 fully safeguard residents needs. Training that is specific to the residents needs will need to be put into place. A plan that details what each individual member of staff training needs are and how they are to be developed will need to be put into place. This will need to include all the areas identified within this report Outstanding from 31/10/07 Staff competency regarding 27/04/08 medications, communicating with residents effectively and protection of vulnerable adults is not sufficient to safe guard the residents. Arrangements that review staff competency and address any concerns will need to be developed. A system that regularly monitors staff skills and addresses any shortfalls needs to be included. Outstanding from 31/10/07 8. OP27 18 (1) (c) 9. OP27 18 (1) (a) Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 30 10. OP33 24 (1) (2) (3) Arrangements to monitor the 27/04/08 quality of the service provided that also takes into account the views of the residents needs to be developed in order to increase the quality of the service. This will need to identify the strengths and the areas to be improved in the home and a plan as to how this will be accomplished put into place. Outstanding from 31/10/07 Risk assessments for residents 27/04/08 individually are either insufficient or not in place this includes, smoking, mattresses next to beds as examples, falls. In order to make sure that residents are fully protected these will need to be reviewed and put into place. Outstanding from 31/10/07 Environmental risk assessments 27/04/08 such as equipment and potential fires need to be updated. This will need to include when and how specific equipment are to be tested, maintained and used. Outstanding from 31/10/07 11. OP38 13 (4) (b) 12. OP38 13 (4) (a) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Review the assessments to determine resident’s psychological needs before admittance in order to make sure that staff have the skills and training to meet their needs. DS0000068442.V358501.R01.S.doc Version 5.2 Page 31 Waverley Nursing Home 2. 3. OP7 OP12 4. 5. 6. OP27 OP38 OP38 Daily records need to record the events and the well being of the residents. Restrictions to residents activities such as a limit on smoking or not leaving the building will need to be clearly recorded, the reasons why and the agreement of the resident will also need to be detailed. Staffing levels need to be reviewed, staff levels should meet the needs of residents and this should be recorded. The security arrangements need reviewing in order to make sure that residents are safeguarded. The current level of understanding of the person in charge at each shift with regards to managing emergency situations such as fire needs to be determined and competency determined. Policies and procedures need to make sure that resident’s safety in this area is maintained. Waverley Nursing Home DS0000068442.V358501.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection North West Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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. 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