Inspection on 08/12/08 for Waverley Nursing Home

This inspection was carried out on 8th December 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Waverley Nursing Home 09/10/08

Waverley Nursing Home 23/03/08

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 13/03/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: Waverley Nursing Home 14/16 Waverley Road Liverpool Merseyside L17 8UA The quality rating for this care home is: The rating was made on: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Julie Garrity Date: 0 8 1 2 2 0 0 8 Information about the care home Name of care home: Address: Waverley Nursing Home 14/16 Waverley Road Liverpool Merseyside L17 8UA 02085315737 Telephone number: Fax number: Email address: Provider web address: phillippa.hoxha@btconnect.com Name of registered provider(s): Type of registration: Number of places registered: Daughters of Mary Mother of Mercy care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 20 Conditions of registration: 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 care home 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 Care Homes for Older People Page 2 of 11 0 9 1 0 2 0 0 8 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. Care Homes for Older People Page 3 of 11 What we found: This site visit was undertaken following concerns identified at previous site visits. In particular the arrangements for managing medications and the quality of care in particular the care of people with high nursing needs. Overall, we found improvement in the arrangements for handling medication. The manager carries out regular medicines audits (checks) and is completing competency assessments to help make sure that staff understand and follow the homes medicines policies. This helps to make sure that medicines are safely managed and should any problems be found, that they would be fixed. The home has arrangements in place so that non prescribed medicines for the treatment of minor ailments can be given. This benefits people living in the home as they can receive treatment for conditions such as minor pain without delay and without the need to see the doctor. Part of the morning medicines round was observed. Care was taken to complete the records immediately after giving out the medicine. This helps make sure that all records are accurately maintained, reducing the risk of mistakes. The ordering of medication had improved; we found sufficient stocks were maintained to maintain continuity of treatment. Arrangements had been made for unwanted medicines to be sent for safe disposal. Records showing the administration of medication were up to date but there were some areas that could be improved to make sure that records were always up to date and clear. As an example when medicines were prescribed as one or two the actual amount given was not always recorded. Records were not always made to show the application of prescribed creams. It is important to show exactly what was applied and records for the use of prescribed creams must be accurately maintained. Where quantities of medication were brought forward from a previous months delivery it was not always possible to track (account for) their safe handling. Writing the open date on liquid medicines will help make it easier for the manager to track the safe handling of liquid medicines at the home. As previously seen, where medicines were prescribed when required there was not always sufficient written guidance for staff about when they may be needed or how this is need is made known. We found that most medicines including controlled drugs were stored securely. This helps to make sure that they are not misused or mishandled. We noticed that external preparations such as creams were kept in peoples own rooms but risk assessments had not been completed to ensure the arrangements were safe and suitable. We looked at other risk assessments such as those for bed rails and people who smoke. There were no risk assessments available for the use of bed rails. This is not safe practice and all bed rails need to be risk assessed and managed in order to make sure that people are not at risk of being trapped in the bed rails or of climbing over the top. Other risk assessments were not in good detail and it was difficult to determine what actions staff needed to take to maintain the safety of people living in the home. Care Homes for Older People Page 4 of 11 Three care plans were looked at one for a person recently returning to the home and two others for people who had lived in the home for some time. The care plans looked at showed improvement, they had been updated monthly and where changes had occured such as returning from the hospital, a plan had been written within 48 hours. The quality of the plans was variable with some plans giving staff very clear instructions and others were very confusing. Plans were often divided into different sections and this meant that when staff came to review and up date the plans they added details into the wrong plan. This caused further confusion and it became difficult to determine what actions staff needed to take or what plan was fully up dated. This meant that staff were not provided with clear instructions and would be unable to maintain continuity of care. An individual was noted to have recently returned to the home from a hospital stay. Staff had correctly identified bruising and skin tears on admission . These injuries were not mentioned on the transfer note from the hospital and as such had no explanation as to how they had occured. The staff had not reported this to adult protection as potential abuse. We contacted the manager a week later to determine if any action had been taken and were told that the referal had not been made. It is the responsibility of the home to report any concerns that they have regarding the safety ogf the people living in the home. Unexplianed injuries need to be reported to adult protection in order to maintain the safety of individuals. The discharge letter from the hospital was unclear and noted that an individual needed to have a blood test. Their was no records in the persons plan that the test had been arranged. The manager did contact us a few days after this site visit to assure us that it had been identified at the time. She explained that the community matron was aware, but the home had not recorded this. Records need to be clear and up to date in order to monitor the condition of the person and make sure that they get the correct treatment. Staff recruitment records were viewed, in all but one case staff had the proper checks to make sure that they were suitable to work in the home. This included a recently recruited member of staff. One member of staffs police check and work permit were not up to date or accurate. The manager said that she would check these with the appropriate authorities. All staff need to be properly checked in order to make sure that they are fit to work with the people living in the home. Staff training has improved, we looked at staff training records these showed that staff had started a number of training courses. These included medications and wound care, all staff were receiving regular supervision to discuss their practice and training needs. What the care home does well: Regular audits are carried out to help make sure that medicines are safely handled and that when weaknesses are identified the home can take any actions to correct the problems. Nursing staff are receiving supervision, this is done in order to determine their skills and arrange for training for any needs identified. Staff are being supported to access training to help improve their skills. Care Homes for Older People Page 5 of 11 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 3 14 (1) (a) (b) All residents need to have a 27/03/2008 (c) full 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 2 7 15 (1) (2) (a) It is essential that residents 27/04/2008 (b) (c) (d) 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. 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. Outstanding from 16/02/08 3 14 16 (2) (m) The opportunity to explore, find out and put in place actions to meet residents 27/04/2008 Care Homes for Older People Page 7 of 11 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 4 16 22 (3) (4)(5) A record of any complaint 27/04/2008 made, 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 5 26 13 (3) The lack of good practice to 27/04/2008 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 6 33 24 (1) (2) (3) Arrangements to monitor the 27/04/2008 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 Care Homes for Older People Page 8 of 11 how this will be accomplished put into place. Outstanding from 31/10/07 7 38 13 (4) (b) Risk assessments for 27/04/2008 residents 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 8 38 13 (4) (a) Environmental risk 27/04/2008 assessments 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 Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Complete, clear and accurate 15/01/2009 records of all medication administered, including prescribed external preparations (e.g. creams). This needs to be done in order be maintained to help ensure medication is safely administered as prescribed. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Where medicines are prescribed when required they needs to be written information for staff about when the medications may be needed and how this need is made known. All staff files need to be checked to make sure that each has a record that demonstrates that they are fit and legally able to work in the home. 2 28 Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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