Inspection on 15/03/06 for Wavertree Nursing and Residential Home

This inspection was carried out on 15th March 2006.

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

The inspector 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

Wavertree Nursing and... 09/09/08

Wavertree Nursing and... 09/10/07

Wavertree Nursing and... 14/02/07

Wavertree Nursing and... 17/10/06

Wavertree Nursing and... 31/08/05

Wavertree Nursing and... 09/12/04

Wavertree Nursing and... 28/05/04

Wavertree Nursing and... 26/02/04

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

CARE HOMES FOR OLDER PEOPLE Amber Court At Wavertree Pighue Lane Wavertree Liverpool Merseyside L13 1DG Lead Inspector Julia Toller Key Unannounced Inspection 15th March 2006 09:30 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 Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 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. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Amber Court At Wavertree Address Pighue Lane Wavertree Liverpool Merseyside L13 1DG 0151 228 4886 0151 228 4886 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) Mr Ilam Din Chaudhry Mrs Evelyn Young Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 36 Nursing and 24 Personal Care within an overall total of 48 To accommodate one named person under 65 years old for respite care To accommodate one named service user under 65 years old To accommodate one named service user under 65 years old for respite care until 31st January 2006 That the home be registered to accommodate one named person aged under 65 years. 31st August 2005 Date of last inspection Brief Description of the Service: Amber Court is a purpose built care home providing both nursing and personal care to 48 residents. All of the accommodation is provided on the first floor and are easily accessible by a passenger lift. On the ground floor there is a large dining room and on the first floor there is large lounge and conservatory, which could be used for a variety of activities. The home is staffed twenty-four hours a day with qualified nursing staff. All of the accommodation is provided in single bedrooms and many of them are very large. The home has many aids to promote the residents safety such as: assisted baths, grab rails, call system etc. The home is centrally heated throughout and the accommodation is bright. Entertainers are brought into the care home once a month and the residents are taken out for day trips and other local places of interests. The home employs an activities person to provide leisure activities for the resident. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted five hours during, which time 5 residents, 3 staff, and the manager were spoken to. Some residents and staff files were inspected as well as a selection of other records maintained at the home. A full tour of the premises was also carried out. What the service does well: What has improved since the last inspection? What they could do better: Staff supervision has not been carried out on a regular basis since the last inspection. This should be used as an opportunity to ensure that staff are aware of their roles and responsibilities, promote the safety of the residents, ensure that staff have the necessary skills to carry out their role effectively, and to deal with any issues where staff are not carrying out their role effectively. The number of nursing staff currently available at the home after 2pm must be reviewed to reflect the high dependency levels of service user’s: the manager must be certain that this is sufficient to meet the needs of service user’s. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 6 The registered person should review the home’s activity budget to reflect the number of residents and to provide additional financial support to activities organised by the staff through fund raising. 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. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 7 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 Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Service User’s are supplied with adequate information upon which to make a choice about living at Amber Court. EVIDENCE: The home has a Statement of Purpose, which clearly sets out the services provided at Amber Court. This gives prospective residents the information they require to make an initial decision about the suitability of the home. Inspection of a sample of service users files showed that staff assess the needs of the service user prior to admission. This information should be used to develop an initial risk assessment, which should then be reviewed and updated on a regular basis. This information is also used to develop care plans to ensure that staff know how to meet the assessed needs of the service user’s, there was evidence that these plans are reviewed on a regular basis. However, some files inspected showed that these records had not been updated adequately, the manager was aware of this issue and had taken steps to address the issue. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 9 The reviews highlight the short and long term needs of individuals. The home does not provide intermediate care. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The staff at the care home monitors closely the emotional and physical health needs of the residents to ensure that they receive the necessary treatment and support promptly to promote their health and wellbeing. EVIDENCE: Inspection of a sample of residents’ file show that they had a care plan in place showing how their assessed needs would be met together with how risks identified would be minimised. The nursing staff review the resident care plans monthly as evidenced in the care plans seen. The nursing staff also carries out various other assessments, that inform the resident care plan such as: nutritional assessment, moving and handling, weight chart etc. Since, the last inspection the home has introduced a contact sheet in the resident’s file where significant conversations with the resident family or health professional is recorded. During the inspection, service users were seen to have been left in wheelchairs following breakfast. The actions of staff, must be monitored by the manager to ensure that service users are cared for on an individual basis. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 11 Other observations showed that staff provide support to individuals caring for them with respect and dignity. This was evidence by staff assisting the residents at lunchtime with their meal. All of the accommodation provided at Amber Court is in single bedrooms. The health care needs of service user’s are met, through regular monitoring by the nursing and care staff and where necessary advice from other health professionals would be obtained. This include support from the Tissue Viability Nurse, the continence adviser, GP, speech therapist etc. The home has various aids in place to prevent pressure ulcers from developing such as pressure relieving mattresses and cushions. In addition the residents have regular health checks from the dentist, optician and chiropodist. At the time of the inspection the recording, storing and administration of service users medication was found to be satisfactory. No service user’s required controlled drugs at the time of the inspection. Where service user’s wish to self-administer their medications, risk assessments are developed to assess the safe arrangements for this procedure. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The residents exercise choice over all aspects of their daily lives and are supported to maintain contact with the community and their family to promote their emotional/psychological well being. EVIDENCE: Observation and discussion with the residents and staff confirm that the residents’ determine their daily routine. During the inspection, residents were seen choosing to be on their own or to participate in activities provided by the staff at the care home. The home employs an activities co-ordinator for twenty hours a week to arrange various activities for service users. These include visits to the local shops, visit to places of interests, video afternoons and engaging service users in art and craft activities, steps are also being taken to encourage service user’s to visit local pubs with staff and families. It is recommended that these activities should be planned, and advertised throughout the home to ensure that all service users’ are aware of social events available. Observation during the inspection show that services provided at Amber Court, are flexible and service users are able to choose when and where to have their meals, times of going to bed and getting etc. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 13 The home has an unrestricted visiting policy. Observation during the inspection showed that service users are able to choose where to see their visitors. Visitors were seen during the inspection using both lounges and resident’s own bedrooms as they wished. The inspector was informed that residents are allowed to handle their own financial affairs for as long as they wish, and have the capacity to do so. However, some service users manage their own finances with the help of family members and solicitors. Inspection of financial records for those who do not handle their own finances, were clear and well maintained holding receipts were purchases were made. Each service user has a lockable facility in their bedroom. Service users are actively encouraged to bring their personal possessions and furniture as long as they can be safely accommodated in their room. The catering staff maintains a record of food provided to residents. Observation of the information kept in the kitchen showed that the catering staff are aware of the special dietary requirement of the residents. This includes soft diet and diabetic diet. Since the last inspection steps have been taken to improve the presentation of liquefied meals to improve the appearance/ presentation, this is ongoing. Currently, the home has a high number of residents that require full assistance at mealtimes and many that require prompting and minimal support. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has various policies and procedures in place to protect its residents from all forms of abuse. EVIDENCE: The home has a complaints procedure, which the management encourages residents and their family to use. The home’s complaints procedure is displayed in the reception area, however, this should be amended to refer staff to adult protection procedures where appropriate. The manager should consider recording the informal complaints and review these at regular intervals to identify if there are areas where improvement in the quality of care could be improved. The manager should maintain a clear record of complaints made at the home, the steps taken to investigate them, and the outcome. Refresher training in adult protection took place for some staff in October, with training for the remaining staff planned for April. An adult protection policy and procedure must be developed to ensure the protection of service user’s. The home is usually used as polling station. There is a separate entrance to the area used as polling station to ensure the safety and privacy of the resident. Thus, those residents who want to vote are able to do so easily. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 The home is well maintained internally and externally to promote the safety of the residents. EVIDENCE: The home is generally well maintained both internally and externally. The home employs a general maintenance person who is responsible for ensuring that minor repairs are undertaken once they are reported to the manager. Inspection of the premises identified the following issues: • There is an uneven area of flooring in the dining room which could cause a “trip hazard” to service user’s or staff. • The first floor bathroom was dirty and needed cleaning. • There was a large number of “zimmer” frames around the home, which need to be returned to the relevant department. • In general, there are a number of areas around the home that require clearing of chairs/furniture/equipment. • The furniture in a number of bedrooms is looking worn and needs replacing. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 16 The grounds of the home are clean, well maintained and are easily accessible to the residents. The two lounges and the dining rooms are bright and could be used for a variety of activities. The furnishings in the home are of a good quality and are domestic in character. The wheelchair users in the home are able to access the garden easily. The home has various aids to promote the safety and independence of the residents such as: passenger lift, assisted baths, grab rails, raised toilets, call system in all parts of the home to allow the resident to obtain help and support from the staff, hoists to enable residents to be transferred easily and safely and other aids to assist staff to transfer the residents etc. The accommodation throughout is centrally heated, well lit and ventilated. Amber Court has promoted the safety of service user’s and staff by the regular checking of fire safety equipment and fire drills. Emergency lighting is provided throughout the home and is also checked regularly. Water temperatures are checked regularly and records are maintained. The last inspection, highlighted issues with the washing machine, this has now been replaced. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The availability of nursing staff at the home must be reviewed to reflect the assessed needs of the residents to ensure that their needs are met in a manner, which promote their independence and choice. EVIDENCE: Inspection of staff files, showed that adequate recruitment procedures are followed for the employment of new staff, with two written references and a criminal records bureau check sought before staff commence employment. The staff files show that they are given a written terms and conditions of employment. However, staff files also showed that staff are not receiving adequate individual supervision in line with the standards. Inspection of the staffing rota, observation of residents and discussion with the staff indicated that given the very high dependency level of the residents at the home the nursing staff hours should be increased to reflect the levels of dependency. Whilst it is acknowledged that the number of care staff hours have been increased since the last inspection, observation of the dependency levels of service user’s during the inspection and inspection of care plans indicate that having only one nurse trained staff available after 2pm, may be restrictive in meeting individual service user’s needs. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 18 In addition to care staff, the home employs domestics to ensure the cleanliness of the building. At the time of the inspection the home was clean and free from malodour. The manager has planned various training courses for the staff to attend to improve the quality of care provided and to promote both the resident and staff safety. The home is currently working towards 50 of its staff group achieving the NVQ level Care Award. Certificates of staff attendance were available for inspection. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 The management of the home promote the safety of the residents through regularly reviewing all aspect of the homes operation, however this could be improved by reviewing the content of policies and procedures at the home. EVIDENCE: Discussion and observation with the manager showed that she is approachable and accessible to residents, their family and to staff at all times. The deputy manager and the nurse on duty supervises staff on a daily basis to ensure that they are carrying out their roles and responsibilities in accordance with the home’s policies and procedures and the resident’s care plan. Although the home has implemented “one to one” supervision of staff this is not being carried out on a regular basis, the manager must ensure that all staff are adequately supervised on a regular basis. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 20 The home has a current Public Liability Insurance displayed, in addition, the home’s administrator keeps records of all expenditure for accounting purposes. The health and safety of service user’s, is promoted through the staff receiving appropriate training in food hygiene, first aid, moving and handling and fire awareness. In addition regular routine maintenance to the building and servicing of equipment is carried out in accordance with the manufacturer instructions or Health and Safety Executive such as:- maintaining records of all accidents/incidents to residents and staff. The home informs the Commission of any significant event in the care home. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 17 3 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Risk assessments must be developed with regard to service user’s needs before admission to the home. The manager must ensure that all service users are cared for as individual’s. The complaints policy must be amended to include involvement of adult protection as necessary. An adult protection policy and procedure must be developed. All issues identified in the “Environment” section of this report must be addressed. The number of nursing staff available must be reviewed to ensure that service user’s needs are being met. The manager must ensure that all staff receive planned regular supervision in line with the standards. Timescale for action 15/03/06 2 3 4 5 6 CH7 OP16 OP18 OP19 OP27 15 22 13(6) 23 12,18 15/03/06 30/04/06 30/04/06 30/04/06 30/04/06 7 OP36 18(2) 30/04/06 Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 23 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 OP12 Good Practice Recommendations It is recommended that all social events are advertised throughout the home, to ensure that all service user’s are aware of activities available to them. Amber Court At Wavertree DS0000025083.V289130.R03.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Liverpool Local Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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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