Inspection on 17/10/06 for Wavertree Nursing and Residential Home

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

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... 15/03/06

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 Les Smith Key Unannounced Inspection 17 October 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.V296888.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. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Amber Court At Wavertree Address Pighue Lane Wavertree Liverpool Merseyside L13 1DG 0151 228 4886 0151 228 4867 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.V296888.R01.S.doc Version 5.2 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 two named service users 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 15th March 2006 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 and a call system. The home is centrally heated throughout. Fees at Amber Court range from £317:50 to £395:00 depending upon the level of service required. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 17th October and was carried out by two regulatory inspectors. The visit lasted a total of 9 hours equating to 18 hours inspector time in total. During the visit time was spent examining records, policies and procedures and a tour of the home was undertaken. Discussions took place with residents, relatives, members of staff, and the registered manager. The home had completed a pre-visit questionnaire. The home is purpose built but is now starting to look dated particularly the interior, which would benefit significantly from a redecoration and refurbishment programme. A relative commented that they ‘felt the home needed to be brought up to today’s standards as regards to decoration.’ During the visit there was little seen of any activities or social interactions and a lack of engagement and stimulation fails to promote residents wellbeing. Record keeping in most areas was poor and Policies and Procedures require revision in order to promote up to date practice, which will support the residents’ health, safety and welfare. The dependency of residents at Amber Court is high but this is not reflected in the numbers or skill mix of staff members on duty at some times of the day. What the service does well: What has improved since the last inspection? What they could do better: The standard of record keeping must be improved in all areas, particularly in relation to the care files. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 6 The home must provide appropriate and relevant activities for residents including were appropriate activities on a one to one basis. Complaints and recruitment procedures must be improved to afford protection to the residents. The environment must be improved by significant decoration and refurbishment. Staff must receive both their mandatory and specialist training to provide a capable, safe and competent workforce. Staffing levels and working patterns need to be reviewed to make sure that there are sufficient staff in an appropriate skill mix on duty at all times to ensure that the residents’ assessed needs can be met. 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.V296888.R01.S.doc Version 5.2 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.V296888.R01.S.doc Version 5.2 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): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have sufficient information to make an informed decision on were they wish to live but cannot be confident that their needs will be fully assessed or that those assessed needs can be met. EVIDENCE: The Statement of Purpose and Service User Guide require updating to fully reflect the facilities and services provided to meet requirements. The review of these documents must clarify the name of the home as being ‘Amber Court’ as registered with the Commission for Social Care Inspection or ‘Wavertree Nursing Home’ as displayed on the external signage and documents. The manager stated the name ‘Amber Court’ referred to the residential element but there is no distinct area within the home specifically for residential care. Following revision it is recommended that the Service User Guide be distributed to all residents or their representatives. A random selection of residents’ files was examined and all contained an appropriate contract or Statement of Terms and Conditions in place. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 9 All prospective admissions to the home have a pre-admission assessment carried out by the registered manager or senior nurse. These assessments lack the detail required in order to construct an initial care plan. There is an assessment carried out on admission to the home but one assessment seen gave no detail in relation to either physical or psychological needs. There was no indication within the documentation to indicate who was involved in the assessment process other than the prospective resident. The home is reminded of the importance of including family or appointed representatives and other health care professionals if relevant in order to achieve a comprehensive assessment. The overall standard of assessment is poor and must be improved. The home is equipped with the necessary aids such as handrails, hoists and assisted bathrooms to aid residents and promote independence. Whilst training for staff is addressed fully in another section of this report it is relevant to the homes capacity to meet assed needs. The homes records show that twenty residents have dementia and a further four have mental health needs, which accounts for 50 of the homes places. There has been no training in either dementia, challenging behaviour or other specialist areas such as tissue viability, diabetes or stroke care. The manager encourages and promotes visits or trial periods of stay in the home before the resident moves in on a permanent basis. Discussions with the manager at these visits and the written information provided allow prospective residents’ and their representative to make an informed decision. Amber Court does not provide intermediate care. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of comprehensive and consistent care planning, risk assessment, review and medication management failing to meet statutory requirements and current good practice guidelines places residents at risk of harm or injury. EVIDENCE: A range of care plans and associated documentation were examined on the day of inspection. These included residents with differing needs such as specialist nursing needs, cultural needs and varying levels of cognitive ability. Following an investigation by Social Services into an adult protection matter the Commission was informed of serious concerns in relation to record keeping. Lack of one or more required care plans was noted in most care files. The care plans that were not present ranged from basic activities of daily living to complex needs. The lack of required care plans fails to demonstrate that the interventions to meet assessed needs have been put in place. The risk of Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 11 required care not being given due to lack of appropriate care plans is not acceptable. The standard of regular care plan review was poor with inadequate statements such as ‘no problems’ or ‘No change to report’ with no justification as to why the care plan is to continue. Where a change to care interventions was identified this was detailed in the evaluation but the corresponding care plan was not amended to reflect the change. The lack of daily reports is a serious concern. The pre-printed record that staff use by underlining ‘No problems/Care as plan’ cannot be considered a daily report. Records such as these give no indication as to the actual care delivered, the outcome of that care or how the resident has spent their day and is unacceptable. The promotion of independence invariably involves an element of risk, which is managed via the completion of relevant risk assessments. The required risk assessments particularly for falls, continence and nutrition were not always present in the care files examined. Where risk assessments were present and reviewed, examination showed that the assessments were not always accurate and any reviews did not always reflect changes, which were evidenced in other parts of the care file. Associated documentation such as fluid intake charts, repositioning charts, investigations done with relevant results and regular observations were completed to a generally better standard. Examination of wound management records showed that information was not present in the detail required. There was no evidence that the advice of the tissue viability specialist nurse had been sought. There were some photographs of wounds but these were not dated so tracking of progress was not possible. Full mapping of all wounds or sores to include grading, size, depth, exudate level and nature together with dressings prescribed and frequency of change must be maintained to ensure that improvements and deteriorations can be identified in the early stages to further plan the treatment to be given. All aspects of wound management including record keeping and practice needs improvement. Residents identified as having sensory impairment had no plans in place to address their special needs and plans in relation to their activities of daily living failed to reflect the additional input and care required due to their sensory impairment. Care plans for residents with specific cultural needs must demonstrate that any such needs e.g. dietary or communication have been identified and addressed. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 12 A Commission pharmacy inspector inspected medication receipt, storage, administration and disposal on 2nd November 2006. The inspector’s findings are as follows: There was no audit system in place for medication. Residents are at risk if the service has no way of monitoring the quality of medicines management within the home. It was not always possible to see exactly what medication residents had received and when. Not all medication received into and leaving the home had been recorded. When medication was not given, the reason was rarely recorded. There was no guidance available for the administration of when required medication. This meant that staff did not have enough information to be able to give medication effectively and safely. Poor record keeping puts the health and wellbeing of residents at risk of harm. Medication was not always given correctly. An audit of current stock showed that some Medication Administration Record charts (MARs) had been signed when items had not been given. Others showed that medicines had not been signed for, but could not be accounted for. The recording of nutritional supplements was particularly poor. Entries for these items on MARs did not match those kept on fluid balance charts. Two residents had been given supplements that they had not been prescribed, whilst another had been given more supplements than intended by the prescriber. Giving residents the wrong medication or the wrong dose places their health and wellbeing at risk of harm. Residents who had medication administered through feeding tubes were at particular risk. There was no written authority for crushed tablets and other medication to be given by this unlicensed route. Detailed procedures for the process were unavailable and records showed that tubes were frequently flushed with the incorrect volume of water. Some products such as Lactulose BP Solution, Movicol sachets and dressings were ‘shared’ amongst residents. This practice is illegal. Residents must only be given medication from their own named supply. Policies and procedures for the handling of medication must be reviewed in order to protect the health and wellbeing of residents. During this visit a substantial number of creams were found in residents rooms that did not belong to the relevant resident. Creams that are prescribed for individual residents and labelled appropriately must not be used for anyone else. Unlabelled creams were also found in rooms. The removal of the label and then use for another resident is not acceptable. The maintenance of residents’ privacy and dignity is of paramount importance. Residents were dressed and spoken to appropriately and all personal care was Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 13 given in private. The lack of tablecloths in the first floor dining area, the use of chipped and cracked crockery and residents eating their meal whilst other residents were smoking at the table are examples of how respect for the dignity of individual residents is compromised and this aspect of care delivery must be addressed urgently. Care files examined contained no reference to the residents’ or their representatives’ wishes in relation to death or dying. Whilst the home has relevant policies in place the resident or their representative must be consulted about their personal wishes which should be clearly recorded so that staff members are fully aware and can ensure that those wishes are met. Amber Court At Wavertree DS0000025083.V296888.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. As far as possible residents have choice and flexibility in how they spend their day in the home but limited activities and social recreation does not promote residents’ wellbeing. EVIDENCE: There is no activities co-ordinator at Amber Court at this moment in time. A concerned relative informed the commission in September that for their dependent there had been no social activity for a considerable period of time. The manager stated that the home is finding it very difficult to fill the position and that attempts to fill the vacancy are ongoing. There has been some organised activity e.g. clothes party in March and another planned for December, two outside entertainers and a trip to a tea dance but the level of activity falls far short of that required. As stated earlier in this report 50 of the residents have dementia and it is essential that that appropriate engagements and activities that focus on individual strengths and abilities are provided. The provision of one to one activities should be provided for those residents who cannot for whatever reason participate in-group activities. Taking account of the size of the home the number of residents and the high dependency of the residents it is strongly recommended that the home Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 15 consider a full time co-ordinator to promote a fully inclusive social recreation programme. The home has a policy of open visiting with friends and family welcome at any reasonable time and to stay as long as they and the resident wish. Visitors were observed to be arriving at the home throughout the day and residents were able to see their guests in one of the communal areas or in their own rooms as they wished. Meals are taken in one of the two dining rooms or in the residents’ own room if that is their choice. The more able residents use the dining room on the ground floor with the more frail and dependent residents using the first floor dining room. The dining room tables on the ground floor were nicely presented with tablecloths and appropriate condiments. The dining tables on the first floor lacked both tablecloths and condiments. Whilst some condiments were seen to be available residents were not asked whether they would like any, thereby restricting their choice. Chipped and cracked crockery was seen to be in use. One resident was seen attempting to eat their meal with a knife having dropped a fork on the floor but there was no intervention from staff. The midday meal served on the day of the visit did not look appetising and was not as according to the menu. One resident when asked did they like the food said ‘sometimes’ whilst another said ‘it is always cold’. Several residents require liquidised meals and these were presented after being pureed all together. The stimulation of colour, flavour and texture is lost when all elements are pureed together and is not acceptable. One residents’ meal was left uncovered on a tray on an armchair whilst the carer was assisting another resident. This meal was cold when it was eventually given to the resident. The menus seen show a two week cycle and appear to provide a wholesome and appealing diet. However there is no choice of an alternative main meal on the menu and as previously stated the meal served on the day was not in accordance with the menu. There is a need to address the dietary needs and preferences of those residents with different cultural backgrounds. Amber Court At Wavertree DS0000025083.V296888.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and their representatives cannot be confident that any complaints will be taken seriously and procedures to protect residents from abuse are not as robust as they should be potentially placing residents at risk of harm EVIDENCE: The home has policies and procedures in place for the management of complaints but there is no mechanism for the recording of such complaints. The CSCI has received five complaints from either concerned relatives or social services. Although four of these had been taken up with the home directly there were no records to show actions taken or outcome of investigation. The complaints received were in relation to lack of activities, lack of appropriate care and heating being turned off in residents’ room. One relative has moved their dependent to another home following a stay in hospital allegedly due to a lack of appropriate care. The home must ensure that all complaints whether verbal or in writing are recorded together with details of the complaint and the actions taken in order to demonstrate an open and transparent process. Training records show that 13 members of staff were scheduled to attend training in protection of the vulnerable adult in April 2006. However, the attendance sheet has not been signed and there is no evidence of actual attendance or who carried out the training. Training records are poor and it Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 17 was not possible to ascertain how many of the 60 member of staff employed at the home have received appropriate training in this important area. Recruitment procedures are addressed fully later in this report but a lack of robustness fails to promote protection for residents. Amber Court At Wavertree DS0000025083.V296888.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment at Amber Court is in need of redecoration and refurbishment in order to promote a homely, safe and comfortable place to live for the residents. EVIDENCE: A tour of the home was made accompanied by the manager. Residents’ rooms were found to be generally clean and tidy. A substantial number of creams were removed from rooms that were out of date, unlabelled or prescribed for another resident. Other inappropriate items such as a communal hairbrush and toiletries were removed from communal facilities. The carpet in corridor B is badly stained, worn and in one place is ripped causing a trip hazard and must be replaced. Corridor A and relevant communal areas have a grey non-slip surface floor covering. This flooring is in many places dirty and dull despite regular cleaning. The overall appearance is worn, drab and institutional and not conducive to residents’ wellbeing. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 19 One sluice was found to be open and without a lock and contained a sharps disposal container. Another storeroom containing various hazardous cleaning materials was found open. Toilets were seen with loose grab rails not secured to wall or floor, paper towel dispensers empty and in one case badly stained. One commode was seen to be dirty, another without an appropriate seat cover and several without bowls in situ. No shower had no drain cover in place. Several rooms were seen with bed rails in situ but no protective bumpers and another with only a single bed rail in use. The use of oxygen in one room was not indicated by a relevant warning sign on the door. All of these observations present a clear risk to the health, safety and welfare of residents. Lighting in the home is domestic in character but is inadequate in terms of brightness particularly in the communal areas and needs to be improved particularly to support and assist residents with dementia. There are sufficient and suitable lavatories for the residents use and appropriate aids such as handrails, grab handles, assisted bathing facilities and hoists are in place to maximise residents’ capabilities. There is a good level of personalisation of individual rooms with residents’ personal memorabilia and furniture. Amber Court At Wavertree DS0000025083.V296888.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 at least once during a 12 month period. 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. There are insufficient numbers of care staff employed to meet the assessed needs of the residents and recruitment policies and procedures are not robust and fail to support and protect the residents. EVIDENCE: Examination of the off duty records shows that there are insufficient staff to meet residents needs. The number of trained staff on duty is reduced to one and the number of carers from eight to five after 1400hrs each day. Given the size of the care home, high dependency of residents and 50 of residents having dementia these staffing levels are not adequate to meet the residents needs. The home is reminded that the level of care required and dependency of residents with dementia increases over the course of the day and staff must be available to meet those increased needs. Staffing levels must be reviewed as a priority. Off-duties do not have all the required detail. Agency staff were only identified by their first name with no indication of employing agency. Records show that 24 of staff have NVQ level 2 or higher. A selection of staff files were examined and showed a lack of compliance with requirements for the recruitment of staff. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 21 Out of five files examined three showed that the staff member had been confirmed in post and started work before a PovaFirst clearance had been received and in one case before it had been applied for. References had been accepted from personal friends and no request made to last employer and in one case the two previous employers had both been care homes. There was no evidence that references were verified or that reasons for leaving previous employment or gaps in employment history were explored. None of the files had appropriate job descriptions or contracts of employment in situ. Evidence of induction within the staff files was not present in two files. Induction records when present were inadequate and do not meet the ‘Skills for Care’ guidelines. The home must provide a structured induction to care programme for newly appointed staff. Training records are poor and comprise the attendance sheets for relevant training sessions during the last twelve months. However most of these attendance sheets have not been signed by staff members attending and do not give any indication of who carried out the training. Incomplete records such as these cannot be accepted as evidence of training. Even if the records were acceptable it is clear that training falls far short of requirements. Training subject Adult protection First aid Fire prevention Moving & Handling HIV/Aids Male Catheterisation Oral Health Health & safety Coshh Food Hygiene Number of names on sheet 13 7 6 5 11 3 3 22 23 14 Number signed as attended 0 0 0 0 0 2 0 9 23 0 Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36,37,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management at Amber Court needs to be strengthened in order to promote the health, safety and welfare of residents. EVIDENCE: The registered manager has recently returned to the home following a period of extended leave. During her absence the deputy manager managed the home. However, the time made available for management duties during this time was limited. There is no evidence of a system of quality assurance, which takes account of residents’ views or continuous self-monitoring. Staff meetings have been held and are minuted. There is a need to ensure that steps are taken to ensure that night staff are included in meetings and have the opportunity to fully participate. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 23 Residents’ monies are held in a separate ‘Wavertree Residents Pocket Money’ account with the registered manager and administrator being joint signatories. This account however, is a non-interest bearing account and the home should investigate the feasibility of changing to an interest bearing account with appropriate interest being apportioned to the relevant residents. No resident’s monies are held at the home and all expenditure is made via a float system. Receipts for any expenditure on behalf of residents are kept. Formal staff supervision is in place and some evidence was seen. However, the managers’ absence has led to formal supervision falling behind and the home is reminded that formal staff supervision is required at least six times per year which requires supervision to be held approximately every eight weeks. Policies and Procedures are in place but there is a need to review and update policies inline with current legislation were appropriate e.g. fire policy last reviewed in 2002. A policy review should also put in place missing policies e.g. peg feeding. The home must also ensure that any guidelines used as a basis for care are up to date e.g. Pressure sore grading guidelines were dated 1985 and have been superseded. Records are held securely and in accordance with the date Protection Act and accessible to residents if requested. The use of books such as communications book, weight and observations book is not in accordance with the Data Protection Act and is not acceptable. Fire alarm and emergency lighting tests are carried out at regular intervals and all portable appliance tests were up to date. The periodic electrical examination certificate seen expired in June 2006 and an appropriate gas safety certificate was not available. The annual inspection certificates for the fire alarm and emergency lighting systems expired in June 2005. The home has not had a fire risk assessment carried out. The home must arrange for all appropriate inspections and assessments as a priority and forward copies of the relevant certificates to the CSCI. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 24 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 2 3 1 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 2 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 1 2 Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 25 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 Regulation 6 Requirement Timescale for action 31/01/07 2 OP3 14(1) 3 OP4 12(1) The registered person shall(a) keep under review and, where appropriate, revise the Statement of Purpose and the Service User’s Guide; and (b) notify the Commission and service users of any such revision within 28 days 30/11/06 The registered person must ensure that new service users are admitted only on the basis of a full assessment undertaken by people trained to do so and to which the prospective service user or their representative and any relevant professionals have been party and that such assessments are fully documented. The registered person shall 30/11/06 ensure that the care home is conducted so as – (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care DS0000025083.V296888.R01.S.doc Version 5.2 Amber Court At Wavertree Page 26 and, where appropriate, treatment, education and supervision of service users. 4 OP7 15(1) The registered person shall, after 31/12/06 consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall – 31/12/06 (c) keep the service user’s plan under review (d) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and (e) notify the service user of any such revision The registered person shall make 30/11/06 arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional The registered person must ensure that medication policies and procedures be reviewed in line with Royal Pharmaceutical Society of Great Britain and Nursing & Midwifery Council guidelines to cover all aspects of medicines management. The registered person must ensure that full and accurate records are kept of all medicines received, administered and leaving the care of the home. DS0000025083.V296888.R01.S.doc 5 OP7 (c)(d) 15(2)(b) 6 OP8 13(1)(b) 7 OP9 13(2) 30/11/06 8 OP9 13(2) Sch 3 (i) 30/11/06 Amber Court At Wavertree Version 5.2 Page 27 There must be a full record of all medication currently prescribed for each resident. 9 OP9 13(2) The registered person must ensure that all medication is only administered in accordance with the General Practitioners instructions The registered person must ensure that medicines are only administered to the resident for whom they were prescribed. There must be no sharing of creams or other preparations. The registered person must ensure that there is a detailed protocol and procedure in place for the administration of medication via PEG tubes. Written authorisation for this practice must be obtained from the resident’s General Practitioner. 30/11/06 10 OP9 13(2) 30/11/06 11 OP9 13(2) 30/11/06 12 OP9 24(1) 13 OP10 12(4) The registered person must 30/11/06 ensure that there is an effective system in place to audit medicines management within the service The registered person shall make 30/11/06 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. The registered person shall so far as is practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare (refer specifically to consultation about terminal care and arrangements after death with service user) DS0000025083.V296888.R01.S.doc 14 OP11 12(2) 30/11/06 Amber Court At Wavertree Version 5.2 Page 28 15 OP12 16(2)(n) 16 OP14 12(3) 17 OP15 16(2)(g)(i) The registered shall having 31/12/06 regard to the size of the care home and the number and needs of service users – Consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The registered person shall, for 30/11/06 the purpose of providing care to service users, and making proper provision for their health and welfare, so far as practicable ascertain and take into account their wishes and feelings The registered person shall 30/11/06 having regard to the size of the care home and the number and needs of service users – (g) provide sufficient and suitable equipment, crockery and utensils (h) provide, in adequate quantities, suitable, wholesome and nutritious food which is varied and properly prepared and available at such time as may be reasonably be required by service users The registered person shall maintain in the care home the records specified in schedule 4 of the Care Homes Regulations 2001 specifically as detailed in schedule 4 para. 11 – A record of all complaints made by service users or representatives or relatives of service users or by persons working at the care home about the operation of the care home, DS0000025083.V296888.R01.S.doc 18 OP16 17(2) Sched(4)(11) 30/11/06 Amber Court At Wavertree Version 5.2 Page 29 19 OP18 13(6) 20 OP19 23(2)(d) 21 OP25 23(2)(p) 22 OP26 13(4) (a)(b)(c) 23 OP27 18(1) and the action taken by the registered person in respect of any such complaint The registered person shall make arrangements, by training or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse The registered shall having regard to the size of the care home and the number and needs of service users ensure that all parts of the care home are kept clean and reasonably decorated and produce a programme of redecoration and refurbishment and forward a copy to the CSCI The registered shall having regard to the size of the care home and the number and needs of service users ensure that ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users The registered person shall ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated The registered person shall, having regard to the size of the care home, the statement of DS0000025083.V296888.R01.S.doc 31/12/06 31/12/06 31/12/06 31/12/06 30/11/06 Amber Court At Wavertree Version 5.2 Page 30 24 OP29 19(1)(a) 25 26 OP30 13(4) 13(5) OP30 27 OP30 23(4)(d) 28 OP30 18(c) Purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users The registered person shall not employ a person to work at the home unless – (a) the person is fit to work at the care home (b) he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001 (c) he is satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person The registered person shall make suitable arrangements for the training of staff in first aid The registered person shall make suitable arrangements to provide a safe system for moving and handling service users The registered person shall make arrangements for persons working at the care home to receive suitable training in fire prevention The registered person shall, having regard to the size of the care home, the statement of Purpose and the number and needs of service users ensure that the persons employed by the registered person to work at DS0000025083.V296888.R01.S.doc 30/11/06 31/12/06 31/12/06 31/12/06 30/11/06 Amber Court At Wavertree Version 5.2 Page 31 29 OP31 10(1) 30 OP33 24(1)(5) 31 OP36 18(2) 32 OP37 17(3) 33 OP38 23(4A) the care home receive – (i) training appropriate to the work they are to perform including structured induction training; and (ii) suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work The registered provider and registered manager shall, having regard to the size of the care home, the statement of Purpose and the number and needs of service users carry on or manage the care home (as the case may be) with sufficient care, competence and skill. The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home and the system shall provide for consultation with service users and their representatives. The registered person shall ensure that persons working at the home are appropriately supervised with formal supervision at least six times per year The registered person shall ensure that all records as detailed in schedules 3 and 4 of the Care Homes Regulations 2001 are kept up to date and are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. The registered person shall ensure that a fire risk DS0000025083.V296888.R01.S.doc 30/11/06 31/12/06 31/12/06 31/12/06 31/12/06 Page 32 Amber Court At Wavertree Version 5.2 34 OP38 13(4) assessment is carried out and a copy forwarded to the Commission for Social care Inspection. The registered person must 31/12/06 ensure that copies of relevant certificates are forwarded CSCI when available (specifically periodic electrical inspection, Gas safety, Fire alarm, emergency lights and nurse call system) 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 strongly recommended that consideration be given to the employment of a dedicated activity co-ordinator. Amber Court At Wavertree DS0000025083.V296888.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Liverpool Satellite 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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