Inspection on 31/08/05 for Wavertree Nursing and Residential Home

This inspection was carried out on 31st August 2005.

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

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

Other inspections for this house

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... 15/03/06

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 Leila Mavropoulou Unannounced Inspection 31st August 2005 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 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.V251131.R01.S.doc Version 5.0 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.V251131.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 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 9th December 2004 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.V251131.R01.S.doc Version 5.0 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, 6 staff, the manager and the provider were spoken to. Some residents and staff files were inspected as well as other records the home is oblige to keep. In addition the premises were inspected. What the service does well: What has improved since the last inspection? The armchairs in the sitting room and the reception area have been reupholstered and new bedroom furniture purchased, for some of the bedrooms to improve the physical environment of the home. The staffing records and staff supervision has improved since the last inspection to promote the safety of the residents and by ensuring that staff have the necessary skills to carry out their role effectively. The staff at the care home have attended a number of training courses and various other courses are booked for staff in the coming months to improve the quality of care provided to the residents. The sickness level and staff turnover has reduced in recent months, thus providing continuity of care to the residents. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 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.V251131.R01.S.doc Version 5.0 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): 1,2,3,6 The staff at the care home carries out their own assessment of the prospective resident needs to ensure that the home would be able to meet their assessed needs. 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. Currently, the manager is amending the home’s Statement of Purpose to reflect changes in the home. The inspector was shown a draft copy of the proposed Statement of Purpose. The manager or the deputy manager of the home would assess the needs of prospective residents prior to offering them a place at Amber Court, to ensure that the home would be able to meet the resident’s needs within the home’s exiting staffing and resources. The staff at the home would support the prospective resident to visit the care prior to making a decision about the Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 9 suitability of the home. Discussion with the manager indicated that more often than not it is the prospective resident family that visit the home to assess its suitability. Once a resident is admitted to the care home a basic care plan is devised from the information obtained from the pre-admission assessment to ensure that staff are aware of the needs of the resident and how they are to be met. This was evidenced in the resident records. All residents are issued with a contract that sets out the weekly fees, period of notice required and what is included in the weekly fees. An amendment is made to the initial resident contract when the weekly fee is increased and the resident or their family are inform by letter and a copy of the letter is kept on file. The home does not provide intermediate care. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 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 would change aspect of the resident care plan to reflect changes in the care that resident require. The nursing staff also, carries out various other assessment 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. The health care of the residents’ is met through regular monitoring by the nursing and care staff and where necessary advice from other health Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 11 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. The nursing staff at the care home administers most of the residents’ medication in the care home. However, residents are able to administer their own medication once the nursing staff assesses the resident as being competent to do so safely. The staff maintains a record of all of the residents medication received into the care home and returned to the pharmacist. The recording of administration of residents’ medication has improved since the last inspection. However, there were still some omissions of recording on the resident’s medication chart when the medication should have been administered. Observation of staff supporting the residents showed that the residents are treated 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 even though many of the bedrooms could accommodate two people. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 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. These included bingo, sing-a-long, outings, entertainers coming into the home etc. The home organises group outings to the Zoe’s Place for coffee mornings and socials held by other organisations such as the British Legion. Recently, some of the residents went to Southport for the day. This was funded through the fund raising by the staff and a contribution from the home. The home employs an activities person for twenty hours a week to organise activities for the residents. However, this post is currently vacant. The home has an unrestricted visiting policy and residents are able to choose where to see their visitors. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 13 The staff would support the residents to maintain their own finance by following the home’s Management of resident money, valuables and financial affairs procedure. Currently, the residents manage their finances independently or through their family or solicitor. A secure place is provided for residents to store valuables and monies in accordance with the home’s policy. The staff would give the resident a receipt for item handed over for safekeeping. Where items are bought on behalf of the residents a written record is maintained and receipts are kept. 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. The presentation of the meals liquefied could be improved in its appearance/ presentation to make the meal look more appetising. The kitchen staff are booked to attend a Nutritional Support training day. Currently, the home has a high number of residents that require full assistance at mealtimes and many that require prompting and minimal support. Given these numbers it is difficult for the staff to provide assistance to the residents in an unhurried manner and discreetly to promote the residents’ independence and dignity. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 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): 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 encourage residents and their family to use. The home’s complaints procedure is displayed in the reception area. Discussion with the manager is that often if the resident or family has any concerns they would speak to a member of staff or her and the issue would be address before it is formalised. 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 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.V251131.R01.S.doc Version 5.0 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): 19,20,22,24,25,26 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. Since, the last inspection some of the vacant rooms have been redecorated and new furniture has been purchased for some of the bedrooms. In addition the lounge and reception area furniture have been recovered. The grounds of the home are clean, well maintained and are easily accessible to the residents. The manager informed the inspector that the environmental officer visited the home recently and was satisfied, as no recommendations were made. At the time of the inspection the home was awaiting a letter from the environmental officer to confirm their visit and findings. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 16 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 a 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 provided is in single bedrooms even though many of the bedrooms are able to accommodate two residents. All of the bedrooms are easily accessible and the doors are wide enough for wheelchair users. The accommodation throughout is centrally heated, well lit and ventilated. Emergency lighting is provided throughout the home and is checked regularly as evidenced in the home fire records and water temperatures are checked regularly and records are maintained. The home has a large laundry room on the ground floor, which is located away from the food preparation area. The home has two washing machines one of which has been repaired several times in the previous months. The staff commented that when only one washing machine is working, keeping up with the laundry is very difficult especially since there is a high level of incontinence in the home. The home has various policies and procedures in place to prevent the spread of infection. Observation of staff showed that the necessary protective clothing is provided and used by the staff at the home to promote the health of the residents. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 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): 27,29,28 The staffing level of 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: The home maintains a record of all staff employed in the care home and what capacity they are working. 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 care staff hours should be increased to reflect the level of dependency particularly in the mornings when the residents are being dressed and given breakfast. The staff told the inspector that an additional carer between 8-12 in the mornings would enable them to meet the care needs of the residents better, as they would be able to spend more time providing care to the residents. 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 a 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. In addition planned training for the qualified nursing staff includes: Syringe Driver training, Palliative Care for beginners, Wound Care Management and Bedrail assessment. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 18 Inspection of some of the staff records show that two written references and a Criminal Records Bureau check for all staff are obtained, before the staff could commence their employment in the care home. This is to protect the residents from all forms of abuse. The staff files show that they are given a written terms and conditions of employment. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 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): 31,33,35,38 The management of the home promote the safety of the residents through regularly reviewing all aspect of the homes operation. EVIDENCE: Discussion and observation with the manager showed that she is approachable and accessible to residents, their family and to staff at all times. Discussion with the staff show that they feel that the manager provide direction and leadership and work towards promoting the residents’ choice and independence. 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. The home has implemented “one to one” supervision of staff and a record is maintained of issues discussed in supervision. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 20 The home has a current Public Liability Insurance displayed and discussion with the home’s administrator indicated that records are kept of all expenditure in the care home for accounting purposes. The residents are able to access their records in accordance with the home’s policy on access of information. It was observed that residents’ records were kept in a secure place. The health and safety of the residents is promoted through the staff receiving appropriate training in food hygiene, first aid, moving and handling and fire awareness. Some staff including night staff are attending a course on Emergency Lift Management to promote the safety of the residents. Fire drills are carried out regularly as evidenced in the home’s fire records. 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.V251131.R01.S.doc Version 5.0 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 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 x 3 x x 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x 3 3 3 3 3 Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement The registered person must ensure that an accurate record is maintained of all service users medication administered. The registered person must ensure that staffing level at the care home reflect the assessed needs of the residents. Timescale for action 01/11/05 2 OP15 18 01/11/05 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 2 Refer to Standard OP15 OP16 Good Practice Recommendations The registered person should ensure that liquefied meals are presented in a manner that is attractive and appetising. The registered person should record all informal complaints, which should be review at regular intervals to assess if the quality of care could be improved from the informal complaints received. The registered person should consider replacement of the washing machine if it continues to breakdown frequently as it has an impact on the operation of the home. DS0000025083.V251131.R01.S.doc Version 5.0 Page 23 3 OP26 Amber Court At Wavertree 2 15 The registered should ensure that liquefied meals are presented in a manner that is attractive and appetising. Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Amber Court At Wavertree DS0000025083.V251131.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!