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Inspection on 09/10/07 for Wavertree Nursing and Residential Home

Also see our care home review for Wavertree Nursing and Residential Home for more information

This inspection was carried out on 9th October 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There was a warm and friendly atmosphere and staff were seen interacting well with both residents and visitors. Residents were relaxed in the company of staff. Staff were observed to be respectful and caring with residents. A relative interviewed stated, "....`s health has improved a great deal since moving in here". Residents were generally happy with the way they live their lives and enjoy a nutritious diet. Residents interviewed stated, "I have an egg or bacon sandwich for my breakfast" and "...she is eating and drinking which she wasn`t doing before".

What has improved since the last inspection?

Some developments have been made to the statement of purpose since the last inspection. The draft copy was viewed. In the main it was okay however some further changes are required in order for it to fully meet the aims and objectives of the service so that people have accurate and up to date information about the service. The service has employed an activities coordinator who meets with the residents regularly throughout the week and plans events suited to their individual needs. One relative interviewed stated, " ....chooses not to join in activities but there are lots of things to do for those who want to join in". Some of the staff have attended abuse training this year, which creates awareness and safeguards residents. Some staff have attended manual handling training this year, promoting safe moving practices in the home. Residents live in a safe and comfortable environment, which is clean and odour free. New carpets have been fitted to all of the residents` bedrooms since the last inspection. The dining rooms have improved with tablecloths and flower arrangements in place. Relatives interviewed stated, "the room is very nice, it has been personalised with many of ...`s own things from home", "the bedroom is clean and homely" and "I am happy with the room it is always clean". A fire risk assessment of the building has taken place with recommendations being actioned.

What the care home could do better:

The assessment process did not fully identify all of the prospective residents needs, which compromises their health. The service needs to ensure that a full and detailed assessment is carried out for all individual residents before admitting them to the service. This will ensure the service is knowledgeable about prospective residents and know they can address their needs before admission. Residents are at risk of having their healthcare needs compromised due to irregular reviews of residents` care and poor record keeping. This is because people`s health and care needs are not regularly monitored and recorded which means that staff are not up to date with residents` conditions. Care plans do not reflect the changing needs of the residents. Care plans also need to be agreed and signed by the resident or their representative to show that they were involved in and agree with their plan of care. The administration of medication needs to be improved to ensure that all residents receive prescribed medication at the correct time and staff should sign the medication administration record sheet at the time of administering medication. The deputy is to commence a weekly-recorded audit to improve the management of medication in the service. The complaints procedure is not always followed therefore residents may be at risk. The service needs to ensure that residents and their relatives are listened to. All concerns/complaints raised need to be recorded and investigated. Residents` health and welfare may be compromised due to erratic staffing levels and lack of training. Staff interviewed commented, "we could do with another member of staff" and "the home is more nursing home now". Pre employment checks are not robust therefore they do not protect the residents. The service needs to ensure that all staff has sufficient training and a structured induction on commencement of employment so that people are clear about their roles and responsibilities. The service needs to improve their quality assurance systems. This will provide information so that the service can look to providing an improved service. The existing management structure is not robust to protect the residents. At present the deputy manager has taken on the role of manager temporarily due to the long-term sickness of the registered manager. The deputy is not supernumerary therefore is unable to have the time to manage the service efficiently. The deputy is also working extra hours to try and compensate for this. Requirements have been made following this visit with some of themoutstanding from the previous inspection. The deputy has made some effort to try and address some of the issues. The service needs to ensure support systems are in place for the deputy manager to ensure the residents care is not compromised.

CARE HOMES FOR OLDER PEOPLE Wavertree Nursing and Residential Home Pighue Lane Wavertree Liverpool Merseyside L13 1DG Lead Inspector Mrs Margaret Van Schaick & Mrs Janet Marshall Key Unannounced Inspection 9th October 2007 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 Wavertree Nursing and Residential Home DS0000025083.V343509.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. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wavertree Nursing and Residential Home 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 Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate up to a maximum of 26 nursing and 24 personal care within the overall total of 48. To accommodate four named service users under the age of 65, but no younger than 55 years. To accommodate one named service user under the age of 55. Date of last inspection 14th February 2007 Brief Description of the Service: Wavertree Nursing and Residential Home is a purpose built care home providing both nursing and personal care to 48 residents. Bedroom accommodation is provided on the first floor and is 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 range from £317:50 to £395:00. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A site visit took place as part of the unannounced inspection. Two inspectors spent one day at the service for 8.5 hours. The Commissions pharmacist visited the service the following day for approximately 5.5 hours. Thirty-nine residents were accommodated at this time. A tour of the premises took place including many residents’ bedrooms and all public areas. Care documentation, staff and health and safety records were viewed. Discussion took place with several residents and three were interviewed on a one to one basis. Eight relatives were interviewed. Discussion also took place with many staff and three were interviewed. The inspection was conducted with Mrs Russell (deputy manager) and Mr Chaudhry (provider) was present for some of the time. During the inspection four residents were case tracked. (This gives the inspector the opportunity to follow the care of a resident from their first assessment to the care they receive. It included discussion with residents, their relatives or representatives, care workers, other professionals and the homes provider and deputy manager). Residents care records were also checked as part of the case tracking process. All key standards were inspected and previous requirements and recommendations were discussed. Satisfaction survey forms “have your say about….” Were distributed to a number of residents, relatives and staff during the visit. A number of comments included in this report are taken from surveys and interviews. An AQAA (annual quality assurance assessment) was completed by the registered manager prior to the site visit. The AQAA comprises of two selfquestionnaires that focus on the outcomes for people. The self-assessment provided information as to how the manager and staff are meeting the needs of the current residents and a data set that gave basic facts and figures about the service, including staff numbers and training. What the service does well: Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 6 There was a warm and friendly atmosphere and staff were seen interacting well with both residents and visitors. Residents were relaxed in the company of staff. Staff were observed to be respectful and caring with residents. A relative interviewed stated, “….’s health has improved a great deal since moving in here”. Residents were generally happy with the way they live their lives and enjoy a nutritious diet. Residents interviewed stated, “I have an egg or bacon sandwich for my breakfast” and “…she is eating and drinking which she wasn’t doing before”. What has improved since the last inspection? Some developments have been made to the statement of purpose since the last inspection. The draft copy was viewed. In the main it was okay however some further changes are required in order for it to fully meet the aims and objectives of the service so that people have accurate and up to date information about the service. The service has employed an activities coordinator who meets with the residents regularly throughout the week and plans events suited to their individual needs. One relative interviewed stated, “ ….chooses not to join in activities but there are lots of things to do for those who want to join in”. Some of the staff have attended abuse training this year, which creates awareness and safeguards residents. Some staff have attended manual handling training this year, promoting safe moving practices in the home. Residents live in a safe and comfortable environment, which is clean and odour free. New carpets have been fitted to all of the residents’ bedrooms since the last inspection. The dining rooms have improved with tablecloths and flower arrangements in place. Relatives interviewed stated, “the room is very nice, it has been personalised with many of …’s own things from home”, “the bedroom is clean and homely” and “I am happy with the room it is always clean”. A fire risk assessment of the building has taken place with recommendations being actioned. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 7 What they could do better: The assessment process did not fully identify all of the prospective residents needs, which compromises their health. The service needs to ensure that a full and detailed assessment is carried out for all individual residents before admitting them to the service. This will ensure the service is knowledgeable about prospective residents and know they can address their needs before admission. Residents are at risk of having their healthcare needs compromised due to irregular reviews of residents’ care and poor record keeping. This is because people’s health and care needs are not regularly monitored and recorded which means that staff are not up to date with residents’ conditions. Care plans do not reflect the changing needs of the residents. Care plans also need to be agreed and signed by the resident or their representative to show that they were involved in and agree with their plan of care. The administration of medication needs to be improved to ensure that all residents receive prescribed medication at the correct time and staff should sign the medication administration record sheet at the time of administering medication. The deputy is to commence a weekly-recorded audit to improve the management of medication in the service. The complaints procedure is not always followed therefore residents may be at risk. The service needs to ensure that residents and their relatives are listened to. All concerns/complaints raised need to be recorded and investigated. Residents’ health and welfare may be compromised due to erratic staffing levels and lack of training. Staff interviewed commented, “we could do with another member of staff” and “the home is more nursing home now”. Pre employment checks are not robust therefore they do not protect the residents. The service needs to ensure that all staff has sufficient training and a structured induction on commencement of employment so that people are clear about their roles and responsibilities. The service needs to improve their quality assurance systems. This will provide information so that the service can look to providing an improved service. The existing management structure is not robust to protect the residents. At present the deputy manager has taken on the role of manager temporarily due to the long-term sickness of the registered manager. The deputy is not supernumerary therefore is unable to have the time to manage the service efficiently. The deputy is also working extra hours to try and compensate for this. Requirements have been made following this visit with some of them Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 8 outstanding from the previous inspection. The deputy has made some effort to try and address some of the issues. The service needs to ensure support systems are in place for the deputy manager to ensure the residents care is not compromised. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 9 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 Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 1,3. Op6 not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment process does not fully identify all of the prospective residents needs therefore this may compromise residents health. EVIDENCE: The Statement of Purpose and Service User Guide is in the process of being updated to fully reflect the facilities and services. A draft copy of the amended documents were examined as part of the inspection visit and discussion took place with regard to what additions still need to be implemented. The required details were explained to the deputy manager. Assessments for residents were viewed. Four residents were case tracked (care files are examined). Each resident had an individual care file and the four files viewed evidenced assessment documentation. The assessments seen did not provide sufficient information to ensure all residents care needs Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 11 were identified and planned. Some of the assessment documentation was not completed at all. One assessment evidences by the date that it was carried out after admission. The service will not know if they are able to confidently meet prospective residents needs unless a full and detailed assessment is carried out prior to admission. The deputy manager said she intends to commence a review of residents’ documentation and the assessment process is one that she is seeking to improve. Relatives interviewed with regard to the admission process stated, “we visited a number of homes before choosing here, we were shown around and given the information before ……moved in”, “we looked at a number of homes before choosing here, we looked around the home and were shown the room” and “the social worker gave us the details of the services, and we chose this one”. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are at risk of having their healthcare needs compromised due to irregular reviews of residents’ care and poor record keeping. EVIDENCE: Each of the residents living at the home had personal file, which contained a care plan. Four care plans were looked at in detail as part of the case tracking process. The care files were disorganised making them difficult to use. Basic information including eating and drinking, elimination, mobility, communication and personal hygiene needs were included in the care plans, however, care plans were not up to date and did not reflect the changes in residents personal and healthcare needs. Reviews classed as necessary due to residents’ physical health were not reviewed often enough. One resident had no care plan for their mental health problem. One resident who had a wound Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 13 had a care plan in place but there was no up to date record on the care plan as to how this wound is being monitored. There was no diagram to ascertain the wound progress. There was also insufficient detail recorded in the care plans for staff to be fully aware of the individual care needs of the residents. Care files evidence that other health professionals visit the residents including GP’s chiropodists, district nurses and opticians. Residents whose nutritional needs are compromised have access to a dietician. The dietician visited the service during the inspection and confirmed that the service carries out all advice and instructions for the residents she provides support for. Risk assessments were in place, with regard to nutritional needs, pressure sores, manual handling, smoking; bed rails and falls although they were not up to date. During a tour of the service, two of the residents were observed to be strapped into chairs. This is not acceptable as it is a form of restraint and was not part of the persons care plan. A daily record is recorded in residents’ files to evidence the support and care provided by staff each day. Care plans did not evidence any agreement or involvement of the resident, their family or representative, therefore there was no guarantee that they have agreed to their plan of care or are involved in reviewing them. Some of the record keeping was being recorded in various books. Therefore it was difficult to ascertain information relating to individual residents. Residents and relatives were complimentary about how their care needs were met. Residents interviewed stated, “They make sure I take my tablets and that I drink enough”. Relatives interviewed stated, “they seem to know how to look after her, the Doctors have come to see …..staff wash, bath and toilet my wife, they are very tender and very caring”. Another relative interviewed stated, “…’s health has improved a great deal since moving in here”. During the visit staff were noted to converse with residents in a friendly and respectful manner. Residents were well groomed. Personal care was provided in the residents’ individual bedrooms. Following discussion with staff they were able to provide good examples of privacy, dignity and respect towards residents. Relatives interviewed stated, “staff are always polite, respect ….privacy and dignity, they always knock on the door before entering their room, they talk to …politely” and “staff always knock on the door and they make sure the door is shut when carrying out personal care”. Another relative commented, “well looked after, always clean with clean clothes every day” and “my husband gets the best care possible, the staff are kind, pleasant and helpful”. The commission’s pharmacist carried out an inspection of the management of medications. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 14 The medicines policy was available for reference but did not always provide clear guidance about the management of medicines in the home. It should be reviewed to help ensure consistency in the handling of medication. A sample audit of records and blistered medication showed that medicines were mostly administered as prescribed. But, on the inspection day the medication records were not referred to nor completed at the time the medicines were given. In failing to refer to the records the nurse was reliant on memory when completing the administration records. This practice puts residents at risk of accidentally missing medication and of any mistakes going unnoticed. Sometimes, where e.g. ‘one or two’ tablets were prescribed the actual dose given was not recorded. Some records listed medication (mostly creams) that nurses thought had been ‘stopped’. To reduce the risk of mistakes a note should be made on the administration record when medicines are ‘stopped’. Most administration records were pre-printed but handwritten entries were not checked by and signed by a second person. This is recommended to help reduce the risk of mistakes. Arrangements were in place for residents with minor ailments such as mild pain to have treatment without delay (home remedies). Residents wishing to manage some of their own medication were supported do so safely Medicines were securely stored within the medicines rooms but during the medication round the medicines packs were spread out across a table, and left unattended whilst medicines were administered. Medicines should not be left unattended and should be handled in such way that they can be quickly locked away in case of emergency to ensure residents health and safety. We saw that morning medicines were still being administered at 11:00 and that the round was not finished until 11:40. One resident asked the nurse why he hadn’t had his tablets yet. The nurses said the medicine round normally finished earlier. The times that medicines are given should be monitored to make sure enough time is left between doses of the same medicine. The deputy manger explained that audits (checks) of medication handling were carried out. She was aware that nurses did not always sign the administration records at the time they administered medication. To try and monitor and improve the handling of medication the deputy manager plans to carry out a new weekly medication audit. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are generally happy with the way they live their lives and enjoy a nutritious diet. EVIDENCE: There was a friendly atmosphere in the home and visitors were received warmly by the staff and were able to meet residents in their bedrooms or lounges. Some of the residents prefer to spend time in their bedrooms and this is accommodated. Some relatives visit the home on a daily basis. Visitors interviewed stated, “we visit daily and are always made to feel welcome, we can visit anytime of the day and evening”. A resident interviewed stated, “I like it very much, it’s more homely, more efficient than others”. The residents’ notice board advertised the planned events for the next two to three weeks, which included outside entertainers at the home. The deputy confirmed that significant improvements have been made in this area since the last inspection and this includes the appointment of an activities co-ordinator who works 24 hours each week. A tour of the activities room took place. It was clean and bright. Equipment included, art and craft materials, a piano, Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 16 tables and chairs, music equipment, sewing and tapestry equipment. Work that residents are currently involved in was on display in the room. A number of residents confirmed their involvement in activities at the home. They said they really enjoy them. Discussion took place with the activities coordinator who confirmed they organised activities both in and out side the home for residents. The activities coordinator has also taken up activities training and provides support to residents with 1-1 and group activities. Activities also include knitting, outings, entertainers, tea dances and musicals. Residents interviewed stated, “I haven’t seen any activities while I’ve been here” and ….chooses not to join in activities but there are lots of things to do for those who want to join in”. The home has a hairdressing team that visit each Tuesday to provide a hairdressing service to residents at the home. A hairdressing salon, which is on the ground floor near to the entrance of the home, was well equipped and suitable for the purpose. One resident was having her hair washed and set. She stated, “I have my hair done every week”. The home has links with the local church and residents have a lay preacher from the RC church visiting every Monday to deliver a service and offer Holy Communion. Another resident receives visits from his church minister on a regular basis. There are some concerns with regard to the service being unable to contact the local church representative for one resident therefore this needs to be looked into and resolved so that all residents who wish to can have access to a representative of their persuasion. Some of the residents of other faiths are not practising. This is their choice although staff have tried to involve some residents to attend multicultural events locally in Liverpool but they have declined to date. There are two dining rooms in the home to cater for residents mealtimes, both were clean spacious and comfortable. Residents who wish to can have their meals served in their bedrooms. Staff were observed assisting residents were needed. Staff took time to sit down with the residents whilst assisting them with their meals. The evening meal was unrushed and staff served the residents individually. Staff were observed explaining to residents what they were about to do before assisting them. Staff were seen offering residents and visitors drinks and snacks during the visit. One resident confirmed that they had a special diet and has lived here many years and is happy. Comments made by residents and relatives include: “I like the food, I have my meals in the dining room, I have a bacon or egg sandwich for breakfast and soup and a ham sandwich for lunch, there is a choice”, “the food is not too good, more variety is needed” and “…is eating and drinking which she wasn’t doing before”. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 17 Dietary advice is sought where needed from the local health personnel as documented in care files. The assistant dietician visited the service during the inspection. The dietician advised the inspectors that she visits the service three monthly to discuss the management of some of the residents’ nutritional needs. All advice given is acted upon and all instructions are followed. Menus were viewed during the visit. The lunch menu was on display and the main course was sausage and onion with no other choice listed. It was confirmed that this is usual. There was a choice of puddings. The new menus were viewed and these offered no choice for the main meal either. Following discussion with the deputy she is to update the menu with choices for the main meals also. Home baking was in evidence and the cook advised that she often bakes including apple pies and scones. A tour of the kitchen storage areas evidenced plenty of fresh food including vegetables, tinned and dried foods The safer food better business document is in use. The diary record showed hot food temperatures. Records showed that meals cooked are occasionally entered in the diary and some cleaning chores are entered and daily fridge freezer temperatures are included. The cooks and kitchen staff confirmed they have attended the Basic Food Hygiene Course last year. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Op16,18 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. That the complaints procedure is not always followed therefore residents may be at risk. EVIDENCE: A complaints procedure is in place including contact details of the Commission. The complaints log was viewed and complaints logged since the last inspection visit evidenced all three were investigated with outcomes recorded. One Adult Protection complaint was upheld. One recent complaint raised by the family of a resident had been passed on to the Commission, as the family were not happy with the staff response to their concerns. The complaints log had no record of any of the concerns that the family had raised. Therefore staff need to be fully aware of the concerns/complaints process to ensure all residents and relatives concerns and complaints are listened to, recorded and investigated with outcomes documented also. Relatives interviewed stated, “we are not aware of the complaints procedure, but would tell someone if they were unhappy, we know who to speak to”, “I have no concerns”. The service also needs to ensure that residents are protected by the visiting policy. No one should be allowed into the home other than for authentic or Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 19 professional visits. This is in response to the lady visiting the hairdressing salon who had an appointment for their hair to be ‘done’. A list of staff that attended adult abuse training was recorded but there are no certificates of attendance available to confirm their attendance. Staff interviewed confirmed they had attended abuse training. Staff interviewed stated, “I would tell someone if I saw a resident being abused”. The staff member also described clearly what they would do. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,26 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and comfortable environment. EVIDENCE: The home is purpose built and all residents bedrooms are situated on the first floor. Residents’ bedrooms were viewed during the inspection visit and all viewed were bright and furnished to a good standard. All rooms were fitted with a vanity sink and a nurse call bell. Pictures, photographs, ornaments, plants and easy chairs were just some of the items seen in bedrooms giving them a more comfortable and homely feel. New carpets have been fitted to all bedrooms since the last inspection. Those seen, matched the decoration in the rooms and appeared to be of a good standard. Relatives interviewed stated, “…’s room is always clean and tidy, the bed is changed every day”, “the room is very nice, it has been personalised with many of …’s own things from home”, Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 21 “the bedroom is clean and homely” and “I am happy with the room it is always clean”. The ground floor dining room, which is next to the main kitchen, was spacious clean and bright. The décor was of a good standard. There were pictures on the walls and each of the dining tables were set with table clothes, colourful placemats and cutlery of a good standard. Each table had a centrepiece of a vase with flowers. The floor covering, which was non-slip, was clean and bright. There was a small chalkboard on the wall in the dining room displaying details of the lunchtime menu. The first floor dining room, which is situated next to the main lounge area, was also clean and bright. There were a number of dining tables, which were also nicely set. A dumb waiter is used to transport food to this dining room from the main kitchen. This was observed during the serving of the evening meal. Staff confirmed that it works well. The public rooms are pleasantly decorated to a domestic standard. The call bell system operating the downstairs toilets was faulty on inspection therefore this needs attention. To ensure residents safety. Specialist equipment such as commodes, handrails and moving and handling aids were available in some resident’s bedrooms. The deputy also advised that a new bath hoist was on order. There were plenty of bathrooms and toilets located around the home close to resident’s bedrooms and communal areas. They were all clean and tidy. Bathrooms and toilets were spacious and had doorways large enough for wheelchair access. They were fitted with handrails, toilet frames and nurse call bells. A lift is in use. Staff commented they did not have sufficient hoovers to maintain the cleanliness of the service. Relatives confirmed that they are able to bring in personal items such as small items of furniture for residents rooms. The home has a laundry facility. It consists of two rooms. One room contains washing and drying equipment with hand washing facilities and the other room has ironing facilities and individual storage baskets for residents. Both floors are non-slip and easy to clean and the walls are painted. The home has a separate hairdressing room with a non slip-floor. The wash hand basin is chipped and the work surface is slightly damaged. A good supply of disposable aprons, gloves and waste bags were located around the home. Staff interviewed stated, “yes, we have gloves and aprons” There are no dissolvable foul waste bags for laundry use therefore the home needs to address this. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 22 An application for a grant has been successful therefore the garden area is to be improved for residents. At present an inner courtyard offers residents privacy. The kitchen areas and storage rooms were clean and organised. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and welfare may be compromised due to erratic staffing levels and lack of training. Pre employment checks are not robust therefore they do not protect the residents. EVIDENCE: The duty rota evidenced 7 care staff are on duty in the mornings with two registered nurses also on duty. On the day of inspection the deputy commenced work later at 10am. The hours on the duty rota evidenced an 8am start. Some shifts for the remainder of the week had yet to be covered. Sufficient domestic cover is allocated. Other support staff are employed including a part time administrator and maintenance person. The service appeared to be fully staffed during the inspection visit. All residents had their breakfasts and medication by approximately 10am. On the day of the pharmacist’s visit staff were still administering morning medications at 11.20am. Breakfast was given out late for some residents. One resident was eating breakfast when lunch was being served to the other residents. Another resident was due to have a shower in the morning and by mid afternoon had still not got their shower. This was due to staff shortage Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 24 The AQAA stated there had been problems in the service with staff taking unplanned leave. The deputy confirmed she is at present trying to recruit additional care staff and registered nurses. Staff interviewed stated, “staffing levels are okay but a bit of a rush in the mornings, we could do with another member of staff” and “the home is more nursing home now”. Relatives interviewed stated, “staff come in to ensure… is okay, staff are lovely, we know the girls by their first names and they are good with the other residents”, “you can tell if they are short staffed, it’s very rare, they sometimes get agency”, “staff are very good, brilliant, good sense of humour always have a laugh and a joke with them” and “staff are very good, caring and sometimes short staffed but they cope very well, no one is ever neglected”. Staff comments include “not always enough staff, could do with extra domestic for evening, don’t take the ex carer off cleaning when a carer short, the handyman should have longer hours as he works 2 homes over 3 days”, “when staff don’t come in and we are working with one staff down it’s hard, but we get through”, “we are mad rushed in the morning times and could do with another pair of hands”, “more staff would be helpful, I like working in the home, it’s very friendly, the staff are caring”, “we would like more staff so we could do more for the clients-take them out or sit and talk to them and I enjoy working here it’s a nice place to work”, “a carer was given a domestic job and is repeatedly taken off to do the care’s job and we never have enough staff”. Residents interviewed stated, “the staff are very helpful, the night staff are more rushed, if I ask for anything they try and help, Pauline is very helpful, very understanding” “they can be late coming, after pressing the buzzer, they do come back”. Staff interviewed stated, “I’ve worked at the home for 4 weeks and really like it, staff were all welcoming” “I love this job”. “staffing levels are okay, it’s a bit of a rush in the mornings, we could do with another member of staff”. Staff member also confirmed that all checks were carried out before being allowed to work at the home. NVQ training is ongoing with some staff files evidencing NVQ Level 2 certificates but not all. The AQAA states that 19 staff has NVQ Level 2 in care and that 4 care staff are working towards it. Four staff files were examined and information included some POVA and CRB (Criminal Records Bureau Checks) application forms and references. One CRB check could not be located in the staff file. The deputy confirmed the check had been carried out. Another file evidenced a previous CRB check from an employer three years ago. The deputy was advised that the CRB was not Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 25 transferable. One of the files evidenced only one reference. Staff files did not have start dates in all. The deputy stated, “I use the code to access and verify PIN (Personal Identification Numbers) numbers for Registered Nurses”. Some of the PIN number dates had expired. The deputy confirmed that the PIN numbers were up to date but had just not been updated on the staff files. One Registered Nurse on duty produced their up to date PIN. One staff member interviewed confirmed that they took part in an induction and understood their role and responsibilities. One new staff confirmed they had up to date training in POVA (Protection of Vulnerable Adults), infection control, manual handling, 1st aid and fire awareness. The deputy confirmed that a number of staff took part in POVA training in July 2007. A list of staff that attended was seen however the certificates to confirm attendance could not be found. The deputy has attended wound care training in July 2007. The deputy also confirmed that staff have undertaken other mandatory training since the last inspection including Dementia and challenging behaviour, manual handling and adult abuse. The certificates were not available to view. Training records do not have dates to clarify when they were held. The deputy confirmed that the induction programme has not yet been developed. Some discussion took place around this including the required content. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Op31, 33, 35, 38 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The existing management structure is not robust to protect the residents. EVIDENCE: The current management structure is not benefiting the residents. The provider was invited to meet with the Commission to discuss the management of the service last month. Due to the long-term sickness of the registered manager, the deputy manager has taken on the role on a temporary basis. The deputy works full time and has been working additional hours during the manager’s absence. She has not got sufficient supernumerary hours to enable her to manage the service efficiently. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 27 Staff interviewed about the management of the service commented, “there is good management, they are approachable”, and “I get on well with the management”. Staff comments included, “I feel like we do not get any support from management staff”. The quality assurance systems in use are not effective. A medication audit is carried out regularly. There are no other continuous self-monitoring systems in place. The minutes of the most recent residents meeting (7/06) were viewed. The service has not canvassed residents’ views in over a year. Relatives questionnaires have recently been sent out with just two returned so far. The responses gave fair to good views in both replies. The deputy has held two staff meetings in September for day staff and one for night staff. The inspectors viewed the hand written notes and the provider also attended the meeting. There was no monthly record of provider visits to the service. The provider does however visit the service regularly. Policies and procedures have been viewed and these have been updated. Financial records for two residents are managed by the service. Both records were examined and evidenced records are regularly updated. Discussion took place with the administrator who explained that the resident’s bank accounts are part of a large account in the name of the company. The administrator stated, “they do not receive individual statements” and confirmed that they were unsure about any interest earned”. The administrator is looking into these matters in the best interests of the residents concerned. Equality and diversity was discussed in relation to providing care for individual residents. The deputy showed she is aware of taking into account gender and cultural preferences. Records were stored securely. Accident records were all checked accidents are fully recorded with dates and signatures and observations of residents recorded. First aid boxes were in place in the kitchen and office. Bed rails in use for resident were not yet monitored/documented. The deputy told the inspectors that the bed rails have been checked but not recorded. The AQAA states all equipment is serviced regularly with certificates in date. A selection of equipment was inspected and confirmed this to be accurate. A fire risk assessment was carried out this year with regard to the building and following this work has begun on improving the fire doors throughout. Some staff are not up to date with fire training including the deputy manager, who has not attended any since 2005. There has been no infection control training. One staff interviewed stated, “we could do with more staff training”. Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 28 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14 (1) (a) (b) (c) (d) Requirement Timescale for action 12/11/07 2 OP7 15 (1) 3 OP8 12 (1) (a b) 4. OP9 13 (2) The registered person must ensure all prospective residents have a full and detailed assessment prior to admission to the service, so that staff can meet assessed needs. The registered person must 26/11/07 ensure that all residents have a care plan that is updated regularly to reflect the changing needs of the residents. With particular regard to pressure area care and mental health problems. This is an outstanding requirement from the last two inspections. 12/11/07 The registered person must ensure that all residents at risk of developing pressure sores are monitored on a regular basis. Also that any resident who does develop a pressure sore has urgent intervention and records show the progress and treatment of any pressure sore/wound. Medication must be safely 12/11/07 administered with reference to the administration records; and DS0000025083.V343509.R01.S.doc Version 5.2 Wavertree Nursing and Residential Home Page 30 5 OP16 22 (3) (4) (5) 6 OP29 19 (1) (a,b,c) 18 (1) (c) (i) 7 OP30 records completely and accurately maintained to ensure residents’ health and wellbeing. The registered person must ensure that all concerns/complaints are fully investigated with outcomes recorded and all residents or their representative to have a copy of the complaints procedure. The registered person must ensure that recruitment procedures are robust so that residents are protected. The registered person must ensure that a staff training programme is put in place and implemented which meets the Skills for Care criteria and includes structured induction training to ensure that staff are able to meet the assessed and changing needs of service users. 24/12/07 12/11/07 24/12/07 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 3 Refer to Standard OP1 OP8 OP9 Good Practice Recommendations It is recommended that the new statement of purpose should be amended to include all details required. It is recommended that all risk assessments such as manual handling and falls should be kept up to date and reflects the residents’ current needs. The medication policies should be reviewed to reflect current guidance and practice within the home helping to ensure consistency in the handing of medication. The times that medicines are administered should be monitored to ensure they meet residents’ needs and to ensure that enough time is left between doses for Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 31 medicines to be given safely. Handwritten entries on the medication administration record should; be signed and countersigned to reduce the risk of making mistakes. It is strongly recommended that residents should be offered a choice of main meal at lunchtime and this is included in the daily menu. It is strongly recommended that the acting manager is afforded extra resources to effectively manage the home in the absence of the registered manager. It is strongly recommended that the registered provider produce a report (Reg 26) following an unannounced visit to the service on a monthly basis. This report should be kept on file so that it can be viewed during the Commission inspections. 4 5 6 OP15 OP31 OP33 Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Wavertree Nursing and Residential Home DS0000025083.V343509.R01.S.doc Version 5.2 Page 33 - 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. 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