Inspection on 09/09/08 for Wavertree Nursing and Residential Home

This inspection was carried out on 9th September 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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... 09/10/07

Wavertree Nursing and... 14/02/07

Wavertree Nursing and... 17/10/06

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Wavertree Nursing and Residential Home Pighue Lane Wavertree Liverpool Merseyside L13 1DG Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 09:00 9th & 11 September 2008 th 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.V362183.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.V362183.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 wavertreenursing@btconnect.com 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 Vacant 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.V362183.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate up to a maximum of 36 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 9th October 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 and is fitted with a call bell system. Fees range from £322 to £429:96. The registered provider is Mr Ilam Din Chaudhry. A proposed manager Mrs Ann Lloyd has been appointed. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor outcomes. A site visit took place as part of the unannounced key inspection. It was conducted over two days for the duration of approximately 16 hours. 43 residents were accommodated at this time. As part of the inspection process all areas of the service were viewed including many of the residents bedrooms. Care records and other service records were viewed. Discussion took place with some of the residents, staff and one relative. The inspection was conducted with Ann Lloyd (proposed manager). The registered provider Mr Chaudhry was present during the inspection. A pharmacy inspector from the Commission carried out an inspection on day one. An Expert by Experience took part in the inspection process for approximately 4 hours on day one. An Expert by Experience is a person who, because of their shared experience of using services/and or ways of communicating visits a service with an inspector to help get a picture of what it is like to live in or use a service. During the inspection many residents were case tracked (their files were examined and their views of the service were obtained). All of the key standards were inspected and requirements and recommendations from the last inspection in October 2007 were discussed. Satisfaction forms ‘Have your say about….’ Were distributed to a number of residents, relatives, staff and health professionals prior to the visit. A number of comments included in this report are taken from the surveys and from interviews. An AQAA (annual quality assurance assessment) was completed by the proposed manager prior to the site visit. The AQAA comprises of two selfassessment questionnaires that focus on the outcomes for people. The selfassessment provides information as to how the proposed manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 6 What the service does well: The proposed manager or senior staff visit prospective residents prior to admission. One resident interviewed stated, “I saw Ann, (manager) she came to see me in hospital a few days prior to coming in”. Residents interviewed confirmed that health professionals do visit and attend to their needs in the privacy of their own bedroom. One resident interviewed stated, “The district nurse comes to see me daily”. Residents were well groomed and dressed in suitable clothing and clean and ironed clothing was noted to be stored neatly in their own wardrobes in their bedrooms. Staff were noted during the visit to be respectful in their approach to all residents Residents interviewed confirmed that visitors were made welcome by staff and visited them in their own rooms or one of the public areas. One resident interviewed stated, “I get loads of visitors and my son visits me most evenings and is made most welcome by the staff”. Residents were complimentary about the meals served in the service. Residents interviewed stated, “The food is very good, you have a choice and I get more than enough”, “We get plenty of drinks throughout the day with cakes in the afternoon and crumpets or toast for supper”. The two dining rooms are spacious and tables were attractively set out with fresh flowers on each table. Staff were available to assist residents and were observed to do so in a discrete manner. Residents interviewed were confident that they knew how to complain. Residents stated, “I have been here …months, the place is great, I couldn’t ask for any more”, “If I have any complaints I would go to Ann”. A tour of the service evidence bedrooms are fully furnished and most are in a good state of décor. Residents confirmed they were happy with their bedrooms. One resident interviewed stated, “My bedroom is beautiful”. There are two areas of garden for the residents to use. Both are situated in a ‘courtyard’ setting therefore sheltered with one situated on the first floor. There is easy access for residents. Mature shrubs/flowers are in pots and suitable garden furniture is in place. The kitchen was clean and organised. Routines for cleaning are kept to as observed with clean equipment in place. The service has a plentiful supply of dry and fresh foods with fresh vegetables and fruit observed. Many of the care staff has the NVQ Level 2 qualification and two staff has gained Level 3. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 7 Staff gave positive feedback about their place of work. Staff interviewed stated, “It’s been brilliant, and the staff are very helpful, any problems there is always someone around to help”. Residents and families gave positive feedback about the staff employed in the service. Residents interviewed stated, “Staff are brilliant, plenty of young girls, to me they are like little angels from Heaven”. Relatives canvassed for their views commented, “I think the staff are very caring and look after…very well”. What has improved since the last inspection? What they could do better: The assessment does not fully identify all the prospective residents needs therefore this may compromise residents health. One resident interviewed stated, “I’ve had no chiropodist since I come in, I have circulation problems, I usually see the chiropodist 4 weekly, I’m desperate to see him, it’s 10 weeks since I have seen him”. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 8 Care plans need to be improved to ensure they are easy to follow and include all individual residents needs. There is no record in a residents care plan of any wounds/treatment therefore this needs addressing to ensure that all staff are aware of the individual needs of the resident. The management and administration of medication was found to be unsafe therefore this needs urgent action to ensure residents are protected. Residents are at risk of being isolated due to lack of activities. Residents gave mixed views about the activities. Residents interviewed stated, “There are no activities, “Yes, there are activities, I like to go out on the outings, we went to Southport last week in a minibus” and “They don’t have any activities”. One relative canvassed for their views commented, “It could improve by possibly more activities for the residents”. Complaints need to be recorded and fully investigated with outcomes recorded to evidence residents are listened to. The service needs to ensure fire escapes are kept clear. Some of the staff recruitment procedures are not robust therefore do not protect the residents. The service need to ensure that registered nurses left in charge of the service need to have the qualifications, skills and experience necessary to work there. The induction for all staff needs to be improved to ensure all government guidelines with regard to this area are in place including principles of care. The service needs to ensure that all staff are up to date with mandatory training to ensure the safety of the residents and staff. The service does not have any effective quality assurance systems in place. Resident views need to be canvassed to ensure the service is run in their best interests. Policies and procedures were last reviewed in 2007 therefore need updating. There are no policies and procedures with regard to equality and diversity therefore this needs addressing. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 9 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.V362183.R01.S.doc Version 5.2 Page 10 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.V362183.R01.S.doc Version 5.2 Page 11 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): OP1, 3, 4 was assessed. 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 does not fully identify all the prospective residents needs therefore this may compromise residents health. EVIDENCE: The Statement of Purpose still needs to be updated to reflect the facilities and services provided. This will ensure prospective residents have sufficient information when making a choice to live there. Discussion took place with regard to what changes and additions are needed. The proposed manager or senior staff visits prospective residents prior to admission. One resident interviewed stated, “I saw Ann, she came to see me in hospital a few days prior to coming in”. Four resident pre admission assessment documents were viewed. Personal details including preferred names were recorded. Two residents had an assessment carried out by the service. One resident had none but had a copy of the district nurse Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 12 assessment on file. One resident had a copy of the social work assessment. There is insufficient information collated to ensure that resident needs are fully identified. Many areas were looked at but not enough detail was in place. Some areas identified as needing further information include detailed personal care, oral hygiene, optical needs, hearing and chiropody needs. One resident interviewed stated, “I’ve had no chiropodist since I come in, I have circulation problems, I usually see the chiropodist 4 weekly, I’m desperate to see him, it’s 10 weeks since I have seen him”. One resident who was identified at the assessment as suffering pain did not have any further information regarding the pain. The manager has introduced a new assessment document and this was viewed in regard to a resident recently admitted. Discussion took place with the manager where this could improve, as the information collated was brief and not in sufficient detail. The dates that the assessments were carried out are not always recorded and there was no signature of the person carrying out the assessment. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 13 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 assessed. Quality in this outcome area is (poor). This judgement has been made using available evidence including a visit to this service. The management and administration of medication needs to be improved to ensure resident healthcare is not compromised. EVIDENCE: All residents have individual documentation with care information being recorded in the individual residents file. The practice of resident information being documented in separate hardback books has ceased. Three residents care plans were viewed. All three were agreed and signed with evidence of monthly reviews. Care plans do show improvement since the last inspection though they still have to be clearer as the planned care is difficult to follow. Not all of the identified care needs are evidenced in the care plans. In some areas where new needs have been identified the care plan does not reflect changes. The daily record identifies one example of a resident sustaining a fall and suffering pain following the fall yet the daily evaluation or care plan does not Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 14 identify how the pain is managed. There is no risk assessment in place with regard to this. One other resident has been identified, as having a painful condition yet there is no evidence to say how this painful condition is managed in their plan of care. Residents were asked if they were happy with the care provided and had it been discussed with them. Residents interviewed stated, “I have discussed my care and mobility with Matron, my medication is spot on, a blip now and again, (unable to say what the blip was) Ann is very good with the medicine” and “I discuss my care all the time, I see the Dr when I’m ill, I get my medication on time”. One resident who is at risk of falls has no action recorded as to how this is managed. Risk assessments are in place with regard to pressure care, nutritional care, mobility and the use of bed rails. The manager was advised that competent and trained staff should review the use of bed rails regularly. Documentation should reflect this. There is recorded evidence on care documentation of health professional visits including speech therapist, district nurses, GP, opticians, dietician, diabetes nurse and chiropodist. There is no record in the residents care plan of any wounds/treatment therefore this needs addressing to ensure that all staff are aware of the individual needs of the resident and that the care plan reflects their changing needs. One resident has a care plan for twice daily intervention but the daily record does not evidence that this is being carried out therefore the manager was advised to ensure the planned care is recorded when carried out. The service has a separate locked room for the storage of medication and trolleys when not in use. Controlled medication records and stock were viewed and correct. Pre printed medication sheets evidence receipt and administration of medication for residents. Following recent blood test results for one resident, the diabetes nurse wrote to the service to advise of a new dose. This dose has not been changed therefore further advice/clarification needs to be sought to ensure the resident is receiving the correct dose. During the visit the registered nurse was observed to sign the medicines records at the end of the ‘medicines round’ rather than at the time of administration to each person. We also saw medicines being given without checking the medicines records first. This means that nurses are reliant on memory when giving medicines and completing the records, which increases the risk of making mistakes. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 15 We also saw that sometimes the nurses signed the medicines records before the medicines had been given. This increases the risk of making mistakes in medicines recording and also increases the risk of people not getting their medicines. Medicines were not always given at the prescribed dose and some medicines had not been given at all. For example we saw a nurse prepare 50ml of a liquid medicine for a person who had been prescribed only 10ml. This places the health and wellbeing of people who use your service at serious risk of harm. We saw that nurses prepared and gave medicines to more that one person at once. This increases the risk of making mistakes and places the health and wellbeing of people who use your service at serious risk of harm. Residents have their own bedrooms. Residents interviewed confirmed that health professionals do visit and attend to their needs in the privacy of their own bedroom. One resident interviewed stated, “The district nurse comes to see me daily”. Residents were well groomed and dressed in suitable clothing and clean and ironed clothing was noted to be stored neatly in their own wardrobes in their bedrooms. Residents preferred term of address is recorded in care files. One resident interviewed stated, “I would like male nurses for personal stuff and not the younger women staff”. This was discussed with the manager who confirmed that she tries to make sure this happens”. A public telephone is available for residents use. One resident has his own. Staff were noted during the visit to be respectful in their approach to all residents. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 16 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 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to make some choices but are at risk of being isolated due to lack of activities. EVIDENCE: Residents, who wish to, spend their time in their own bedrooms. Other residents spend their time in one of two lounges or dining rooms. Residents interviewed confirmed that visitors were made welcome by staff and visited them in their own rooms or one of the public areas. One resident interviewed stated, “I get loads of visitors and my son visits me most evenings and is made most welcome by the staff”. At present the service is without an activities person and the manager is advertising this post. Some of the residents were observed to be sleeping, watching television or just watching what was happening around them. Residents gave mixed views about the activities. Residents interviewed stated, “There are no activities, I don’t mix much with the others”, “Yes, there are activities, I like to go out on the outings, we went to Southport last week in a minibus” and “They don’t have any activities, I read when I want and watch Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 17 television and go for walks”. One relative canvassed for their views commented, “It could improve by possibly more activities for the residents”. Some of the resident preferences are recorded in care documentation. Residents interviewed confirmed that they generally get up and retire to bed when they wish to with staff support. Residents interviewed stated, “Bedtime varies, I fall in with the staff, I go to bed between 9-11.30, I don’t mind and I like to get up soon after 8 (this is accommodated)”, “I decide when to get up in the morning with the day staff, I go to bed late after my drink” and “I get up at 6.30-7am, I like to, I ring the bell to go to bed at 11-11.15 I’m happy with that”. A hairdressing room is available for residents who wish to use the service hairdresser. This was in use during the inspection and one resident who just had her hair done confirmed she was very pleased with the result. Meals are served at specific times of the day and residents have a choice of two dining rooms. The majority of residents were observed to be using the upstairs dining room. One resident interviewed stated, “I eat downstairs with …,”. The two dining rooms are spacious and tables were attractively set out with fresh flowers on each table. Staff were available to assist residents and were observed to do so in a discrete manner. Staff were observed to be patient with residents at mealtimes. One or two residents were observed to have a little difficulty reaching their food therefore it would benefit residents to have a cushion on their chair to assist with this. Residents gave positive feedback with regard to the meals served. During the inspection visit the daily menu was displayed on a large board in the dining room. Residents interviewed stated, “I think there should be fruit provided”, “The food is very good, you have a choice and I get more than enough”, “We get plenty of drinks throughout the day with cakes in the afternoon and crumpets or toast for supper” and “The food is good, get a choice, it’s warm and plenty to eat”. Residents are offered a cooked breakfast each day and many have one. One resident interviewed stated, “I had a full cooked breakfast and the other two had bacon butties”. Other residents have the choice of various cereals including porridge. Residents of ethnic minorities are catered for. One resident confirmed this and stated, “I enjoy my meals and always have curries”. Four weekly menus are in place. Specialist diets are catered for. Residents are asked about their religious needs during the admission process and are encouraged to follow their religion where they wish. The local church visits weekly to provide Communion. The local library service visits regularly to provide books including large print to residents. Wavertree Nursing and Residential Home DS0000025083.V362183.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): OP16,17,18 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints need to be recorded and fully investigated with outcomes recorded to evidence residents are listened to. EVIDENCE: A complaints procedure is in place. Residents interviewed were confident that they knew how to complain. Residents interviewed stated, “I have been here …months, the place is great, I couldn’t ask for any more, I get on alright, I’ve no complaints”, “If I have any complaints I would go to Ann, I know how to complain” and “I’m aware of how to complain”. The complaints log had no record of any complaints since the last inspection. The manager stated, “We have not received any complaints since I’ve been here”. During day one of the inspection a visitor came into the office and complained that his relative had lost a new cardigan and then went on to say it was not the first time clothing had gone missing. The manager dealt with this. The manager went on to say that as she met with the residents and spoke with families regularly she was able to deal with any concerns as they came up. Discussion took place with the manager regarding the recording of complaints and how important it was to do this and to record the investigation and outcomes. This evidences that residents and their families are being listened to. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 19 The advocacy service contact details are available for residents with some residents using it at present. Residents who wish to vote via the local ballot box do so or use the postal system. The service has policies and procedures in regard to physical and verbal aggression. The service has a copy of the adult protection procedure. Most of the staff have attended adult protection training this year with certificates evidencing this. Wavertree Nursing and Residential Home DS0000025083.V362183.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): OP19, 26 were assessed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to ensure fire escapes are kept clear to ensure the safety of residents and staff. EVIDENCE: The service has been purposed built and all resident bedrooms are situated on the first floor with lounge and dining facilities to both floors. The dining rooms and two lounges are pleasantly decorated and furniture suitable for older people is in place. A tour of the service evidence bedrooms are fully furnished and most are in a good state of décor. Divan beds are in place in some of the bedrooms. The divan bases have no covers with one or two showing damage, such as torn material on the bases. This does not look welcoming. One or two of the trims were damaged/missing on furniture. Some of the bedrooms have been fitted with new sink bases. Residents confirmed they were happy with their Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 21 bedrooms. One resident interviewed stated, “My bedroom is beautiful, I had a new sink fitted yesterday”. Many residents have personalised their bedrooms. There are no en-suite facilities but there are sufficient bathroom facilities throughout. A nurse call system is fitted throughout the service. The call system in one of the toilets on the ground floor was tested and found faulty. This needs addressing. Suitable equipment is in place for residents to enable easier mobility. Specialist equipment is also in place including hoists, nursing beds and other nursing equipment. There are two areas of garden for the residents to use. Both are situated in a ‘courtyard’ setting therefore sheltered with one situated on the first floor. There is easy access for residents. Mature shrubs/flowers are in pots and suitable garden furniture is in place. The service has a laundry facility, which consists of two rooms. Washing and drying facilities in one room and the other contains an iron/ironing board and individual baskets for resident personal linen. There was soap for staff but the hand towel container was broken from the wall and needed repair. It may benefit the staff to have a more substantial ironing facility because of the amount of linen to be ironed during the day. There are no red plastic ‘foul’ laundry bags in use at present therefore this needs addressing to promote hygienic laundering. The washing machine has a foul laundry facility. The service has a hairdressing room. The sink in this room remains damaged and has not been repaired/replaced since the last inspection. The blind needs replacing also as it is broken. Not all residents have a lockable facility in their bedrooms therefore this needs addressing to ensure safe storage of valuables. The service does not have a valuables book. The manager was advised this needs to be in place for residents. Some fire exit areas are being used as storage and in one area a clothing rail for clean clothing was in place. The manager has already tried to clear one area of equipment and now needs to ensure free passage to all fire exits to ensure resident and staff safety. CCTV is in place for the external areas of the service. The maintenance person is employed for three days each week. A maintenance book evidences all jobs needing to be carried out and it evidences jobs done and dated. The cleanliness of the service was satisfactory. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 22 The kitchen area was toured whilst the Chef was on duty. The kitchen was clean and organised. Routines for cleaning are kept to as observed with clean equipment in place. Fridge and freezer and hot food temperatures are recorded daily. Paper towels, soap and aprons are available for staff. The service has a plentiful supply of dry and fresh foods with fresh vegetables and fruit observed. At present there is nowhere to store the fresh vegetables as the previous external store is now out of use therefore this needs addressing. At present kitchen staff are using kettles to boil large amounts of water, which takes up a lot of their time. An urn might be more suitable and this was discussed with Mr Chaudhry. Wavertree Nursing and Residential Home DS0000025083.V362183.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): OP27, 28,29,30 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff recruitment procedures need to improve to ensure staff are qualified and skilled to meet the needs of the people who live here. EVIDENCE: The staffing rota was viewed and evidences sufficient staff are on duty days and nights. The duty rota does not evidence all of the staff’s full names therefore this needs addressing. Kitchen and domestic staff are recorded. Many of the care staff has the NVQ Level 2 qualification and two staff has gained Level 3. Four staff files were viewed. Three had completed application forms with one not fully complete. Police checks for all four were in place prior to starting work. Start dates of employment are not recorded for all. Staff files evidence references are taken up although one of the staff members has none but has been employed some years in the service. One of the registered nurses has no references relating to their employment as a nurse therefore this needs addressing. The service need to ensure that registered nurses left in charge of the service need to have the qualifications, skills and experience necessary to work there. One registered nurse has no up to date evidence to ensure they can practice as a registered nurse. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 24 The induction for all staff needs to be improved to ensure all government guidelines with regard to this area are in place including principles of care. At present the evidence for a staff induction is on individual staff files but the documented evidence is very brief and some of which are undated and unsigned. The manager showed us the video and questionnaire for health and safety that will be used as part of the new induction programme. One registered nurse who was interviewed stated, “I had an induction and it lasted a month and is ongoing with me for three months, I worked the first few days with Ann then the other registered nurses”. This has not been documented in their staff file. Some of the staff files evidence previous training attended. Wound care training has been booked for some of the registered nurses later this month. Staff gave positive feedback about their place of work. Staff interviewed stated, “I think I get enough training, the care is very good, if I had worries I know it would be listened to and acted on”, “I had an induction, it lasted three days, its been brilliant, the staff are very helpful, any problems there is always someone around to help, we are given a report of the residents every day, residents have choices, what they wear, what they want for breakfast and what they want to do in the day, I’d be happy for any of my family to be here”. “There is a caring attitude amongst the staff, they have been supportive in the last few months as it has been difficult with staff leaving but it is getting better, we have a high dependency level amongst our residents therefore more difficult to manage their needs if there is only one registered nurse on duty”. One of the relatives canvassed for their views stated, “Sometimes I think they need more staff”. Discussion took place with the manager regarding the importance of monitoring the dependency levels of residents and registered nurse cover. Residents and families gave positive feedback about the staff employed in the service. Residents interviewed stated, “Staff are brilliant, plenty of young girls, to me they are like little angels from Heaven”, “Staff are great, very helpful and patient” and “Staff are very good, they are much better than in hospital”. Relatives canvassed for their views commented, “I think the staff are very caring and look after…very well”, “They do very well, the staff and nurses are very good, they listen and do things to improve” and “Staff are always considerate and kind”. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 25 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): OP 31, 33, 35 and 38 were assessed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Mandatory training needs to be updated for all staff to ensure the safety of the residents and staff. Resident views need to be canvassed to ensure the service is run in their best interests. EVIDENCE: The proposed manager is a registered nurse and has been in post since May2008. A formal application to be registered manager has not been applied for yet. The proposed manager has attended fire, abuse and manual handling training this year. The manager has also attained a Level 4 in management in 2007 and the ENB (English Nursing Board) 998 (teaching and assessing certificate). Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 26 The service does not have any effective quality assurance systems in place. None of the residents are canvassed for their views in a formal way and there are no residents meetings. Relative questionnaires were sent out in May this year with only six replies. The responses were positive. The manager stated, “I talk with the residents individually and ask them for their views e.g. when updating the menus”. Since the last inspection one monthly provider report has been returned to the Commission. At present the provider visits need to be carried out and a copy of their report kept on file within the service. There is no annual development plan for the service A staff meeting was held in May this year and minutes were viewed. Policies and procedures last reviewed in 2007 therefore need updating again. There are no policies and procedures with regard to equality and diversity. The manager advised that a senior carer checks the hoist slings regularly but there is no documented evidence of this. The manager stated, “An audit of the bedrooms was carried out last month”. The audits were viewed and evidence each room was checked and any repairs/replacements identified but it is not dated. A secure facility is available for residents who wish valuables to be kept on their behalf. The service needs to have a valuables book in place for this purpose so that a record is kept and residents have a receipt of their possessions. There are no policies and procedures with regard to the management of resident funds. There is also no information with regard to this area in the statement of Purpose or Service User Guide therefore this needs addressing. There are occasions when residents may have difficulty accessing their funds therefore limiting their access. Good computer records evidence how much each resident has in their funds and receipts evidence what money is spent on. Some of the staff have attended training this year including adult protection, fire and manual handling as viewed by certificates issued. Training, development and supervision of staff is inconsistent. Staff have not had sufficient training to enable them to work safely. The service needs to ensure that all staff is up to date with mandatory training. Hazardous substances are stored securely with data provided also. All electrical and gas appliances and equipment have been serviced and up to date certificates were viewed. Accident records were viewed and are recorded correctly. A procedure is in place for RIDDOR (Reporting of Dangerous Diseases or Occurrences Register). Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 27 First aid boxes are in place in the manager’s office and kitchen. The employers insurance is in date. Legionella was last tested in February this year. Fire alarms are tested weekly at various points with records kept. Fire equipment is serviced and replaced as documented. A fire risk assessment of the service was carried out in 2006 and not since therefore this needs addressing. One area at the rear fire escape has been used to store equipment and the carpet is now damaged and dirty therefore needing attention. Wavertree Nursing and Residential Home DS0000025083.V362183.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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 8 9 10 11 2 X X X X X X 3 2 2 1 3 X STAFFING Standard No Score 27 3 28 2 29 1 30 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 2 X X 1 Wavertree Nursing and Residential Home DS0000025083.V362183.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 OP1 Regulation 4 (1) (c) Requirement Timescale for action 31/12/08 2 OP3 3 OP4 4 OP7 5 OP7 The registered provider must ensure that the statement of purpose reflects up to date information with regards to facilities and services provided. 14 (1) (c) The registered person must (d) ensure all prospective residents have a full and detailed assessment prior to admission to the service, so that staff can meet assessed needs. This is an outstanding requirement from the last inspection. 12 (1) (a) The registered person must ensure that the service is able to make proper provision for the health and welfare of residents. 15 (1) The registered person must ensure that all residents have a care plan that reflects their needs. With particular regard to pressure area and wound care. This is an outstanding requirement from the last three inspections. 15 (1) The registered person must ensure that where a resident has a painful condition identified DS0000025083.V362183.R01.S.doc 20/10/08 20/10/08 20/10/08 20/10/08 Wavertree Nursing and Residential Home Version 5.2 Page 30 6 OP7 15 (1) 7 OP8 13 (1) (b) 8 OP9 13 (2) 9 OP9 13 (2) 10 OP9 17 (1) Sch 3 11 OP9 18 during assessment it must be included in the care plan as to how this will be managed. The registered person must ensure that where residents are identified as at risk of falls a care plan must identify how this risk is to be managed. The registered person must ensure residents receive chiropody advice and treatment in particular where circulatory problems exist. A record of the receipt of all medication must be kept. There must be adequate supplies of all medication available for each resident so that residents are not left without medication To prevent medication errors an accurate record must be made of the date and time medication is administered to each resident. If medication is omitted a reason for this must be recorded. Medication must be given to residents at the right time in relation to food and other prescribed medication. Failure to so could seriously affect the health and wellbeing of the resident. This is an outstanding requirement from the last inspection. Staff must administer medication in accordance with the prescribers’ instructions so that people who use the service receive the correct amount of medication at all times. Staff must undergo appropriate medicines management training and be assessed as competent in this area before being allowed to handle, record and administer medication in order to protect people who use this service. DS0000025083.V362183.R01.S.doc 20/10/08 20/10/08 09/10/08 09/09/08 09/09/08 31/10/08 Wavertree Nursing and Residential Home Version 5.2 Page 31 12 OP9 24 (1) 13 OP12 16 (2) (m) (n) 12 (2) (3) 14 OP14 15 OP16 17 (2) 16 OP19 23 (4) (b)(d) (e) 18 OP29 19 (5) (b) 19 OP30 18 (1) (c) (i) 20 OP31 8 (1) (a) To ensure medication is managed correctly a system must be put in place to regularly audit all aspects of the management of medication including staff competence. The registered person must ensure that suitable activities are provided for residents to prevent risk of isolation. The registered person must ensure residents can exercise choice so they can have control over their lives. The registered person must ensure that all complaints are registered and investigated and evidences outcomes for residents. The registered person must ensure that all staff attend fire training at regular intervals and ensure fire exits and passageways are always kept clear. Staff must also be trained in the procedure for saving life. The registered person must ensure that all registered nurses are skilled and qualified to carry out the work they perform. The registered person must ensure that a staff training and development programme which meets the National Training Organisation workforce training targets that ensures staff fulfil the aims of the service and meet the needs of the people who live there. A structured staff induction must be evidenced in all staff files with dates and signatures documented. This is an outstanding requirement from the last inspection. The registered person must ensure that an application is submitted to the Commission in DS0000025083.V362183.R01.S.doc 09/10/08 31/10/08 31/10/08 20/10/08 20/10/08 20/10/08 31/12/08 10/11/08 Wavertree Nursing and Residential Home Version 5.2 Page 32 21 OP33 24 (1) (a) (b) 22 OP35 17 23 OP38 18 (1) (a) (c) (ii) respect of the registered manager position. The registered person must 31/10/08 ensure that effective quality assurance systems are in place to gain the views of the residents who live there. Policies and procedures in the service must be updated on an annual basis or sooner where needed. The registered provider must produce a report (Reg 26) following an unannounced visit to the service on a monthly basis. This report must be sent into Commission. The registered person must 10/11/08 ensure that residents have easy access to their finances. Policies and procedures must be in place with regard to the management of finances. The registered provider must 31/12/08 ensure that all staff are provided with regular mandatory training which also includes infection control, health and safety, first aid and equality and diversity. The training must be evidenced in staff training files. 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 OP7 OP7 Good Practice Recommendations It is recommended that care files should be organised and care plans easy to follow. It is recommended that planned care should be evidenced in the daily evaluation in particular where treatment is prescribed twice daily. DS0000025083.V362183.R01.S.doc Version 5.2 Page 33 Wavertree Nursing and Residential Home 3 OP9 Policies and procedures should be reviewed and developed further so that staff has clear guidance about all aspects of the medication service provided. Dose changes should be clearly recorded and signed by two members of staff, so that residents receive the correct dose of medication. Where possible, changes should be confirmed in writing by the prescriber. There should be clear, personalised directions for the use and administration of when required and variable dose medication for all service users prescribed such items. When required and variable dose medicines should also be included in the residents care plan. The opening date should be recorded on eye drops, insulin and other items with a short expiry date. Medication requiring refrigerated storage should be stored in a dedicated medication maintained at a temperature of between 2-8°C 4 5 6 OP10 OP18 OP19 7 8 9 OP19 OP27 OP29 It is recommended that residents who wish to have the same gender carer should have their request accommodated. It is recommended that all residents should have a lockable facility in their bedroom. A valuables book should be in place. It is recommended that more time should spent in keeping the service maintained as some areas showed signs of wear and tear including, The call bell system should be repaired for one of the ground floor toilets. Divan bed bases should be repaired and valances fitted. The hand towel container should be fixed to the laundry wall. Red disposable foul laundry bags should be in place for use. The damaged sink and blind in the hairdressing room should be repaired/replaced. The carpet damaged at the rear fire exit should be replaced. It is strongly recommended that a fire risk assessment of the service should be carried out. It is strongly recommended that the staffing rota should evidence full staff names in ink. It is recommended that staff files should evidence the start date of all staff. All application forms should be fully completed. DS0000025083.V362183.R01.S.doc Version 5.2 Page 34 Wavertree Nursing and Residential Home 10 OP29 It is recommended that all Nursing and Midwifery Council PIN numbers for registered nurses should be listed with up to date information held. Wavertree Nursing and Residential Home DS0000025083.V362183.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG 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. 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