Inspection on 15/11/07 for Wayside Nursing Home

This inspection was carried out on 15th November 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.

Other inspections for this house

Wayside Nursing Home 03/05/07

Wayside Nursing Home 06/02/07

Wayside Nursing Home 20/10/05

Wayside Nursing Home 10/05/05

Wayside Nursing Home 14/01/05

Wayside Nursing Home 22/07/04

Wayside Nursing Home 23/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Wayside Nursing Home 25 New Road Bromsgrove Worcestershire B60 2JQ Lead Inspector Andrew Spearing-Brown Key Unannounced Inspection 09:00 15th November 2007 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 Wayside Nursing Home DS0000004150.V348101.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. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wayside Nursing Home Address 25 New Road Bromsgrove Worcestershire B60 2JQ 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) 01527 837774 01527 872631 www.alphacarehomes.com Alpha Health Care Limited vacant post Care Home 30 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 2007 Brief Description of the Service: Wayside Nursing home provides care and accommodation for up to 30 older people. The homes registration allows the home to offer all 30 placements for older people with physical disabilities and includes up to 3 placements for people who are over 65 years of age and have dementia. Wayside Nursing home is located close to Bromsgrove town centre. The home is a large detached period property with a mature enclosed garden and limited car parking. Accommodation is on three floors (ground, first and second floors), which can be accessed by a central passenger lift. There are a range of single, double and en-suite bedrooms. The home has several lounges, a dining room, a conservatory and a hairdressing room. The area manager gave details regarding the fees charged at Wayside during the previous inspection. Information regarding fee levels and what is included within the fee was not included within the Service Users Guide. The reader may therefore wish to obtain up to date information from the care service. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out without prior notice. One Regulation Inspector visited the home on three separate occasions. A pharmacy inspector visited the home for part of this inspection. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was sent to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas where they believe they are doing well. Due to the absence, at that time, of a manager the area manager completed the document to the best of her knowledge. As part of the inspection process a number of questionnaires were sent to a sample number of people using the service, their relatives and health care professionals. A number of completed questionnaires were returned to us prior to our visit. Comments within these questionnaires are included within this report. The manager designate was present throughout except on the second day of this inspection. The area manager was present during part of the first day. In addition to the manager designate and the area manager discussions took place with other members of staff and some people using the service. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen during our visit included medication records, staffing training and recruitment records. What the service does well: Information is available for potential users of the service although this does need to be revised. The service obtains information prior to somebody’s admission to ensure that care needs can be met. People using the service appeared well attired and well cared for. People were seen sat in lounges and appeared to be relaxed and showed no outward signs of distress. We received some good comments about the service provided from representatives of people using the service and General Practitioners who visit the home. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 6 is not applicable to this service. Quality in this outcome area is adequate Pre-admission assessments and initial care plans are sufficient to ensure that the home can meet the individual care needs of people who are going to live there. Prospective people to use the service and their representatives have some information available to them to assist in choosing the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During our inspection we saw a copy of the homes Service Users Guide within each bedroom viewed. These were dated March 2007. We were given a copy of the guide dated December 2007, which contained the name of the manager designate who was recently appointed by the company. The December 2007 version stated that the guide ‘can be made available in large print’. The service users guide needs to contain information as listed within the National Minimum Standards as currently it is missing some of this information. The Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 9 registered person should ensure that an up to date version of this guide is freely available to current and prospective users of the service. It was reported that work is currently underway to revise the Statement of Purpose. This documents needs to set out the aims and objectives of the home and how it meets these aims. The files of two recently admitted people using the service were seen. The pre admission assessment of one person was not dated therefore it was not possible to establish whether this was completed prior to the person’s admission. Another person was recently admitted from a considerable distance away and therefore no assessment was carried out by anybody within the home. The home did however have a copy of an assessment completed by the persons local social services department. An initial assessment was carried out on the day of admission and provided sufficient information to establish how care needs were to be met. Wayside nursing home does not offer intermediate care and has no plans to provide this service in the future. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is adequate Improvements have taken place in relation to care planning and medication management although further improvements are necessary to ensure that health and personal care needs of each individual are identified and met. The principles of respect, dignity and privacy are put into place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample number of care plans were viewed during this inspection. A number of concerns were highlighted as part of the previous inspection and we have in the past made repeated requirements in relation to care planning. The Annual Quality Assurance Assessment completed during September 2007 stated that the service needs to ‘continue to develop the care planning system’. A report prepared by the Area Manager in December 2007 concluded that care plans continue to be developed. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 11 Overall it was evident that improvements have taken place although the quality and style of the care plans continued to vary. It was evident that care plans are generally reviewed on a monthly basis and evidence existed regarding seeking the opinions of people using the service and their representatives. Care plans were in place in relation to events such as chest infections. One care plan provided some good information regarding expressing sexuality. It is necessary that all care plans provide information for staff to ensure that care is delivered in a consistent style reflecting individuals identified care needs. It was disappointed to note that one care plan made reference to an individual needing dentures having left their’s elsewhere. No action was recorded as having taken place and the person concerned confirmed that nobody had spoken to her about this matter. Some four weeks later the individual’s representative managed to retrieve the original dentures, therefore solving the care need. It is however of some concern that this need continued for a period of time without any action or evident consultation with the person concerned. Prior to this inspection we posted survey forms to a sample number of relatives seeking their views of the service. We received a number of these back. In response to a question asking whether they felt care needs were met three people stated ‘always’ while five stated ‘usually’. We also surveyed a number of GP’s (General Practitioners) all of whom stated that the home seeks advice and acts upon it to manage and improve individuals’ health care. One person commented that the home does well in ‘skin care, dressings, nutrition, good solid nursing care particularly post stroke. Good communication with relatives. Good care of the dying.’ A Pharmacist Inspector undertook the inspection of the control and management of medication within the service. A medication procedure was available to staff, which means that safe procedures to protect residents from harm could be followed, however the medication procedures would benefit from a review and updating in particular for disposal of medication and an errors procedure. It has since been confirmed that Alpha Healthcare is in the process of updating the medication procedures. Medication was stored within the managers office, which is not ideal for the size of the home, however staff said that the office would be locked when not in use. Medication was seen stored in two locked medicine trolleys (one in managers office and the other locked to a wall in a corridor). A lockable refrigerator was available for the safe storage of medication requiring cold storage. The temperatures were recorded and monitored daily and were within a safe range. This was safe practice and protected people using the service Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 12 from potential harm. The storage arrangements for ‘controlled’ medication met the required safe storage arrangements. The cupboard was secured safely to a solid wall, which means that medication with special storage arrangements were protected by safe and secure procedures within the home. Medication for disposal was stored in an unlocked cupboard in manager’s office, which was not safe or secure. This means that there is a potential for the unauthorised access to medication and therefore a risk to the health and welfare of individuals. The majority of the medicine records seen were accurately recorded with a signature for administration or a code to explain why medication had not been administered. The local pharmacist had recently visited the service and made the following written comment ‘MAR sheet excellent – only looked at first few however’. It was therefore disappointing that the records for the application of creams and ointments stated that the ‘carers’ applied them with no further documentation available to record who had applied the cream or ointment. This means that the records for application of creams and ointments were not accurate or clear. Some of the medicine records seen did not document the amount of medication that had been given to individuals, particularly when the directions stated ‘one or two tablets’ or ’10-15ml’ to be given. This is not good practice and means that some medication records did not accurately document how much medicine had been given. The service provided written evidence of monthly medication audits to ensure medication had been administered correctly. Random medication audits undertaken by the pharmacist inspector were difficult to undertake correctly because total balances of medicines were not carried over onto new medicine charts to ensure accuracy. Medication that was administered from the monitored dosage system (supplied by the pharmacy) was checked and was accurate. Some of the medicine records were hand written and signed by a member of staff, however there was no system in place to ensure that a second member of staff checked the written information. Four residents care plans were seen, which recorded their medication requirements. The section for ‘Doctors visits’ included details of any medication changes and therefore ensured that residents changing healthcare needs were being recorded. The management for the administration of the influenza vaccination to people using the service did not protect or safeguard individuals from potential adverse reactions. The health and welfare of people residing at the home were therefore at an increased risk of harm. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 13 Risk assessments for people who were looking after their own medicines in their bedrooms were not available. A written letter from one person was available which stated ‘I self medicate the following..’ but there was no further consent document available. A lockable drawer was provided for the safe storage of the medication in the persons bedroom, however due to the lack of a formal risk assessment the individual was not properly safeguarded from harm. During a tour of the home we found a tub of cream in a person’s bedroom with the name of the person for whom it was prescribed crossed out and another persons name handwritten on the label. Items must only be used on or for the person for whom it was prescribed. We saw no evidence that the privacy and dignity of people using the service is not maintained. People using the service looked suitably attired taking into account gender issues and the weather conditions. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate The current arrangements for the provision of suitable activities need to be reviewed to ensure that they play a central role in the daily living arrangements of people using the service. People using the service are able to maintain contact with family and friends and have access to a balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although no visitors were consulted during this inspection open visiting is in place whereby no restrictions exist. Visitors are able to see their relative within either communal areas or within the individual’s own bedroom. An Activities Co-ordinator is employed who works 18 hours each week directly with people who live at the home providing opportunities for stimulation, and enabling people to do the things they enjoy. This employee is also employed as the maintenance person and therefore this role can at times appear to need to take priority, the activity part of the job only covers part of each week. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 15 The previous report highlighted the range of activities available to people and favourable comments were received from people working in the home. During this visit comments were made signalling that people would like to see an improvement in the current arrangements and to have more time to spend ‘chatting’ or listening to people living in the home. We received good comments regarding the food available and catering staff appeared to have a good understanding of people’s dietary needs. The menu was on display in the corridor. Staff were seen assisting people with their meals in a caring and sensitive manner. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good People using the service has access to a suitable complaints procedure and procedures are in place to safeguard people from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The vast majority of relatives who completed and returned a survey questionnaire to us prior to the inspection indicated that they were aware of the homes complaints procedure. One person commented: ‘I do not envisage making a complaint since I am pleased ’ A number of people using the service also indicated both within the surveys sent to them prior to the inspection and during our visits to the home that they know how to make a complaint. The complaints procedure or what to do ‘if things go wrong’ is included within the Service Users Guide. It states that the home takes complaints very seriously and always investigates them fully. The procedure makes suitable reference to the Commission for Social Care Inspection and gives details of how to make contact. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 17 Information and guidance regarding the safeguarding of people was available within the home. Staff consulted were able to give a verbal account of the actions they would take in the event of any actual or potential safeguarding matters within the home. The level or frequency of staff training regarding safeguarding was not assessed as part of this visit. There have been no referrals to safeguarding since the previous inspection. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 24, 25 and 26. Quality in this outcome area is adequate Progress is taking place to improve the environment in which people reside to enable people to live in a safe and comfortable home. Further improvements are necessary to full ensure these needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As a result of the concerns within the last two inspection reports a number of areas within the home were viewed as part of this inspection. Although a number of the previous concerns have now received suitable action other shortfalls either remain or were highlighted as part of this inspection. It was pleasing to note that the previously described ‘threadbare in places’ carpet along the first floor corridor has been replaced. In addition replacement carpeting is in place along the ground floor corridor. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 19 Some bedrooms on the first floor can only be reached by means of a sloop. The sloop is permanently in place and creates additional risks, such as when gaining entry to the bathroom. People using the service are able to personalise their bedrooms. Wardrobes were secured to the wall to prevent accidental toppling. A risk assessment was seen on people’s files regarding door locks however some bedrooms do not have locks in place therefore removing the opportunity for people to have such a facility should they wish. The lounge areas are comfortable and well used by people using the service. It was noted early one morning that the lighting within the main lounges was dull due to either the light fittings or the use of energy saving bulbs. The dull light could potentially make reading a book or newspaper difficult for people using the service especially anybody with a visual impairment. Our previous report stated that the dining room appeared ‘tired’. We highlighted that the varnish on some dining room chairs had worn off and that in addition some chair covers were stained. It was reported that this area is due for improvement in the foreseeable future. We previously brought to the providers attention some concern regarding the glazing used in the patio windows and whether they met the relevant safety standards. Since the previous inspection the provider has replaced these windows. Not only is the glazing now going to be to the necessary standard but it also makes a start in improving the dining room. The temperature of bath water was recorded within one bedroom although using green paper towels for this purpose is far from ideal. At the time of the last inspection we identified a particular wash hand basin in a toilet where the hot water supply took a very long time to be delivered and then it ran very hot. We continue to have concerns regarding the delivery of water. We were informed that the supply to some bedrooms is poor and that at time care staff have to transfer hot water from one room to another using plastic bowls. Throughout this inspection no offensive odours were detected. Although domestic hours appear rather low the cleanliness of the home is good. A number of comments were received within the surveys returned to us prior to the inspection from relatives regarding the cleanliness of the home: ‘ Keep a very clean and tidy happy environment and care very much for the residents’ ‘It is very clean and there are no smells other than food from the kitchen’ Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 20 The storage of cleaning materials was a concern during the previous inspection. Although we did not see any unsecured cleaning materials during this visit the labelling of cleaning materials was a concern and needs to be addressed to ensure that procedures are safe. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 and 30. Quality in this outcome area is poor Training is provided however some employees have not undertaken any training for a long period of time which could potentially place people using the service at risk or result in care needs not being fully met. Staffing levels are usually sufficient to meet care needs. The recruitment procedures that are in place are robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff consulted confirmed that normally six carers are on duty during the morning shift and four during the afternoon shift. Two carers cover the night shift. One trained member of staff is on duty at all times. The manager designate works supernumerary. The names of staff on duty are displayed on a wipe board near to the kitchen. It was unfortunate that on one of our visits only four carers were on duty during the morning shift. It was evident that one carer had telephoned in sick that morning however due to an apparent breakdown in communication the qualified member of staff on duty had not realised that another person also remained on sick leave, therefore the shift was not covered. The staff rota Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 22 showed that it is usual practice to cover staff when they are off sick or on annual leave. There was no evidence of staff working excessive hours. In the surveys sent out prior to the inspection we asked relatives whether they believe staff have the right skills and experience to carry out their job. Two responses were ‘always’ while five stated ‘ Usually’. We received a comment during this inspection about a perceived insufficient number of qualified members of staff on duty. As previously reported this perception needs to be taken into account by the registered providers. The number of staff who have obtained a level 2 NVQ (National Vocational Qualification) is low. It was reported that currently 4 carers out off 26 hold this qualification accounting for just over 15 . The National Minimum Standard states that 50 of carers should hold this level of qualification. A number of carers are currently undertaking this qualification. The previous inspection report stated that shortfalls were identified in training especially fire safety. In addition concern was raised regarding some staff who have not received moving and handling training since 2006. We are aware that the organisation has, in the past, written to staff regarding the need to attend training provided. The organisation provides in house training on a regular basis across each of their registered homes therefore staff are provided with opportunities to take training. Although some training has recently taken place including recent fire awareness training significant shortfalls remain in relation to some members of staff. Some staff have no recorded training for the last two years. According to the rota both carers on duty one night in December had no moving and handling training and no fire awareness training. Although these individuals would have had a qualified member of staff on shift with them the lack of training could of potentially placed people using the service at significant risk. Since this inspection, but prior to writing this report, we have been informed that mandatory training is arranged for all staff. This shortfall will therefore be re assessed at the time of the next inspection by which time the requirement must be fully met in order to prevent the commission considering enforcement action. A small number of files were examined in relation to staff recruitment. These were found to be in good order and demonstrated that robust procedures are in place to safeguard individuals. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is adequate Management systems within the home are improving in order to ensure a safe, open and respected service is in place. Further improvements are necessary in order to fully meet the necessary standard of provision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection Alpha Health Care Limited have appointed a manager designate at Wayside nursing home. An application to apply for registration as manager needs to be made without undue delay. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 24 The area manager continues to visit Wayside regularly and prepares written reports upon the conduct of the home as required under Regulation 26 of the Care Homes Regulations. At the time of the last inspection it was reported that the results of a recent survey had been collated and the former manager designate was due to complete an action plan. As far as could be established this action plan was not done and therefore was not available. The current manager designate assured us that she will action the findings of a forthcoming survey. The manager designate is aware that the formal supervision of staff needs to continue to improve in order to fully meet the required standard. The fire records were viewed and gave some concerns, which need to be addressed. It was evident that the fire alarm although tested regularly there was no system in place to ensure that all break glass points are tested sequentially. The break glass in the dining room was last tested during June 2007. The fire risk assessment dated May 2007 was viewed. The assessment highlighted a number of recommendations requiring action. Although it was believed that the work was undertaken no record of this work existed within the risk assessment document. The manager designate stated that she would check each of the recommendations and ensure that the records were in order. Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 25 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 3 17 X 18 3 2 2 X X X 1 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(1) Requirement Identified care needs must be recorded on care plans and evidence of how these needs are met or addressed must be demonstrated. The above requirement replaces earlier requirements regarding care planning. A safe system for the administration of vaccines to people using the service must be available in order to ensure that individuals’ health and welfare needs are safeguarded. Ensure that records and other recording regarding medication and its administration are clear, accurate and up to date to ensure that residents received items as prescribed therefore ensuring the health, safety and welfare of people using the service. Although improvements were noted the above requirement is similar to a number of previous requirements with numerous Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 27 Timescale for action 28/02/08 2 OP9 13 (2) 15/11/07 3 OP9 13 (2) 15/11/07 4 OP9 13 (2) 5 OP19 13(4) 23 unmet timescales including 30/04/07 and 03/05/07. Safe medication systems must be developed in order to ensure that medication is stored securely and safely at all times to ensure the safety and welfare of people using the service. All areas of the home must be maintained in a good state of repair to ensure that residents have a safe and comfortable place to reside The above requirement is now partly met and is therefore on going. Suitable lighting must be provided to meet the needs of people using the service. Sufficient hot water must be available at all times to people using the service. All staff in the home must have received up to date training in: Moving and handling, fire safety and infection control. Written records must be kept of all training undertaken. Although now partly met. Previous timescales 14/01/05 10/05/05, 30/04/07 and 31/08/07 not met All hazardous substances within the home must be correctly labelled and risk assessed prior to use. 15/11/07 28/02/08 6 7 8 OP25 OP24 23 (2) (p) 23 (2) (j) 18(1) 28/02/08 28/02/08 28/02/08 OP30 9 OP38 13 (4) 28/02/08 Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 28 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 OP9 OP9 Good Practice Recommendations The service users guide should be further amended to provide details required. A copy of the amended version should be widely available. The medicine policy should be reviewed and updated in order to ensure that the health and welfare of people using the service taking medication is safeguarded. It is recommended that any hand- written medicine charts are double- checked and signed by a second member of staff to agree that the medication details recorded were correct. A system should be introduced to ensure that balances of medicines are carried over onto a new medicine chart in order to ensure accurate medicine audits can be done. A self-administration medication assessment should be undertaken in order to ensure that the abilities and wishes of people using the service are taken into consideration regarding their medication and that this is recorded into their care plan. Lockable facilities and door locks should be provided. An action plan should be devised to reflect how the 50 level of staff qualified to NVQ level 2 is to be obtained. Care staff should receive supervision at least six times per year. The staffing rota should denote the person responsible for first aid each shift. 4 5 OP9 OP9 6 7 8 9 OP24 OP28 OP36 OP38 Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Wayside Nursing Home DS0000004150.V348101.R01.S.doc Version 5.2 Page 30 - 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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