Inspection on 03/05/07 for Wayside Nursing Home

This inspection was carried out on 3rd May 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 15/11/07

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 Unannounced Inspection 10:05 3 May and 4th June 2007 rd 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.V334891.R02.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.V334891.R02.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 Vacancy 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.V334891.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 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. The home is a large detached period property which includes a pleasant and mature enclosed garden and limited car parking. Residents accommodation is on three floors (ground, first and second floors), which can be accessed by a central passenger lift. A stair lift also accesses a limited number of rooms on the first floor. 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 stated on the first day of this inspection that the current fees charged at Wayside range from £460.00 to £505.00 per week. Additional charges are made for items such as hairdressing, private chiropody, newspapers and toiletries. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulation inspector based at the Worcester office of the Commission for Social Care Inspection (CSCI) undertook this unannounced key inspection over a period of two days. A regulation manager from the Worcester office joined the inspector for part of the first visit to the home. This inspection takes into account any information received by the CSCI in relation to the home since the previous inspection as well as the visits to the home. Prior to this inspection a pre inspection questionnaire was posted to the home for completion, this document was not returned to the commission. A number of questionnaires were also sent to the home to be completed by residents, relatives and health and social care professionals. A few completed questionnaires were returned to the commission. The contents of the completed questionnaires are taken into account as part of this inspection. The home had no vacancies on the first day of this inspection therefore accommodating 30 residents. Wayside does not currently have a registered manager. The manager designate was not on duty on the first day of this inspection but was present during the second visit. During this inspection discussions took place with the manager designate, the area manager, two relatives, some staff members (trained nurses and care assistants) and a number of residents. A partial look around the home took place which included a number of bedrooms as well as communal areas. The care documents of a number of residents were viewed including care plans, daily notes and risk assessments. Other documents seen included medication records, service records, risk assessments and staffing records. What the service does well: Information is available to potential residents regarding the service offered at Wayside nursing home. Open visiting is in place and visitors to be home appeared to be welcomed and seemed comfortable within the home. Residents seen looked suitably attired. Residents sat within the lounge appeared relaxed and showed no signs of distress. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 6 Residents and relatives spoke highly both during the inspection and within survey forms returned of the home’s activities coordinator. A number of activities are provided to stimulate and occupy residents. Information gained from survey forms suggested that residents relatives are aware of the home’s complaints procedure. What has improved since the last inspection? What they could do better: The information available to potential residents needs to be changed or amended to ensure that the details are correct and in line with the required standard. Care plans and risk assessments were insufficient in detail and at times contained conflicting information making it difficult to establish current care needs. The use of some bedrails without suitable bumpers to protect residents from the risk of entrapment was a serious concern. The management and recording of medication was poor and had the potential of placing residents at serious risk. As a result of the concerns an immediate requirement notice was issued. The registered provider took the concerns seriously and invested time to ensure that a full investigation was carried out. A range of concerns were apparent regarding the physical environment many having health and safety implications for residents and others within the home. Gaps were apparent in the training records including mandatory training such as fire awareness and moving and handling. The commission was informed during this inspection that the manager designate was leaving the home therefore creating a vacancy for the manager’s post. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 7 Management within the home was found to be weak and ineffective resulting in potential risks to the health and safety of residents and therefore potential poor outcomes. Following this inspection but before this report was issued a meeting took place at the Worcester office of the commission involving the registered provider, the area manager with a responsibility for Wayside and the inspector. During the meeting the majority of issues covered within this report were discussed. The home’s area manager handed to the commission an action plan covering many of the serious concerns which were previously discussed at the end of the inspection. 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.V334891.R02.S.doc Version 5.2 Page 8 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.V334891.R02.S.doc Version 5.2 Page 9 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, 2 and 3. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient information is available to potential residents and their family to help them decide whether the home is suitable for them. An assessment is carried out so that potential residents care needs can be agreed prior to their admission to ensure that these are able to be met. EVIDENCE: A colour brochure was freely available within the reception area of the home. The brochure would afford potential residents and or their representatives with some basic information regarding the home. It was noted that the brochure states ‘ Wayside New Road is a long established Nursing Home registered with the local Health Authority and Social Services in Worcester.’ The home is Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 10 actually registered as a care home providing nursing care with the Commission for Social Care Inspection. It was evident that a copy of the homes service users guide was available within each bedroom. The inspector requested a copy of this document however as no spare copies were available it was necessary to have a copy faxed over from the organisations head office. Although the service users guide was recently up dated it does not contain all the areas stipulated within the amended regulation. The file of a recently admitted resident was viewed. It was evident that the manager designate undertook a pre admission assessment. The assessment seen was not dated although other evidence suggested that it was carried out shortly before the potential residents admission into the care home. The assessment contained sufficient information to initiate a care plan. One relative commented upon a survey form returned to the commission that they found Wayside to be ‘a really homely place, the information was good and we were treated very well.’ Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 11 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 poor This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments were not always updated and did not always contain sufficient information to provide staff with the necessary information to ensure consistency in care delivery. The unsafe use of bedrails without bumpers was a potential risk to the health and safety of the residents concerned. Medication systems were poor and had the potential of placing residents at serious risk of harm. EVIDENCE: A number of resident’s files were examined. Each one contained a care plan and a number of other documents including risk assessments. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 12 The quality of the care plans varied. While some areas of care need were covered other areas were lacking. Some information recorded was too generic and not specific to the individual concerned. It was also noted that conflicting information was recorded across different documents for example details regarding an individual’s history of falls while another residents file contained conflicting details regarding weight and dietary care needs. One file contained a number of incomplete documents some of which were signed off by a trained member of staff. Some files contained care plans for newly identified care needs such as a chest infection while others did not. As a result staff were not provided with the necessary information to enable them to care for an individual in a consistent style. Not all care plans were reviewed as required and risk assessments were either incomplete in detail or not up dated. Care plans that were seen failed to demonstrate how emotional, spiritual and social needs were to be met. It was of concern to see a resident in bed with bedrails in place without any bumpers. Bedrails without bumpers can become a potential entrapment hazard. The above observation was brought to the attention of the area manager who took immediate action and arranged for the loan of some bumpers from another home within the organisation and place an order for some new ones. As part of this inspection the management and administration of medication was assessed and found to have a number of serious shortfalls. As a result of the concerns an immediate requirement notice was issued. The immediate requirement was followed up by means of a letter to the registered provider. The concerns included: A number of gaps were evident on the MAR (Medication Administration Record) sheets whereby staff had failed to either sign for medication as given or enter a code to explain why it was omitted. The date of opening was not recorded upon the majority (eleven out of twelve) of boxed medication checked therefore making a full drugs audit difficult. The date of opening was not recorded upon some eye drops. Eye drops often have a limited shelf life once opened therefore making it crucial that the date of opening is known Two MAR sheets contained the incorrect number of signatures for courses of antibiotics. Another two MAR sheets gave cause for concern regarding the recording of liquid antibiotic medication. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 13 Staff had failed to indicate on one MAR sheet the actual dose given when an item was prescribed on a variable dosage. It was evident that staff had signed the MAR sheets prior to administration as on occasions staff had over signed them with a code such as ‘R’ (refused) or ‘S’ (asleep). On one occasion the over signing was in relation to a drug which needs to be treated as a controlled drug. It was noted that an entry within the controlled drugs register was not completed (although the actual balance was correct). In addition an overstocking had occurred in relation to another controlled drug. Medication is stored in a suitable medication trolley, which is held securely in a communal area. The medication trolley was clean and tidy. A fridge for the storage of medication is available. Records regarding the temperature of the medication fridge were briefly seen as part of the second visit to the home and noted to be in good order. The area manager and the registered provider took on board the seriousness of poor recording and that it could not always to evidenced that residents had received the correct medication. As a result of the concerns the registered provider undertook an investigation regarding the actions or omissions taken by the trained nurses. It was of concern to note that the previous months MDS (Medication Dispensing System) cassettes were within the main office awaiting collection by the pharmacist. The door to the office was unlocked, it was later established that the door was not lockable. Although the cassettes were not looked at in any detail it was however noted that medication was remaining in at least one of them. Residents seen looked suitably attired taking into account gender issues and weather conditions. It was noted that resident’s glasses were clean. Conversations with residents were limited due to varying degrees of dementia type illness. Residents sat within the lounge appeared relaxed and showed no signs of distress. Wayside Nursing Home DS0000004150.V334891.R02.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 and 14 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Stimulation is provided within the home and residents are able to maintain contact with family and friends. EVIDENCE: Open visiting is in place whereby no restrictions exist. A number of visitors were seen within the home throughout this inspection, two visitors were consulted. Visitors seemed to be comfortable within the home and were able to see their relative within either communal areas or within the individuals own bedroom. An activities coordinator is employed 16 hours per week worked over four days. The activities person was described as ‘excellent’ on one survey form while a relative commented that the activities coordinator ‘ works extremely hard and includes ** whenever possible.’ Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 15 A number of planned activities were highlighted upon a notice board and within a newsletter prepared by the activities coordinator. It was reported that a planned trip to a local garden centre had to be cancelled due to a lack of volunteer helpers. Activities planned for June included making birthday cards and playing games such as an alphabet game, bags in hoops, give me five facts and dominoes. It was reported that another member of staff undertakes a game of bingo each Wednesday when the activities coordinator is on a day off. Recently each resident has either made their own or picked a design for a new door plaque. These plaques were on bedroom doors. Pictures were displayed of the recent Easter party. It was evident that the activities coordinator has the enthusiasm to develop the range of activities undertaken within the home and was looking forward to forthcoming training. Religious care needs are reported to be met by means of a visiting minister / priest. Standard 15, which concentrates upon food and drink, was assessed as meeting the National Minimum Standard during the previous inspection. This standard was not assessed on this occasion. It was however noted that the days menu was on display. On the first day of this inspection lunch consisted of roast chicken, sage and onion stuffing, roast and creamed potatoes, cabbage, carrots and leaks in a cheese sauce or ham salad or jacket potato and salad. One resident wrote on a survey form ‘We have a very good cook.’ Wayside Nursing Home DS0000004150.V334891.R02.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 adequate This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place and staff have in the past receiving training related to safeguard adults which supports the rights of residents and the protection of residents from abuse. EVIDENCE: The majority of people who responded to surveys issued by the commission stated that they are aware of the home’s complaints procedure and that they knew who to speak to if they had any concerns. The commission have not received any direct complaints since the last inspection. Some comments / observations which were recorded within the survey forms issued prior to the inspection are referenced elsewhere within this report. It was stated during the inspection that the home had received no complaints regarding the service provided since the last inspection. Information regarding the home’s complaints procedure is included within the service users guide. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 17 Information regarding staff training upon safeguarding adults was not available on this occasion. Policies and procedures regarding safeguarding adults or protecting vulnerable people were not viewed on this occasion. These documents were however described as ‘satisfactory’ following the previous inspection which took place during February 2007. Wayside Nursing Home DS0000004150.V334891.R02.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, 24, 25 and 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Progress to improve the environment and address a range of serious health and safety matters is slow. People living within the home are not afforded a safe and well-maintained environment therefore placing them at risk of harm or injury. EVIDENCE: As a result of the concerns within the previous inspection report a number of areas within the home were viewed as part of this inspection. A number of shortfalls in the required standards were noted giving cause for concern. The previous report mentioned that a toilet had carpeted flooring. The carpet flooring was still in place on the first day of this inspection however contractors Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 19 were working upon replacing it with non-slip flooring on the day of the second visit. The contractors were asked to repair a potential trip hazard noted elsewhere within the home. Some bedrooms were viewed as part of this inspection. Freestanding wardrobes were unsecured to the wall and therefore presented a risk of toppling over. The vanity unit in one bedroom was damaged. Some items of furniture in other bedrooms were damaged and in need of replacement. An emergency call bell system is fitted within the home. Although the appropriateness of the system was not assessed it was noted that staff responded promptly to it. The carpet on the first floor landing described as ‘threadbare in places’ within the last report remains the same. Some carpeting along the ground floor corridor is also heavily worn. The décor along some corridor areas is tired in appearance. 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. A stair lift is in place up the main staircase however this brought about other concerns highlighted later within this report. The lounge areas appeared to be comfortable and well used by residents. Storage facilities are limited for example the hairdressing room continues to stow wheelchairs. While a number of residents were having their hair attended to the wheelchairs were transferred to the dining room. The dining room appeared ‘tired’. The varnish on some dining room chairs has worn off in addition some chair covers were stained. A fire door leading from the dining room did not fit correctly into the rebate. It was of some concern that no motifs were in place on the patio windows leading outside from the dining room. The standard of the glazing was not established. The suitability of glazing is detailed in the Workplace (Heath and Safety) Regulations 1992. Guidance issued by the Health and Safety Executive states ‘ serious injuries have occurred when people have fallen through glass windows. It may therefore be necessary to fit suitable safety film (or replace with safety glazing to BS 6262 to glass at or below waist level’. The guidance continues with ‘Glass doors and patio windows must be fitted with toughened or safety glass or covered with a protective film that prevents glass from shattering. They must have a conspicuous mark or feature sufficiently obvious that people will be unlikely to collide with them. When replacement glass is required then reference to BS 6262 should be made.’ Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 20 Low-level windows were found to be restricted to prevent accidental or deliberate falling to the floor. The suitability of these restrictors needs to be kept under continual review. Some concern was expressed regarding higherlevel windows in areas such as first and second floor bedrooms were by windows could be opened wider than 100 mm (4 inches). The hot water delivered to a wash hand basin in a toilet on the second floor took a long time before it ran hot; however once hot water was supplied it became very hot therefore presenting a potential risk of scalding. Signage was seen over wash hand basins stating ‘caution very hot water’. Sluicing facilities are provided on each of the three floors however only one of these is a thermostatic sluice disinfector. The previous report found that given the size and layout of the home as well as the use of commodes the sluicing facilities to be insufficient. A label on a spray bottle within a locked sluice was illegible as to its contents. Another spray bottle containing ‘blue toilet cleaner’ was found unattended in a downstairs toilet, this hazardous substance could potentially of been accessed by a resident. On the second visit of this inspection a further concern regarding the recognition of the implication of not storing cleaning materials was apparent. A carrying case containing a range of cleaning materials was found along a corridor. It was noted that cleaning materials were again decanted into spray bottles. Other cleaning materials were stowed under a table in the main body of the home. A requirement to ensure that all substances hazardous to health are stored securely formed part of the previous inspection report is therefore unmet and gives cause for concern. Throughout this inspection no offensive odours were detected. One relative who had never visited the home before commented on the fact that no odours were apparent. A number of persons made comments within the survey forms issued by the commission that the home is not always fresh and clean. One person made reference to odours at weekends while another made reference to a shortage of cleaning staff. Wayside Nursing Home DS0000004150.V334891.R02.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, 29 and 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Training is provided however some staff have not undertaken recent up dates to ensure the needs of residents are able to be fully met. Staffing levels are believed to be insufficient by a number of persons therefore potentially failing to met care needs. EVIDENCE: It was reported that six carers are on duty during the morning shift and four during the afternoon. Two carers cover the night shift. One trained member of staff is on duty at all times. The manager designate was supernumerary on the day of this inspection however he was having to work as the trained member of staff 2 days per week. Concern had been passed to the inspector regarding a perceived insufficient number of trained staff on duty. This perception needs to be taken into account by the registered provider. The names of staff on duty are recorded upon a wipe board. Due to staff sickness the names of staff was having to be amended on the second day of Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 22 this inspection. It was noted that a number of staff were working a 12½ hour shift. A number of respondents to survey forms distributed made comments regarding staffing matters. ‘staffing seems low . . understaffing and very low morale’ ‘The staff are hardworking and pleasant but there doesn’t seem to be too many of them’ ‘The staff are very helpful and cheerful.’ ‘It is not always easy to find a member of staff . .’ Shortfalls were identified in training especially fire safety where it was noted that some members of staff had not received any training since March 2006 therefore over 12 months ago. The training records demonstrated that some staff did not received any moving and handling training during 2006. The organisation provides in house training on a regular basis across each of their registered homes therefore gaps in training needs should not happen. It became evident during this inspection that a full audit of training undertaken by Wayside staff is necessary to establish shortfalls and therefore be able to develop an action plan. The number of staff who have completed National Vocational Qualification level 2 or above was not assessed as part of this inspection although areas regarding this qualification were discussed with the area manager. The previous inspection report (February 2007) stated that examination of staff files at that time ‘showed no shortfalls in the recruitment procedure.’ Although a number of good recruitment practices were in place a number of shortfalls were evident during this inspection. The shortfalls identified were brought to the attention of the area manager. Wayside Nursing Home DS0000004150.V334891.R02.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, 37 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Quality assurance and monitoring systems are in place, however a lack of consistency in ensuring that health and safety systems are in place has the potential of placing people within the home at risk. EVIDENCE: The last inspection at Wayside was undertaken during February 2007. The previous report stated ‘ The home is drifting and lacks purpose and direction.’ Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 24 The manager designate of the home was not on duty during the first day of this inspection. The area manager was contacted by the nurse on duty and attended the home for a considerable period of the visit. The manager designate was on duty on the day of the second visit. The area manager visited the home and once again took part in a considerable part of the visit. The manager designate is not registered with the commission as the manager of the home and no application had been made to the commission. It was reported during this inspection that the manager designate had tended his resignation from the organisation. It was stated that the recruitment process was underway to secure a new manager designate. A number of quality assurance systems are in place within the home. The area manager visits regularly and prepares a written report as required under Regulation 26 of the Care Homes Regulations. A recent survey has taken place by means of a questionnaire to residents. The results of the survey were collated within the organisation and given to the manager designate. The majority of responses were either excellent or good however the organisation requested an action plan from the manager designate. At the time of this inspection the action plan had not been completed. A facility for the safekeeping of residents money and valuables is available. As part of the inspection the records and balances of a random number of residents monies were checked. Following some time studying the records and cross referencing receipts held it was established that the balances were correct. However the record keeping was in a number of places poor and a number of mistakes that had been rectified were evident. On one of the records checked it was apparent that people charging for services to the residents are seeing the balance sheets as they are signing these records. This is not good practice as these records are confidential and should only be seen by designated employees of the home. It was reported that the supervision of staff (both trained and care assistance) has started. A matrix of supervisions undertaken evidenced a number of gaps. Progress in meeting the standard upon the formal supervision of carers will be re assessed as part of forthcoming inspections. A number of records required in the home including those in respect of each individual resident are not being fully maintained. As reported throughout this report failings include care plans, medication records, recruitment documents, residents finance records and risk assessments. The stair lift mentioned earlier within this report was of concern due to the potential risks to residents using the equipment. Concern was heighten when a document dated 5th December 2006 stating ‘should not be used’ was seen. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 25 The records regarding the weekly / monthly testing or checking of fire safety systems such as the alarms and extinguishers were in good order. Staff consulted had a reasonable knowledge of the whereabouts of stop taps and isolation points in case of emergency. It was reported that no emergency plan was available. The current fire risk assessment was carried out during May 2006, it was reported that this is due to be redone shortly. The landlord gas safety certificate was out of date by a few days. As highlighted earlier within this report the records regarding staff training were not satisfactory and demonstrated that some staff have not undertaken some mandatory training for a considerable period of time. The risk assessment regarding the portable ramp used on the first floor was out of date and insufficient in content. No other environmental risk assessments were viewed on this occasion. Throughout this inspection poor management and a lack of ownership and understanding regarding health and safety were apparent. Many of the issues highlighted throughout this inspection gave serious cause for concern, as they were potentially hazardous to the health safety and welfare of residents. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 26 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X 1 2 1 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 1 Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 27 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 5A Requirement The service users guide must be amended to provide details required by the amendment to the regulations. The above requirement is similar to a previous requirement which had a timescale of 30/04/07 and is unmet 2 OP2 5 (1) (b) The homes terms and conditions must include details of the fee level. The above requirement is similar to a previous requirement which had a timescale of 30/04/07 and is unmet 3 OP7 15(1) Care plans accurately covering 31/07/07 all identified care needs including emotional needs, must be in place and updated when any significant changes become apparent. The above requirement is similar to a number of Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 28 Timescale for action 31/08/07 31/07/07 previous requirements with numerous unmet timescales including 30/04/07. 4 OP8 12(1) Risk assessments must be reviewed and updated at least once a month and also when significant changes occur. The above requirement is similar to a number of previous requirements with numerous unmet timescales including 30/04/07. 5 OP8 13 Systems must be in place to ensure the health, safely and welfare of residents including the appropriate use of bedrails and bumpers. 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 residents. The above requirement is similar to a number of previous requirements with numerous unmet timescales including 30/04/07. 7 OP19 13(4) 23 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 similar to previous requirement. 30/09/07 30/06/07 30/06/07 6 OP9 13 (2) 03/05/07 Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 29 8 OP26 23 All areas of the home to be kept clean. Previous timescale 10/05/05 20/10/05 and 30/04/07 not met 30/06/07 9 OP27 18 At all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. Previous timescales 14/01/05 10/05/05, 20/10/05 and 30/04/07 not met 30/06/07 10 OP30 18(1) 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. Previous timescales 14/01/05 10/05/05 and 30/04/07 not met 31/08/07 11 OP38 13 (6) 18 A risk assessment must be documented with regard to the use of the portable ramp and action taken to reduce/eliminate any risks identified. A risk assessment was in place however in need of reviewing. 30/06/07 12 OP38 13 (4) All substances noted to be hazardous to health must be stored securely. Previous timescales of 20/10/05 and 30/04/07 not met. This requirement must be met without further delay 30/06/07 Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 30 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 4 Refer to Standard OP24 OP26 OP36 OP38 Good Practice Recommendations Lockable facilities should be provided within each bedroom. Sluicing facilities within the home should be assessed for their appropriateness Care staff should receive supervision at least six times per year The staffing rota should denote the person responsible for first aid each shift. Wayside Nursing Home DS0000004150.V334891.R02.S.doc Version 5.2 Page 31 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. 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