Inspection on 16/03/10 for Wear Court

This inspection was carried out on 16th March 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wear Court 27/05/10

Wear Court 17/05/10

Wear Court 18/02/10

Wear Court 11/12/09

Wear Court 30/07/09

Wear Court 01/08/08

Wear Court 08/11/07

Wear Court 01/12/06

Wear Court 25/01/06

Wear Court 13/09/05

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Random inspection report Care homes for older people Name: Address: Wear Court Rock Lodge Road Roker Sunderland SR6 9NX zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Irene Bowater Date: 1 6 0 3 2 0 1 0 Information about the care home Name of care home: Address: Wear Court Rock Lodge Road Roker Sunderland SR6 9NX 01915496441 01915485305 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Moorlands Care Homes (N.E.) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 Wear Court Nursing Home provides nursing and personal care for 30 older people.The home is situated in a residential area of Sunderland approximately 50 metres from the sea front and within easy reach of public transport facilities.The three-storey house was originally a residential dwelling and was converted to a care home in 1993. There is a passenger lift, which provides access to most areas of the home. A stair lift provides access to several bedrooms on the first floor that are inaccessible via the passenger lift.There are twenty-seven bedrooms, four of which are double and are currently used as single rooms. Eight single and two double rooms have en-suite toilet Care Homes for Older People Page 2 of 20 Brief description of the care home facilities however, some are not of a suitable size to allow access for wheelchair users or people with mobility difficulties. Corridors and door widths are wide enough to allow access for wheelchair users. The laundry, kitchen, dining room and lounge areas are all on the ground floor with the majority of bedrooms on the upper floors.There is a conservatory to the rear of the building, which overlooks the private and mature gardens.It costs between 405 pounds and 485 pounds per week to live at this home.The costs of newspapers, hairdressing, and toiletries are not included in the fees.Fees vary depending on peoples circumstances, further details can be found in the homes Service User Guide. Care Homes for Older People Page 3 of 20 What we found: We carried out this inspection to check whether the provider has complied with requirements made in a report issued following the Key Inspection of the 11 and 29 December 2009. The Key Inspection was completed following safeguarding issues concerning the health, safety and welfare of people using the service. Before the visit, we looked at the providers improvement plan and any changes to how the home was being operated. We also checked information that had been shared with us by other professionals with an interest in the service. An inspection was also completed by the Pharmacist Inspector from the Commission and this report plus requirements and recommendations have been issued separately. An unannounced visit was made on 16 March 2010. This visit was carried out by three inspectors and it was completed in ten and a half hours. During the visit we spoke to the provider, operations manager and the acting home manager. The acting manager had introduced a new assessment record called the HART (Health Assessment Rating Tool). Qualified nurses had reviewed and updated the assessments for everyone living in the home. The assessment tool was comprehensive but those seen had not been completed in detail and several areas were contradictory. For example, it was recorded that someone was unable to communicate. However further on in the assessment it stated communicates by facial expression. The end of life care plan had more detail. However it stated that X does not want to be resuscitated but no mental capacity assessment had been completed or information provided as to how this decision had been reached. The assessment answers were mainly yes or no with little detail of identified risk. Without good information staff will be unable to identify service users health and social care needs and the appropriate care may not be provided. Five peoples care was looked at during the visit. Assessment tools in use included pressure ulcer risk, using the Braden Scoring system, Malnutrition Universal Screening Tool(MUST), continence, dependency and falls risk assessments. Individual care plans were also examined. Care plan A: The assessments showed that this person was at risk of repeated urinary tract infections and also had moving and assisting problems. There were no care plans in place to show how infections were to be minimised and managed and there was no care plan to ensure the safety of the person and staff when any transfers were carried out. Care plan B: This plan did identify likes, dislikes and involvement of family. Information was available about nutrition and offering fortified foods although the daily records did not specify what food and fluids had been taken. The moving and handling information was vague and only said two to transfer This person had pressure damage but there was no care plan or information about wound Care Homes for Older People Page 4 of 20 care and the nurse did not know what was underneath the dressing on the day of the visit. Qualified staff were unaware of best practice guidance regarding pressure care and record keeping. They were also unaware of this persons poor skin condition from a discharge from hospital to the day of the visit. The electrical air flow mattress was set at high when the persons weight indicated that a low setting was necessary. There was no detail in the care plan regarding the use of the mattress and no information about what pressure care was to be carried out when the person was out of bed. Care plan C: This person had difficulty swallowing and needed a pureed diet and thickened fluids although further on in the care plan the records said has a soft diet. Information about food likes and dislikes were recorded but there were no daily records of food intake. Detail of how the person was transferred was recorded with regard to which hoist and sling to use. The type of electrical air flow mattress was specified for the prevention of pressure damage but again there was no detail in the care plan about setting the mattress to correspond with body weight. This person had pressure damage but there was no wound care plan to show the degree of damage and what action staff were taking. The Braden score had not been completed from 25 January 2010 to 12 March 2010. The mental capacity assessment was incomplete and signed by a nurse with no evidence of any input from any psychiatrist or mental health services. Care plan D: This person had been identified as at risk from losing weight and a care plan around providing a high protein diet with supplements was in place. This persons body weight was stable with weights regularly recorded. Care plan E: This person had been seen by the Tissue Viability Nurse and clear instructions had been provided about how to manage wound care. This information had not been transfered into a plan of care. It was identified that previous requirements in relation to care planning and care delivery had not been met and statutory requirement notices have subsequently been issued. A designated activity organiser had been employed at the home who was enthusiastic and was working hard to complete life histories of people in order to know what people like and want. She told us she would also love a budget so she could do more. A Memory wall had been created in one lounge with photographs of old Sunderland and other photographs to assist with reminiscence. On the day of the visit people were planning events for St Patricks Day.There were several newspapers lying round, some for individuals, some were the homes and people shared the newspapers throughout the day. Social events had included film nights and crafts were displayed around the home. There Care Homes for Older People Page 5 of 20 were plans for one to one walks to the sea front and to the nearby park. One person regularly went out on his own in his electric wheelchair. Comments from service users included: I feel better and join in things,I am coming back in,Wonderful,Its better than Buckingham Palace. The dining room was clean and tidy and new crockery and cutlery was in use. A four week menu was available which set out choices and alternatives for all meals and snacks. Breakfast was served about 8:30am. Tables were properly set and choices for breakfast included cereals, porridge, bacon, tomatoes, toast and hot and cold drinks. An inspector joined people for lunch which was of ample portion size, tasty and well presented. Mealtimes were unhurried, homely and staff gave assistance in a discreet manner. A complaints procedure was displayed in the home. It referred the complainant to the previous Commission(CSCI) and a Safeguarding policy referred to No Secrets guidance and CSCI. However, there was no formal complaints record and no complaints had been recorded for over a year. There was an ongoing safeguarding investigation which the Local Authority were leading on. Staff were receiving safeguarding training and commented that morale is much better and we can talk to the manager. Generally the home was much cleaner and had no odours. The conservatory was cleaner but still had cobwebs and dirt at ceiling level. There was access to tea and coffee making facilities although the coffee machine was dirty. There were still outstanding environmental issues from the previous visit and the following problems were found during the visit. Toilet 5: There was a hole in the wall from the door handle. Room 27 en-suite: The extractor fan was noisy and dusty. It appeared that two unnamed tubs of Sudocrem were in use. The wardrobe had not been fixed to the wall. Bathroom 4: The wash hand basin plug hole was dirty. There was no bath thermometer for staff to check the hot water temperature before anyone was bathed. Room 25: The wood was chipped off the small bedside unit. Room 22: The front of the drawers were broken and there were two plastic mattresses standing by the bed which were reportedly being used as crash mats should the service user fall out of bed. This created little space to move around the room. Room 20: This room was being used as a temporary store. It was full with discarded items of furniture, rolls of carpets, incontinence pads, paper towels, a fan and cardboard boxes. The door was unlocked which meant that this room was accessible and posed a fire and safety risk. The linen cupboard was also unlocked despite having signage to say it must be locked. Care Homes for Older People Page 6 of 20 Bathroom 3: This area was extremely hot and full of incontinence pads, a carpet cleaner and carpet shampoo. The door to this room was also unlocked. Immediate requirements were issued to keep these doors locked until the rooms could be cleared also to make sure that all doors were adjusted so that they would safely close nto their rebate. The sluice rooms: These areas were clean but their doors were unlocked. The upstairs sluice room had no liquid soap and contained a bin with cleaning materials. A sluice disinfector had not been provided despite previous requirements to do so. Toilet 2: This area still required a new light cord to replace the existing knotted and dirty cord which posed an infection control risk. Room 18: A new wardrobe had not been fitted to the wall and the wall remained unpainted and had wooden strips still attached where the original wardrobe had been located. Several of the rooms had been personalised, however radiators were noisy, bedrooms felt uncomfortably warm and it was not possible to turn the heating down in individual bedrooms. The back corridor which leads to the kitchen, laundry and staff areas was cleaner and doors were closed. The laundry remained untidy and the sink was still ingrained with debris as was the wash hand basin. There were broken floor tiles which meant the floor could not be cleaned properly and the windows remained damaged either from stones or an air gun pellet. Three care staff, one qualified nurse, a laundry assistant and cook were on duty. The laundry assistant was then allocated to domestic duties as the domestic had telephoned in sick. The maintenance person was no longer employed and administrative duties were carried out from another home. Night staffing had increased to two carers and one qualified nurse although it was unclear if this was to be a permanent arrangement. A designated activity person had been employed. On the day of the visit there were twenty people living in the home. Fifteen had been assessed as needing nursing care and five required personal and social care. The rotas were eventually produced although the rota for domestic staff had to be written on the day. The duty rota for week commencing 15 March 2010 referred to four qualified staff with no detail of their designation or nurse qualifications. The night duty rota was of poor quality with almost illegible first names for both nurses and care staff and several crossings out. A domestic rota only contained first names and a rota for the catering staff never materialised despite a request to see it. The office filing cabinet was a complete muddle and it took some time to get the files for Care Homes for Older People Page 7 of 20 the staff on duty. The individual staff files were not in order. An immediate requirement was made to ensure that the qualified nurses had an up to date Personal Identification Number (PIN) with the Nursing and Midwifery Council (NMC) to prove they are able to practice as Registered Nurses. There was little evidence to show that staff had completed mandatory or any specialist training. Records seen indicated that some training for moving and handling had been completed in 2008 and first aid over two years ago. Staff were unsure when they had received health and safety, infection control and fire training. No one has completed any training in elderly conditions including dementia, nutrition or wound care. Staff had not completed Mental Capacity Act or Deprivation of Liberty safeguarding training. It was identified that previous requirements in relation to staff training had not been met and a Statutory Requirement Notice has subsequently been issued. The acting manager had started to complete supervisions with the staff team but confirmed that only two had been completed so far. Staff said we used to have a work rota which was great but it was got rid of and not re introduced, and staff morale is better,very unhappy before. There has not been a registered manager in post at the home since 2006 and a warning letter had been sent to the Provider regarding the lack of long term management arrangements in the home. A new manager had been appointed in November 2009. However she was uncertain as to whether she would be seeking registration with the Commission. The acting manager and provider were in the home on the day of the visit and a short discussion took place to inform them about the inspection process. The acting manager had an understanding of the issues to address and was trying to prioritrise the major concerns. An audit of service users personal allowances identified that some receipts did not reflect money spent, record sheets did not include receipt numbers which made it difficult to balance monies plus there were no audit systems in place. No in house maintenance records were in place to demonstrate checks on hot water temperatures, nurse call systems, window restrictors or that bed rails were being safely maintained. An immediate requirement was issued to obtain confirmation that PAT testing of electrical appliances and the five year electrical installation testing had been completed. Accident records were kept but record sheets had been left in the accident book which did not comply with the Data Protection Act. There was no analysis in place to track trends although a risk assessment was in place after a service user had fallen outside. Care Homes for Older People Page 8 of 20 Since the Inspection in December 2009 a detailed fire evacuation plan had been completed. The fire marshall certificate for the in house fire trainer had expired on 30 January 2008. The instruction and duration column of the fire instruction drill log were all listed as N/A as were the fire drill evacuations and time column. The column to detail the person receiving and participating in the drill was marked all staff and the nature of instruction/overview of drill column only contained all staff to meeting point which provided no specific evidence of individual staff attendance. Fire drills had not been carried out for night staff. It was also confirmed that drills were part of the weekly fire alarm test and therefore expected at the same time and day each week. A recent fire incident, where the fire alarm had been triggered for a genuine reason had not been logged anywhere and the staff had reset the alarm themselves once they had identified that there was no actual problem. Fifteen of the twenty nine staff listed on the staff training matrix had no recorded date for fire safety training. Observations and concerns relating to fire safety at the home have been forwarded to the fire authority. What the care home does well: What they could do better: Although a new assessment record has been introduced staff must ensure that it is completed in detail. Further work is needed with the care plans so that they clearly detail the current and longer term personal and health care needs of individuals. Also to ensure that all equipment is used properly. Information about how staff assist people with their care needs must be recorded in the care plans. Care Homes for Older People Page 9 of 20 People and their representatives need to be involved in planning their own care with the staff. All food provision must be recorded to include fortified and specialist diets. A robust recording system for managing complaints must be developed. All staff training requirements must be met. Arrangements must be in place to ensure that all grades of staff receive regular, formal supervision sessions so that they are all clear about their roles and responsibilities and have an opportunity to discuss their work at the home. A written plan of urgent and routine maintenance which includes refurbishment and redecoration must be in place and be regularly reviewed and updated. The heating, lighting, ventilation and water supply arrangements at the home must meet health and safety requirements. A hot wash steriliser to assist in prevention of cross infection must be provided. Quality assurance and quality monitoring systems must be fully implemented. All maintenance checks must be completed to ensure that people are kept safe. All records required by regulation must be available, up to date and kept in a secure location. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 20 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 To make arrangements to 12/04/2010 ensure that records are kept of all medicines received, administered and leaving the home, disposed of or carried forward from one month to the next. To maintain a full audit trail of medication in the home. 2 9 13 To make arrangements to 12/04/2010 ensure that medication administration records are accurately maintained; that the reasons for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the Medication Administration Record in respect of each individual service user at the time of administration. To maintain an accurate record of medication administered. 3 19 13,23 The registered person must 01/02/2010 Page 11 of 20 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action continue the work to audit and improve the environment in line with the plans already submitted to CQC. This must include all of the items identified in this report. This is so that people who live in the home have an acceptable level of comfort, hygiene and safety. 4 24 16,23 The registered person must continue to implement the action submitted to CQC to provide suitable furniture and fittings in all bedrooms. This will provide a comfortable environment for people to live in. 01/02/2010 5 26 13 Staff in the home must be provided the facilities to adequately clean and disinfect equipment being used for personal care including the provision of adequate numbers of hot wash sterilisers. This will minimise the risk of cross infection. 01/02/2010 6 30 18 The registered person must ensure that staff are provided with appropriate 29/01/2010 Care Homes for Older People Page 12 of 20 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action training for the work they are to perform. This is so that people living in the home receive the care and support they need. 7 33 24 The quality assurance and 29/01/2010 monitoring systems must be fully implemented in line with the companys proposal. This will make sure that the quality of the service is regularly reviewed taking account of the residents views. 8 38 13 Arrangements must be 29/01/2010 reviewed and action taken to safeguard the health, safety and welfare of residents and people working in the home. Care Homes for Older People Page 13 of 20 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 38 13 Provide a copy of the Gas 05/04/2010 Safety Certificate for all gas appliances, Electrical Safety Installations certificate and information regarding PAT testing, hot water and Legionella checks and details of checks on window restrictors. This is to ensure the safety of service users. 2 38 13 Ensure that all door closures 05/04/2010 are assessed and adjusted appropriately. This is to prevent them closing too quickly and with a force that would present a hazard to service users. 3 38 13 Clear room 20 and bathroom 05/04/2010 3 and until this has been completed ensure that the doors to these rooms are kept locked.The linen cupboard door must be locked when not in use. This will ensure the safety of service users. Care Homes for Older People Page 14 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Carry out a full review of all care plans to ensure that every individual service users plan clearly identifies how that service users needs in respect of their health and welfare are to be met. Put in place effective arrangements to ensure that when there are changes to an individual service users health and welfare needs, that the service users plan is revised to accurately reflect that service users change in needs. Put in place effective arrangements to ensure that every individual service users plan is reviewed at least monthly or as dictated by that service users changing health and welfare needs. This is to make sure that staff plan and review how they work with people so that everyone works in the same way to ensure peoples needs are being met. 21/05/2010 2 8 12 Put arrangements in place to 21/05/2010 ensure that all service users who are using specialist pressure relieving mattresses have the mattresses set correctly for each person. Put in place arrangements to Care Homes for Older People Page 15 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action ensure that staff are providing care as detailed in individuals care plans. Make sure that those service users who need their weight monitoring are weighed as directed in their care plans. Medical advice and input must be sought before deciding the mental health and DNAR status of service users. This will make sure peoples health care needs are met. 3 8 13 Ensure that individual risk assessments are in place which are updated to show any changes. Outstanding timescale of 30/01/10 not met. This will ensure that people are cared for safely. 4 25 23 Ensure that the heating, lighting, ventilation and water supply arrangements in the home meet environmental and health and safety requirements. Outstanding timescale of 01/03/10 not met. This will ensure people live in a safe and comfortable environment. 5 30 18 Demonstrate that 21/05/2010 Page 16 of 20 21/05/2010 21/05/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action arrangements for staff to receive appropriate training have been put in place. This is to ensure that people are cared for by staff who are competent and trained for the work they are to perform. 6 30 18 Ensure that sufficient 31/07/2010 numbers of staff receive first aid training in order that first aid assistance is always available in the home. Ensure that all members of staff with responsibility for administering medication are trained to do so. Provide all staff with training in adult safeguarding and whistle blowing. Ensure that all staff are provided with training in moving and handling which is appropriate to their work. Provide all staff with suitable training in health and safety. Provide all staff with suitable training in infection control. Provide all staff who prepare and handle food with suitable training in food safety and hygiene. Provide all staff with suitable training in the Mental Care Homes for Older People Page 17 of 20 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Capacity Act and deprivation of liberties safeguarding. This is to ensure that people are cared for by staff who are competent and trained for the work they are to perform. 7 35 17 Maintain written records of all service users personal money transactions. This will make sure peoples money is protected. 8 36 18 Ensure that all staff receive appropriate supervision at least 6 times a year. Outstanding timescale of 01/03/10 not met. This will ensure people receive consistent, proper care delivered by trained experienced staff. 9 37 17 Ensure that all records required by regulation are avaiable, in good oredr and held securely. Outstanding timescale of 31/01/10 not met. This will make sure peoples rights and best interests are protected. 10 37 17 Ensure that the records of 21/05/2010 the food provided for service users, to include individual special diets are in sufficient Page 18 of 20 30/04/2010 21/05/2010 21/05/2010 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action detail to determine whether their diet is satisfactory. Outstanding timescale of 30/01/10 not met. This will allow staff to monitor peoples food intake. 11 38 23 Ensure that maintenance 21/05/2010 checks are carried out to include hot water temperatures, nurse call systems, window restrictors, and bed safety rails. Outstanding timescale of 07/01/10 not met. This will ensure the safety of those in the home. 12 38 13 Ensure that free standing wardrobes in bedrooms are risk assessed and where necessary securely fixed. This is to prevent toppling incidents and prevent injury. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 21/05/2010 1 31 The person in charge of the home should be provided with supernumerary hours in order to allow them time to oversee and improve the operation and efficiency of the home. Care Homes for Older People Page 19 of 20 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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