Key inspection report CARE HOMES FOR OLDER PEOPLE
Wear Court Rock Lodge Road Roker Sunderland SR6 9NX Lead Inspector
Anne Urwin Brown Key Unannounced Inspection 30th July 2009 09:20
DS0000064820.V376999.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 2 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Wear Court Address Rock Lodge Road Roker Sunderland SR6 9NX 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) 0191 5496441 0191 5485305 Moorlands Care Homes (N.E.) Limited Manager post vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st August 2008 Brief Description of the Service: 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 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 and £485 per week to live at this home. The costs of newspapers, hairdressing, and toiletries are not included in the fees. Fees vary depending on people’s circumstances, further details can be found in the homes Service User Guide. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is one star adequate service. This means that the people who use the service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. How the inspection was carried out Before the visit we looked at: • • • • Information we have received since the last visit. How the service dealt with any complaints & concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The Visit: An unannounced visit was made on 30th July, 2009 and a second visit was made on 14th August. These visits were carried out by two inspectors and lasted a total of 12 hours. During the visit we: • • • • • • Talked with people who use the service, staff, a representative of the management, the manager and visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 6 What the service does well:
Residents were relaxed and had a good rapport with staff. Staff welcome visitors and communicate well with them making them feel comfortable when they come to the home. The new systems for care planning have the potential to provide good information about peoples’ needs and how they are met. There is a stable and committed staff team who work hard to provide a good service to the people living in the home. The food is well cooked and presented and people said they enjoyed their meals and there was a choice. People are protected by the home’s systems for dealing with complaints and safeguarding matters. The staffing rotas showed that there are enough nurses and care staff to meet the individual needs of the people living in the home. Good recruitment practices and procedures are in place to protect people using the service. There are plans in place for implement and develop further the current management systems to make sure that the quality of the service is regularly reviewed and changes are made to improve the service. The senior management of the home have shown a willingness to engage with Care Quality Commission (CQC) to address previous requirements and further develop good systems for the management of the service. What has improved since the last inspection?
A new care planning system has been introduced and work is ongoing to bring all of the care plans up to the standard required. Improvements have been made in the physical standards of the home and this work is ongoing. A detailed audit has been carried out of the outstanding work and there is a commitment to complete this within reasonable timescales. The home has had an improvement in the standards of cleanliness and work is ongoing including the introduction of a domestic cleaning rota and a system for auditing this.
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 7 All call cords and light cords are in easy reach, free from knots and easily cleaned. Suitable bins with lids have been provided to assist with odour and infection control. The walls and floor in the laundry have been made impermeable and are easy to clean. Staff are aware of the procedures to minimise any spread of infection. The registered person has produced a business plan to demonstrate the current and future financial viability of the home. The provider has ensured that there are adequate care staffing hours in the home to meet the needs of the residents in the home. All health care records are kept in one place so that staff can easily implement the prescribed care. Plain English is now used in care plans. A manager has been appointed and will be seeking registration with CQC. A quality assurance system has been developed and is being implemented. Some work has been done to improve the environment including redecoration, work on the roof and ivy removed from the front of the house. The garden to the front of the building has been tidied. What they could do better:
The needs of each person must be fully assessed before they move into, or return to the home following hospital admission where there has been a change in their needs. This will ensure that the service can meet their needs. The registered person must ensure that the ongoing work to improve the care plans is completed in line with the company’s new systems and processes. This will ensure that people get the care and support they need. Risk assessments must be in place for individuals and updated to show any changes. This will ensure that people are cared for safely. Staff training must be provided to ensure that they can safely operate any new systems for the administration of medication. Systems for auditing medicines must be introduced. The facilities in the treatment room must be reviewed and steps taken to provide safe and appropriate storage. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 8 Menus must be reviewed to ensure that a balanced, nutritious diet is provided, which takes account of peoples’ preferences and needs. This will ensure that residents are offered a varied and nutritious diet. The registered person must 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 and have clear timescales. This is so that people who live in the home have an acceptable level of comfort, hygiene and safety. 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. 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. The provider must complete the recruitment process for domestic and laundry hours in the home. This will promote the welfare of the residents by ensuring that they get the full attention of the nursing and care staff. The registered person must ensure that staff are provided with appropriate training for the work they are to perform. This is so that people living in the home receive the care and support they need. The manager must have regular formal supervision and a review of her performance at regular intervals. An appropriate training plan must be developed for her continuing professional development. This will ensure that the manager has the skills and competencies to fulfil her role. The quality assurance and monitoring systems must be fully implemented in line with the company’s proposal. This will make sure that the quality of the service is regularly reviewed taking account of the residents’ views. Arrangements must be reviewed and action taken to safeguard the health, safety and welfare of residents and people working in the home. It is recommended that improvements are made to the social activities programme to make it more person centred and reflect the interests, abilities, previous lifestyle choices and preferences of people living in the home. It is recommended that the manager progresses with application to become registered. A programme of regular effective formal staff supervision must be in place to ensure that staff are clear about their role and responsibilities.
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 9 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent assessments do not always provide enough information to show that individuals’ needs can be met by the service. EVIDENCE: The pre-admission assessments use tick boxes and provide space for comments to the side. Care plans of recently admitted residents did not include sufficient information recorded to show that a full assessment had been made of whether or not the home could meet the person’s needs. Tick boxes had been completed, but there was little additional information provided to give a rounded picture of the person and their needs. It was not clear from these assessments what staff interventions were needed by each individual. By the second visit of the inspection these had been reviewed and additional information added, which improved the level of detail. Files of people admitted
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 12 earlier had been completed appropriately to provide sufficient information to ensure a full assessment could be carried out. Intermediate care is not provided at Wear Court. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for planning peoples’ care are not always being used effectively and this means that sometimes care is not person centred and is not regularly reviewed. EVIDENCE: Since the last inspection a new care planning system has been introduced and this has the potential to provide good information about peoples’ needs and how they are met. However, at the first visit of this inspection, sections of some peoples’ care plans including the biography, life history, interests, routines and background were not fully completed. There was also insufficient information in plans about the support provided to individuals by staff. However work was progressing at the second visit to complete these areas to ensure that enough information was available to show that needs were met.
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 14 This means that peoples’ preferences and routines were being identified so that they could be added to the care plan. Risk assessments were sometimes generalised with the same areas of risk recorded in each person’s plan and individual sections were not always updated to show the current situation for individuals. For instance when someone returned from hospital there was no update on their individual plan to show changes in their risk assessments. Manual handling plans did not always contain sufficient information to show what support staff were providing. Daily notes do not always contain sufficient information to show that account was being taken of identified risks. Recent improvements have been made to the recording of peoples’ nutritional and fluid intake. This is being reviewed as part of the improvements to recording systems. There was evidence that staff knocked on peoples’ doors before entering rooms to protect peoples’ privacy. Staff were seen to speak respectfully towards the people living in the home. Although generally people living in the home looked comfortable, clean, well dressed and well cared for there were three people in one of the public rooms who were sitting in chairs covered in sheets. This gave a poor impression of the suitability of furnishings and detracted from the appearance of a comfortable domestic setting. At the first visit one of these people had some of her drink on her face and staff had not wiped this off after assisting her to take this, however this was an isolated issue. Some rooms were untidy and grubby, which does not promote peoples’ dignity and well being. At the second visit improvements were evident and staff had taken account of comments made by the inspectors. There had also been improvements made to the housekeeping routines and systems resulting in the provision of good records to show domestic work being carried out. There are generally good systems in place to make sure that residents receive their prescribed medication in line with safe practices. The staff are knowledgeable about the medication need of the residents and there is a good system for ordering the monthly supply which takes into account changes in that have occurred. However, the recently introduced ordering documentation was not clear and had been put into place without the nurses being fully involved or trained in its use. This compromised the efficient and effective use of the new system. It was also not possible to accurately audit one of the individuals medication record as it was not clear if the supply from the month before (that had not been used) had been carried forward. The treatment room was very small, cluttered and lacked appropriate shelving and lockable cupboards. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems to ensure that people are supported and encouraged to make choices about their lifestyle and routines are not consistently applied and may impact on peoples day to day lives. EVIDENCE: Some care plans lacked clear information about peoples’ previous and preferred lifestyles, routines, choices, social and cultural needs, others were more detailed and showed good information. Currently there is no activity coordinator and this has impacted on the provision of social events or opportunities to engage in meaningful activities. A weekly activity programme was available, which included opportunities for residents to take part in some group sessions. Staff try to be flexible and attempt to provide an individualised service, however this was being affected by pressures on care staff particularly as they were also engaged in some domestic tasks. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 16 Relatives or friends are supported to visit regularly by offering them the opportunity to spend time with people living in the home in either a choice of lounges or in peoples’ own rooms. One visitor described the way that she is greeted and made to feel welcome. She said “the staff are always lovely” and that she was always offered beverages when visiting. Most rooms had been personalised by people bringing small items from their previous homes, which made it more homely and reflective of their own interests and taste. People living at the home are encouraged to make choices about the food. Those who were able to express their views said that they liked the meals at the home and that they are asked what they would like. There are menus in place in a four week cycle, however these are not followed. Although the choices being offered are to the residents’ taste it was difficult to assess the nutritional content of meals from the information available. It was also not possible to clearly determine if a good varied diet is being offered. There was plenty of food in the home and the kitchen was well organised and clean. Staff were seen asking people about their choice of meal and size of portion to make sure that people got what they wanted. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported and protected by the systems in place for dealing with complaints and allegations. EVIDENCE: There is a written complaints procedure available that provides clear information about how to make a complaint and the action that is taken to deal with complaints. Good systems are in place to record complaints, their investigation and outcome. People living in the home said that they felt able to raise any concerns or complaints with the manager or her staff and they were satisfied that these would be taken seriously. They said that they were aware of the complaints procedures and had a copy supplied when they came to live at Wear Court. There have been five complaints made since the last inspection and these have been appropriately investigated. There are written procedures for dealing with safeguarding matters. Two safeguarding referrals have been made since the last inspection and these have been appropriately dealt with. The manager said that staff training is ongoing to ensure that all staff members have a good understanding of safeguarding procedures. Good systems are in place for dealing with money held on behalf of people living in the home.
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DS0000064820.V376999.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical standards in Wear Court are varied, which means that some areas are comfortable and pleasant places to spend time, but other areas are shabby, poorly maintained and do not always suit the needs of the people living in the home. EVIDENCE: Wear Court is a converted three storey house that has been extended to provide more accommodation. It is sited in a pleasant residential street within sight of the sea. It is near to bus routes and convenient for local amenities and services. A shaft lift and stair lift is fitted to give access to people with mobility problems. There are gardens to the rear of the building.
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 19 Since the last inspection further work has been undertaken to address some of the concerns raised in the last three inspection reports. These works include work to the roof, removing the ivy from the building and some redecoration. This has made an improvement, but there are still areas that need urgent attention. The décor, furnishings and general maintenance needs to be better prioritised to ensure that the environment is made comfortable, safe, attractive and well maintained for the people living in the home. Despite good efforts by staff this is not sufficient to ensure that a clean and safe environment is maintained. The accommodation is provided on three floors and a shaft lift is fitted for ease of access. The public areas of the home have the potential to provide very good quality spacious accommodation. However there is a feeling of “quick fix” to the work that has been carried out and some of the décor, furnishings and carpets are stained and worn and need replacement to provide a more comfortable and appropriate environment for the people living in the home. Some of the armchairs, tables and other furniture are scratched and worn. The dining area is spacious and clean with appropriate seating for the people living in the home. There are attractive gardens to the rear of the building with a ramp for ease of access. The front of the building has been tidied and presents an attractive appearance. Ivy is growing into the conservatory through gaps in the boarding. The gardens would benefit from the grass being cut. Guttering has plants growing in them. External paintwork is bare wood in some places and badly chipped in others. Toilets and bathrooms would benefit from upgrading or refurbishment. Issues noted include: • Some taps have been affected by hard water deposits and need cleaning. The taps are in rooms, bathrooms and toilets are not always suitable for people with arthritic conditions. • Flooring in bathrooms, toilets and en-suites is often marked, stained with paint and requires replacement. • Some toilets and bathrooms do not have foot operated pedal bins and pull cords were damaged and marked in some rooms. • In the shower room on the ground floor the cistern of the toilet was badly cracked and requires replacement. • Some rooms occupied by people in wheelchairs do not have wheelchair accessible en-suites. In one case a person has no access to a toilet on the second floor and has to be taken to the first floor to use the toilet. This person’s room is arranged in such a way that they can only access on side of it because of the position of the bed. • Some en-suites are being used for storage making them less accessible. • Some of the commodes in use are rusty and marked.
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 20 • • • In one toilet there was no soap dispenser on the wall, in others these had been replaced leaving holes in the wall where the previous one was sited. The sluice room had bolts on the door that could be opened by anyone. The sluice macerator does not work and it was not clear how commodes are emptied and cleaned. Some sinks are stained, some were dirty and some had rusty wastes. There are three double bedrooms currently being used as single rooms. A number of rooms have en-suite accommodation of a wash basin and toilet. Issues noted in bedrooms: • Sometimes the bed was not within reach of the call system buzzer meaning that people were unable to summon assistance without getting out of bed. • Some of the furniture is damaged and needs replaced and sometimes there is no bedside table. • Some rooms were very cluttered or furniture was arranged in such a way as to make it difficult to move easily around the room. While providing some element of choice to people about their rooms there is a need to ensure that health and safety issues are addressed. • Some bed linen was worn, had not been ironed and towels were threadbare. An audit of the linen is needed to ensure appropriate items are made available for peoples’ use. Several beds were unmade at the time the tour of the building (approximately 11.00 am) was made and it was noted that some duvets were dirty. Some beds had no valances. • Some window catches were broken or not working properly. • Some light fittings were not working or there were no lampshades or these were dirty. • Some curtains needed re-hanging as hooks were missing. Some curtains were very thin. • One bedroom was being used for storage and perm solution (this was removed during the inspection) which could present a hazard to residents was found on a shelf as the door was unlocked. The lighting in some corridors is inadequate, particularly on the second floor where none of the lights on the landing work and there is only emergency lighting. This matter had been addressed by the time of the second visit. Lighting in bedrooms is not always adequate. There are attractive centre lights in the sitting areas, although one centre fitting needed the glass covers cleaned. Some windows are sealed with paint and do not open. Some window catches are broken. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 21 The laundry has new flooring laid and the walls have been painted. This has improved the environment. There is some shelving in the laundry that was used for bed linen. No shelving is available for peoples’ clothing and staff said that baskets were used to return items to individual rooms. There is no space for baskets to stand waiting for collection. There was no evidence that staff have had recent infection control training. The laundry assistant is only available for one hour per day and at other times care staff are responsible for laundry work. There was no working hot wash steriliser for commodes available and this results in staff using ineffective methods for cleaning and puts staff and residents at risk of cross infection. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although sufficient numbers of nursing and care staff are available and plans are in place to recruit more domestic and laundry staff. The lack of these staff is impacting on the quality of care provided to people living in the home. EVIDENCE: On both days when a visit was made the following staff were on duty: the manager, one qualified nurse, three care staff, one domestic and one cook. Night staffing currently consists of one carer and one nurse, although at the beginning of the year the staffing was 1 nurse and 2 carers due to there being a higher number of residents. Care and nursing staffing levels are currently adequate for the number and dependency levels of the people living in the home. In addition there are not enough domestic staff and as a result care staff are regularly undertaking domestic and laundry work. However, at the time of this inspection a review was taking place of the staffing levels particularly in relation to domestic and laundry hours and further staff recruitment was in progress. Written evidence was in place to show this is happening. One of the
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 23 plans was to employ a laundry assistant in the evening and on discussion it was agreed that this would not be an effective way of addressing the problem as the majority of the work falls in the mornings and this would still result in care staff undertaking laundry tasks. There are currently three staff on long term sick and existing staff are covering for this and for annual leave. This is placing additional strain on the staff team. The management of the home was exploring the possibility of setting a bank of staff from the organisation who could provide cover for home with the group. It was not clear from the service’s records that staff receive appropriate training to equip them to meet the needs of the residents. The home’s training plan was not completed and there was no evidence to suggest that training is focused on achieving better outcomes for people living in the home. Individual training records are not in good order and were not kept up to date. Adequate staff recruitment procedures are followed for appointing new staff, although these could be improved to take account of equality and diversity principles. Appropriate checks including reference, Criminal Records Bureau and POVA checks are carried out and records confirmed this. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed home and are encouraged to put forward their views. EVIDENCE: The manager has been in post since January and is a qualified nurse. She is currently working thirty two hours as a nurse on duty and spending eight hours on management tasks. This means that she is unable to fulfil her role as the manager. This is further compounded by there being no administrator in the home, although it is acknowledged that some administrative tasks are carried out the administrator in one of the other services in the group. This situation
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 25 is currently being reviewed and there are plans for administrative supportive to be provided on site. The manager has not completed any management training and as this is her first manager’s post this is particularly important. The manager has not received regular formal supervision or a review of her performance since she came into post. She is supported by an experienced and settled staff team, however she has not yet developed systems to delegate work and allocate responsibilities. The organisation is currently developing new systems for the strategic management and financial planning and identifying how business plans are to be developed and implemented. Equality and diversity, human rights and person centred service delivery are not currently given priority by the manager, although some training is planned. Regular staff meetings and staff supervision has not been provided and it was not clear that staff felt well supported by the manager. There has not been a qualified nurses meeting since the manager came into post. The home has a statement of purpose that sets out the aims and objectives of the service. There is evidence of the recent development and introduction of systems that monitor practice and compliance with the plans, policies and procedures of the home. This includes a weekly manager’s report and monthly group managers meetings. There are also now systems in place to ensure that the quality of the service is reviewed taking account of the views of people living in the home and other stakeholders, such as relatives, care managers and health care professionals. However these systems are still at an early stage of implementation and their effectiveness can not be fully determined. People are encouraged and supported to retain control of their own money. Transactions relating to money held are clearly recorded and appropriate procedures for managing residents money are in place so that staff are clear about their responsibilities. Health and safety policies and risk assessments are basic and would benefit from review. Records of staff training have not been kept up to date and it was not possible to confirm that appropriate mandatory training has been provided at regular intervals. Regular checks and servicing of fire equipment are carried out. Records of staff fire training have not been kept up to date. During this inspection all staff received basic updating training and further training has been arranged. Records are kept of accidents in an appropriate form. Wear Court DS0000064820.V376999.R01.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 X 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 1 3 X 1 2 2 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The needs of each person must be fully assessed before they move into, or return to the home following hospital admission where there has been a change in their needs. This will ensure that the service can meet their needs. Risk assessments must be in place for individuals and updated to show any changes. This will ensure that people are cared for safely. Staff training must be provided to ensure that they can safely operate any new systems for the administration of medication. Systems for auditing medicines must be introduced. The facilities in the treatment room must be reviewed and steps taken to provide safe and appropriate storage. Menus must be reviewed to ensure that a balanced, nutritious diet is provided, which
DS0000064820.V376999.R01.S.doc Timescale for action 01/11/09 2. OP8 13, 15 01/10/09 3. OP9 13 01/10/09 4. OP15 16 01/10/09 Wear Court Version 5.2 Page 28 takes account of peoples’ preferences and needs. This will ensure that residents are offered a varied and nutritious diet. The registered person must 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. 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. 7. OP26 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. The provider must complete the recruitment process for domestic and laundry hours in the home. This will promote the welfare of the residents by ensuring that they get the full attention of the nursing and care staff. 9. OP30 18 The registered person must ensure that staff are provided
DS0000064820.V376999.R01.S.doc 5. OP19 13,23 01/02/10 6. OP24 16,23 01/02/10 01/02/10 8. OP27 18 01/12/09 01/11/09
Page 29 Wear Court Version 5.2 with appropriate training for the work they are to perform. This is so that people living in the home receive the care and support they need. The manager must have regular formal supervision and a review of her performance at regular intervals. An appropriate training plan must be developed for her continuing professional development. 10. OP31 9 01/10/09 11. OP33 24 This will ensure that the manager has the skills and competencies to fulfil her role. The quality assurance and 01/11/09 monitoring systems must be fully implemented in line with the company’s proposal. This will make sure that the quality of the service is regularly reviewed taking account of the residents’ views. Arrangements must be reviewed and action taken to safeguard the health, safety and welfare of residents and people working in the home. 12. OP38 13 01/11/09 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. Refer to Standard OP7 Good Practice Recommendations The registered person must ensure that the ongoing work to improve the care plans is completed in line with the company’s new systems and processes. This will ensure that people get the care and support they
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DS0000064820.V376999.R01.S.doc Version 5.2 Page 30 2. OP12 3. 4. OP31 OP36 need. It is recommended that improvements are made to the social activities programme to make it more person centred and reflect the interests, abilities, previous lifestyle choices and preferences of people living in the home. It is recommended that the manager progresses with application to become registered. A programme of regular effective formal staff supervision must be in place to ensure that staff are clear about their role and responsibilities. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk
We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Wear Court DS0000064820.V376999.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
