Inspection on 18/12/07 for Weatherstones House Nursing Home

This inspection was carried out on 18th December 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Weatherstones House Nursing Home 10/12/08

Weatherstones House Nursing Home 31/05/06

Weatherstones House Nursing Home 05/09/05

Weatherstones House Nursing Home 03/05/05

Weatherstones House Nursing Home 10/02/05

Weatherstones House Nursing Home 02/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Weatherstones House Nursing Home Chester High Road Neston Wirral Cheshire CH64 7TD Lead Inspector Helena Dennett Unannounced Inspection 09:30 18 December 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Weatherstones House Nursing Home Address Chester High Road Neston Wirral Cheshire CH64 7TD 0151 3368383 F/P 0151 336 8383 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) Weatherstones House Care Ltd Dawn Clair Holland Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2006 Brief Description of the Service: Weatherstones House is a large sandstone detached property set in two acres of grounds. It is situated on the A540, close to the village of Willaston and the town of Neston. A private drive leads to the house and there are good parking facilities. Accommodation for residents is on two floors, with a passenger lift providing access to the first floor. In certain areas ramps have been constructed to provide access to rooms that are on different levels. A large basement houses the laundry, kitchen storage, and a repair and maintenance facility. On the ground floor there are two lounges, a conservatory and a dining room. The ground floor also has 11 bedrooms, an office, nurse station and kitchen. The first floor has a small sitting area, 13 bedrooms and the clinical room. There are assisted toilets and bathrooms on both floors and a nurse call system and fire alarm system are installed throughout. The home is registered to provide nursing care to frail older people and is staffed by registered nurses at all times. The home also employs care assistants, domestic, kitchen and laundry staff, and a maintenance person. Fees range from £402 to £464 per week. This information was provided by the manager after the site visit. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit, which is part of the key unannounced inspection, took place on 18th December 2007. Staff at the home were not informed of the date the visit was to take place, but a few weeks before the visit the manager was asked to complete a questionnaire to provide us with some information about the service. The manager was also asked to distribute questionnaires to residents, relatives and health and social care professionals to help us find out what they think of the home. During the visit the inspector spoke with the manager, staff, residents and visitors. A tour of the building took place and records relating to the running of the home were looked at. What the service does well: What has improved since the last inspection? The provision of activities has improved since the last inspection. An activity organiser is now employed covering 20 hours per week so there is dedicated time to engage residents in activities thus providing stimulation and enhancing their well-being. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 6 The manager of the home is now registered with us and has completed Registered managers award so residents can be confident a competent person runs the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents have a full assessment of needs before admission to ensure that the home has the right resources to meet their needs. EVIDENCE: Information about the home is available for people considering moving in so that they can make an informed choice on whether the home will suit their needs. The manager confirmed that a senior nurse visits prospective residents before they move into the home so that an assessment of needs can be done to ensure that staff at the home can meet those needs. Intermediate care is not provided so standard 6 does not apply. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 9 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): 7,8,9 & 10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although people living at the home receive adequate health and personal care, which is based on their individual needs there were some problems with care plans and risk assessments which could leave people at risk of their needs not being fully met. esidents’ dignity is maintained at all times. EVIDENCE: Three peoples’ records were looked at during the site visit. These contained an assessment of need, which forms the basis of the care plans. Some risk assessments were in place, however the risk assessment for bedside rails was not detailed enough and did not cover all areas of risk to ensure that the person using the rails would not be placed at risk. This needs to be reviewed. Pre printed care plans were used in the main. Although these form the basis of the care to be delivered they were not person centred and so did not always identify individual needs. For example: in one person’s care plan it stated ‘apply barrier creams as appropriate’. There was no instruction on which cream to use and when. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 10 Although there was evidence that the care plans were reviewed, some were not updated to reflect the changing needs of the individual. For example: In one care plan the evaluation in November identified that the person required some assistance with diet and fluids as they were bed bound – the care plan for eating and drinking was not updated to reflect this. Reviews of the care plans were not always written in terms of outcomes. For example in one person’s care plan the review for December stated ‘back from hospital’. Records of wound care were kept, this included mapping of the wounds and in some instances photographs had been taken. There was evidence that the tissue viability nurse visited in August for one person with a pressure sore. An entry was made in that person’s records in October, which suggested that the tissue viability nurse be contacted again for advice as the sore was not improving. There was no evidence this had been done. There was evidence that specialist equipment is provided when needed. Hoists were available to assist people to move and transfer and the manager confirmed that eight new beds have been purchased since the last inspection. Policies and procedures were in place regarding the management of medicines. Registered Nurses administer medicines. A sample of Medicine Administration Record (MAR) sheets was looked at. One person’s medicine had not been signed for three days. There was no indication why the person was not given their medicines. In some cases the code O (other) was used to indicate that the person did not have their medicine. The member of staff did not record what code O meant so it was difficult to ascertain why the person did not have their medicines at that time. Staff also need to make sure that variable doses of medicines are identified on the sheets. The privacy and dignity of residents is maintained. Staff were seen to treat residents with respect, knock on bedroom doors before entering and maintaining their privacy before personal care was carried out. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of recreational activities provides more stimulation and interest for people living in the home. EVIDENCE: The home employs an activities coordinator for 20 hours a week. A weekly activity programme is available. The Christmas party was due to be held the day after the site visit. Other activities include pat a dog scheme, music, external entertainers, nail care, quizzes etc. Visitors can come at any reasonable time. Members of the clergy visit regularly. Residents spoken with confirmed that they can decide whether they wish to stay in their own room or go to the lounge during the day. They also confirmed they have a choice with their meals. One person was visited at approx 11.15 am, their breakfast was untouched. The person confirmed that they like to have a banana with their breakfast, however the home had run out of bananas the previous week. Members of Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 12 staff confirmed that this person always had a banana with their breakfast since they had come into the home. However on checking the order with the chef, bananas had not been ordered and there was only a very small amount of fresh fruit available. One resident said that they thought ‘the food is bland’. Another resident suggested that they would like ‘ garlic or more seasoning in the food.’ A separate dining room is available for residents. This is nicely decorated and provides a pleasant environment for residents to eat in. Residents can choose where they wish to eat. Members of staff inform residents of the choices on offer, however a menu was not displayed. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a complaints procedure and are protected from abuse. EVIDENCE: There is a complaints procedure available in the home. Residents spoken with were positive about staff and knew whom to approach if they had a concern or complaint. One complaint has been received since the last inspection, however a complaint log was not kept in the home. The complaint was investigated by an outside agency and was not upheld. An adult protection procedure is in place. This provides staff with information on the action to be taken should an allegation of abuse or misconduct be made. Members of staff spoken with knew the action to be taken should an allegation of abuse be made. Although all staff have not had training on safeguarding adults the owner of the home has written to the manager advising that all staff must be encouraged/enabled to do this training. All staff have Criminal Record Bureau checks done before they are employed to ensure that they are suitable to work in the care industry. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home is generally well maintained there were problems with storage which means residents cannot access all of the bathrooms. EVIDENCE: Weatherstones House is set in two acres of grounds and provides a pleasant environment for people to live in. It is situated on the A540, close to the village of Willaston and the town of Neston. A private drive leads to the house and there are good parking facilities. The inside of the home was generally well maintained and furnished. A tour of the building took place. Residents’ bedrooms were personalised, containing their own possessions such as small items of furniture, photographs, paintings etc. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 15 Separate lounge and dining rooms are available for residents to use. A conservatory is situated off the lounge area, however this was considered cold and residents chose to use the other lounge instead. The temperature of the conservatory should be monitored. A maintenance man is employed to deal with any problems that might occur. Several of staff belongings were seen stored in one of the bathrooms. These should be removed as they are a fire risk, an infection control risk and limit the number of bathrooms that residents can use. One resident’s bedroom window was open quite wide and could be a risk to residents or visitors. The manager agreed to address this on the day of the site visit. Staff confirmed that they sluice items manually as there is no sluice disinfector in the home. This could be an infection control risk and is not considered good practice. Consideration should be given to the provision of a sluice disinfector. The door leading directly to the kitchen was wide open during the site visit. This is an infection control risk and should be kept shut at all times. Separate laundry and domestic staff are employed in the home. Residents were positive about the laundry facility. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There were enough suitably qualified staff working in the home to meet the needs of the residents. Good recruitment procedures meant that residents could be confident that only staff suitable to work in care are employed. EVIDENCE: A clinical manager who is a Registered General Nurse has been appointed since the last inspection. She has worked at the home for some time as a nurse and knows the residents well. She provides staff with guidance on clinical issues. One member of staff was absent due to illness on the morning of the site visit. However the remaining staff working during the morning met residents’ needs. Two residents spoken with were very positive about the staff working in the home. One relative said ‘staff are very good – my relative is happy here’ Three personnel records were looked at during the site visit. These contained all the necessary checks including two references and evidence that Criminal Record Bureau disclosures were obtained before staff started work in the home. Induction records were not kept for a member of staff who had recently been employed at the home. The manager said that plans were in place to provide Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 17 induction training to all staff. Members of staff confirmed that they felt supported in their training. Sixteen care staff are employed to work in the home. Seven of these have completed a National Vocational Qualification (NVQ) Level 2 or equivalent in care. Three are in the process of completing this qualification so residents can be confident that staff have the necessary knowledge and skills to care for them. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The home is generally well managed and well run. EVIDENCE: The manager of the home holds a National Vocational Qualification (NVQ) level 3 in care and is registered with us. She has recently completed a manager’s qualification. A clinical manager who is a Registered General Nurse has been appointed since the last inspection. She provides guidance and direction to staff on clinical issues. Residents spoken with were positive about the manager and staff working at the home. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 19 There is a quality assurance system in place to monitor the quality of the services provided. The manager confirmed that questionnaires have been sent out to the residents and action taken on any issues identified. However the residents are not routinely informed of the results. Residents/relatives meetings have not taken place for some time so residents may not get the opportunity to influence the running of the home. A senior manager from the home visits monthly speaks to residents and staff so that the quality of the service can be monitored. An audit of accidents occurring in the home is carried out monthly so staff can monitor any trends thus minimising the risks. A system is in place for the management of residents’ monies. Two signatures are obtained for all transactions. Care files are kept behind the nurses’ station. The clinical manager confirmed the intention to purchase a lockable cupboard so these files can be kept more secure. The computer used by the manager for business purposes is not password protected and so there could be a risk that an unauthorised person could access this information. The senior manager confirmed that this would be actioned straight away. A sample of maintenance records was looked at. These were found to be satisfactory. The manager confirmed that all staff have had fire safety instruction. The manager provided this instruction. Discussion took place regarding the need to ensure that she has the necessary knowledge and skills to provide this training. Fire safety tests have been carried out regularly. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 20 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x X X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15(2) Requirement The residents’ care plans must be kept up to date and under review, after consultation with them or their representative. They must be revised as necessary and the resident or their representative told of any changes to their care. This means that staff will have detailed guidance on what they must do to meet each resident’s needs in respect of their health and welfare and the resident will be kept aware of any changes to their care. Timescale for action 31/01/08 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 OP9 Good Practice Recommendations The residents Medicine Record Administration (MAR) sheets should be maintained accurately so staff and residents know they are receiving their medicines DS0000018819.V339466.R01.S.doc Version 5.2 Page 22 Weatherstones House Nursing Home 2 3 OP15 OP26 4 OP37 according to their prescription. The chef should make sure that he has adequate stocks of fresh fruit to meet the needs of residents. The manager should review infection control procedures and practices within the home to make sure that residents are not placed at risk of cross infection. Consideration should be given to the provision of a sluicing disinfector. The manager should make sure that systems are put in place to ensure that the security of confidential information. Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Weatherstones House Nursing Home DS0000018819.V339466.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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