Inspection on 31/05/06 for Weatherstones House Nursing Home

This inspection was carried out on 31st May 2006.

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 18/12/07

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 A Gillian Matthewson Key Unannounced Inspection 10:00 31ST May 2006 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.V291743.R01.S.doc Version 5.1 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.V291743.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Weatherstones House Nursing Home Address Chester High Road Neston Wirral Cheshire CH64 7TD 0151 3368383 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 Mrs Jayne Beard 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.V291743.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 31 service users in the category OP (Old age, not falling within any other category) * Within the maximum of 31 service users, one named service user under 65 years of age for nursing care may be accommodated The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The registered manager must attain an NVQ Level 4 in Management by 31st December 2006 Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 5th September 2005 2. 3. 4. Date of last inspection 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 £389 to £446 per week. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spent time planning the inspection by reviewing previous inspection reports and the service history over the last twelve months. The inspection took place over seven hours and included a tour of the building, inspection of records and consultation with seven residents, five members of staff , a visiting GP and four visitors. In the main, residents and relatives were extremely happy with the care provided by the home, but some felt that improvements could be made to the environment. Feedback was given to a company director and the deputy manager of the home. What the service does well: What has improved since the last inspection? Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 6 Care plans and medicine records are fully documented in accordance with requirements to give staff all the information they need to provide comprehensive care for each resident. 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. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 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.V291743.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3. The home does not provide intermediate care. The quality of this outcome area is adequate. Residents are provided with all the information they need in order to make a decision whether to take up residence in the home. In the main, residents have their needs assessed by an appropriately skilled person prior to admission, to ensure that the home will be able to meet those needs. EVIDENCE: The home’s statement of purpose and service user guide had been revised and updated on 9th May 2006. Residents and relatives confirmed that the home had provided them with the service user guide prior to admission. On examination it was found to detail the services and facilities available, in accordance with requirements. Residents and relatives also confirmed that they had been provided with a contract at the point of moving into the home. The contracts of the three residents who were case tracked were reviewed and found to include all the necessary information. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 9 Care files were reviewed. Each resident had been visited by the home manager and an assessment carried out prior to admission. Residents also confirmed that they had been visited prior to admission for an assessment of their needs and wishes. Details of pre-admission assessments and copies of care management assessments were contained in the files, including nursing assessments for those funded by the local authority. However, not all residents requiring nursing care who were privately funded had been assessed by a nurse from the home prior to admission. As the manager is not a registered nurse, she is not able to assess nursing needs. See Requirement 1. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. The quality of this outcome area is good. There is a care planning system in place, which provides staff with the information they need to meet residents’ needs. The health needs of residents are well met, with evidence of good multidisciplinary working taking place on a regular basis. Medicine policies and procedures ensure that residents receive their prescribed medication. Residents are treated with respect and their dignity is maintained. EVIDENCE: The records of the three residents who were case tracked were reviewed. Each had a plan of care that had been agreed with them. It contained information regarding all areas of the individual’s life including health, personal and social care needs. It also included a risk assessment. There was evidence that the plans were reviewed regularly involving residents and their families. Care staff said that they were informed of residents’ needs via verbal reports and reading care plans. The home had an allocated GP who visited the home twice a week. The doctor was called to see a resident during the inspection. He was consulted about his opinion of the home and said that he thought they gave a good standard of Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 11 care and were knowledgeable about residents’ needs. Care files contained evidence that residents were able to consult with other health care professionals as required, for example tissue viability nurse, community psychiatric nurse, optician, dentist and chiropodist. Residents were assessed as to their risk of developing pressure sores and appropriate equipment was provided. Nutritional assessments were carried out. Residents had been assessed by the continence nurse and the appropriate aids supplied. Residents spoken with were satisfied with the health care that they received and there was evidence that their personal hygiene needs were met by care staff. Policies and procedures were in place describing all aspects of the medication process. None of the residents were self-medicating but an assessment document was available for any future resident who may wish to self-medicate. There was a clinical room on the first floor, which was found to be clean, tidy and well organised. All medication was stored appropriately and arrangements for disposal of unused medication were satisfactory. Medicines were only administered by registered nurses. Three medication administration record (MAR) charts were reviewed and found to be fully completed with the required entries and signed by appropriate staff. The deputy manager was observed administering medication and was seen to follow the correct procedures for administration and recording. Residents spoken with commented on how helpful all the staff were, that staff treated them with respect and helped them to maintain their privacy and dignity. Two residents’ care plans detailed that they wished to have only female staff for personal care. Call bells were answered very promptly. Extension leads were provided to enable the call bells to reach chairs for those residents who chose to stay in their rooms. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. The quality of this outcome area is adequate. The routines of daily living and activities made available are flexible and varied. Residents are able to have visitors at any reasonable time but more effort is needed to ensure they can receive them in private if they wish. Residents receive a healthy, varied diet according to their assessed requirements and choice. EVIDENCE: The home had an excellent assessment document that enabled residents, their representatives or staff to record the resident’s preferences in relation to activities of daily living, hobbies, interests and spiritual needs. Residents spoken with were satisfied that daily living routines were appropriate to their individual needs. The manager had responsibility for organising activities for the residents. Care plans contained records of activities that each resident had participated in. There was a weekly activity programme that included a visit from the hairdresser, keep fit sessions, ball games, bingo, giant crosswords and reminiscence. Entertainers visited the home on a monthly basis. A Roman Catholic priest visited the home every Sunday and an Anglican priest every three to four weeks. The manager acknowledged that there was room for Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 13 improvement in the range of activities available and had appointed an activity coordinator to work two afternoons a week. There was open visiting from 10am to 10pm but visitors were requested to avoid meal times. Two relatives and a resident commented that they did not like visiting a resident in the main lounge. They said there was limited space, so often had to sit on a low stool, and found it difficult to converse with other residents around and staff constantly passing through. See Recommendation 1. The home had satisfactory policies in place that stipulated that residents were to handle their own financial affairs for as long as they wished and were able to do so. There was also information for staff, residents and relatives on local advocacy services. Residents could bring small items of furniture and other possessions into the home to personalise their own room. Residents spoken with at this inspection and on previous inspections expressed their satisfaction with their meals. Three full meals a day were offered including a cooked breakfast, and a choice was available at each meal. Night staff were able to make snack meals if a resident wanted something to eat during the night. One of the residents said “the chef is a very good cook”. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. The quality of this outcome area is adequate. Residents have access to a complaints procedure and are protected from abuse. EVIDENCE: The home had policies and procedures for dealing with complaints. A complaints procedure was included in the service user guide and the resident contract. The one in the service user guide said that complaints should be addressed to the manager, but did not state that complaints could also be referred to the registered provider. This could cause a problem if an individual wished to complain about the manager. See Recommendation 2. The complaints log was reviewed. There had been no complaints since the last inspection. Residents spoken with said they would speak to the manager if they had any concerns and felt confident that any concerns would be listened to and acted upon. The home had satisfactory adult protection policies and procedures in place, including information for staff on whistle blowing. Training records demonstrated that staff received training in these matters during their induction period, which included familiarising themselves with the policies and procedures. However, staff who were interviewed had scant knowledge of adult protection issues and reporting procedures. They had been in post for some years and had obviously forgotten the information they were given previously. See Recommendation 3. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. The quality of this outcome area is adequate. In the main the home provides a pleasant, comfortable environment although carpets need to be reviewed in some bedrooms and planned renewal undertaken so that a good standard is maintained. EVIDENCE: A tour of the premises found that the home was generally clean and wellmaintained, and adequate furniture was provided. Some bedroom furniture had been replaced since the last inspection and some redecoration had taken place. However, some carpets were stained. Two bedroom carpets smelt of urine. Cleaning staff said that they were constantly shampooing carpets but the stains and odour did not always come out. These rooms were identified to the owner during the feedback following the inspection. See Requirement 2. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. The quality of this outcome area is good. The numbers, skill mix and training of staff ensures that residents’ needs can be met. The procedures for the recruitment of staff are robust, providing safeguards to offer protection to people living in the home. EVIDENCE: Twenty seven people were resident at the time of the inspection. The home provided six care staff in the morning, four in the afternoon and evening and three at night. These numbers included one registered nurse throughout the twenty four hour period and an additional one from 8am to 2pm. The manager was over and above these numbers. Two catering staff were on duty from 8am to 6pm plus domestic and maintenance staff. Sixteen care staff are employed to provide care in addition to registered nurses. Three of the care staff had attained an NVQ Level 2 in Care and seven were working towards it. Four staff files were reviewed. All the required information and documentation was obtained prior to employment. One new member of staff confirmed that she had not been able to start employment until the home had obtained a Criminal Records Bureau disclosure and two satisfactory references for her. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 17 The home had an induction programme that covered all the induction targets set by Skills for Care. All new staff appointed since its implementation went through the programme in the first six weeks. Residents and relatives all said that the staff were very caring. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38. The quality of this outcome area is adequate. There are quality assurance systems in place, but residents should be consulted more frequently about their views of the home. Safeguards are in place to protect residents’ financial interests. Safe working practices are maintained. EVIDENCE: The registered manager had left the home in February. The previous deputy had been appointed as manager and has submitted an application for registration to the Commission. She holds an NVQ Level 3 in Care and is currently undertaking the Registered Managers’ Award. There is a deputy manager in post who is a registered nurse and is responsible for providing clinical leadership and advice to the manager and directors. Most residents had a family member who looked after their financial affairs. Residents could keep personal money in the home’s safe if they wished. A Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 19 detailed record was kept of all transactions for each resident and entries were double signed for checking purposes. The money was kept in the safe, in individual packets for each resident The manager was auditing the residents’ monies when the inspection commenced. Checks were made on the records and balances of those residents who were case tracked and found to be in order. Valuables handed in for safe keeping were also kept in the safe and records were maintained. The registered provider has made arrangements for a director of the company to visit the home and prepare a written report on the conduct of the care home. These reports were available for inspection. There had only been three documented visits since the last inspection, although they are required to take place on a monthly basis. One of these did not contain any evidence of consultation with residents or relatives. See Requirement 3. A resident survey had been carried out last summer and the registered provider indicated that another would be carried out in the near future in readiness for the home’s audit for the Investors in People Award. The standard of record keeping in the home was found to be generally good and records were maintained in accordance with the Data Protection Act. Notifiable incidents were reported to the Commission for Social Care Inspection. Staff records demonstrated that all staff received training in safe working practices on induction and updates were provided as necessary. Observation of them going about their duties confirmed that safe working practices were maintained. The pre-inspection questionnaire submitted indicated that equipment had been checked and serviced at the required intervals. Accident records were reviewed. These were completed appropriately and there had been no serious injuries. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 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 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 3 3 Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 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 OP3 Regulation 14(1)(a) Requirement Timescale for action 01/06/06 2 3 OP26 OP33 16 26 The registered person must ensure that prospective residents requiring nursing care are assessed by a nurse prior to admission. The registered person must 31/08/06 replace the bedroom carpets identified at inspection. The registered person must 01/06/06 ensure that the Regulation 26 visits are carried out monthly and include interviews with residents and their representatives. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP13 OP16 Good Practice Recommendations Residents should always be offered the opportunity to move out of the lounge into a more private area when receiving visitors. The complaints procedure in the service user guide should DS0000018819.V291743.R01.S.doc Version 5.1 Page 22 Weatherstones House Nursing Home 3 OP18 include the right to refer a complaint to the directors of the company that owns the home. Staff should receive regular updates of training in the protection of vulnerable adults. Weatherstones House Nursing Home DS0000018819.V291743.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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