Inspection on 28/10/05 for Wirral Christian Centre

This inspection was carried out on 28th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Wirral Christian Centre 21/06/06

Wirral Christian Centre 13/01/06

Wirral Christian Centre 14/03/05

Wirral Christian Centre 15/09/04

Wirral Christian Centre 18/02/04

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 Wirral Christian Centre Woodchurch Road Birkenhead Wirral CH41 2UE Lead Inspector Natalie Charnley Unannounced Inspection 28th October 2005 10:30 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 Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 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. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wirral Christian Centre Address Woodchurch Road Birkenhead Wirral CH41 2UE Telephone number Fax number Email address 2Provider 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) 0151 653 8307 Wirral Christian Centre Trust Limited Mrs Evelyn Jane Epton Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Two named adults with physical disablement and one named adult with a learning disability may be accommodated Thirty-six elderly persons (not falling within any other category) To accommodate one named person under 65 years old Date of last inspection 14th March 2005 Brief Description of the Service: The Wirral Christian Centre is a residential home located in Birkenhead, Wirral and was formally the local children’s hospital. It is located on a busy main road and is close to local shops, bus stops and transport links. The home is located in a large building that also houses a day nursery which is inspected by Ofsted. The home uses two floors of the building, bedrooms and lounge areas are located on both. The total maximum number of residents living at the home at one time is 39. The home has a small car park to the front and access is via the main reception. This area is accessible for wheelchairs. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. The inspector arrived at the home at 10.30 and left at 16.00.The inspector spoke to the deputy manager, the responsible person, 3 members of staff and 12 residents. The inspector completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. Feedback was given to the deputy manager during and at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home needs to review the staffing structure with the inspector to solve the problems with recruitment of staff to take on a ‘sleepover’ role. This will ensure that staff do not become tired and are able to have sufficient time off in between shifts. The home must ensure that staff are aware of and are trained in the management of abuse. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 6 Care plans and risk assessments need to be re structured and regularly updated. The home must involve residents in the development of their own care plans. Residents who are identified as being out of category by staff need to have a review by social services to ensure the home is suitable for them to live at. 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. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 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 Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 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): 2,3 and 4 Resident assessments do not contain the necessary information to allow staff to care for them, leaving them at possible risk. Some of the residents living at the home are not within category and require urgent re assessment to ensure they are in a suitable home. EVIDENCE: Residents are all assessed before they move into the home, usually by the home manager. The inspector looked at two pre-admission assessments which detailed medication and what a resident can or can’t do for themselves. There was no information regarding residents past or current medical history and the assessments were not signed or dated. The assessment documents are kept in the filing cabinet in the office and not with the care plans, despite the two pieces of information being related to each other. Residents are also given a contract when they move into the home, these were clear but need to reflect the Commission for Social Care Inspection as a point of contact, not the NCSC. This is also the case for the complaints procedure and service user guide. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 9 Some of the residents living at the home were identified by staff as being out of category and needing input for their dementia. Seven residents in total were named. These residents need to have an urgent assessment by professionals to ensure that they are in the right home and that staff can meet their needs. These residents had details recorded regarding their verbal and physical aggression, confusion and wandering. During discussion, staff told the inspector that they are reluctant to move residents once they become settled and that is why no re assessment has taken place. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 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 and 9 There is no clear or consistent care planning or risk assessment format in place to provide staff with the information they need to satisfactorily meet the needs of residents. Medication recording is poor in some areas leaving residents at risk EVIDENCE: Each resident living at the home has an individual care plan which details how staff need to look after specific residents. Seven of these plans were looked at during the inspection. Care plans contained basic risk assessments regarding residents bedrooms and environment, however not all plans had risk assessments on nutrition, falls and moving and handling. Most risk assessments had not been reviewed for a substantial period of time and one was found to have correction fluid on it making reading the assessment difficult. Care plans were not reviewed on a monthly basis and showed no sign that they had been made along side the resident or their next of kin. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 11 One resident’s care plan stated that staff were having trouble maintaining the residents weight, however the resident had not been weighed since January 2004. Another resident who was diabetic had also not been weighed since that date. One care plan looked at was not signed or dated. Residents were asked during the inspection if they knew what their care plan was or had been involved in writing it, all replied they did not. Residents at the home are registered with a local GP (General Practitioner) and are supported in their care by many other healthcare professional such as nurses, dentists, dieticians and opticians. The home are currently recording details of when a doctor visits in the daily report book, however this makes finding records difficult and advise was given as to a more appropriate way to keep these records. Medication records and storage areas were looked at during the inspection. Medication records had no photographs of residents and no sample signature lists to identify staff. Records of daily medication administration were good, however staff must make sure that any handwritten entries are double signed and dated. The home showed good practice in recording the pulse rate of residents who take the drug Digoxin. Serious concerns were identified by reviewing the records of controlled drugs, some drugs had not been recorded as given and some drugs were not accountable for. The home was then issued with an immediate requirement notice to rectify these problems. The medication policy needs amending to show that the home need to keep medication for a period of seven days following the death of a resident. Discussion with staff highlighted that they were not aware of the recent changes regarding how medication is to be disposed of and risk assessments for residents who self medicate had not been updates since 2003. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 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 and 15 Activities at the home suit the individual needs of residents Residents are not restricted whilst living at the home The meals at the home are good offering choice and variety EVIDENCE: Residents at the home participate in a variety of activities both inside and outside of the home. One lady said “ I enjoy the trips out we get here, it keeps me on my toes” another stated, “ the staff take me shopping if I need anything or even if I just want to look in the windows”. Recent trips had taken place to Blackpool and a local nursery and staff were busy planning the residents Christmas party for December 14th. The home has just started taking residents to the local pictures, which residents stated they had particularly enjoyed. The home has a visiting hairdresser and hold a weekly keep fit class. Residents spoke highly of the food offered by the home. One gentleman stated, “the food is always hot and tasty”. New menus are currently being developed but current ones showed choice and that special diets were available for those who are vegetarian, diabetic or on a low fat diet. Residents Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 13 confirmed that drinks are available throughout the day. One lady who required assistance with eating was being assisted by a member of staff in an appropriate and caring way during the inspection. The home has an open visiting policy and residents can meet visitors in either communal or private area of the home. One resident currently living at the home is being supported and assisted by staff in not allowing specific individuals to visit. One member of staff stated “ we always make visitors feel welcome and offer them a drink if they want one”. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 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 and 18 The home has a satisfactory complaints procedure in place to protect residents. Staff have a poor understanding of abuse awareness leaving residents at possible risk. EVIDENCE: The home have a clear and easy to follow complaints procedure. Residents spoken to were aware of how and who to make a complaint to if needed. Complaints are dealt with by the general manager, but records were not seen during this visit. All staff confirmed that they had undergone a police check at the home. Some staff were not aware of the local or home adult protection policy and had received no training in this area, however some had covered this topic as part of their NVQ (National Vocational Qualification) training. This needs to be addressed by the home. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 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 and 26 The home is suitable for the residents who live their, creating a homely environment. The home is clean and tidy which promotes good health for residents who live there EVIDENCE: The home is currently working towards an agreed timescale with the Commission for Social Care Inspection to change the layout of some areas of the home that interact with the nursery school. The work in this area is progressing well and was discussed with the registered provider. The home is undergoing some major redecoration and refurbishment work at present, however this is not impacting on the daily lives of the residents who are happy with the situation. Bedrooms are being updated and lounge areas are being repaired. New double glazing panels are being put into some corridor areas. The home has a pleasant outdoor area which is accessed via a Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 16 conservatory. One resident commented, “I enjoy sitting here as it is very peaceful”. Residents have a small smoking lounge on the upper floor of the home. The home has a lift and stair lift to assist residents around the home. Staff at the home were noted to be taking their breaks in the main office as the home do not have a designated staff room, this area needs to be looked at by the home management. All areas of the home were clean and tidy. Bedroom 13 was noted to have a slight odour to it. The home has policies and procedures in place regarding infection control that staff are familiar with. Residents felt that their bedrooms and communal living areas were always cleaned to a high standard and that cleaning staff were through in their jobs. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 17 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 and 30 Staff morale is low due to problems recruiting staff. This may impact on the care given to residents. Staff are competent to provide care to residents and have been trained on a variety of subjects. EVIDENCE: The home employ three care staff on the morning shift and three care staff on the afternoon shift. Another staff member works on a ‘middle’ shift between 10-4.At night two care staff are on shift and a senior care assistant sleeps over at the home in case of an emergency and to give the evening medication out. A group of supporting staff are also employed at the home including two cooks, one kitchen assistant, four cleaners, one handyman and a laundry assistant. The home are currently recruiting care staff but are finding posts difficult to fill. Staff are covering extra hours since the home have stopped using agency staff, but feel that they are becoming “tired” and “demotivated”. Care staff acknowledge that every attempt has been made to solve the staff shortages by the home management, but feel that the staffing levels need looking at as a matter of urgency. Residents spoken to felt that on the whole there were enough staff to look after them but commented that as the layout of the home is vast, finding staff sometimes takes a bit longer. One lady stated “ staff here are wonderful and very, very kind” another, who was quite new to the home Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 18 said “ the staff here have helped me through some very difficult times and I owe them many thanks for their support. I feel safe here at the home”. Staff have received a variety of training and 12 out of 18 care staff have NVQ qualifications. Recent training had taken place on fire awareness and manual handling and accident training is planned in the next few months. Staff receive all training free of charge and attend in house as well as external training sessions. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 19 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): 33,36 and 38 Residents and family views and opinions are listened to at the home. Staff are appropriately supported by their manager and maintain the safety of residents living at the home. EVIDENCE: Neither of the homes registered managers were present at the inspection. Staff commented on how supportive the care manager, who runs the home on a day-to-day basis, was and stated that they could approach the general manager if they needed to. The staff team meet on a regular basis and have separate meetings for senior and night staff, however the general manager does not attend these meetings. One member of staff stated, “ my manager is very supportive and works alongside staff”. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 20 Residents spoke to stated that they were always asked by staff to make suggestions as to what happens at the home. One lady commented, “we are asked what activities we want to do, but no one is forced to join in”. No formal residents forum is in place, however staff stated that this was attempted but residents were not particularly interested. Six monthly questionnaires are sent to residents for them to comment on how things are running and developing at the home. Ideas that the management team have in developing the home were discussed with the inspector. Staff receive monthly supervision from their manager where they are able to discuss and ideas, concerns or training needs they may have. A full range of policies and procedures relating to employment issues is available for staff to view. Accident records were well recorded at the home, however they were not recorded to protect the confidentiality of the residents. Certificates and insurances required by the home were up to date. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 21 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 3 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 X 2 Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement The registered manager must ensure assessment documentation contains adequate details of a resident’s past and current medical problems/diagnosis. Documents must be signed and dated. The registered manager must ensure that the seven identified residents who staff feel are out of category are re assessed by social services. The registered manager must ensure that care plans are developed along side service users and are updated at least monthly The registered manager must ensure that risk assessments are completed for all residents in relation to a) Falls b) Nutrition c) Manual handling and that these are updated on a regular basis. The registered manager must maintain regular weight monitoring for all residents DS0000018956.V262386.R01.S.doc Timescale for action 01/01/06 2 OP4 14(2) 15/12/05 3 OP7 15(1) 15/12/05 4 OP8 13(4)(a) 01/01/06 Wirral Christian Centre Version 5.0 Page 23 5 OP9 13(2) The registered manager must ensure that a list of specimen signatures of staff is held on the front of the medication records The registered manager must ensure that all controlled drugs are recorded correctly The registered manager must update the medication policy to ensure staff keep residents medication for a period of seven days following their death The registered manager must ensure all staff are aware of how to dispose of waste medication The registered manager needs to ensure all staff are trained on abuse awareness and can access local policies and procedures The registered manager must ensure the smell to bedroom 13 is eliminated The registered manager must ensure that accidents are stored appropriately to maintain confidentiality 28/10/05 6 OP18 18(1)(c) 30/01/06 7 8 OP26 OP38 23(2) 12(1) 15/12/05 15/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP3 OP19 OP27 Good Practice Recommendations The home may wish to consider keeping care plans and assessment documentation together. The home may wish to provide a formal staff room for staff to take their designated breaks other than the main office. The home may wish to alter the way staff are allocated to DS0000018956.V262386.R01.S.doc Version 5.0 Page 24 Wirral Christian Centre shifts to ensure staff can be recruited at the home. This would be in negotiation with the inspector. Wirral Christian Centre DS0000018956.V262386.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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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