CARE HOMES FOR OLDER PEOPLE
Woolston Mead 4 Beach Lawn Waterloo Liverpool Merseyside L22 8QA Lead Inspector
Mrs Claire Lee Unannounced Inspection 22nd May 2006 09.20 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 Woolston Mead DS0000065851.V291726.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. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Woolston Mead Address 4 Beach Lawn Waterloo Liverpool Merseyside L22 8QA 0151 928 3796 0151 931 4989 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) Tulip Care Limited Sharon Mary Elmer Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection Service users to include up to 28 OP Date of last inspection 8th November 2005 Brief Description of the Service: Woolston Mead is registered to provide care to twenty eight older people. The home changed ownership in February 2006 and is now privately owned by Tulip Care Limited, the responsible individual is Dr Jaydeep Kantilal Patel. The registered manager is Sharon Mary Elmer. The home is located in a quiet residential area in Waterloo. From the front of the house there are lovely views across Liverpool Bay and over to North Wales. Accommodation is provided over four floors with the main lounge areas on the ground floor. The home is fitted with stair lifts and a passenger lift. There is a garden at the front of the house and an enclosed garden and patio area at the rear. The current fee rate for accommodation is £410.00 a week. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two days, approximately eleven hours. It was an unannounced inspection (site visit) and was carried out as part of the regulatory requirement for care homes to be inspected. A partial tour of the home was conducted and care records and other home records were viewed. Discussion took place with the owner (by telephone), deputy matron, three care staff, the chef and six residents individually. Group discussion also took place with the residents available during the visit. Twenty four residents were accommodated at the time of the inspection. During the inspection three residents were case tracked (their care files were examined and their views of the home were obtained). This process was not carried out to the detriment of other residents who also took part in the inspection process. Discussion also took place with two visiting health professionals and a friend of a resident. All the key standards were inspected and also previous requirements and recommendations from the last inspection in November 2005. Satisfaction survey forms “Have Your Say About …” were distributed to a number of residents prior to the inspection and some were left relatives to compete at the time of the visit. Comments included in the report are taken from the survey forms and also during the site visit. What the service does well:
Woolston Mead is located in a pleasant area overlooking Liverpool Bay. The home is comfortable, spacious and welcoming. The residents’ bedrooms are very nicely presented and furnished with many of their personal possessions. The lounges have comfortable armchairs. The home has a pleasant relaxed atmosphere and staff were observed to communicate effectively with the residents. There are good links with health care support services and these visits had been documented in the residents’ care files that were seen. Two district nurses were visiting at the time of the site visit and it was evident that where needed residents receive regular clinical support along side the support and care they have from the staff. Staff accompany residents for external appointments. A resident said, “The staff will always come with me and give me help”. Residents interviewed were complimentary regarding the care they receive and described the home as ‘homely and comfortable’. Personal care for residents is
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 6 given in an unhurried manner to ensure the residents’ dignity is not compromised in any way. Residents interviewed felt that the staff approach to care was supportive and respectful throughout the home. Staff understood the need for residents to exercise choice with regard to how they wish to spend their day. This was discussed in relation to activities, meals and personal care. Staff were observed working well as a team and those spoken with were pleased with the support they receive from senior staff and the manager. Residents interviewed and written feedback received from residents confirmed that the home’s menu is appealing and the food well presented. A resident said, “There is a good choice and the cooks are really good”. The dining room tables were attractively laid for lunch. What has improved since the last inspection? What they could do better:
The home were unable to locate the Statement of Purpose and Service User Guide. These documents are an essential guide for residents and/or their representative to view as they provide detailed information regarding the service and facilities at Woolston Mead. Both documents must be made available for residents and/or their representative and a copy should be made available on request for inspection. As part of the case tracking process, three resident files were viewed and these did not evidence a standard form of contract, which should be provided for each resident. The contract advises residents of the terms and conditions of
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 7 residency, what is included in the fee and details of the care provision. The home were unable to comment on when these are given out and residents interviewed were unsure of contract details. The home should develop further the assessment process, to include a new format for recording pre admission details. This would ensure staff have more detailed information to assist with developing the care plans. Each resident has a plan of care however the home must ensure that residents’ care plans include details of current health care needs and the level of assistance required by staff to ensure they can provide the support and care needed. This information was not evidenced in all care files viewed. The home does not currently involve resident and/or their representative with the drawing up of their plan of care. Each resident must have a plan of care that has been agreed by them and they must be consulted as part of the review process regarding any action that affects their individual care. The home must ensure a daily written record of the care and support given to each resident is completed. This will ensure records are maintained accurately and evidence care given in accordance with the care plans. (This was introduced at the time of the site visit.) The home has a medicine policy and procedure and five senior staff including the manager are responsible for administering medicines to the residents. The Commission’s pharmacist was consulted at the time of the site visit with regard to medicine administration and a number of good practice recommendations are stated in the main report. The home offers an informal activities programme and this should be developed further. Residents should be consulted with regard to what they would like in the home and activities should be advertised in a prominent position for residents to view. Residents’ meetings would be a good way of accessing this information. There are no advocacy details on display or a copy of the home’s complaint procedure. Both should be displayed to ensure residents are aware of whom to contact for advice if needed. Adult protection training for staff is required to ensure they are familiar with the latest guidance and which agencies to contact should an alleged incident be reported. The building is both large and old and a full maintenance, decoration and refurbishment programme is required if standards are to be both maintained and improved. A number of doorframes, skirting boards and window frames require painting and are to be included in the maintenance plan. The carpet in the lounge to the left of the entrance hall is very badly marked and although the carpet is cleaned the stains remain. The carpet must be replaced as this detracts from the overall look of the lounge. The Medibath (a bath designed to
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 8 assist residents with limited mobility) in the basement must also be replaced as it is rusty and the paintwork chipped. This could cause an injury to a resident or staff member. With regards to recruitment, poor practice was evident. Following the change in ownership there seems to be confusion in the home as to who is now responsible for obtaining the necessary police checks and the correct recruitment procedure that must be followed to ensure staff are fit to work with vulnerable adults. Three staff files were examined and there was no evidence of a POVA (Protection of Vulnerable Adults) First check for new staff or CRB (Criminal Record Bureau) enhanced disclosures being attained. One staff file only had one reference on file; two are required prior to commencing work at the home. Requirements regarding recruitment are outstanding from the previous two inspections. The home once again continues to fail to meet the Care Home Regulations. This matter must be addressed with urgency as residents are being put at risk. The home has an ongoing programme for NVQ courses at Level 2 and Level 3 for care staff. 40 of staff have obtained an NVQ in care. This programme is to continue to acquire the 50 required. The home does not have an up to date record of training given to staff and only one staff file evidenced a completed induction programme. A training plan for all staff is a priority to ensure the staff have the knowledge to meet the needs of the residents. This remains an outstanding requirement from the last inspection. The home has arranged a manual handling training session for this month. A number of staff have attended a health and safety course however there were no details on file. The home still does not have a quality assurance system, which incorporates obtaining feedback from residents and/or their representatives, for example, arranging residents’ meetings or sending out satisfaction questionnaires regarding the service. This remains an outstanding requirement from the last report. The new owners are required to undertake a monthly visit to the home and submit a report to the Commission of their findings. The last report received was in January 2006. The home’s policies and procedures should be made more available for staff as they were found kept in a locked office. They should also be reviewed to reflect any changes in legislation and it is recommended and staff should sign to acknowledge their understanding of them. The home must ensure certificates and contracts for equipment and safe working practices are available in the home, for example, gas electric, bath hoist and chair lifts. Records must be maintained for fire prevention training for staff and the fire safety department should be contacted for advice regarding the frequency of this training. Fire alarms must be checked weekly and recorded.
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 9 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. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 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 Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3 (Standard 6 was not assessed as Intermediate Care is not provided) The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There was no Statement of Purpose or Service User Guide available and terms and conditions of residency for the residents and/or their representative were not evident in resident files viewed. Residents and/or their representative are therefore not provided with information regarding the services and facilities in the home, which would enable them to make a choice as to whether they wish to take up residency. Pre admission assessments help ensure that the home can meet the needs of the residents. Prospective service users can visit prior to admission. EVIDENCE: The home were unable to locate a Statement of Purpose or Service User Guide and residents interviewed were unsure as to whether they had received this information. A copy of the Statement of Purpose must be available for residents and/or their representative, be made available for inspection and
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 12 also be sent to the Commission. The Statement of Purpose must include details of the change of ownership for Tulip Care Limited. It was agreed that a copy of these documents would be forwarded to the Commission. A number of completed survey forms made reference to residents and/or their representative having received a contract and information of the home however when examining files as part of the case tracking process, there were no contract details recorded. Residents interviewed were also unsure as to whether they had a contract. A contract is required for the provision of services, terms and conditions or residency and facilities by the registered provider (owner). Placement statements were on file for two residents with their placing health authority. Three care files viewed evidenced admission assessments containing information on the needs of the residents, which included health care needs, past medical information and any identified risks, for example, risk of falls. The assessment form is a tick box and senior staff review the information on a regular basis as part of the care plan review. The home should develop further the assessment process, to include a new format for recording pre admission details. This would ensure staff are provided with more detailed information to assist with developing the care plans. There was evidence of a social services care plan received for one resident. A resident commented on the good level of help and support they received when arriving at the home. One completed survey form made reference to receiving welcoming letter and details of fee charges. Standard 6 is a key standard to be assessed however the home provides long term care only and does not provide intermediate care. A number of the residents have lived at the home for many years. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents have an individual plan of care however there is no input from residents and/or their representative and insufficient information is recorded regarding individual health care needs. There is a risk that care needs are not addressed appropriately. Residents are able to self medicate if they wish and staff administer medicines according to the home’s policy and procedure. Staff were observed as being respectful their manner and approach with residents. EVIDENCE: Residents have an individual care file and three files were examined as part of the case tracking process. The care files are stored in the office and are accessible for staff. Care documentation seen had been reviewed on a regular basis however there was no evidence of resident and/or their representative being involved when drawing up the plan of care or during the review. A number or residents require support and assistance from staff with their personal care, for example, washing, dressing and walking (with the use of aids). One care file examined did not have a plan of care detailing this assistance although a risk assessment had identified this need. Risk
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 14 assessments for assessing a resident’s mobility include details of any aids required, for example, zimmer frame, walking stick. This information must also be recorded in the plan of care to ensure staff are fully instructed on how to deliver the care. Senior care staff are responsible for writing the care plans and care staff confirmed that they could read the files at any time. They should however be encouraged to become more involved with the resident’s plan of care. Senior care staff complete a written record of the care they give. The files viewed did not evidence a daily written entry; one record sheet had not been completed since April 2006. The staff are therefore not maintaining accurate records of care provision in the home. The district nurse service provides clinical advice and treatment to the residents when needed. The district nurses record the care they give following their visit and notes are left at the home for residents and staff to view. Two district nurses were visiting at the time of the site visit and were seen to liaise with staff regarding the prescribed treatments. It was evident that good communication exists between the home and staff. Residents interviewed stated that the staff worked well with them and comments regarding the care included: “All the staff and the district nurses are really good” “The staff are just lovely to me, just like family” “The care is fine and I am pleased with everything” “All the carers at Woolston Mead are wonderful, kind and very caring” Liaison with other health care support services is good so that health care needs are fully met. Residents interviewed stated that they can see their own GP at any time and that staff accompany them on appointments to local hospitals and clinics. Staff were observed assisting a resident with making an optician’s appointment and taking time to sort out the necessary transport arrangements. Discussion took place with the deputy manager regarding a resident whose health care needs can be unpredictable and can result in the resident having falls. Staff provide a good level of support to the resident and have kept in contact with the resident’s GP. A further external review would beneficial at this stage. Medicines are administered from blister packs, which are kept in a locked cupboard in the office. The home does not have a medicine trolley. Two residents currently self medicate their own medicines which is good evidence of personal choice. The lockable storage space in their rooms should be used for the storage of their medicines. Residents who self medicate should also complete a declaration form stating they wish to undertake this practice and the home should also complete an individual risk assessment for each resident to ensure they have the capacity for this. For the administration of the medicine Temazepam (a sleeping tablet) two staff members should sign the
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 15 medicine sheet following administration. This demonstrates good clinical practice. Medicine sheets of residents who were case tracked were examined and these evidenced prescribed medicines administered by staff. A photograph was also in place of each resident for verification purposes. Five senior staff including the manager and deputy manager are responsible for the overall administration of medications in the home. There has been no formal external training arranged regarding medicine awareness; current training is arranged between staff. Following advice from the Commission’s pharmacist it is very strongly recommended formal training in medicine awareness be accessed or the manager should complete an assessment of competency for each staff member to ensure they have the skills and knowledge for this practice. The home’s pharmacist visits the home to review medicine practices and an audit form was seen of the most recent visit. Staff were observed as being respectful towards the residents and residents interviewed commented on their polite attitude. Residents seen were appropriately dressed and staff were observed offering help in an unhurried manner. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 16 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 and 15 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents have the opportunity to take part in activities of their choice within the home and local community. Residents are encouraged to make decisions and are supported to maintain independence were possible. Their rights are respected. A healthy diet and flexible meal times are in place. EVIDENCE: There was a relaxed, friendly and warm atmosphere in the home and it was evident that residents could choose how to spend their day. A number were joining in musical entertainment with staff in the lounge and others were going out with family members or friends. A visitor to the home stated, “I am always made welcome and the staff are really polite. A resident confirmed that visitors could pop in any time. The home operates a key worker system for staff (extra responsibilities are assigned) where staff can get to understand and know residents’ needs in more detail and this enables a closer staff resident relationship. Residents spoken with were pleased with the home’s routine and said that staff accommodated their wishes with regards to time of getting up in the morning or retiring at night. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 17 The residents are encouraged to bring their own personal belongings to the home and bedrooms seen had residents’ own furniture and one room had a resident’s bed which was brought in from home. Activities tend to be arranged on an informal basis. The home offers bingo, musical entertainment and exercise to music in the mornings. Completed survey forms make reference to activities usually/sometimes being arranged however it would be beneficial to develop a more formal activities programme, which should be displayed in the home. There are currently no outings /trips out from the home and with the summer approaching this should be arranged. Residents’ meetings would be an ideal way of finding out where they would like to visit. The home’s entrance hall would lends itself to an information board or desk with a copy of the home’s Statement of Purpose, a copy of the most recent inspection report, social arrangements and other information relevant to the service. There is currently no information on display for residents and/or their representative to view. A member of staff was unsure how to contact the advocacy service on behalf of a resident and contact details were not evident. It would be beneficial to have this information to hand. Residents are able to manage their own monies and the home offer support with financial affairs where needed. Two financial files were viewed and these evidenced recent expenditures (hairdresser and chiropody) and a balance total. The home offers a four-week menu and this evidenced a good choice of hot and cold meals. Residents receive their meals in the dining room, one of the smaller lounges or in their rooms if preferred. Residents spoken with were complimentary regarding the food and also the contact they have with the cooks. A resident said, “The cook will prepare anything you want”. The kitchen was tidy and clean and the cupboards well stocked with fresh, dry and frozen goods. An order is placed most days for fresh fruit and vegetables. Fridge and freezer temperatures are recorded daily; a record sheet for May 2006 was seen. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 18 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 quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has a complaint procedure and residents interviewed were confident that their concerns would be listened to. The home has a policy and procedure in place to safeguard residents from abuse however recruitment but there needs to be more awareness regarding the local adult protection procedures so that residents are not placed at risk. EVIDENCE: The complaint procedure is kept in the policy and procedure file and this was found in a locked office. The complaint procedure should be kept in the main office for staff to access and also a copy should be displayed in a prominent position for residents and/or their representative to view. Survey forms make reference to residents knowing who to talk to if they were unhappy and residents interviewed said they would talk with the manager if they had a complaint. A staff member stated she would always report a concern to Sharon (manager). The home has a policy and procedure to safeguard people living in the home and also a copy of Sefton’s Vulnerable Adult Procedure. Staff interviewed stated that they would report an incident to the manager however they were unclear of the role of the statutory bodies such as the police, social services or the Commission for Social Care Inspection [CSCI] and that the home should not take on the role of full investigators without reference to the Adult
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 19 Protection process. The home’s recruitment of staff is not robust, as a number of staff files did not evidence the necessary police checks with regard to POVA and CRB disclosures. These are required to ensure staff are fit to work in the home. Training for staff must therefore be given in adult protection procedures. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 20 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): 19,20,21,22,23,24,25 and 26 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides comfortable clean accommodation however certain areas require attention to ensure the general upkeep of the building is maintained. EVIDENCE: The home provides single and double accommodation and has spacious communal areas with comfortable armchairs. A number of residents were sitting in the lounges or in chairs in a small sitting area in the main hall. They are able to meet visitors in these rooms or in their own private accommodation. There is a hairdressing salon on the ground floor and this is used by the district nurses to provide clinical treatments for residents and for visiting clergy to conduct services. The building is both large and old and a full maintenance, decoration and refurbishment programme is required if standards are to be both maintained and improved. A number of doorframes, skirting boards and window frames require painting and are to be included in the maintenance plan. The carpet in the lounge to the left of the entrance hall is very badly marked and although the carpet is cleaned the stains remain. The
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 21 carpet must be replaced as this detracts from the overall look of the lounge and is not pleasant for the residents to view. The home’s maintenance man completes every day repair jobs within the home and also decorates bedrooms when vacated. Three bathrooms were viewed, the Medibath (a bath designed to assist residents with limited mobility) is rusted in places and the paintwork is chipped. This must be repaired or replaced as it could cause an injury to the residents. The other bathrooms seen are domestic in style and have a bath hoist. Hot water temperatures are recorded to ensure the hot water is delivered to a safe temperature for residents use. The home has handrails in the corridors and raised toilet seat in WCs. There is no portable hoist however the deputy matron stated that no resident currently requires the use of this piece of equipment. The home has a passenger lift and chair lift to all floors. Bedrooms seen were pleasantly decorated and residents had personal items from home, for example, ornaments, pictures and pieces of furniture. Residents interviewed were happy with their bedrooms and did not feel they were lacking anything. Bedrooms are fitted with a call system with an alarm facility. The home has a maintenance man who completes every day to day jobs in the home. These are recorded in the maintenance book. Emergency lighting is checked monthly in house and subject to an annual safety check. Records seen were in date. The laundry room is situated in the basement and staff confirmed that they have a good supply of gloves and aprons. COSHH data was available on most of the cleaning products used by the home. A resident said, “The laundry service is excellent”. The laundry assistant also assists in the kitchen early in the morning prior to commencing laundry duties. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Staff numbers were appropriate to ensure residents’ care needs were met promptly however with lack of evidence of staff training and poor recruitment procedures, residents are vulnerable and at risk. EVIDENCE: The first morning of the site visit the home was fully staffed. The deputy manager was on duty with four care staff, a cook and laundry assistant. Three care staff are on duty at night. The staffing rota was seen for the month of May and this demonstrated the number of staff on duty. It was noted that Woolston Mead does not employ any domestic staff and care staff are responsible for cleaning of resident bedrooms and bathrooms each day and communal areas at night. The cleaning carried out is basic dusting and vacuuming; there is no thorough cleaning programme for each room as care staff have to undertake this work along side their care duties. The home did present as clean and tidy however care staff are employed to care and their time must be spent with the residents. At present there are many residents who require assistance with washing, dressing and walking and therefore care staff must be available at all times to provide this support. Domestic staff must be employed to ensure numbers are appropriate for the health and welfare of the residents. Residents interviewed were complimentary regarding the care they receive and comments included:
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 23 “The staff are wonderful and very caring” “The staff are very good at what they do” “The staff are just lovely” The home has an ongoing programme for NVQ courses at Level 2 and Level 3. 40 of staff have obtained an NVQ in care. This programme is to continue to acquire the 50 required. With regards to recruitment, poor practice was evident. Following the change in ownership there seems to be confusion in the home as to who is now responsible for obtain the necessary police checks and the correct recruitment procedure that must be followed to ensure staff are fit to work with vulnerable adults. Three staff files were examined and there was no evidence of a POVA (Protection of Vulnerable Adults) First check for new staff or CRB (Criminal Record Bureau) enhanced disclosures being applied attained. One staff file only had one reference on file; two are required prior to commencing work at the home. Recruitment requirement from the previous inspections dated, November 2005 and June 2005 remain outstanding and once again the home continues to fail to meet the Care Home Regulations. This matter must be addressed with urgency as residents are being put at risk. The owner was contacted during the site visit regarding these requirements. The home does not have an up to date record of training given to staff and only one staff file evidenced a completed induction programme. A training plan for all staff is a priority to ensure the staff have the knowledge to meet the needs of the residents. This must include – induction for new staff, manual handling, fire safety, first aid, food hygiene and infection control. The home has arranged a manual handling training session for this month and the deputy matron stated that a number of staff have recently completed a course in Health and Safety. A member of staff said she had a guided tour of the building when she started working in the home. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has a manager who is registered with the Commission. There are no particular systems in place for attaining their views and a number of the home’s health and safety records and contracts were not available. This may affect the welfare and safety of residents and staff. EVIDENCE: The manager was on holiday at the time of the site visit and discussions took place with the deputy matron and the owner (by telephone). Staff interviewed described the manager as being supportive and helpful. The home still does not have a quality assurance system, which incorporates attaining feedback from residents and/or their representatives, for example,
Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 25 arranging residents’ meetings or sending out satisfaction questionnaires regarding the service. The new owners are required to undertake a monthly visit to the home and submit a report to the Commission. The last report received was in January 2006. The home’s policies and procedures should be made more available for staff as they were found kept in a locked office. They should also be reviewed and it is recommended and staff should sign to acknowledge their understanding of them. Staff meetings are held however minutes were not available. Residents manage their own monies if they wish and a system is in place to record transactions. Financial records viewed were satisfactory. Supervision records were available in some staff files however this should be built upon to ensure all staff receive supervision at least six times a year. Staff stated that they receive a good level of support when working with the manager. With regards to maintenance contracts and certificates for safe working practices and equipment in the home a number were not available. The owner was contacted with regards to contract details for the gas, electric, bath hoists, chair lifts and portable appliance certificates. It was agreed that a copy of the certificates would be forwarded to the Commission and the home must ensure these are all in date to protect the health and safety of the residents. A risk assessment on the environment and all health and safety topics should be completed to ensure the home is compliant with current legislation. The home has a contract for the necessary safety checks of fire prevention equipment. The home is required to check the fire alarms weekly; at present these checks are being carried out monthly. Not all staff files viewed indicated that fire prevention training is given every six months. The home should contact the fire safety officer regarding the recommended frequency. A fire risk assessment of the building was not available. A training plan for all staff is yet to be developed (as outlined in the above section “Staffing”). The home has an accident book and this evidenced any an incident that affects the well-being of the resident. Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 27 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. 2. 3. Standard OP1 OP2 OP7 Regulation 4(1) and 5(1) 5(1) 15 Requirement The home must provide a Statement of Purpose and Service User Guide The home must provide a standard form of contract for residents The home must ensure that care plans identify health care needs and detail the action needed by staff to deliver the care The home must ensure the care and support given each day to the residents is recorded The home must ensure residents are consulted regarding their plan of care and be advised of any change in care provision The home must ensure all staff are aware of the home’s abuse documentation and receive abuse awareness training. The home must have a full maintenance plan for decoration and refurbishment, to include painting of skirting boards, door and window frames The owner must replace the lounge carpet identified in the report
DS0000065851.V291726.R01.S.doc Timescale for action 22/06/06 22/06/06 22/06/06 4. 5. OP7 OP7 15/37 15 22/06/06 22/07/06 6. OP18 13/18 22/08/06 7. OP19 23 22/08/06 8. OP19 23 22/07/06 Woolston Mead Version 5.1 Page 28 9. 10. 11. 12. OP22 OP27 OP28 OP29 13/23 18 18 19 13. OP29 19 14. OP33 26 15. OP30 18 16. OP33 24 17. OP38 12/13/23 18. OP38 23 The home must replace the Medibath identified in the report The home must employ sufficient numbers of domestic staff. The home must continue with NVQ training for staff to achieve the required 50 . The home must ensure staff do not commence employment until a relevant POVA and or a Criminal Records Bureau enhanced disclosure has been attained. This remains at outstanding requirement from the last two inspections. The home must obtain two written references for staff prior to them commencing work. This remains an outstanding requirement from the last two inspections. The owner must complete a monthly visit of the home and submit a report to the Commission The home must keep a record of all training provided including a record of induction for new staff. A training plan must be developed. This remains an outstanding requirement from the last inspection. The home must introduce a quality assurance system. This remains an outstanding requirement from the last inspection. The home must forward a copy of maintenance contracts and certificates for equipment, which is stated in the main report. The home must ensure these are in date. The home must have a fire risk assessment of the building and fire alarms must be checked and recorded weekly
DS0000065851.V291726.R01.S.doc 22/07/06 22/07/06 22/09/06 22/06/06 23/06/06 22/06/06 23/06/06 23/06/06 23/06/06 23/06/06 Woolston Mead Version 5.1 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 3. 4. 5. Refer to Standard OP3 OP7 OP9 Good Practice Recommendations A new format for writing the pre admission assessments should be introduced. Care staff should be more involved with the residents’ care plans. A self-disclaimer form should be used for residents who wish to self-administer their own medications. The home should complete an individual risk assessment for this practice. Medicines being self-administered should be stored securely in residents’ rooms. Two staff signatures should be recorded on the medicine sheet when administering Temazepam. Staff should receive formal medicine awareness training or the manager should complete an assessment of competency for each member of staff responsible for this practice. A more formal activities programme should be developed for the residents and the programme should be advertised in the home. Advocacy details should be available for residents The complaint procedure should be displayed in a prominent position The home should ensure supervision for staff is carried out at least six times a year and a record be kept of all sessions The home should contact the fire safety department regarding the frequency of fire prevention training for staff The home should carry out a risk assessment relating to safe working practices 6. 7. OP9 OP9 8. 9. 10. 11. 12. 13. OP12 OP14 OP16 OP36 OP38 OP38 Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. Extracts may not be used or reproduced without the express permission of CSCI Woolston Mead DS0000065851.V291726.R01.S.doc Version 5.1 Page 31 - 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!
