Care Home: Walton House Nursing Home

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What the care home does well The needs of people were thoroughly assessed before admission, so that individual needs could be fully met by the staff team. A variety of external professionals were involved in the care of the people living at Walton House and the management of medications was satisfactory. The staff team respected people living at the home, ensuring that their privacy and dignity was consistently upheld. Staff had a good understanding of the principles of care and promoting privacy and dignity. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 6Nutritious, well-balanced meals were served for service users, in pleasant dining areas. People were able to eat their meals within the privacy of their bedrooms, if they preferred. Those spoken to enjoyed the food served and told us that alternatives to the menu were available, if required. People were offered choices of meals and beverages were served at regular intervals throughout the day. One service user said, `the meals are very good`, and another commented, `we can have more or less what we want`. People living at the home were supported to remain independent for as long as possible and they were encouraged to maintain contact with their family and friends so that they continued to have links with the outside community. Service users` finances were adequately protected by the home`s policies and procedures, clear record keeping and audited practices. A detailed social history was completed for each service user outlining important events, hobbies and interests. This helped to tailor some activities to individual preferences as well as group activities. Visiting was flexible and it was evident that people visiting the home were made to feel welcome and it was confirmed that if people wished to appoint an independent advocate to act on their behalf, then the home would support them to do so. When asked what the service does well the manager told us, `we listen to our service users, their families and friends and also staff. Any concerns or complaints are listened to and acted on promptly. Visitors to the home are made welcome and are confident in voicing their concerns or complaints in order for us to improve our quality of care or the environment`. Complaints were, in general, well managed and policies and procedures were available for staff reference in relation to safeguarding vulnerable adults. The environment was relaxed and the routines of the home were well managed. It was evident that people living at Walton House were happy and contented. The home was clean, tidy and pleasant smelling, providing a comfortable environment for the people living at Walton House. Service users were able to bring their own possessions to the home if they wished in order to promote a homely atmosphere. Robust infection control policies and procedures had been adopted by the home so that people were adequately protected from cross infection. The new documentation implemented showed that the induction of staff was satisfactory, providing them with a good, basic understanding of their role.The home was being well managed and systems and equipment within Walton House had been checked and serviced at regular intervals, ensuring that they were safe for use so that residents and staff were adequately protected. The quality of service provided was being monitored through surveys for service users and relatives and by auditing and inspecting a variety of systems within the home. What has improved since the last inspection? The care planning process had significantly improved since the last inspection, which is commendable. The new manager had identified that the system of planning care could be better and so she had audited care records to ensure that they provided clear guidance for staff as to how individual assessed needs were to be met. The management of medications had improved since the last inspection to ensure that people living at the home were adequately safeguarded. The provision of activities had improved since the last inspection and people spoken to were, in general, happy with how they spent their time at the home. The management of meals was a lot better at this inspection, providing a relaxed and pleasant atmosphere for people to eat in. The environment had significantly improved since the last key inspection by decoration in several areas of the home. The environment was much less `cluttered` and a much calmer atmosphere prevailed, providing people with a safer and more comfortable environment in which to live. Significant improvements had been made since our last visit to this service. The manager of the home had been appointed since the last key inspection and it was evident that she, along with the provider, had worked very hard to improve the standards for the people living at the home. All six requirements made at the last inspection had been appropriately addressed, which was pleasing to see. What the care home could do better: The pre-admission assessments could have always been dated and signed to show when the information had been obtained and who had conducted the assessment. Although, care records were much improved, it is recommended that guidance be provided for staff as to what strategies should be implemented when risks are identified, particularly in relation to nutrition. It is also advisable to change the colour of the paper on which daily reports are written so that they are easier to read and clearer to photocopy, if necessary.The social care needs of people, identified before admission could have been consistently included within the plans of care, so that staff were aware of how service users` interests could be maintained whilst living at Walton House. The care planning process could have involved the service user or their relative so that people were given the opportunity to say how their assessed needs could be best managed. The menu could have been produced in larger print so that it was easier to read and service users` clothing could have been protected with more suitable garments at meal times. The record of complaints received could have been retained in a more secure manner by documentation being kept in a numbered page record book to avoid pages being removed or mislaid. Staff working at the home needed to receive relevant training in relation to safeguarding vulnerable adults to ensure that those living at Walton House were being adequately protected. The training matrix needed to be updated and other training, including 50% of care staff achieving a relevant qualification (NVQ), needed to be improved so that all the staff team were competent to deliver the care required. One bedroom was in need of slight attention to the torn wallpaper, in order to enhance the private accommodation for the two people living in this shared room. The door of the industrial drying machine was in need of repair to promote the safety of staff operating this equipment. The recruitment practices could have been better. Not all relevant checks had been obtained and others had been received after staff had started working at the home. One person working at Walton House had not completed an application form and two references for another person were not appropriate, which did not demonstrate that people living at the home were always protected. When asked what the service could do better the manager told us, `since my employment commenced in January 2008 all paperwork is being updated and improved, with some new documentation being put into place`. The home could improve the system for monitoring the quality of care provided by introducing surveys for stakeholders in the community and for those working in the home, to allow them to give their views about how the home is achieving goals for people who live there. CARE HOMES FOR OLDER PEOPLE Walton House Nursing Home Walton House 188 Chorley Road Walton-le-dale Preston Lancashire PR5 4PD Lead Inspector Vivienne Morris Unannounced Inspection 09:30 3 September 2008 rd 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 Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walton House Nursing Home Address Walton House 188 Chorley Road Walton-le-dale Preston Lancashire PR5 4PD 01772 628514 01772 697200 waltoncare@btconnect.com 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) Walton Care Limited Mrs Pat Dixon Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 44 service users to include: Up to 44 service users in the category of OP (Old Age, not falling in any other category) 19th July 2007 Date of last inspection Brief Description of the Service: Walton House is a care home providing both personal and nursing care for up to forty-four elderly people. The home is a purpose built two-storey establishment, being located on the main road through Walton-le-Dale, Preston and is situated near to shops, pubs, a post-office and other local amenities. A passenger lift provides easy access to the upper floor. There are car parking spaces available at the main front entrance and a garden area with flowerbeds, patio areas and seating to the rear of the home. The majority of bedrooms provide single accommodation. However, a number of companion rooms are available for those who wish to share. There are no en-suite facilities at Walton House. However, accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. There are lounge areas on each floor and the dining facilities are situated on the ground floor. Corridors are wide and fitted with grab rails. Other aids are provided to assist people living at the home with mobility problems. Information about the services that the home offers is provided in the form of a service users’ guide, which is available to existing and prospective residents and their relatives. The fees as of 13th September ranged from £390.00 to £550.00 per week. Additional charges were incurred for hairdressing, chiropody, newspapers and magazines. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience good quality outcomes. An unannounced site visit was conducted to this service over one day in September 2008, which formed part of the key inspection process. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Comment cards were received from six people living at the home and four relatives and their feedback is reflected throughout this report. Every year the provider completes a self-assessment (AQAA), which gives information to the Commission about how the home is meeting outcomes for people using the service and how the quality of service provided is monitored. We observed the activity within the home and ‘tracked’ the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The Commission for Social Care Inspection has received five complaints about this service since the last key inspection, which were referred back to the provider to investigate using the home’s complaints procedure. We conducted one random inspection in response to part of one of the complaints received. Two safeguarding vulnerable adults alerts have been invoked since the last inspection in relation to allegations received. What the service does well: The needs of people were thoroughly assessed before admission, so that individual needs could be fully met by the staff team. A variety of external professionals were involved in the care of the people living at Walton House and the management of medications was satisfactory. The staff team respected people living at the home, ensuring that their privacy and dignity was consistently upheld. Staff had a good understanding of the principles of care and promoting privacy and dignity. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 6 Nutritious, well-balanced meals were served for service users, in pleasant dining areas. People were able to eat their meals within the privacy of their bedrooms, if they preferred. Those spoken to enjoyed the food served and told us that alternatives to the menu were available, if required. People were offered choices of meals and beverages were served at regular intervals throughout the day. One service user said, ‘the meals are very good’, and another commented, ‘we can have more or less what we want’. People living at the home were supported to remain independent for as long as possible and they were encouraged to maintain contact with their family and friends so that they continued to have links with the outside community. Service users’ finances were adequately protected by the home’s policies and procedures, clear record keeping and audited practices. A detailed social history was completed for each service user outlining important events, hobbies and interests. This helped to tailor some activities to individual preferences as well as group activities. Visiting was flexible and it was evident that people visiting the home were made to feel welcome and it was confirmed that if people wished to appoint an independent advocate to act on their behalf, then the home would support them to do so. When asked what the service does well the manager told us, ‘we listen to our service users, their families and friends and also staff. Any concerns or complaints are listened to and acted on promptly. Visitors to the home are made welcome and are confident in voicing their concerns or complaints in order for us to improve our quality of care or the environment’. Complaints were, in general, well managed and policies and procedures were available for staff reference in relation to safeguarding vulnerable adults. The environment was relaxed and the routines of the home were well managed. It was evident that people living at Walton House were happy and contented. The home was clean, tidy and pleasant smelling, providing a comfortable environment for the people living at Walton House. Service users were able to bring their own possessions to the home if they wished in order to promote a homely atmosphere. Robust infection control policies and procedures had been adopted by the home so that people were adequately protected from cross infection. The new documentation implemented showed that the induction of staff was satisfactory, providing them with a good, basic understanding of their role. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 7 The home was being well managed and systems and equipment within Walton House had been checked and serviced at regular intervals, ensuring that they were safe for use so that residents and staff were adequately protected. The quality of service provided was being monitored through surveys for service users and relatives and by auditing and inspecting a variety of systems within the home. What has improved since the last inspection? What they could do better: The pre-admission assessments could have always been dated and signed to show when the information had been obtained and who had conducted the assessment. Although, care records were much improved, it is recommended that guidance be provided for staff as to what strategies should be implemented when risks are identified, particularly in relation to nutrition. It is also advisable to change the colour of the paper on which daily reports are written so that they are easier to read and clearer to photocopy, if necessary. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 8 The social care needs of people, identified before admission could have been consistently included within the plans of care, so that staff were aware of how service users’ interests could be maintained whilst living at Walton House. The care planning process could have involved the service user or their relative so that people were given the opportunity to say how their assessed needs could be best managed. The menu could have been produced in larger print so that it was easier to read and service users’ clothing could have been protected with more suitable garments at meal times. The record of complaints received could have been retained in a more secure manner by documentation being kept in a numbered page record book to avoid pages being removed or mislaid. Staff working at the home needed to receive relevant training in relation to safeguarding vulnerable adults to ensure that those living at Walton House were being adequately protected. The training matrix needed to be updated and other training, including 50 of care staff achieving a relevant qualification (NVQ), needed to be improved so that all the staff team were competent to deliver the care required. One bedroom was in need of slight attention to the torn wallpaper, in order to enhance the private accommodation for the two people living in this shared room. The door of the industrial drying machine was in need of repair to promote the safety of staff operating this equipment. The recruitment practices could have been better. Not all relevant checks had been obtained and others had been received after staff had started working at the home. One person working at Walton House had not completed an application form and two references for another person were not appropriate, which did not demonstrate that people living at the home were always protected. When asked what the service could do better the manager told us, ‘since my employment commenced in January 2008 all paperwork is being updated and improved, with some new documentation being put into place’. The home could improve the system for monitoring the quality of care provided by introducing surveys for stakeholders in the community and for those working in the home, to allow them to give their views about how the home is achieving goals for people who live there. 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 Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 9 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The preadmission process was thorough enough to ensure that the staff team were able to meet everyone’s individual needs. EVIDENCE: When asked what the service does well, the registered manager wrote on the home’s self-assessment, ‘we enable service users the opportunity to exercise choice, rights and diversity. We offer potential service users a service users’ guide that is understandable and we offer trial visits to the home before providing each individual service user with a statement of terms and conditions’. The manager then provided us with some examples to support her comments, including telling us that full pre-admission assessments were conducted to ensure that the service user’s needs could be met. On looking around the home we noted that service users’ guides were available within each bedroom we viewed and information packs (‘choosing a home’) Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 12 were given to each prospective service user, so that people could easily access any information they needed. Six comment cards were received from residents. All said that they had received enough information before they moved into Walton House to help them make an informed choice about where to live. Five said that they had received a contract and one said they had not. One person wrote, ‘I visited the home and was happy with the surroundings and care provided’. The registered manager told us, ‘to ensure that the views of people who use the service are promoted and incorporated into what the home does we send out surveys, listen to concerns and complaints and hold meetings for a range of different professionals’. All six residents said that staff listen and act upon what they say and this was observed during our visit to the home. When asked what the service could do better, the registered manager stated on the self-assessment, ‘more intense training for staff after they have completed their National Vocational Qualification so that they are more involved in care planning, assessments and medication administration’. We looked at the care records of three people living at the home. We noted that a new care planning format was in the process of being implemented, which showed that some significant improvements had been made in the care planning process. Although the pre-admission process was thorough and contained some detailed information, the assessments conducted by the home were not always dated and signed to show when they had been done and who had carried them out. Good social histories were recorded for each person whose care was ‘tracked’, so that staff knew about people’s backgrounds and interests. However, these were not always included within the plan of care, so that staff were aware of how the home was going to maintain people’s interests whilst living at Walton House. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the home were being met and the privacy and dignity of residents was consistently respected. The management of medications was satisfactory. EVIDENCE: Of the six service users who submitted comment cards four said that they usually received the care, support and medical attention they needed and two said they always did. One of these people wrote, ‘the staff are all very kind and helpful’ and a relative wrote, ‘I believe my relative’s condition is managed well and I have been informed of any difficulties he has had or hospital appointments he has had to attend. I believe that when staff are unable to help him medical support from the local Doctor or hospital has been organised as necessary’. Relatives felt that care needs were usually met and that they were always kept up to date with important issues affecting their relative. They were satisfied Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 14 with the level of care and support their relatives received in the home. One person wrote, ‘I have no trouble with my relatives care’ and another commented, ‘the staff are very good at their job’. All relatives indicated that the care service always met the differing needs of people living at the home. When asked what the service does well one relative wrote on the comment card, ‘it provides individual care for each resident’ and another wrote, ‘my relative is happy and well cared for in Walton House. She is kept clean and well fed. Also more important is that the staff spend time with her talking to her, as she is blind and quite deaf. I am very happy with the way she is looked after at Walton House’. When asked on the self-assessment what the service does well the manager wrote, ‘we promote and maintain service users’ health needs that have been assessed and to ensure that people have access to health care services in order to meet those particular needs’. We ‘tracked’ the care of three people living at the home. The care planning process was well organised and had significantly improved since the previous key inspection, with the introduction of a new care planning format. The new manager of the home had audited the plans of care and had realised that a better system could be introduced. The three plans of care examined were clear, well written documents, which included all assessed personal and health care needs to ensure that staff knew how these individual needs were to be fully met. Clear guidance was provided for staff, which was reviewed every month to make sure that up to date information was available and it was evident that privacy, dignity and choice were of high importance within the home. It was noted that within the care records the new format included daily written reports, so that staff were aware of any changes in circumstances. These reports were written on red paper, possibly so that they could be easily identified because of their frequent use. However, we found this made the documents difficult to read and thought that if they needed to be photocopied for any reason then perhaps the clarity would be poor. Although a range of risk assessments had been conducted, it was not always explained to staff what strategies should be implemented in accordance with the degree of risk to ensure that identified risks were always managed appropriately. There was no evidence available to show that the care plans had been developed with the involvement of the resident or their relative, so that they had the opportunity to have some say in the care planned for them. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 15 There was a lot of evidence available to show that other professionals were involved in the care of people living at the home, so that external advice had been sought about any health care needs. The statement of purpose showed that the home ensured that the privacy and dignity of people was upheld at all times and the residents spoken to confirmed this information. One stated, ‘the staff are really nice. They will do anything for us’ and another commented, ‘I am very happy living at this care home’. Staff were seen to be treating residents with respect and were heard talking to them in a kind manner. One relative said, ‘the staff here respect my relative as a person’. It was established that qualified nurses were responsible for administering all medications and relevant policies and procedures were in place to ensure safe medication practices. The management of medications was satisfactory so that people living at the home were adequately safeguarded. When asked on the self-assessment what the service could do better the manager wrote, ‘improve assessments for risk of falling. To develop more in house training for basic care. To improve existing care plans, policies and procedures’. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines within the home were flexible and the lifestyle experienced by people living there satisfied their leisure interests, religious needs and hobbies. Meals were well managed and people were helped to exercise choice and control over their lives. EVIDENCE: When asked what the service does well, the registered manager wrote on the self-assessment, ‘we satisfy peoples’ preferences, social, cultural, religious and leisure interests and needs. We respect preferences and freedom of choice and conduct an assessment of service users’ social needs. We offer choices of well balanced diets. There is no set routine, thus allowing more flexibility. We employ a hobby therapist and social activities are circulated to service users and their relatives. Visiting times are flexible and people are encouraged to personalise their own rooms’. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 17 When asked what the service could do better, the registered manager told us ‘we could involve the service users more. We could improve the choices of menu, serving of food and increase the activities provided’. All four relatives indicated on the comment cards that people living at the home were usually supported to live the life they choose, and one simply wrote, ‘everything is OK’. We discussed the programme of activities with the activities co-ordinator. We were told that this was circulated to service users and their relatives on a monthly basis, which is good practice, so that people know what is going on in the home and so they can plan their daily lives. We noted that social histories were obtained from each service user, detailing important life events, hobbies and interests, which could help the home to tailor some activities to individual preferences as well as providing group activities. This was considered to be good practice, although it would be better if all this information were transferred to the plans of care so that staff could support people to continue their interests whilst living at the home. We saw that one gentleman had artist equipment in his room as he enjoyed painting. He was eager to show us some of his work, saying, “As I cannot fish or hunt any longer I have taken up painting as I really enjoy it”. We also noted that those with poor eye sight had access to talking books, so that they had the same opportunities as the people who could see well. Those living at the home were offered a variety of choices throughout the day and it was evident that the daily routines of the home were as flexible as possible in order to suit individual needs. One service user said, “there are some activities I join in with, but other than that I am quite happy just sitting and watching what is going on’. A record of which activities people joined in was kept, so that the level of stimulation for each person could be monitored. People living at the home looked cheerful and happy in their surroundings. They were comfortable with the staff and there was a relaxed, calm atmosphere, which was pleasing to see. Responses from those living at the home in relation to staff availability when they are needed varied. One person wrote, ‘they (the staff) tend to be busy but will make time for you if you need to talk to them or just ask them a question’. Four relatives submitted comment cards and one of them wrote, ‘my relative is unable to communicate and I have known him to spend most of his time alone watching TV. I feel that he has little stimulation in his day, but the Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 18 circumstances are frustrating for him and I have every faith that all has been and is being done for him with the available resources. Pam the activities coordinator is invaluable. Nursing staff are sympathetic, approachable and efficient. All staff care about the residents’. Another relative commented, ‘Over a number of years now at Walton House I believe my relative has been kept as reasonably comfortable as possible. My only wish is that there was a way possible to make his day more stimulating’. At the time of our visit to the home a group of service users were enjoying a gentle exercise session, provided by a representative from the local leisure centre. Those taking part said that they liked joining in the activity each week as it helped keep them fit. Service users spoken to confirmed that the home worked to open visiting arrangements and they knew that they could entertain their family and friends in their own rooms if they wished. If they preferred they were also able to use community areas of the home to talk to visitors and relatives and friends were encouraged to participate in the various events taking place in the home. Policies seen showed that if people living at the home required an independent person to act on their behalf, then this would be arranged, so that their interests would be protected. Those spoken to confirmed that visitors were made welcome to Walton House and that the home worked to open visiting arrangements and this information was supported by the policies of the home. Information about the use of the local advocacy service was readily available and policies seen showed that if people living at the home required an independent person to act on their behalf, then this would be arranged, so that their interests would be protected. When asked what the service does well, one person wrote on the comment card, ‘the meals are really good and the staff try with people who do not eat well. On the whole they (the staff) do a good job’. A four weekly menu was available, which showed a choice of meals, including a wide range of breakfast food. However, the menu could have been produced in larger font, so that those with poor eyesight could read it more easily. The menu of the day was displayed in the dining room, but service users spoken to confirmed that they could have an alternative to the menu choices if they preferred something different. We spoke to the chef who was aware of people’s special dietary needs and he said that people are able to have what they want for their meals. Staff were seen offering people alternatives to the Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 19 main menu and two people were seen being provided with the alternatives, which they had requested. We observed lunch being served. Those living at the home were supported to eat their meals, as was necessary and they could go to the dining room or eat their meals in their own rooms if they wanted to do so. The dining tables were pleasantly decorated and condiments were available, so that people could help themselves. Age appropriate background music made lunch a pleasant experience. The meals served looked well presented and wholesome, providing residents with a nutritious and well balanced diet. Alcoholic and soft beverages were offered with lunch and it was nice to see people being routinely offered more to eat. Staff chatted to the people living at the home in an unrushed manner about their individual interests, whilst they ate at their own pace and enjoyed a relaxed lunch time. The kitchen was well organised and special equipment was available for those requiring it, such as plate guards and angled cutlery. However, it is recommended that the blue, plastic aprons used to protect service users’ clothing should be replaced with a less obvious garment in order to protect people’s dignity. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at the home were able to voice their concerns if necessary and were supported and protected by the home’s policies and procedures. EVIDENCE: A new complaints procedure had been implemented, which was readily available for people to refer to, should they want to make a complaint. All six service users who submitted comment cards indicated that they would know how to make a complaint. One relative wrote, ‘I feel that if I do have a complaint to make that I can approach the staff and it will be looked into quite quickly’. Three relatives told us that they would know how to make a complaint, but one said that they would not know how to complain, although all four said that the home had responded appropriately in the past if any concerns had been raised about the care provided. A system was in place for the recording of complaints, which was seen to be satisfactory, although it is advisable to document complaints in a numbered page record book so that pages cannot be removed or mislaid. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 21 Robust procedures were in place in order to safeguard those living at the home from abusive situations and policies were in place so that staff were aware of their responsibility in reporting any concerns. Although, training for staff in relation to the Protection Of Vulnerable Adults had been provided in the past, it was now overdue and needed to be renewed. However, those spoken to knew what to do should they have any concerns about the care of someone living at the home. The registered manager told us that relevant training for staff had been arranged and was to be provided by the end of the year. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was clean, homely and, in general, pleasant smelling. The premises were maintained to a reasonable standard, providing a comfortable place for people to live in. EVIDENCE: When asked what the service does well, the registered manager wrote on the self-assessment, ‘the home is well maintained and odour free. We conduct regular fire checks and there is an ongoing maintenance programme. There are safe and comfortable communal and outdoor areas and refurbishment is ongoing. We provide a smoke free environment with a bright, roomy dining area and bright, roomy lounges. The environment is warm, friendly and welcoming and the bedrooms are comfortable’. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 23 All six service users indicated on their comment cards that the home is usually fresh and clean. One relative wrote, ‘the home always appears to be tidy and clean. I know my relative’s bedroom has been kept clean. My only thought about this is that on several visits to the home the smell on entering the building hasn’t always been fresh, particularly with the central heating on’. A tour of the premises took place during this site visit. We noted a great improvement to the appearance and feel of the environment since the last inspection, which is commendable. Some areas of the home had been decorated and the bathrooms had all been tastefully refurbished. The environment was much less ‘cluttered’ The home was clean, tidy and, in general, pleasant smelling, thereby reducing the risk of infection. Detailed infection control policies were in place and clinical waste was being disposed of in the correct manner, ensuring that people in the home were adequately protected against cross infection. Bedrooms were personalised and the environment was warm and comfortable, creating a homely atmosphere for the people living at Walton House. The bedrooms seen were personalised with service users’ belongings, providing a homely environment for those living at the home. Good quality furnishings were provided and people spoken with told us that they were very happy with their bedrooms. One bedroom on the ground floor was in need of some slight repair work to the wallpaper where it had been torn, so that a good standard of accommodation is provided throughout. The door of one of the industrial drying machines was broken and in need of repair to ensure that equipment operated by staff is safe for use. The outdoor patio and garden area provided a pleasant place for people to sit during warmer weather with solid garden furniture, promoting the safety of those who use it. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff working at Walton House met the needs of people living there. However, staff were not always sufficiently trained to ensure that they were consistently competent to do their jobs and service users were not always protected by the recruitment practices of the home. EVIDENCE: When asked what the service does well the registered manager wrote on the self-assessment, ‘we ensure rotas are correct and that staffing is adequate for the number or service users. We employ bank staff who are able to cover shifts at short notice. All staff employed for care work are over eighteen years of age. We make sure that there are adequate numbers of ancillary staff on duty. We provide on going in-house training to ensure staff competency’. Since the current manager took up her post she had implemented an improved, detailed induction procedure for new staff, which was shown to us and which had been signed by the employee and their assigned mentor, indicating that sections of the induction had been completed, during the probationary period of twelve weeks. A new employee handbook had also been introduced, providing staff with relevant policies and procedures in relation to working practices, which was considered to be good practice. Some training courses had been provided for staff and those working at the home told us that they had received Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 25 a period of induction. However, the training matrix was insufficient and it was established that the range and frequency of training could be further developed, so that a well-trained work force is provided for the people living at Walton House. Records seen showed that 33 of care staff had achieved a recognised qualification in care. The registered manager was in the process of developing staff training, so that a higher percentage would be appropriately qualified. She also told us that it was now mandatory for staff to complete a recognised qualification in care following their induction period. The staff rota was examined showing which staff were on duty at any one time. On the day of the site visit there were thirty-three people living at Walton House and people spoken to felt that the staff team was appropriately meeting their needs. The personnel records of three people working at the home were examined. We found that the files were well organised, but the recruitment practices needed to be improved in order to safeguard people living at the home. There was only one reference on file for one member of staff, and this had been received after employment had commenced. Friends provided both references for a second member of staff, which is not entirely appropriate, in order to obtain a true reflection of the employee’s suitability. The manager showed us that she had amended the application form to state that referees should be previous employers. There was no application form on file for a third member of staff and the Criminal Records Bureau disclosure for this employee had been obtained after employment had commenced. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was being well managed and the health and safety of people living there was protected. EVIDENCE: The manager of Walton House had been appointed since our last visit to the service and it was evident that she, along with the provider, had put a lot of effort into improving the standards for the people living at the home, which is commendable. The six requirements made at the last key inspection had been addressed satisfactorily. However, it was established that the manager was taking on board most of the work herself and it was questionable as to how long she could actually sustain this level of input. Therefore, it is advisable that strategies be put in place, so that delegation of some duties is possible. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 27 When asked what the service does well the registered manager told us, ‘The home is managed by a person who is fit to be in charge, is able to discharge her responsibility fully and is of good character. Service users benefit from ethos, leadership and management approach of the home. There is a positive atmosphere. The home is run in the best interest for its service users’. The manager of Walton House is registered with the Commission for Social Care Inspection and is currently doing the Registered Managers Award, alongside a degree course. Staff spoken to felt supported by the management of the home and one of these people told us that she had done a lot of training whilst working at the home, including moving and handling, fire and health and safety. When asked about plans for improvement in the next twelve months the manager told us: ‘we plan to have all paperwork in place. I plan to have completed the Registered Managers Award and to have implemented a business plan’. Four of the six relatives who submitted comment cards told us that they usually get enough information about the care home to help them to make decisions. When asked how the home could improve, one relative wrote, ‘I think it is already an excellent service’. A range of audits had been conducted, which had been reviewed at regular intervals, so that the quality of service provided could be monitored. The home had achieved several quality awards and inspections were being conducted every month, by an external consultant, following which a report was formulated and retained at Walton House, so that any shortfalls could be identified and addressed. Customer satisfaction surveys had been conducted for residents and their relatives in order to obtain people’s views about the quality of service provided. The system in place for monitoring the quality of service provided should now be extended to allow stakeholders within the community and those working at the home the opportunity to provide their views about how the home is achieving goals for service users. Minutes were retained of staff meetings, although some of these had to be cancelled due to lack of interest. A meeting for service users and relatives had been held earlier in the year and the manager told us that she intends to establish these meetings in a more structured way. Service users’ personal allowances were retained safely and clear records were kept. Receipts were obtained of any expenditure, including hairdressing and chiropody, so that a clear audit trail was evident. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 28 Clear records showed that systems and equipment in the home were serviced at regular intervals to ensure that they were safe for use. Policies and procedures had been reviewed and updated, so that people were provided with current guidelines. Some training had been provided to ensure that staff had received guidance to enable them to do the job expected of them. However, it is important that training in relation to the Protection Of Vulnerable Adults is arranged, so that staff are fully aware of what to do should they be concerned about possible abusive situations. Detailed policies and procedures were in place in relation to Health and Safety, providing guidelines for staff about safe working practices. Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 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 X X 2 Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 30 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 OP18 OP38 Regulation 18 (c)(i) Requirement All staff must receive training appropriate to the work they are to perform, including safeguarding adults to ensure people living at the home are adequately protected. Recruitment practices must be thorough enough to safeguard the people living at the home. Two written references and a Criminal Records Bureau disclosure must be obtained for each person employed, before they commence work. Timescale for action 31/12/08 2. OP29 19(1) Schedule 2 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The assessed social care needs of people should always be transferred to the plan of care, so that staff know how service users can be supported to maintain their leisure interests whilst living at the home. DS0000025584.V360919.R01.S.doc Version 5.2 Page 31 Walton House Nursing Home 2. OP3 Pre-admission assessments should always be dated and signed to show when the information was obtained and who had conducted the assessment. People living at the home or their relative should be given the opportunity to be involved in the planning of care to enable them to make decisions with respect to the care they are to receive. It is recommended that the colour of paper on which daily records are made is changed to a more subtle colour to enable easier reading and to ensure clarity if records are needed to be photocopied. Guidance should be provided for staff so that strategies can be implemented for any identified risks, particularly in relation to nutrition. The plans of care should be generated from the information obtained before admission, so that all assessed needs are recorded on the initial care plan, including social care needs. It is recommended that the menu be produced in larger font so that it is easier to read. The blue plastic aprons used to protect service users’ clothing at meal times should be replaced with a less conspicuous garment. The system for recording complaints should be reviewed in order to avoid pages being removed or mislaid. The torn wallpaper next to the first bed in the identified bedroom on the ground floor should be repaired or replaced. The door on the industrial drying machine should be repaired. 3. OP7 4. OP7 5. OP8 6. OP12 7. 8. OP15 OP15 9. 10. OP16 OP19 11. OP28 The home should continue to work towards 50 of care staff achieving a relevant qualification in care (NVQ), so that the work force is sufficiently trained. Each prospective member of staff should complete a staff application form to include precise periods of employment history, so that any gaps in employment may be easily identified and explored. DS0000025584.V360919.R01.S.doc Version 5.2 Page 32 12. OP29 Walton House Nursing Home 13. OP30 OP38 The training matrix for staff should be updated and the provision of staff training programmes should be improved, to ensure that the staff team, as a whole and individually are able to provide the care required. This includes training for the Protection Of Vulnerable Adults. Systems should be implemented so that the manager can delegate some of her duties to other senior staff. The system for monitoring the quality of service provided should be extended to allow stakeholders in the community and people working at the home the opportunity to give their views on how the care home is achieving goals for it’s service users. 14 15 OP31 OP33 Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Walton House Nursing Home DS0000025584.V360919.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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