Care Home: Waterloo House

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What the care home does well The care plans are up to date and have a lot of relevant information about peoples assessed needs meaning the care is based on individual need. This information informs the staff what they need to do to ensure people are looked after in a way that is appropriate for them. The staff are friendly and work together to deliver care to the people living in the home. Staffing levels are designed to meet people`s needs throughout the day and night. The manager is approachable and manages the home in a style that is open, positive, and inclusive for everyone living there and staff working there. Waterloo House is clean and hygienic. What has improved since the last inspection? The people using this service are treated as individuals and with respect and dignity by all the staff working at the home. An abusive practice towards people using this service by some staff was uncovered and appropriate measures put in place to ensure it was stopped. All staff at the time of this visit had attended the local authority `Safeguarding Vulnerable Adults Alerter` training this year. Regular group sessions about recognising and reporting behaviour and care practices that could be considered as `abusive` have been set up by the manager. These are optional for both the people who experienced behaviour that was emotionally harmful to them as well as for staff. Regular events and a programme of daily activities have been set up with consultation and ideas from people using this service. This includes sessions encouraging awareness about health and well being. Since the last inspection a programme of refurbishment and redecoration has started through out the home. This has improved the physical surroundings for the people using this service. What the care home could do better: Every staff file should have a photograph of the staff member. People`s bedrooms are identified by whichever `Zone` they are in. Although this correlates with the fire zones, it gives an institutional character that contradicts the ethos and values being promoted within the home. The staff should consider discussing with the people living at Waterloo House how they would like to refer to different areas of the home. CARE HOME ADULTS 18-65 Waterloo House, Stoke 3 Nelson Gardens Stoke Plymouth Devon PL1 5RH Lead Inspector Megan Walker Unannounced Inspection 24th October 2008 08:30 Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 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 Waterloo House, Stoke DS0000066199.V372935.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 Adults 18-65. 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. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterloo House, Stoke Address 3 Nelson Gardens Stoke Plymouth Devon PL1 5RH 01752 567199 01752 567199 waterloocare@tiscali.co.uk 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) Vivacare Limited Vacancy Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (20) Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service must only accommodate service users over the age of 30 Date of last inspection 30th October 2007 Brief Description of the Service: Waterloo House is a care home registered with the Commission for Social Care Inspection (CSCI) to provide personal care and accommodation for up to twenty people. People use this care service because both their care needs and primarily long standing mental health issues of various types can be met. Waterloo House is not registered to provide intermediate care or nursing care. It is not registered to provide care for anyone with a dementia care need or a learning disability. Vivacare Ltd purchased Waterloo House on 19/12/05. The home is a large terraced building, approximately 150 years old, situated in a small private road close to Stoke village in Plymouth. Local amenities and facilities are within walking distance of the home and there is good access to transport links. On the ground floor is the manager’s office, the kitchen (shortly to undergo refurbishment and update), a large lounge to the rear of the building that opens through patio doors onto a large enclosed garden, and a separate dining room. The laundry is also located at the rear of the building on the ground floor. A further lounge room is provided on the first floor for those people living in the home who wish to smoke. Bathrooms and/or shower rooms with toilets, and separate toilets, are situated on each floor. There are also bedrooms on each floor. All the bedrooms have a wash hand basin and some have en-suite facilities. A shaft lift provides access to all floors. The current weekly fees for the home range from £560.00 up to £850.00, and are according to assessment of the person’s individual care needs. Additional charges include hairdressing, chiropody, toiletries, newspapers, magazines, journals etc, all charged at commercial rates. All charges’ information was provided to the CSCI in October 2008. Information regarding the services provided at Waterloo House can be obtained directly from the home. Although the home is registered to provide a service for people from the age of 30, those currently living at the home are all of, or are nearing, retirement age. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 5 Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. This was a Key Inspection undertaken by one regulation inspector. The fieldwork part of this inspection was unannounced. It took place over two days on Friday 24th October 2008 between 08:30 and 17:20, and Monday 3rd November 2008 between 08:00 and 13:40. This inspection included talking to people who live at the home and care staff working at the time of each visit , observation of interactions between staff and people using this service, a tour of the premises, and inspection of care plans, staff files, medication and other records and documentation. The person with day to day responsibility was present on both days to provide relevant information such as the day-to-day routines as well as the management of the home. For the purposes of this report, we will refer to this person as the manager. At the time of this visit Waterloo House did not have a Registered Manager. In addition other information used to inform this inspection: • The Annual Quality Assurance Assessment (AQAA) completed by the manager. • The last Key Inspection report • All other information relating to Waterloo House received by the CSCI since the last inspection. Two requirements and one “good practice” recommendations were made as a consequence of this inspection. What the service does well: The care plans are up to date and have a lot of relevant information about peoples assessed needs meaning the care is based on individual need. This information informs the staff what they need to do to ensure people are looked after in a way that is appropriate for them. The staff are friendly and work together to deliver care to the people living in the home. Staffing levels are designed to meet people’s needs throughout the day and night. The manager is approachable and manages the home in a style that is open, positive, and inclusive for everyone living there and staff working there. Waterloo House is clean and hygienic. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents can be confident that their needs will be assessed to ensure that these can be met when they move into the home. EVIDENCE: Since the last inspection two people have moved into Waterloo House. One of them told us that they had been offered a visit before moving in. We looked at five care plans. They all had pre-assessments of care needs. One of the care files also had a comprehensive Health and Social Care Assessment and Plan completed by the funding authority. Each care file had a signed contract and a copy of the home’s Statement of Purpose. The AQAA states that anyone enquiring about Waterloo House would be offered a one to three day trial visit. There is also wide consultation with families and carers who know the person to glean better insight and understanding about an individual. This helps the staff to make a comprehensive assessment on which they base a decision to offer someone a place at the home. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People using this service are involved in their individual plan of care and are supported and encouraged to make decisions as part of an independent lifestyle. EVIDENCE: The people we spoke to about living at Waterloo House were all positive about it. They spoke highly of the manager and staff. Observation of the people living at Waterloo House and staff interactions throughout this visit found that each person was consulted about their daily lives. Each person was supported and encouraged to manage their own daily routines and personal decision-making within the risk-strategies and restrictions agreed with them. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 11 Each person using this service had an individual Care File with a full assessment of their care needs, and a plan of care. Inspection of five of these files found that they had been reviewed and updated regularly and/or when required however this was not always recorded clearly. Some people had signed their personal care plan. We were told about plans to introduce a monthly review when people could meet with their key worker. This would be an opportunity to review things generally as well as plan the things they would like to do during the coming month, and, for example, check if they needed new clothes. At the time of this visit the manager was reviewing the current arrangements of handling individuals’ monies. She was hoping to set up receivership arrangements with the local authority for some people, and Power of Attorney arrangements with other people’s families. We checked a random selection of personal monies held on behalf of people at the home. These were all found to be correct with receipts for any purchases made on behalf of the person. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People living at Waterloo House are encouraged to exercise choice and control over their lives. People are supported to continue to enjoy familiar supportive relationships with family and friends, and within the local community. EVIDENCE: For people who require twenty-four hour care Waterloo House provides a home where each person is treated with respect and dignity, choice is positively encouraged and self-esteem is promoted through “person-centred care” every day routines and practices are adapted to suit individual people and improve their daily life so it is meaningful to her/him. The five care files we inspected included a “Clients Protection Plan”. This provided staff with Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 13 information about how to recognise if someone was becoming unwell, what should be done, and by whom. Each risk assessment was personalised for the individual person. During our visit we saw people around the home. Some people prefer to stay in their bedrooms rather than join in activities in the lounge. For those who prefer to eat alone staff take their meals to them. We saw people going out to the near by village shops and coffee shop. Their individual risk assessments supported each activity. On the day of our first visit there were preparations underway for a Halloween Party. On our second visit (after Halloween) three people showed us photographs taken of them in fancy dress costumes. They told us about the party and how much they had enjoyed it. There were other photographs taken during trips out on a notice board in the hall. (The home has a car available for small group outings.) The manager told us that after consultation with everyone it was decided that only significant events would be photographed. This was because some people didn’t wish to have photographs taken every time they went out on a house trip. All the photographs on display were taken and put up with the individual person’s permission. There were regular residents’ meetings. Staff were involved in these. After meals everyone was encouraged to join in informal group chats. These provided an opportunity for individuals to talk about anything that may be bothering them, and to look at how they could support one another to ensure the home runs how they wish it to. The different areas of the home are referred to as zones. We saw evidence of this on record keeping, and also how the staff talked about the home. The manager agreed to consider with the people using this service if there were other ways to describe different areas of the building so it was less institutional. The cook had recently left so a member of staff was temporarily covering this. His cooking was very popular with the people living at Waterloo House. Individual preferences of food were recorded, and dietary needs catered for. As we toured the premises we saw individual bowls of fruit in each bedroom. The manager told us this was because when fruit was kept in a bowl in the dining room it was not being eaten. Each week everyone was given a bowl of mixed fruit in season as well as bananas and apples to keep in their room. There was evidence on each of the care files we inspected of consultation about meals. People were actively encouraged by the staff to maintain healthy, balanced diets. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be always be met. EVIDENCE: As we toured the premises we spoke to people about what it was like to live at Waterloo House. They confirmed that they receive the care and support they need, the medical support they need, that the staff listen and act on what they say, and that the staff are available when they need them. We chose five people, both men and women, to look at their care files and care generally because they were, for example, people with more complex needs (such as health care needs), and/or people with changing needs. Each care file seen stated the name by which the person preferred to be called. Each had a full assessment of care needs, and a care plan that was reviewed regularly Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 15 with the individual. If the person’s health deteriorated so they were limited in their ability to be involved with their care planning, then a family member/representatives or an independent advocate would be invited to become involved (if not already). The care plan continued to focused on the person. We saw evidence of multi disciplinary care planning to enable a proactive approach by staff to provide suitable care for individual health care needs. Daily Records showed that any medical condition was monitored and recorded. There was evidence of recording of allergies, blood tests, weight checks (with agreement), medications and their side affects. People were able to choose to have dental checks, eye-sight checks and chiropody services. We asked about health care check visits, for example, a chiropodist. We were told that people were always treated in the privacy of their own rooms. Any history of falls was recorded to monitor anyone living at the home that was at risk of falling. One file we looked at had a personalised risk assessment to guide staff about monitoring the person’s risk of falling and what to do. We looked at Incident/Accident records. These were kept securely according to relevant guidelines. They were not kept in chronological order so it was difficult to cross reference accidents recorded on individual care files with accidents recorded on an accident form. We discussed this with the manager who explained that a lot of information had recently had to be provided for the coroner. It needed sorting out since it had been returned. A senior carer explained the medication system at Waterloo House to us. Two staff on each shift were responsible for medication handling and administration. At the time of this visit only one person was able to be responsible for taking their own medication. This had been decided after a risk assessment. Other people had been assessed as being unsafe to manage their own medication and this was recorded on their individual care file. There were no controlled drugs prescribed to anyone however we saw a separate controlled drugs lockable cupboard. Each month two members of staff complete a spot check of all medication. Inspection of the medication records found that all had been given correctly and signed for accordingly. Most people had medication at mealtimes however for anyone requiring specific times, these were adhered to. Refused medication was put into an envelope that was then sealed with the date, time, drug and dosage. These were countered signed for returns, Spoilt medication was also countersigned. Anyone going on home leave had their medication counter checked and signed before they left, and countersigned and double checked on return. In case of emergency or planned hospital admissions a photocopy of the current medication record sheet was sent with the person to the hospital. Everyone had a description of their medication, what it was for and any side affects. The dispensing chemist identified a change in any medication, for example, colour or shape, and this was indicated on the person’s medication records for staff. People were able to Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 16 drink alcohol if was compatible with the medication they were taking. This was recorded on individual care plans. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The people living at Waterloo House and their families and friends can feel confident that any issues of concern or complaints raised by them will be dealt with appropriately. People are protected from abuse, neglect and self harm by the home’s policies and procedures, and by a robust recruitment process. EVIDENCE: Everyone living at Waterloo House that we asked about complaints told us that they could talk to the manager. They told us they could go to the manager’s office. They also said they talked about things together in the lounge and at mealtimes. Two people told us that they felt safe to talking openly about how they felt if a staff member treated them in a way they didn’t like. Since the last inspection there have been two safeguarding referrals and one complaint. The evidence showed that these were being managed pro-actively with the involvement of families and the individuals as well as clear instructions on care plans for staff. There has also been a safeguarding investigation of four staff members who were suspended at the time of the last inspection. Subsequently two of these staff members have left and the other two have resigned. They have all been Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 18 referred to be named on the Protection of Vulnerable Adults (POVA) list. This is because their behaviour and attitudes towards the people living at Waterloo House whom they were employed to care for was found to be abusive. We saw the Complaints procedure displayed in the hall. It was also in the Service User’s Guide. The manager told us about group sessions she has started for everyone living at the home and staff to attend. These are informal to provide people with an opportunity to understand what is abuse, how to recognise it and how to report it. In her opinion these groups were essential to rebuild individual people’s confidences and to enable them to understand that how they had been treated in the past was unacceptable and wrong. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 30 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 Waterloo House have a comfortable and safe environment that maximises their independence and meets their needs. The home is clean and hygienic. EVIDENCE: As we toured the premises we met people in their rooms. They told us that they had arranged their room to suit their preferences. Two people told us that they had chosen the decoration for their room. Two people told us they choose to stay in their rooms rather than go downstairs and be in a group. They had arrangements with the staff about cleaning the corridors outside as well as the bedrooms. They also chose to eat in their rooms and staff respected this. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 20 Each room was decorated in a domestic style. All the rooms seen were personalised to suit individual preferences. If for example someone liked their furniture laid out in a certain style, this was included in their care plan and staff respected these choices and preferences of style. At the time of this visit there was a programme of refurbishment and redecoration. A choice of colours for walls and carpets was available for each person to choose from for their bedroom. There are bedrooms on each floor. All the bedrooms have a wash hand basin and some have en-suite facilities. There were toilets and bathrooms throughout the home, with adaptations to meet the needs of the people currently living at Waterloo House. It was identified during the first visit that toilets separate from bathrooms did not have a hand wash basin. This therefore posed a risk to everyone of cross infection. By the time of the second visit the Registered Provider had agreed and purchased items necessary to completely redecorate all the toilets, including tiles and wash hand basins. A shaft lift and two staircases provide access to all floors. At the time of this visit the corridor leading to the laundry and the laundry were being refurbished. This included impermeable flooring and washable walls. There were plans to upgrade the kitchen so it would be more practical and reduce the risk of cross infection. The local Environmental Health Agency (EHO) officers had been involved in the planning of the new kitchen to ensure it would be fully compliant. The back garden was accessible to the people living in the home. We saw photographs taken during a warmer period showing people living at Waterloo House enjoying a barbeque inn the back garden. There was a large patio area and seating was provided. There was a room on the first floor for anyone living at the home who wishes to smoke. As part of the refurbishment programme there were plans to ensure this room was better ventilated so the smell of cigarettes did not permeate surrounding rooms and the corridor. On our second visit this was particularly strong although on our first visit the smell of cigarettes had been negligible. The home was clean and tidy with no offensive odours other than the smell of cigarettes as described above. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People’s needs are met at all times by trained and competent staff. EVIDENCE: At the time of this visit twelve people, including the manager, were employed to work at Waterloo House, caring for nineteen people living in the home. The manager was advertising and interviewing for more staff to complete the staff team. We looked at four staff files, three of which were relatively new employees. Each file showed that the correct recruitment checks had been completed. Everyone had a job description and a statement of the main terms of employment. Each file had a training record and for those newer employees there was evidence of induction training based on Skills for Care induction training. Two of the files we looked at had a photograph of the staff member however the registered provider confirmed she would arrange for photographs to be taken and ensure every file had one. According to the AQAA three of the twelve staff members has a National Vocational Qualification (NVQ) Level 2 or Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 22 above. Two people has signed a notice in accordance with the European Working Time Directive that states no-one should work more than forty-eight hours, including overtime within any seven day period. We saw evidence of other training staff had attended ‘in house’ including First Aid, Moving and Handling, and Basic Food Hygiene. Other courses were booked to attend before the end of 2008. This included fire training for all staff, Mental Health Awareness for four staff, and updating Handling and Administration of Medicines for four staff. The manager was aware that Health and Safety At Work needed updating, and that newer staff needed to be booked on the local authority Safeguarding Vulnerable Adults’ Alerter’ training in the near future. She explained that she was reviewing the current training systems and was looking at introducing more external facilitators to supplement the current ‘in house’ training package. Although the Statement of Purpose had been updated, the manager explained that the Service Users Guide was currently under review. It would be updated and given out to people using this service once there was a full staff team. The staff group at the time of this visit was a balanced mix of female and male, assorted ages, and from different backgrounds, beliefs, cultures and nationalities. People using this service therefore receive care that is unprejudiced and recognises their differences and values. Throughout this visit our observation of the staff found they were friendly and caring towards everyone. They were gentle and respectful as they assisted people with daily living tasks, and mindful of preserving people’s dignity and self respect. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Registered Provider shows a responsible attitude and continues to implement changes and improvements in order to keep improving and achieving positive outcomes for people using this service and staff working with them. EVIDENCE: The person in day to day charge of the home at the time of this visit (the manager) was found to be approachable. She was willing and able to provide information to assist with the inspection. During this visit she shared ideas for the future of the home. She told us about how everyone was encouraged to contribute their views and thoughts to ensure that the home was run according Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 24 to people’s wishes. We saw evidence of quality assurance checks on individual care files showing consultation about the home – communal areas and individual bedrooms; meals; staff and staff attitudes; the manager; activities and events. Issues relating to cross infection and general health and safety that were identified during our first visit had all been rectified by the time of our second visit. During this visit we discussed at length the purpose of the AQAA and how it informs the CSCI about the home. The manager agreed that the current AQAA provided basic information that, without a visit to the home, it would be difficult to make a fair assessment of how the home was run. She therefore proposed that in the forthcoming year she would review it and consider using it as part of the quality assurance systems already used at the home. In compliance with the requirement made at the last inspection, the manager confirmed that she had made an application to the CSCI to become the Registered Manager of Waterloo House. She was awaiting confirmation of a date for the “Fit Person Interview”. The manager confirmed that all the necessary maintenance checks as reported in the AQAA were correct and up to date. Smoke detectors, emergency lighting and fire alarms she confirmed were checked weekly. There was a fire alarm practice during one of our visits. Everyone in the home was involved. All the fire extinguishers had been renewed in May this year. The Accident Book was seen and accidents had been recorded correctly. They were not however in any chronological order and the manager was made aware that this could pose a risk if someone was regularly having accidents but it was not quickly and easily identified. The CSCI had been notified of any serious incidents affecting the health, safety or well being of any of the residents. Care plans inspected had risk assessments included in them that were relevant to the individual person. Hand gel was provided in the entrance hall with a notice for visitors to use this on arriving and leaving the care home. Strict rules were in place about staff entering the kitchen and handling food. On both days of our visit, the home was clean and tidy, free from offensive odours throughout. Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 4 26 4 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 x 4 x LIFESTYLES Standard No Score 11 x 12 3 13 4 14 x 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 4 x 4 4 3 x x 3 x Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation Sch 2 (1) Requirement Information and documents in respect of persons working at the care home must include proof of identity, including a recent photograph. As the care home is owned by a company, a manager must be registered with the CSCI. This would ensure the home is managed for the best outcomes of the people using this service. This requirement is carried forward from the previous inspection. Timescale for action 31/01/09 2 YA37 CSA Ch.14, Part II 11(1) 31/01/09 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 YA42 Good Practice Recommendations The registered person should ensure that all accidents and incidents that adversely affect the well being of people using this service are recorded and stored chronologically with a copy on their individual care file. DS0000066199.V372935.R01.S.doc Version 5.2 Page 27 Waterloo House, Stoke Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Waterloo House, Stoke DS0000066199.V372935.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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