Care Home: Waterloo House

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What the care home does well This home provides a pleasant, homely and clean environment for residents. The home has provided evidence, prior to this inspection, which shows that it continues to meet the needs of the residents. Those residents spoken to expressed their satisfaction about all aspects of the care provided. Comments received were this is my home and its a good home, `we have good relationships with the staff they are very good, there is a good atmosphere in this home`. The carers were observed throughout this visit as being competent, kind and polite when speaking to residents. What has improved since the last inspection? The acting manager stated that since the last inspection, care plans are being reviewed as well as all care staffs training needs. Decoration is an ongoing item so that all rooms are decorated to a high standard. Care staff are always highly motivated to provide appropriate care for all residents. What the care home could do better: The care home should continue to maintain its present standards of providing services. No comments were received from residents during the inspection relating to what the home could improve on. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Waterloo House Walesby Road Market Rasen Lincs LN8 3EX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Douglas Tunmore     Date: 1 6 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Waterloo House Walesby Road Market Rasen Lincs LN8 3EX 01673842343 Telephone number: Fax number: Email address: Provider web address: waterloohouse@btconnect.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Isobel Elizabeth Sugden Type of registration: Number of places registered: Platinum Care (Lincoln) Limited care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The total number of service users in categories DE(E) & MD(E) together will not exceed 5. Date of last inspection Brief description of the care home The home is in a residential area of Market Rasen, within five minutes walking distance of the local shops and amenities. The home provides personal care for up to thirty five residents in the category of mental disorder/dementia (older people) and old age, over sixty five years of age. Bedrooms are located on the ground and first floors; with lounge areas being available on both floors and the dining room is located on the ground floor. The rooms on the first floor are accessed by a shaft lift. At the time of the inspection the home confirmed that the weekly fees ranged from three hundred and Care Homes for Older People Page 4 of 26 Over 65 5 5 30 0 0 0 Brief description of the care home forty eight pounds to five hundred and fifty pounds depending on the residents assessed needs. Additional charges are made for services such as chiropody, hairdressing and toiletries. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report, can be found in the reception area or from the homes office. The home has a statement of purpose and service user guide, which sets out resources and services offered, by the care home. These documents are made available to all new potential residents. The homes Website Address is www.waterloohousecarehome.co.uk Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The fees for the home range from three hundred and fifty two pounds to four hundred and thirty five pounds per week. Additional costs are made for hairdressing, chiropody and news papers. These are all private arrangements and the individual residents meet these costs. Information about these costs as well as the day-to-day operation of the homes including a copy of the last inspection report, is available from the main office of the home. The service users guide and statement of purpose is available in the entrance to the home. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. Care Homes for Older People Page 6 of 26 This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. The main method used to carry out the inspection is called ‘case tracking’, this includes following the care of a sample of people through their records and assessing their care. Have Your Say surveys were received by the commission from five residents five relatives and two carers. The inspector spoke with five residents who he joined for lunch. The inspector also spent time with a visiting Director of the company, the acting manager, two carers and two visiting community nurses. The manager was present throughout the visit and the general outcomes of the visit were discussed with her. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available which enabled residents to make a choice as to whether or not to enter the home. People received an assessment, which resulted in their needs being met. Evidence: The providers AQAA states that, We offer prospective residents a free day at Waterloo House to meet other residents and staff. They are able to come and have a meal and bring their family if they wish. They are given a copy of the Residents Guide To Our Home which includes fee schedule, operational philosophy, A to Z Directory of Services copy of Standard Terms and Conditions of Residence, complaints and suggestions, and results of our residents annual quality assurance questionnaires. Four of the five surveys received from people who live at the home confirmed that they received information about this home prior to admission enabling them to decide Care Homes for Older People Page 10 of 26 Evidence: if it was the right place for them. Relatives supported residents in completing these questionnaires. One resident felt that he did not have a contract and did not have information about the home as he was put in by relatives after a fall. Five surveys from visitors confirmed that the care home meets the needs of their relative. A previous inspection undertaken in September 2007 found that prospective residents are invited to visit the home, look around, and discuss the services offered. Residents stated that they had the opportunity to visit the home prior to coming to live there. The homes statement of purpose sets out the resources available for residents and is found in the reception area of the home. The acting manager described the assessment process. Care needs are identified by completing a detailed assessment. Written confirmation is then given to the residents that the resources of the care home can meet their needs. All new residents are offered a trial period. We looked at care records for three residents being case tracked which contained a detailed assessment carried out prior to the person being admitted to the care home. The records identified the needs of each resident including care and social needs. Risk assessments had been carried out and where a risk had been identified the management of the risk was recorded on care records. Two visitors confirmed that an assessment had been carried out on their relative and that the manager and staff were very friendly when she was admitted. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and welfare needs of people living in the home are fully met. Robust medication systems are in place to ensure that medication is safely administered. Care plans address the intimate care needs of residents and their wishes regarding their privacy and dignity. Evidence: We looked at three resident’s care records who were being case tracked and each had a comprehensive care plan on their individual file. A previous visit in 2007 confirmed that residents are involved in the writing of their individual care plans. These were signed and dated by both resident and the assessor. Care plans included the dietary needs of each resident. Their likes and dislikes in respect of food. Social life opportunities had been discussed with each resident and their choices of activities recorded. There was a comprehensive risk assessment, which identified any potential risk to the resident in each care record. Where a risk had been identified the management of that risk was transferred onto their care plan. Care Homes for Older People Page 12 of 26 Evidence: Residents files also showed that their health care needs are met with visits by community nurses and general practitioners recorded. On the day of this visit two community nurses were visiting and commented staff are always friendly and helpful, they take residents to their bedrooms to maintain their privacy during any examination. We give instructions to staff an and they always Carry it out. The staff are very respectful to residents when addressing their needs. Medication sheets were examined and it was found that an accurate record is kept of all medication given to residents on the day of this visit. None of the people living in the home self medicate. Two residents stated that they get their medication when they need it. A previous inspection found that staff are trained by outside agencies in the administration and storage of medication. Boots inspected the pharmacy systems on the 24/06/08 and no problems were identified. The acting manager states in the Annual Quality Assurance Assessment (AQAA) that resident’s dignity and privacy is always respected. The staff induction and ongoing training stress the importance of ensuring outcomes and demonstrate that the privacy and dignity of residents is respected at all times. We looked in residents files, which showed that residents individual intimate care needs are not being addressed. There is a blanket statement regarding maintaining privacy and dignity without a discussion with residents about how they see their privacy being maintained. The acting manager confirmed that this issue is to be addressed with the changes being made in care plans. Those residents surveys received except for one confirmed that residents felt that they receive the care and support, including the medical support they need. Five visitors surveys showed that the care home met the needs of their relative always and two felt their needs were usually met. Specific comments were that everything in the home is brilliant. Another comment was they treat the residents as a person, not a patient. Residents spoken to at this visit confirmed staff treat them with courtesy and respect. Observations made on the day supported the statement. A resident stated, the staff are very good and I dont self medicate but staff give me medication when I need it. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are available and provide interest for people living in the home. Visitors are made to feel welcome at the home. Meals provided are nutritious and varied. Evidence: The providers AQAA shows that a range of activities are made available for the residents to participate in, if they choose to. Residents are involved in the planning of activities outings and menus. Relatives and friends are made welcome anytime the resident wishes. Reminiscence activities take place on a regular basis carried out by a trained professional. These sessions are well attended and thoroughly enjoyed. Residents are assisted to attend local religious services if they wish to attend. We have a dedicated member of staff who coordinates activities. Specific comments made in residents surveys were; I join in dominoes, quizzes, movement to music and outings if I wish to go. Another comment was the quality of food is good. All other surveys except for one were positive about activities provided and quality of food. However, one resident comment that the food, its usually a small portion when its edible. Visitors surveys showed that they considered that the support Care Homes for Older People Page 14 of 26 Evidence: that residents get enables them to live the life they choose. One comment was they really look after them very well and the food is excellent. The acting manager stated the choices and wishes of the residents regarding their social life are identified at the initial assessment. She described the range of activities, which are made available for residents to participate in. Residents are involved in the planning of activities. Daily games/activities are posted on the notice board and staff provide residents with the details of the activity of the day. Entertainers visit the home weekly. There are weekly keep fit sessions organised for residents. Residents confirmed that they had been to the east coast on trips and had fish and chips. Residents are assisted to attend local religious services. Services are held in the home for those who are not able to go into the community. The Inspector had lunch with five residents and comments from residents regarding the meal were all positive. A resident stated, the food is very good and there is a varied menu, you can also ask for an alternative if you want. The inspector found the food to be well presented of good quality and sufficient in quantity. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures for addressing and monitoring complaints and concerns are in place to protect residents who are vulnerable. Safeguarding vulnerable residents is taken seriously and the acting manager would seek advice if she had concerns. Evidence: The providers AQAA confirms that complaints and suggestions policy clearly displayed and widely distributed. Manager and Care Manager see residents daily. Staff are trained using the Lincolnshire County Council protection of vulnerable adults policy and procedure and we have obtained the latest edition of this document. Advocacy services have been used in the past. Advocacy services are advertised on the notice board. All surveys showed that they the relatives and residents know how to make a complaint and no concerns were raised. Residents also knew who to speak to if they were unhappy. The providers complaints procedure which is given to all residents and displayed in the reception area. No complaints had been received since the last inspection. One resident told the inspector that, nobody shouts at us here and they had no complaints. Other comments were your treated as an individual here. The staff keep me in touch with the Royal Institute of The Blind which is very useful. They also Care Homes for Older People Page 16 of 26 Evidence: confirmed that they were confident in being able to raise any concerns with any member of staff or the acting manager who is good and mixes with us. Staff confirmed that they were aware of the homes whistle blowing policy and stated that they use it if they have any concerns about care practice. The acting manager stated that she is currently arranging training for all staff in the prevention and recognition of abuse. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a comfortable and clean environment that meets their individual needs. Evidence: The providers AQAA states that, The environment is checked daily to ensure that the residents independence can be maintained. If required aids will be obtained for individual residents. The home is well maintained, clean, bright and free from odour. Furnishings and fittings are of a good standard. A handyman is employed to carry out minor repairs, decoration and gardening.Domestic staff are employed to keep the home clean, pleasant and hygienic. A previous visit in 2007 found that the provider has an ongoing maintenance program, which includes an improvement plan. That inspection found that extensive work had been carried out on the hot water system to ensure safe temperatures are maintained. Carpets have been replaced in ground floor corridors. Bedrooms were decorated prior to any new resident moving into the room. Special equipment had been purchased for a terminal ill resident. We undertook a tour of the building and met the handyman who was decorating a bedroom. He confirmed that he carries out maintenance work throughout the home as Care Homes for Older People Page 18 of 26 Evidence: well as decorating all rooms that become vacant before other residents move in. No health and safety issues were identified during the site visit. Staff stated that they were happy with the environment of the care home. Residents stated their satisfaction with the environment of the care home in their surveys. There were no negative comments made by staff or residents regarding the environment. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was adequately staffed with employees who were experienced, competent and trained to care for older people. Robust procedures for the protection of people are followed. Evidence: The providers AQAA showed that, recruitment procedures are robust and selection, induction and training of staff is of prime importance. The home has developed a comprehensive in-house induction, which conforms to Skills for Care guidelines. Staff are actively encouraged to undertake NVQ training. Staffing levels have been maintained throughout the year without the use of agency staff. The acting manager stated that the recruitment policy of the home is being followed. We looked at a sample of two new staffs files which evidenced that robust recruitment procedures were in place, with Criminal Record Bureau checks and written references taken. Two staff commented that they had undertaken induction training when they started working at the home. Two staff surveys evidenced that they are given information about the needs of people in their care plans. They also confirmed that checks were carried out prior to their employment. Both carers stated that they had an induction to the home when they Care Homes for Older People Page 20 of 26 Evidence: started work. One confirmed that she receives training relevant to her work. One carer also said that she has support from all staff and management of the home. The other carer made a specific statement that, there is a good level of cleanliness throughout the home. Resident’ surveys show that they feel that staff listen and act on what they say and staff are available when they need them. One surveys comments were, on rare occasions I might have to wait a minute or two (for staff). Residents stated there is always sufficient staff on duty to meet their needs. Staff confirmed that the staffing rota is maintained and expressed the view that there should be a bank staff system to call on if staff are off sick. Staff said that they feel they are able to meet residents needs with the numbers of staff on duty. We looked at the staff rota and training information available on staff files which confirmed that appropriate staffing levels are being maintained and ensures a mix of skills are available to meet the needs of residents. The acting manager confirmed that the staff training profile needs to be reviewed to ensure that staff have the right training to meet the needs of residents. Two carers stated that the have National Vocational Qualifications (NVQ) for working with people who are elderly. They had undertaken training including; fire training, first aid, care of the dying, manual handling care for people with dementia, valuing people and challenging behaviour. The second carer confirmed that she would be undertaking her NVQ level 3 in the near future. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed, and there are good systems in place, which protect the health, safety and welfare of residents. Peoples valuables are protected due to the homes procedures and policies. Evidence: The acting manager is proceeding with her application to become the fit person. The commission is now awaiting her criminal record bureau check and her formal application. The director of the company confirmed that this matter is in hand and hopefully the fit person interview will take place as soon as the commissions process is completed. she has a NVQ level 2, 3 in caring for older people and has applied to undertake NVQ level 4 in care. She also has experience in other settings including the health service where she worked as a care health supporter in the emergency and accident department. Due to not undertaken the fit person interview at the time of this visit this standard will be a level 2 but no requirement will be made. Care Homes for Older People Page 22 of 26 Evidence: Observations made by the inspector during this inspection were that the manager spent a lot of time with residents and had an approachable manner. The inspection of care records, discussion with staff provided evidence of good positive leadership and direction to all staff members. Residents stated that, she is a good manager and mixes with us. Two staff members commented that, we like her, she has done wonders, residents like her and she listens to what you say. We asked for some equipment and she gets it for us. Irregular residents meetings are held, but this has been due to the change over of managers. The current manager commented that there will be more regular residents meetings in the future. This visit found that the quality assurance documents and discussions with residents who were being case tracked provided evidence that in their opinion residents feel the home is being run in their best interest. The manager confirmed that there has been no change in how records of any monies held on behalf of residents is maintained, which is kept in a safe place. Two residents monies were checked and an accurate record is kept with receipts available for monies spent. We looked at residents files and a record had been made about clothing items and valuables that the residents have brought with them on admission. The providers AQAA identified that there are a range of policies and procedures available in the home relating to the health and safety of residents. This document also showed dates when equipment was serviced and fire alarms checked to ensure the safety of resisents. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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