Care Home: Waterside Care Centre

What the care home does well Prior to coming to stay at the home people are encouraged to make informed decisions about whether they would like to live there. Preadmission assessments are undertaken so that the home and prospective resident know that their individual needs can be met. Care plans are being reviewed to ensure that staff have current information about peoples needs. This means that people will be supported in a consistent way. People have access to a range of Health and Social care professionals and this ensures that health care needs are met. People are supported to maintain their pastoral and religious needs. Meals look good and healthy and relatives are encouraged to have meals with their loved ones. During our observation we saw that staff interacted more with the people who live at the home. This means that people should have a more interesting lifestyle. People can be confident that any complaints will be listened to and acted upon. The accommodation is spacious so people have a choice of areas where they can spend their time or see their visitors. The garden area is an attractive green space where garden furniture has been provided and there is a water course which provides habitats for wildlife so that people can enjoy the wild life and benefit from the fresh air to enhance their sense of well being. What has improved since the last inspection? The home has responded to our concerns and has acted upon the requirements made at previous inspections to ensure the way the home is run is improved. All preadmission assessments, care plans and risk assessments are now being read by staff and this process needs to continue. This will ensure that people`s needs are met by staff who have the knowledge and understanding to keep people safe whilst still meeting their needs. Relatives and representatives are now being consulted about the care provided and have opportunities to raise areas that require some improvement so that the best interests of people living in the home are being met. Staff practices in relation to upholding people`s privacy, respect and dignity has improved and we observed this through staff interaction with people who live in the home, appropriateness of how people were supervised and assisted to dress. Although we did not inspect the administration and management of medications when we visited the home we are aware that these practices have improved as a pharmacist inspector has recently completed medications review.Meal times have improved and with further improvements people who live at Waterside should have pleasant social experiences. Social stimulation and the provision of activities has improved but further improvements are necessary so that all people whatever their interests and abilities are provided with appropriate stimulation and activities that meet their mental health needs. The homes environment is improving as there are more pictures on the walls, rummage boxes with tactile items in them, coat and hat stand and a sensory area that is being set-up. Staffing levels have now increased to ensure that there are sufficient staff on duty to meet the needs of each person who lives at the home and keep people safe. Training for staff is now being proactively planned and arranged including dementia care training so that staff have the confidence, knowledge and skills to meet the needs of all the people who live at the home. Now training needs to be continued and sustained. What the care home could do better: All information that tells people about what it would be like to live there should be made available in alternative formats to include larger print, audio visual, audiotape and pictures to illustrate the written word. Some work has been undertaken in a number of areas such as care plans, activities, meals and staff interaction, however these could all be further developed. Care plans must be available to provide staff with instructions to follow so that all identified needs and risks to each person is known by all staff thereby meeting peoples full range of needs and keeping them safe. End of life care plans should be in place so that at this important time in peoples lives staff have instructions on how to meet peoples practical care needs, emotional and psychological needs together with following individuals last wishes. The home had reviewed the menu and choices of food offered to people, however this needs further work to ensure that everyone at the home receive food that they like. Involvement of relatives and having pictures to aid individual`s choices should be utilised. Activities offered could be further developed to ensure that all people have an interesting and stimulating lifestyle. This should include in-house and community based activities. All employment gaps in application forms must have written explanations together with dates so that people are protected by a robust recruitment process. The home needs to sustain the improvements made while also continuing to improve the quality of the service in the best interests of the people who live there. Key inspection report Care homes for older people Name: Address: Waterside Care Centre Waterside Care Centre Leigh Sinton Malvern Worcestershire WR13 5EQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sally Seel     Date: 1 1 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 39 Information about the care home Name of care home: Address: Waterside Care Centre Waterside Care Centre Leigh Sinton Malvern Worcestershire WR13 5EQ 01886833706 01886832882 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Minster Care Management Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 46 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 46 Date of last inspection Brief description of the care home This is a purpose built two storey home situated in the village of Leigh Sinton, near Malvern. It provides nursing care on a permanent and respite basis for up to 46 older adults who have dementia and may also have some physical disabilities. All bedrooms are single occupancy and have ensuite facilities. There is a choice of well furnished seating areas. Bathing facilities are available on each floor offering a choice of a bath or shower. Aids and adaptations are available so that people requiring assistance can Care Homes for Older People Page 4 of 39 Over 65 0 46 2 6 1 1 2 0 0 9 Brief description of the care home receive it safely. There is a passenger lift so that people can access all parts of the home and there is a secure garden to the rear of the premises that is accessible to people with limited mobility. At the front of the building is a car park providing off road parking for staff and visitors. The home has a no smoking policy. There is a bus route to Leigh Sinton and the home is within walking distance of the local shops. In the reception area there is a range of information for people living in the home and their visitors to access about the home . A copy of the inspection report should now be added to that information.The home has a range of fees and the manager should be contacted for up to date information about what these are. Care Homes for Older People Page 5 of 39 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: one star adequate 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 focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. It is recommended that this report is read in conjunction with the previous report dated the 10th September 2009. The visit to the home was undertaken by two inspectors over one day on the 11th February 2010. We, the commission were assisted throughout the day by the acting manager and project manager. The home did not know that we were visiting that day when there were 25 people living there. An expert by experience was present for part of this inspection. Mr. Suresh Sharma an expert by experience is a person who, because of their experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Experts by experience observe what happens in the Care Homes for Older People Page 6 of 39 home and talk to people who live their to get their views of the home. The expert talked with people who live at the home and staff, looked around the home and observed some staff practices. The expert provided a report of her findings, parts of which have been included in this report. It is difficult to get peoples views about the home due to differing levels of dementia however we spoke with staff that were on duty at the time and undertook some observations of practices within the home. Four people were case tracked. Case tracking involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were reviewed. Prior to our visit we sent out random surveys to people who live in the home, relatives and staff. Three surveys from people who live in the home, nine relatives and six staff returned the surveys. Comments were positive about the home and also stated where improvements could be considered and are included in this report. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about the staff and people who live at the home. Before our visit we reviewed any notifications received about the home, these are reports about things that have happened in the home that they must tell us about. We would like this opportunity of thanking people, who live in this home, the acting manager and project manager and all staff for assisting us with this inspection and making us feel welcome. Care Homes for Older People Page 7 of 39 What the care home does well: What has improved since the last inspection? The home has responded to our concerns and has acted upon the requirements made at previous inspections to ensure the way the home is run is improved. All preadmission assessments, care plans and risk assessments are now being read by staff and this process needs to continue. This will ensure that peoples needs are met by staff who have the knowledge and understanding to keep people safe whilst still meeting their needs. Relatives and representatives are now being consulted about the care provided and have opportunities to raise areas that require some improvement so that the best interests of people living in the home are being met. Staff practices in relation to upholding peoples privacy, respect and dignity has improved and we observed this through staff interaction with people who live in the home, appropriateness of how people were supervised and assisted to dress. Although we did not inspect the administration and management of medications when we visited the home we are aware that these practices have improved as a pharmacist inspector has recently completed medications review. Care Homes for Older People Page 8 of 39 Meal times have improved and with further improvements people who live at Waterside should have pleasant social experiences. Social stimulation and the provision of activities has improved but further improvements are necessary so that all people whatever their interests and abilities are provided with appropriate stimulation and activities that meet their mental health needs. The homes environment is improving as there are more pictures on the walls, rummage boxes with tactile items in them, coat and hat stand and a sensory area that is being set-up. Staffing levels have now increased to ensure that there are sufficient staff on duty to meet the needs of each person who lives at the home and keep people safe. Training for staff is now being proactively planned and arranged including dementia care training so that staff have the confidence, knowledge and skills to meet the needs of all the people who live at the home. Now training needs to be continued and sustained. What they could do better: All information that tells people about what it would be like to live there should be made available in alternative formats to include larger print, audio visual, audiotape and pictures to illustrate the written word. Some work has been undertaken in a number of areas such as care plans, activities, meals and staff interaction, however these could all be further developed. Care plans must be available to provide staff with instructions to follow so that all identified needs and risks to each person is known by all staff thereby meeting peoples full range of needs and keeping them safe. End of life care plans should be in place so that at this important time in peoples lives staff have instructions on how to meet peoples practical care needs, emotional and psychological needs together with following individuals last wishes. The home had reviewed the menu and choices of food offered to people, however this needs further work to ensure that everyone at the home receive food that they like. Involvement of relatives and having pictures to aid individuals choices should be utilised. Activities offered could be further developed to ensure that all people have an interesting and stimulating lifestyle. This should include in-house and community based activities. All employment gaps in application forms must have written explanations together with dates so that people are protected by a robust recruitment process. The home needs to sustain the improvements made while also continuing to improve the quality of the service in the best interests of the people who live there. Care Homes for Older People Page 9 of 39 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 39 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 11 of 39 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. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre-admission assessments ensure that people know their needs can be met prior to moving in. Evidence: A statement of purpose and service user guide is given to people who may be considering whether Waterside Care Centre meets their needs and lifestyle choices. These can be found in the reception area of the home which ensures that the information is available to people if they choose to read it. There have been improvements made to the contents of both the statement of purpose and service user guide since we last inspected the home. There is now a wealth of up to date information provided which ranges from, what the home is like inside, how peoples needs could be met and what facilities are offered. There are also staffing and management details together with the fees charged to live at the home. Care Homes for Older People Page 12 of 39 Evidence: This makes sure people have enough information to be able to make informed decisions about whether the home is the right one for them. The Annual Quality Assurance Assessment (AQAA) completed by the acting manager told us that improvements for the next twelve months are:To further enhance our ability to provide information to people with a range of diverse needs and abilities, over the next 12 months our intention is to;1. Rewrite the Guide and Statement of Purpose to make it more user-friendly (possibly with the use of pictograms and/or emoticons), 2. Produce the Guide and Statement of Purpose in an audio (CD) format and 3. Produce the Guide and Statement of Purpose in a visual (DVD) format. This shows that the acting manager is always looking at ways to improve the information in both the statement of purpose and service user guide. This should make sure they are of value to all people regardless of their abilities which is sometimes a difficult goal to achieve. The statement of purpose tells us that, Service users interested in accommodation at Waterside Care Home are encouraged to visit the home and sample the atmosphere and level of service. This gives the service user time to get to know the staff, adjust to new people and surroundings and sample the food before committing themselves. This is positive as it gives individuals real opportunities of seeing what life would be like if they choose to live at the home and speak to other people who live there. This practice also gives people another way of experiencing what the home has to offer, especially if reading information is particularly difficult for them. The statement of purpose, documents:The home is registered with CQC (Care Quality Commission) to provide nursing care for 46 Service Users over the age of 65 years with a diagnosis of dementia. This information is also readily accessible in the home and can be seen in the homes registration certificates which are displayed near to where people sign in and out. At the time of our visit there were twenty-five people living in the home. The information provided tells us that all people have a full assessment of their needs before they move into the home. This makes certain that these are all able to be met Care Homes for Older People Page 13 of 39 Evidence: by appropriate staff qualifications, experiences, skills and knowledge. We were told that staffing levels have improved and staff told us that there are usually sufficient staff on duty to meet individuals needs at all times. These details are all confirmed in the statement of purpose and service user guide. We saw from looking at the assessments of two people who had recently come to live in the home that each person had their needs assessed before they moved into the home. On the day we visited we spoke to a mixture of staff who provide care and assistance to people at Waterside Care Centre. We spoke to the, acting manager, project manager, nurses, staff that support people with their daily tasks and interests. Full discussions with people living at the home were not always appropriate. Therefore our observations and discussions with staff will be referred to throughout this report. Care Homes for Older People Page 14 of 39 Evidence: Care Homes for Older People Page 15 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have improved but need to be further developed to make sure that all identified needs are met with all risks fully assessed. This will help to ensure that people get the care they need in ways that suit them best, and be supported to stay safe from harm. People are treated with dignity and their right to privacy is respected. Evidence: The care and support provided to four people who live in the home was focused upon to ensure that individuals are supported and encouraged with meeting their individual goals in relation to their specific needs. Each individual had their own care plan. Areas covered in these plans were, washing, dressing, physical abilities, mental health, diabetes, continence, eating and drinking and sleeping. One area in relation to care planning which has improved since we last inspected the home is that we are told that care staff are now having more time to read peoples care plans. Some staff that we spoke with showed that they had knowledge of peoples particular behaviours that required managing and demonstrated this to us. We saw staff confirming with an agency staff member what individuals liked and Care Homes for Older People Page 16 of 39 Evidence: disliked at meal times. However, we were told that at times new care staff and or agency staff are not always reading care plans in a timely manner. We are confident that the acting manager will use methods to ensure all staff have some time to read care plans so that they have some understanding and knowledge when assisting people with meeting their holistic needs. In the care records of the two new peole who had recently come to live at the home we saw social profiles which gave staff details about peoples past lives, likes, dislikes and interests. As discussed further in the Daily Life standard of this report further improvements should be made in extending peoples social histories whilst people are living in the home. This will assist staff to have meaningful conversations with people about the things important to them. In the main assessments and care plans that we looked at showed how each persons goals are to be acheived together with what staff actions are required in order to assist the person in their daily lives. For example we saw, I want to have a good quality of life and due to my poor memory I need your help with the following, mentions directions to bathroom, unaware of whereabout on unit so needs some support, unsafe to go out alone and Maintain my continence, please prompt me to use the toilet on a regular basis. Unsettled at night, milky drink, help me to feel sleepy, encourage to wash and change into my night clothes. Further improvements need to be continued in relation to, what time people like to get up in the morning together with the time individuals like to go to bed, whether people prefer a female or male staff member to assist them and individuals religious choices. This practice will make sure that people are receiving care and assistance that reflects their own likes and dislikes. We were informed that people who live in the home have named nurses and key workers who are building close relationships with individuals. They are gaining knowledge of peoples preferences and dislikes so that consistency of care is maintained. Also people are able to share any issues and or concerns they may have in the presence of a staff member they feel comfortable with. The AQAA states, We have introduced primary nurse and key-working responsibilities. This has given relatives a primary contact when discussing and enquiring about their next of kins healthcare status. It has also promoted ownership and accountability for nursing and care staff in relation to care delivery. This should ensure the focus of care is driven by each person who lives in the home, rather than the needs of the service and the limits to what it can provide. As discussed on the day we inspected the home some care now needs to be taken in making certain that all the identified needs of each person can be found within a care plan as we found some of the needs of people were not written down into a plan. For Care Homes for Older People Page 17 of 39 Evidence: example, we could not find one persons plan for managing their pain or weight loss. It is important that each persons identitifed needs both short term and long term are developed into plans that provide staff with sufficient instructions to meet individual needs. Without care plans in place we cannot be confident that all of a persons identified needs are bieng met with all risks noted and minimised. However, staff and the manager within their comments recognise that care plans need to be further improved as confirmed in the AQAA, Continued improvement and development of care records and staff training. We will look at care plans and risk assessments when we next inspect the home. In another persons we found that some plans still needed to be written. This person had come to live at the home on the 11th February 2010. The care plans of another person who has recently come to live at the home on the 4th February 2010 were also looked at. The acting manager must ensure and prioritise significant care plans which identify staff assistance is needed and or where there are identified risks should be in place in a timely manner. This will ensure all staff have this information to support all care in a consistent way and have knowledge of each persons specific risks. The acting manager had already recognised what other information was required and this would be put in place. We observed people to be dressed appropriately for the time of year and reflected their gender. Comments received from one relative survey told us:Residents are kept clean. Clothing washed and ironed and put away with care. A staff member told us that staff are now consistently recording when they have assisted people with their personal care needs. We looked at the records and found this to mainly be the case which is an improvement that has been made since we last inspected the home. Some care now needs to be taken when a persons needs have changed in respect of how their personal care is given and any changes should be reflected in all care plans. For example, one person was taking a bath, shower or strip wash on a daily basis but their needs have changed and staff said that they are now having bed baths. This change was not highlighted for all staff to follow to ensure all staff are delivering consistent and appropriate care as outlined in individuals care plans. Risk assessments were in place for moving and handling and gave staff instructions about how to move people safely. Risk assessments were also completed for falls. People had individual risk assessments for identified needs such as people who may wander and try to leave the home unescorted placing themselves in danger. The care Care Homes for Older People Page 18 of 39 Evidence: records we looked at told us that people were weighed monthly or more frequently if they were at risk from weight loss. This will mean that staff can monitor any changes and refer to other external professionals if further guidance is required. The care records that we looked at informed us that people had access to a range of health professionals including the general practitioner, tissue viability nurse, community mental health nurses, social workers, and consultants. This means that people receive specialist advice. Observations and examination of records confirm that peoples privacy and dignity appeared to be met by staff who were on duty when we visited the home. This is an improvement that has been made since our last inspection visit. For example staff were seen escorting individuals to their bedrooms and bathrooms in order that personal care could be given in order not to compromise their dignity. In the main staff interaction with people living in the home was observed to be done in a respectful and less hurried manner. We saw that staffing levels have improved which is helping staff devote more time with people who may have some behaviour that requires additional support from staff to manage this appropriately. The AQAA tells us, We are in the process of offering Dignity in Care training to the staff and a member of our staff is to take up the roll of Dignity champion. We have been informed that the unit manager has now taken up the role of Dignity Champion. Also the staff training matrix shows us that staff are receiving training in dementia awareness. The AQAA confirms, We have a member of staff who has just completed the Leadership Matters in Person-centred Dementia Care course and she is now in the process of implementing Worcestershire County Councils Draft Dementia Standards. Therefore all of these processes should help staff practices in assisting and supporting people to maintain their dignity and respect whilst observing each persons level of dementia. As was reported at the last inspection information is not always available regarding peoples and their relatives wishes in relation to death and dying which include preferred funeral arrangements. In one persons care records we could not find a care plan which would inform staff about a persons end of life wishes, pain management and psycological needs. This should be completed as it is important that people and or their representatives are able to have their say in how care, emotionald and psychological needs are met at this time. However, the acting manager within their AQAA has told us, Possible access to and implementation of the Gold Standards Framework for End of Life Care. The surveys received from relatives told us:- Care Homes for Older People Page 19 of 39 Evidence: I am informed immediately if there is any change in my husbands health or wellbeing. They care for my mother and we are happy with the service they provide. Hairdressing service - This would certainly have a positive affect and help towards some dignity. Nails are not always kept clean. Occasional dirty marks on clothes. The administration and management of peoples medications were not reviewed at this inspection as the pharmacist inspector had recently visited the home for this purpose. The pharmacist inspectors overall comments were positive and medication systems in the home had improved. Care Homes for Older People Page 20 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for activities and meal times have improved. There is room for further improvements as all activities may not meet the needs of some people so they may not experience a meaningful lifestyle. Evidence: There are two dedicated activity co-ordinators employed by the home who both work on a part time basis, a total of forty hours. We spoke with one of the activity coordinators who told us about the range of activities that are provided to people. These included painting, arts and craft work, making cards, hand and nail massages, music to movement, board games, puzzles, play cards and memory cards. A singer visits the home once a month. On the day we visited we observed some people making some cakes with the activities co-ordinator. Others were playing a quiz with care staff. One improvement that is being considered is the use of a vehicle so that all people can enjoy days out. We were told that two church ministers visit the home on alternative weeks to give services and we saw that a timetable of when these visits happen was displayed for people to choose whether they wished to take part. This enables people to continue to Care Homes for Older People Page 21 of 39 Evidence: follow their chosen religion. The Expert provided their observations:There was a timetable of activities on the notice board and it listed two activities a day. Examples of a days activity are: Painting/Film, Darts/Dominoes Snooker/Listen to music. Many of these listed activities such as listen to music and read newspapers should have been day to day activities anyway, so it felt that most of the timetable had just been made up to look as though a lot of activities were taking place. There were activity boxes in the corridors and assorted materials on a table in the poolroom. I saw them being utilised and their introduction, as suggested in the last inspection report, has clearly benefited the residents. However, I also saw one man sitting on his own in one place all the time I was there. We were informed that this person enjoys sitting in their chair within the corridor area and watching the happenings within the home as part of their daily life. Another resident was opening and shutting the window at the end of the corridor. The poolroom is bright and pleasant and there was music playing. In my three stops there I saw the same resident on his own trying to find things to do in the room. When I was there the third time talking to a member of staff this man fell over and could have injured himself badly by hitting his head on the edge of the table. The member of staff, instead of seating him and checking to see if he was well, got him up quickly on his feet and took him away. I reported this incident to the inspector. I felt that the residents were bored and needed more stimulation. There werent even any newspapers or magazines lying around. I found it odd that whenever I was talking to a resident and an awkward situation (falling, crying or being upset) occurred, the resident was quickly, almost abruptly, taken away by the same member of staff. Despite this, I would say that since the last inspection report, the staff has been earnest in trying to make improvements. A sensory room has been designed for people to use in which they are able to experience relaxation and stimulation where aids such as lights and tactile items are in place. We were told that there are plans to improve this sensory experience for people who live in the home, which we shall inspect when we next visit the home. It is suggested that further progress should be made in documenting peoples social histories. It is acknowledged in the AQAA that staff needs to proactively ask relatives and representatives of people who live in the home to be part of this process. To gain Care Homes for Older People Page 22 of 39 Evidence: information background about peoples past lives is important to people as this create talking points, help to celebrate the diversity of individuals and are able to be used to make certain individuals interests are followed to bring meaning to their lives. This will enhance the activity opportunities that are offered to individuals making these more person centred. We will look at activities that are offered to people when we next undertake an inspection. As at the last inspection there is a flexible visiting policy enabling people to maintain contact with friends and relatives at a time that suits them. This helps people to maintain relationships that are important to them. One relative told us that they are encouraged to have meals when they visit the home. Daily records and care files sampled showed that contact with family and friends are supported. Relatives are invited to review meetings where appropriate and we saw care records where minutes confirmed this practice. There are parent and carer liaison meetings that take place every six months, a monthly newsletter, annual quality surveys, gatherings for special events where relatives and friends are invited. There are no restrictive visiting policies apart from bearing in mind late nights and very early mornings. We were told that the registered manager does have an open door policy where family members can call in and or contact by telephone if they wish. This practice ensures good communication links are maintained with relatives and friends. We observed the meal times and found that they have improved for people who live in the home. For example, they are less chaotic and hurried. We saw that staff assisted people who needed help and encouraged them to eat their meals in a dignified manner. We saw a four weekly rolling menu and these showed a variety of meals offered. We observed the meals at breakfast and lunchtime. We saw that meals are not always being kept warm when serving to people, such as, the porridge in the morning and rice pudding. This was highlighted to the acting and project manager who will look into this. At lunchtime only one choice of hot meal was served to people and we wondered how choices were made in relation to lunchtime meals. Staff told us that they had knowledge of individuals likes and dislikes. This may be so but some agency staff are covering some shifts at the home and can become reliant on permanent staff to tell them what people like and dislike. Therefore some areas that require further improvements are, ensuring each person is assisted to choose their meals and planning of these where appropriate using the written word and pictures as aids to this process. Relatives can also help in identifying meals for their loved one. The Expert said, I was shown menus for four weeks. They were clear with a variety of food available, including vegetarian options. The environmental health officer visited the home and awarded five stars which is the highest grade given to reflect the high Care Homes for Older People Page 23 of 39 Evidence: standard of kitchen and food hygiene practices within the home. Responses from relatives told us:Activities take place in the mornings 4 days a week I believe, but there is room for more stimulation. Activities although improved still need to improve more to stimulate residents. Activity ladies are brilliant. Patient, kind and understanding. Always very helpful, will always go the extra mile when I need information. Care Homes for Older People Page 24 of 39 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. There are systems in place to listen to and respond to complaints about the service. Arrangements are in place so that people should be safe from harm. Evidence: The complaints procedure is displayed in the home and is included in the service user guide so that people know how to make a complaint if they need to. Surveys returned to us by people living at the home told us that people knew who they could speak to if they were unhappy. The AQAA tells us, We respond openly to complaints and concerns, and encourage people to let us know if we get something wrong or if we do something that isnt liked. We have adopted an open approach to the resolution of complaints that aims to use incidents of dissatisfaction as opportunities to learn and improve standards. One relative told us, We have been told to come forward with any concerns immediately and not let them fester this has been a positive and constructive approach and it works. We have not received any complaints and the home has not received any complaints since our last inspection. The home had an adult protection policy in place and had the local multi agency guidelines to follow. There have not been any adult protection concerns raised at the home since we last our last inspection. The majority of staff has received training in safeguarding vulnerable adults and this should ensure that they know what to do in Care Homes for Older People Page 25 of 39 Evidence: the event of an allegation. One staff member demonstrated a good understanding of how to protect people from harm. Staff still need training in the Mental Capacity Act (MCA) and Deprivation of liberty Safeguards (DOLS). Although we acknowledge that the AQAA tells us that, nursing staff have been trained in the application and use of DOLS. This should be highlighted upon the staff training matrix for planning and reviewing of this training. It is important that staff have training in the MCA so that they are aware of their responsibility in supporting people who lack mental capacity to make decisions. DOLS examines how risk assessments and decisions to restrict someones liberty such as movement, leaving the home or making decisions for themselves should be done to ensure that their liberty is not denied. Staff training in both MCA and DOLS is particularly relevant as a significant number of people living in the home have some form of cognitive impairment. We were told that the home does not manage peoples personal finances but does hold some money on behalf of some of the people using the service. This money is kept safely and records kept of the balance of money held and expenditure. Care Homes for Older People Page 26 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the homes environment. The acting manager is striving to make further improvements to the homes environment so that it is relevant in meeting the mental health needs of people who live there. Evidence: The service has two floors, the physical layout on each is almost identical with choices of combined lounges and dining areas, toilets and bathrooms. It has spacious corridors which provide people with sufficient space to walk about. Some people we saw were able to move around the home freely. Walking aids, such as frames or walking sticks were available to help people to walk around the home safely. The Expert gave us their report:Although the home is situated off a busy main road, it has lovely surroundings with green space, neat gardens and a large pond. My first impression on entry was that it was clean, spacious and well decorated. In the main reception they had the last random inspection report on display, as well as a notice on how to complain. Care Homes for Older People Page 27 of 39 Evidence: The rooms and corridors were bright and airy. The pictures on the walls were dull and not stimulating, which added to the hotel like environment. However, there have been improvements made since the last inspection in ensuring that some pictures are relevant and interesting to people who live in the home. In the lounge I noticed a vague smell of urine. X (persons name), a resident came and grabbed my arm. I asked her if she could show me her room and she said that she didnt know where it was. She was distressed and started crying and said, I feel so lonely here. At this point a member of staff took her away. While this was going on, a resident without any pyjama bottoms appeared and he too was whisked away. I walked around the corridors wondering how easy it was for the residents to find their rooms. It wasnt. I asked two residents who were hanging around to show me their rooms and they couldnt because they were confused. The bedroom doors had nameplates with titles of themes such as appreciation, cheerfulness and eternity. Apparently an architect who said that they would be a helpful aid for people with dementia designed them, but I couldnt imagine them of being any use. The doors were, however, painted in different colours and this was probably more helpful. Some of the doors of peoples rooms are decorated with pictures as aids to individuals recognising their rooms. It is acknowledged that the homes environment has improved since we last inspected. For example, there are more pictures on the walls, information is displayed, rummage boxes, coat and hat stand. The AQAA tells us about planned improvements for next twelve months:To have all of the downstairs floor replaced. We have begun purchasing memory boxes and intend to use them on doors to promote personalisation and to aid recognition of a persons personal space. To increase the amount of signage within the home. To purchase a greenhouse for our allotment area, this will be used by our activity coordinators and our service users as part of recreation. Consideration should also be given to other aids that may help people who may have tendencies to become disorientated, such as, large picture calendars, menus and so on. Care Homes for Older People Page 28 of 39 Evidence: Bathrooms were seen to be functional spaces for people to use but these could be made less clinical by using warmer colours, pictures that are relevant for people living in the home and blinds on the windows. All bedrooms have ensuite facilities and were seen to be personalised as people had chosen and had items that were familiar to them to make their room as comfortable as possible. The majority of staff have received infection control training and we saw staff using gloves, liquid soap and paper towels when required to promoted good hygeine practices. Care Homes for Older People Page 29 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements and planning has improved for staff supervision, training and development. With continual improvements staff should have the support, knowledge and skills they need in order to do their jobs well, for the benefit of the people in their care. Evidence: Since the last inspection staffing levels have increased to two registered nurses and six care staff covering the morning, afternoon and evening shifts. During the night there are three to four care staff and one nurse. These staffing levels appeared to meet the needs of the people living at the home on the day of our visit. Although they may need to be reviewed again when the home is full. In addition to care staff the home has domestic, catering and maintenance staff to help meet all the needs of the people living at the home. On the day we visited we saw an agency member of staff working at the home and the staffing rotas confirm that agency staff are used. We were told that if possible the same agency staff cover shifts at the home so that people know who will be assisting them to meet their needs. The AQAA tells us that, Approximately 25 of care staff have, or are working to NVQ Level 2 or 3 in Care, and all other care staff are enrolling with Aspirations training to undertake NVQ Level 2 or 3 in care. Our objective is to have all care staff qualified to NVQ Level 2 or 3. This shows that the acting manager is working toward meeting the recommended 50 of staff with this qualification to ensure that a knowledgeable and skilled Care Homes for Older People Page 30 of 39 Evidence: workforce can meet peoples needs individually and collectively. The Expert reported:I spoke to one member of staff in depth, and briefly to the project manager, an activities co-ordinator and a cleaner. In the lounge, I saw two members of staff interacting with residents. One was doing a quiz on a laptop with two residents. The staff were polite and respectful. The activities lady was taking residents downstairs to make cakes and the residents were clearly delighted to be participating. The member of staff I talked to was doing a lot of running around. He was well trained - NVQ 3, and undergone a range of other training such as dementia awareness, POVA and adult safety. He was happy working there and said that the good things about the home were: good food, intelligent staff who were quick at understanding to needs of new residents, and a good working environment. When asked what changes he would make, he said that he would have more outdoor activities for the residents e.g. shopping and going to the pub. The cleaner too was happy to be working there and said that the residents were well looked after. The AQAA informs us that, All new appointments receive two days supernumerary time. If staff need more supernumerary time, this is accommodated. This should help staff in gaining knowledge about their role. The home has a training matrix, which is updated with the training that staff have undertaken to increase their knowledge and skills. Training includes various topics such as fire, first aid, moving and handling, abuse, infection control, nutrition and dementia. We were also shown confirmation that additional training courses have taken place, such as, continence training and prevention of falls. One of the unit managers has completed training in Feelings Matter Most, Parkinsons Disease study day and Mental Capacity Act 2005, client support awareness workshop. This training is relevant to the needs of the people who live in the home and the acting manager now has a proactive approach which has meant that staff training has improved in ensuring that all staff receive the training they require to meet the holistic needs of people living at Waterside. All training and staffing levels need to be sustained now over a period of time. Responses in staff surveys told us:Staff are also working well as a team at this time. Employing more regular staff; hopefully now Waterside is more positive, staff will be Care Homes for Older People Page 31 of 39 Evidence: interviewed. If we have agency people in make sure they know what they are doing. The home is a caring place, who look after the service users very well. The home does well with all residents needs. All the staff and management work as a great team and full support for all staff and residents the same. Three staff files were reviewed and were found to contain all of the relevant information including two written references, POVA first checks (Protection Of Vulnerable Adults) and CRB checks (Criminal Records Bureau). An area that now needs to improve is to make sure that when staff are completing their application forms, the month and year of their previous employments, should be given together with documenting any gaps in employment. This will mean that people within the home are further protected by robust staff recruitment procedures. Staff had been provided with job descriptions and staff told us that they had received an induction into the home so that they are aware of their responsibilities. Care should now be taken to ensure the forms held on staff files are also completed in relation to staff inductions. Without exception all of the staff that we spoke with told us that improvements have been made in the quality of care provided to people, meals, activities, staff training, staff are happier in their work and the acting manager is approachable. Responses from relatives surveys told us:Show good understanding and support in difficult situations. They are kind considerate and respectful. The home environment and care staff have benefited from all the training they have received, but it needs to continue. The training courses and lectures for care staff has improved greatly since the concerns of last year, staff appear more settled and happy. Care Homes for Older People Page 32 of 39 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 needs to sustain improvements while continuing to further improve. This should ensure that the home is managed in the best interests of the people who live there. Evidence: As at the previous inspection a registered manager, Mrs. Kay Lowry, from another of the providers other homes is now in the position of acting manager until a new manager is recruited. They are supported by the project manager and two unit managers who are qualified nurses. The acting manager is experienced and is a qualified nurse. They are also aware of the structure and actions required to ensure that the home is well run. Staff told us, Kay has been brilliant, very understanding, seen big improvements since Kay been here. She wants the best for the residents. Gets on well with the area managers, always there to talk to. Care Homes for Older People Page 33 of 39 Evidence: They listen to the staff and take comments on board. All staff are approachable no matter what time of the day. Staff have been brilliant, we all get on really well, like a big family. Meetings are held for people who live in the home and their relatives so that they have an opportunity to voice any concerns or raise any ideas about how the home could improve. One relative said in their survey, The relatives meetings with Mr. Patel have been very beneficial and I feel he has listended to what was said and acted where necessary to improve situations. Responses from relatives:I do feel that the home has made huge improvements within the last six months but need to ensure this continues. Friendliness of staff from top to bottom has improved beyond recognition from a few months ago. It was positive to see that staff meetings are regularly taking place and we saw copies of the minutes. These informed is that items discussed provided staff with an opportunity of raising any ideas and suggestions for further improvements to benefit people who live in the home. There is a system in place to monitor the quality of the service provided by the home. This includes audits of care plans, medications and accidents. A representative from the provider visits the home each month and writes a report about the quality of the service. These reports were very detailed and included actions to be taken. The acting manager has acknowledged what needs to be improved, Further develop our quality assurance mechanisms. This should include sending out satisfaction questionnaires to people to gain their views about the home. Progress will be reviewed at our next visit to the home. Prior to the inspection the acting manager had completed the Annual Quality Assurance Assessment (AQAA). This gave us information about how the home thought they were performing, what they do well and how they could improve. The acting manager had identified areas were improvements could be made and had plans how to achieve this. In the main the information in the AQAA was consistent with our findings on the day of our visit. Although care should be taken to make sure all of the data is entered in relation to staffing in appendix A. A sample of records in relation to health and safety and maintenance checks were looked at and we found that checks had been undertaken to ensure that the equipment was safe and in full working order. Care Homes for Older People Page 34 of 39 Evidence: Staff attend fire drills and training to ensure that they know how to keep people safe in the event of a fire. Care Homes for Older People Page 35 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 12 When a person is discharged 27/11/2009 from hospital the manager of the home and or the deisgnated person must ensure that a reassessment of the persons identified needs are completed prior to them returning to the home. This will ensure that staff are confident in meeting peoples needs so that their health and safety is not placed at risk. Not fully assessed at this inspection visit but will be focused upon when we next inspect the home. This will ensure that staff are able to meet a persons health needs with confidence so that people are not at risk. Care Homes for Older People Page 36 of 39 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 1 7 12 Care plans must provide staff with current information about how to meet peoples needs. This will ensure to ensure risks to individuals health and wellbeing is minimised. 25/03/2010 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 1 2 1 The registered person must ensure the statement of purpose and service users guide includes all relevant information in a format accessible to people, so that they can make an informed choice. Care plans should provide details about personal preferences so that people receive care in a way that they prefer. The service should ensure that information relating to peoples medication, including any changes, is easy to locate in their individual plans of care. Consideration should be made to all staff receiving end of Page 37 of 39 3 7 4 9 5 11 Care Homes for Older People 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 life care training that is appropriate to their position to ensure peoples and relatives needs are met in an appropriate manner. 6 12 Activities must be reviewed and based on individuals needs. Following this review an action plan should be drawn up and findings implemented so that each person has an activity planner that meets their specific needs in a meaningful way. Utilising peoples social histories would assist with this task. People should have opportunities to access the local community with staff on a regular basis so that they are supported to lead interesting and meaningful lives. People should be offered a choice of meals daily and if individuals are unable to participate in this process their relatives and representatives should be involved. This will ensure peoples personal and dietary preferences are met. A pictorial menu may assist as an aid to this task. Continued improvements must be continued to meet the specific needs of individuals who experience dementia so that peoples privacy, dignity, rights, choices and independence is fully promoted. This will make sure that the environment not only meets individuals specific needs but is in line with homes are for living in. The management team must continue to review and audit the suitability of the premises against recognised national guidance such as Alzheimers 50 Point Action Plan and the needs of current residents. It is recommended that 50 of care staff complete a recognised care qualification so that people receive care from a knowledgeable and skilled workforce. Application forms must be completed to provide exaplantory evidence where gaps in employment have occurred so that people are safeguarded by the homes robust recruitment procedures. 7 13 8 15 9 19 10 22 11 28 12 29 Care Homes for Older People Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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