Care Home: Waverley House

What the care home does well We found a warm and friendly atmosphere at Waverley House. Staff were comfortable to talk with us and clearly took a pride in their work. The comments cards that we received from staff before the visit indicated that they enjoy working at the home and feel that they provide a very good service for the residents. Care plans are completed in detail to reflect the individual needs and preferences of residents so that staff know what they must do to meet people`s needs in the way they prefer. Residents can choose where they want to spend their time in the home and are given as much help as they need so they can maintain their independence and keep active. Records showed that complaints are investigated and appropriate action is taken to address any issues arising so that residents and their relatives can be confident that their concerns will be listened to and acted upon. The building is kept clean and in a good state of repair to provide a pleasant environment for people to live in. What has improved since the last inspection? More training has been provided for the staff across a range of relevant subjects and this is helping to build a skilled staff team and keep people safe. This training needs to continue to ensure that all staff are kept up to date with best practice regarding the support of people with dementia. Radiator covers have been fitted to protect residents from the risk of burns from hot surfaces. Systems for monitoring and reviewing the quality of the service have been developed and implemented. These systems need to be developed further to ensure that senior staff are aware of the strengths, and areas for improvement, in the service they provide. There has been considerable improvement in the standard of documentation and record keeping in the home over the last year. This needs to be maintained so that there are written records to show that good care is being provided and that people are kept safe. What the care home could do better: Staff should have access to information about new residents to make sure that they are aware of people`s individual needs and preferences when they first come to live at the home. New staff must not be employed at the home until two satisfactory valid references have been received. Whenever possible this should include a reference from the person`s last employer, as references from friends may not be a reliable source of information about the person`s suitability to work in a care home. All new staff must receive structured induction training, to ensure that they know how to work safely. The electrical circuits in the building need to be tested by a qualified person to confirm that they are safe. CARE HOMES FOR OLDER PEOPLE Waverley House 27 Victoria Road Grappenhall Warrington Cheshire WA4 2EN Lead Inspector Wendy Smith Unannounced Inspection 12th December 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waverley House Address 27 Victoria Road Grappenhall Warrington Cheshire WA4 2EN 01925 602453 01925 210736 residentialpar@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) PAR Residential Homes Ltd Mrs Pam Roberts Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (1) Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 30 service users to include:* Up to 30 service users in the category of DE(E) (Dementia over the age of 65 years) * 1 named service user in the category of OP (Old age, not falling within any other category) * Up to 3 named service users in the category of MD(E) (Mental disorder over the age of 65 years) Staffing must be provided to meet the dependency needs of service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 17th December 2007 2. Date of last inspection Brief Description of the Service: Waverley House is a care home providing personal care for up to 30 people over 65 years of age, predominantly people with dementia. It is situated in Grappenhall, a residential area on the outskirts of Warrington. The home was first registered in 1984 and is an adapted Victorian building with a purpose built extension. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. We visited Waverley House unannounced on 12 December 2008 as part of this inspection. Two inspectors carried out the visit. At the time of our visit there were 27 older people living at the home. During the visit we spoke with residents, staff and a visitor. We walked round the building to see all the communal areas and were able to visit some of the bedrooms. We checked some of the records kept at the home and spent time talking with the owner/manager, Mrs Roberts. We also looked at any information that we had received about Waverley House since our last inspection there. We arranged for our comment cards to be circulated so people who live at the home and the staff could let us know what they think about it. Before the inspection Mrs Roberts was asked to complete a questionnaire to give us up to date information about the service. What the service does well: We found a warm and friendly atmosphere at Waverley House. Staff were comfortable to talk with us and clearly took a pride in their work. The comments cards that we received from staff before the visit indicated that they enjoy working at the home and feel that they provide a very good service for the residents. Care plans are completed in detail to reflect the individual needs and preferences of residents so that staff know what they must do to meet people’s needs in the way they prefer. Residents can choose where they want to spend their time in the home and are given as much help as they need so they can maintain their independence and keep active. Records showed that complaints are investigated and appropriate action is taken to address any issues arising so that residents and their relatives can be confident that their concerns will be listened to and acted upon. The building is kept clean and in a good state of repair to provide a pleasant environment for people to live in. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People’s needs are assessed before they go to live at Waverley House to make sure that this is the right home for them; however written information about new residents is not always available to make sure that staff know about people’s individual needs. EVIDENCE: When we visited the home there were 27 people living there. They were all older people who have dementia or a long-standing mental illness. Two people who usually live at Waverley House were in hospital. Three people were having a short stay at the home. The owner/manager, Mrs Roberts, told us that she went out to meet and assess all of these people before they moved into the home but there was not always a written record of this. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 9 We looked at the care plans for the people who had moved in most recently and found little information about their needs. The full care plan for each person takes a considerable amount of time to complete and we suggested to Mrs Roberts that a brief summary of the needs, abilities, preferences of new people coming to the home, could be provided for the staff until the full care plan can be written. This would make sure that staff had some useful information about each person and their preferences so they could meet their needs more effectively in the time after they moved into the home before their full care plan was completed. In the information she sent to us before our visit, Mrs Roberts told us that she provides a statement of terms and conditions (contract) to all residents’ families. This includes the fees payable for living at the home, and the service user’s guide explains about any extras that are not covered by the fees. People interested in going to live at the home are invited to spend an afternoon there for tea or have their hair done. There is a six week trial period to allow the person and their family to decide whether they wish to stay there. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Residents’ care plans are thorough and written to a good standard so that staff know what they must do to meet people’s needs in the way they would prefer. EVIDENCE: We looked at a selection of care plans for people living at the home to check the care they receive. We found that, except for the people who had moved in shortly before our visit, the plans had been completed in great detail to describe people’s needs and what the staff should do to meet their needs. Most of the care plans had been kept up to date with monthly reviews. We found that one of the senior staff has recently left the home and the care plans that she was responsible for needed updating. Good daily records were maintained, and very good daily progress reports were made by the care staff. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 11 The care plans we saw showed that residents receive visits from GPs, district nurses, optician, dietician and continence advisor to ensure that their health needs are met. A new mobile hoist has been provided in the home for those people who have problems with mobility. Most residents are able to mobilise around the home, some using walking aids. There are five senior staff who give out medicines to residents. We found that the medicines were stored satisfactorily, with no unnecessary stocks being held. We found a small number of missed signatures on the medication administration records. Some handwritten entries on the medicine administration records were very good and thorough but others were not completed in full. Overall however, the records indicated that people living at the home always receive their medicines as prescribed by their doctor. A relative we spoke with said that her mother has been in the home for a few months. She has found the staff very helpful and told us her mother is treated well. During the time we spent at the home we observed that residents were treated with respect and there was good humour between them and the staff. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People who live at the home are able to make choices about how they want to spend their time and receive the support they need from staff so they can remain as independent as possible. EVIDENCE: We observed that residents are free to walk about the home and there is a choice of lounges for them to sit in. A relative was washing and styling her mother’s hair in the conservatory and later the hairdresser arrived and was kept very busy. There are new large screen TVs in the lounges and these are much easier for people to see. Each person’s care plan includes a record of what activities they have done. The records of one person that we looked at showed that over the last two weeks they had joined in writing Christmas cards, a singalong, watching a movie and listening to carol singers. Another person goes out regularly several times a week with his family. In the information she sent us before our visit, Mrs Roberts told us that ‘two staff members act as activities co-ordinators. They organise outings and parties for birthdays, and the local clerical team Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 13 attend the home. Residents choose what activities they become involved in. They can see visitors in their rooms in private, their families can visit and take the residents for outings whenever they want’. Most of the bedrooms have been personalised with people’s own belongings to make them more homely. People have a choice of meals and mealtimes are flexible to suit them. Drinks and snacks are available at any time. A cooked breakfast is available for those who want it and nutritional supplements are provided for people who need them. This helps to ensure that people receive a varied nutritious diet to keep them healthy and well. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The complaints procedure is well managed so residents and their families can be confident that their concerns are listened to and acted upon. EVIDENCE: There is information on display in the home about how to make a complaint or concern about the service provided there. We looked at the home’s complaints records and these showed that complaints had been fully documented, investigated, and responded to appropriately. Policies and procedures are in place to inform staff about how to recognise abuse and what action they should take if they witness or suspect abuse. Training about safeguarding adults has been provided for staff during 2008 so they know what they must do to make sure that people living in the home are protected from abuse. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. The home is well maintained so that people live in homely, comfortable and safe surroundings that suit their needs. EVIDENCE: During our visit, we walked round the home and found it to be clean and wellmaintained. All of the corridors have been re-decorated recently to keep them bright and fresh for the residents. Radiator covers have been fitted. They look nice and keep people safe from hot surfaces. There were Christmas decorations all through the home. A bathroom on the ground floor has been completely refurbished including a new walk-in bath, which enhances the facilities available for the residents. The Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 16 lounges were tidier and less cluttered than we had seen them before, making them more comfortable for residents and easier to move around. There were hold-open devices on some bedroom doors, which means that the doors could be kept open but would close automatically if the fire alarm went off. Two cleaners are on duty each weekday and there is a full-time maintenance person to make sure the home is clean and well maintained. A gardening firm keeps the grounds neat and tidy. Plans have been submitted to improve communal space at the home by adding an extension to the conservatory. This will provide residents with more choice of where to spend their time during the day. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. There are enough staff provided to meet the needs of the residents but recruitment and induction needs to be improved to make sure that new staff are suitable and safe to work with the people who live in the home. EVIDENCE: The staffing rotas we saw showed that there is a senior carer on every shift. There are four care staff on duty in a morning, three in an afternoon and evening, and two at night. This appeared to be adequate to meet the needs of current residents. There have been a lot of new staff recruited during 2008. At the time of our visit there was only one staff vacancy which was for a domestic assistant to work at the weekend. There is some use of agency staff to cover absences, in order to make sure that the staffing levels remain sufficient to meet people’s needs. We looked at the personnel records for new staff. They all had an enhanced Criminal Records Bureau disclosure. We found that the standard of references was not satisfactory. For several people there was no reference from their last employer. References from ‘friends’ had been accepted, which were of Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 18 doubtful value, as they could not provide information on how the person carried out care work. Some new staff had attended the Warrington Borough Council induction programme for care staff, but for others there was little evidence to show that they had been shown how to work safely. This means that residents could have been put at risk because staff were not aware of safe working practices. The training records we saw showed that a good range of training has been provided for staff during 2008. This included food safety, first aid, moving and handling, fire safety, infection control, safeguarding, medication and dementia care. The staff who completed one of our questionnaires told us they were very satisfied with the training they receive. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. Improvements to the way the home is managed have been maintained to make sure that the service provided is kept under review and changes are made where needed in the best interests of the residents. EVIDENCE: The home is owned and managed by Mrs Roberts. She is an experienced registered nurse, and also has an institutional management certificate. An auditing system has been introduced to monitor the standard of care plans, risk assessments and medicine management. Mrs Roberts told us that she is Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 20 working towards the Investors in People award for the home. A system of staff supervision and appraisal has also been introduced, but the senior member of staff who took lead responsibility for this has now left the home and it had not been maintained during the last quarter of the year. Residents are able to keep small amounts of personal spending money in safekeeping. A sample of the records was checked and found to be satisfactory. Mrs Roberts provided information about the servicing of plant and equipment in the home. It appeared that the electrical installation certificate was due for renewal and this needs to be checked to ensure that electrical circuits are safe. The maintenance person carries out a weekly fire alarm check and monthly emergency lighting test to make sure these systems are working properly and that people living and working in the home are safe. Fire drills are carried out regularly so that all staff are kept up to date with what they need to do to keep residents safe if there is a fire. Notifications of accidents and incidents are sent to CSCI as required but we found that the home’s monthly accident audit had not been completed since September 2008. The accident audit is a useful tool in helping to reduce the number of accidents and making sure that each resident is safe in the home. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement New staff must not be employed at the home until two satisfactory valid references have been received. (Whenever possible this should include a reference from the person’s last employer.) This is to help make sure they are suitable to work with the people who live in the home. All new staff must receive structured induction training, to ensure that they know how to work safely. Timescale for action 09/01/09 2. OP30 18 09/01/09 Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations Care staff should have basic information about new residents, including their care needs and preferences, so they can provide appropriate care for them as soon as they move into the home. Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Waverley House DS0000026997.V373766.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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