Latest Inspection
This is the latest available inspection report for this service, carried out on 15th April 2010. CQC found this care home to be providing an Adequate service.
The inspector found no outstanding requirements from the previous inspection report,
but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Waverley House.
What the care home does well Because this was not a full inspection there may be things the home does well that we didn`t look at or find out about. People staying at the home for reablement are supported by a regular team of support staff and team leaders who know them well. The two people we met told us that they have improved a lot during their stay and had been helped to get their confidence back. People are able to have fun and enjoy themselves during events such as the quiz we saw. The home has got better at recognising incidents that need to be referred under adult safeguarding and at informing us about things that happen. The home is working at improving the number of regular staff employed so that less agency staff need to be used. Improvements are also underway to make sure that staff training is up to date. The new acting manager is enthusiastic and keen to settle in and make an impact on thethings where improvements are needed. What the care home could do better: The service needs to make sure that information about how a person will be supported is recorded in a care plan so that staff have information about how to give each person the right care. This helps to make sure care is organised and provided in a consistent way. This matters whether someone is at the home short term for reablement or because it has become their long term home. Although staffing levels have been increased since our last inspection some of the things we found indicated that either staff still don`t have enough time to carry out all the tasks involved in their roles, or that deployment of staff needs to be more effectively managed. Some people living at the home may need more time spent with them to help them look their best. The management of medication needs to be improved to make sure records are up to date, stock control is effective, disused and out of date stock is disposed of and staff have clear information available about `as required` medication for each person. Random inspection report
Care homes for older people
Name: Address: Waverley House Etnam Street Leominster Herefordshire HR6 8AQ one star adequate service 09/12/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Denise Reynolds Date: 1 5 0 4 2 0 1 0 Information about the care home
Name of care home: Address: Waverley House Etnam Street Leominster Herefordshire HR6 8AQ 01568612126 01568620445 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Shaw Healthcare Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 47 Number of places (if applicable): Under 65 Over 65 47 47 dementia old age, not falling within any other category Conditions of registration: 47 0 The maximum number of service users to be accommodated is 47. 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: Old age not falling within any other category (OP) 47 Dementia over 65 years of age (DE) 47 Date of last inspection Brief description of the care home Waverley House is registered to provide accommodation and personal care for a maximum of 47 people over the age of 65. The registered provider is Shaw Healthcare
Care Homes for Older People Page 2 of 10 0 9 1 2 2 0 0 9 Brief description of the care home Ltd. The building was rebuilt in 2007 to conform with the National Minimum Standards for Care Homes for Older People. The home is located in Leominster within walking distance of the town centre. Accommodation is provided over three floors providing specialist nursing care and long-stay care for older frail people and includes people with dementia. There is also a seven bed unit for respire care or rehabilitation after hospital treatment where the maximum stay is six weeks. People who use the service and their representatives are able to gain information about this service from the Statement of Purpose and Service User Guide. Inspection reports can be obtained direct from the provider or are available on our website at www.CQC.org.uk Care Homes for Older People Page 3 of 10 What we found:
This was an unannounced inspection so the manager and staff did not know that we were going. The main purpose of the inspection was to check if the requirements we made after our inspection in December 2009 had been met. We were at the home from 10am until 4:40pm and spent time in each of the units (ie the reablement unit, the dementia unit providing personal care and the dementia unit providing nursing care). We met some of the people who are using the service, looked at some records, spoke with several staff and spent time with the new acting manager. The new acting manager, Lea Larson, had started work about a month before this inspection. She is an experienced manager who has worked as a registered manager for a number of years. She was enthustiastic about working hard in the coming months to continue the improvements at the home. We spoke with two people staying in the reablement unit following recent hospital admissions. They were very positive about the support they had received and described the staff as very good and excellent. They felt they had got their confidence back. One person said they could now dress themselves independently again after weeks in hospital wearing nightwear. Staff explained that both these people are now being helped to regain skills such as making cups of tea. Staff had visited both people in hospital to check what care they needed but had not written full care plans to help guide staff in how each person would have their needs met while at Waverley House. We spoke to staff about this and heard that several factors had caused this including the fact that four people had arrived at the same time. We noted that there was more information in the other two care plans and that these people had more complicated care needs. It was reassuring that staff in the reablement unit were very familiar with each persons care needs. This would be more difficult when more people are staying there without written information to support staff. We noted that there was no information in the records to show what goals people were working towards to make a return home realistic (eg being able to dress, make snacks and drinks or manage medication themselves). Staff said they realise that some of the written information was not up to date and explained this is due to lack of time. This appeared to be partly due to the team leaders role in supporting the support staff in both the dementia unit on the ground floor as well as the reablement unit on the second floor. At the time we inspected the team leaders were also spending a lot of time dealing with medication in the reablement unit. We were surprised to learn that there is only one support worker rostered to work in the reablement unit. We considered this could have an impact on how much time can be spent with each person supporting them to regain their independence. Staff explained that the staffing levels are taken into account when they decide if they are able to offer a reablement place to someone ie they generally only accept people who can safely be assisted by one person. Care Homes for Older People Page 4 of 10 When we did our last inspection we had concerns that not all of the people who live at the home were receiving care promptly enough. At that time we discussed this with the area manager and said that based on what we saw and what staff told us, two nurses and three support staff was not enough in the nursing unit for 30 people. As a result the staffing levels in this part of the home were increased to two nurses and five/six support staff. During this visit most people we saw looked as though they had been given the help they need to look their best and we observed staff attending to people and taking notice of how they were. For example, a lady spilled water from her flowers over herself and a member of staff quickly helped her. We saw some people in the nursing who needed their hair washed. A member of staff expressed a concern that the staffing levels still do not always enable them to give people as much attention as they would like. In all parts of the home we saw that people were spoken to in a polite way and treated with respect. When we did our last inspection we made a recommendation that when staff make handwritten entries about what medication someone has these should be signed by two staff. We checked if this is now being done and found that in most cases it is. However, we found some examples where entries were only signed by one person and a small number which were not signed at all. We had also recommended that the files containing the medication records be tidied so information was easier to find. Again, most of the records were tidy but we did find a Do Not Resuscitate form which was sandwiched between other papers inside a plastic wallet with the medication records. This could easily be overlooked and the persons wishes not met. While looking at medication records in the nursing unit we found some items for a person where two prescribed items (lorazepam and ensure) were printed on the form by the pharmacy as none supplied this month. There were no entries to show these had been given in the current month. We checked the medication trolley with one of the nurses and found a box of lorazepam dispensed by a pharmacy on 02/09/08 and opened on same date. There were 19 left in the box. The expiry date was 11/09. The nurse confirmed that the person no longer takes either lorazepam or ensure. The out of date lorazepam should have been disposed of via the secure service the home uses and the items should have been deleted from the medication records. We also noted that the quantity brought forward boxes had not been used to show how much of these items was in stock. The out of date lorazepam could therefore have been taken from the trolley and no-one would have realised it had gone or even that it had still been there. While looking at the medication records we noted that there was no written guidance available for some items prescribed as and when required. This is important information needed to help staff recognise when a person needs to have their medication. We spent some time sitting in the residential dementia unit where the activity worker was doing a quiz with people about washdays. The activity co-ordinator made sure everyone in the room was involved by helping people make their contribution and by encouraging them to give their answers and other comments. This made it a lively and very sociable event. We saw that people were enjoying talking about the topic and there was a lot of smiling and laughing even from those people less able to join in. The quiet rooms in the nursing units and the residential dementia unit are being developed as reminiscence style rooms with more traditional furnishings and decor. Staff told us these are proving popular, partly because they are more homely than the main
Care Homes for Older People Page 5 of 10 sitting rooms which have more modern furnishings. We saw records showing that when a person may be at risk staff recognise this and make a referral under the local safeguarding arrangements. They also send us the required notifications about incidents. These records were well organised and the requirement we made about this after our last inspection had been met. The training records at the home showed that 75 staff are up to date in their training about adult safeguarding. We saw information displayed in the home for staff about senior Shaw healthcare staff they should contact if they have concerns about the home; for example if they feel their concerns are not being acted on. The staffing levels on the day of this inspection were good. The core staffing for the day included the acting manager, the deputy manager, 2 nurses, a team leader and eight support staff as well as the activity co-ordinator, domestic, catering and administrative staff. The acting manager was interviewing for new staff and explained that since her appointment vacancy levels have reduced so she has been able to bring down the number of shifts they need to use agency staff for. For example new night staff covering a total of 120 hours would be starting once their criminal records bureau checks came through. We spoke to the acting manager about whether the staffing levels are adequate and she explained that one of her priorities is to monitor how staff are used in the home to check that best use is being made of the total hours available. She plans to work a number of shifts doing hands on care to see for herself where the pressures and strains are. The acting manager also showed us the up to date training records for the home and was confident that a backlog of training had been addressed and that the majority of staff are now up to date in mandatory training topics. We spoke to the relative of a one person. She told us that at one time the family were concerned but that since our last inspection things have begun to improve. What the care home does well:
Because this was not a full inspection there may be things the home does well that we didnt look at or find out about. People staying at the home for reablement are supported by a regular team of support staff and team leaders who know them well. The two people we met told us that they have improved a lot during their stay and had been helped to get their confidence back. People are able to have fun and enjoy themselves during events such as the quiz we saw. The home has got better at recognising incidents that need to be referred under adult safeguarding and at informing us about things that happen. The home is working at improving the number of regular staff employed so that less agency staff need to be used. Improvements are also underway to make sure that staff training is up to date. The new acting manager is enthusiastic and keen to settle in and make an impact on the
Care Homes for Older People Page 6 of 10 things where improvements are needed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, 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 9 13 You must ensure that medication policies and procedures are in place and implemented effectively so that the storage, recording and administration of medication is well managed and safe. This is to make sure that people receive their medication correctly. 31/05/2010 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 7 The information staff know about each persons care from their day to day contact with them needs to be better supported by the written information that is available. Care plans need to be set up as soon as a person arrives at the service and should include the goals people are working towards to make the most of their abilities. Staffing arrangements for each unit need to be reviewed to ensure that staff have the time they need to fulfill their roles effectively. 2 27 Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. Care Homes for Older People Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
