Care Home: Wavertree Nursing and Residential Home

What the care home does well The service provides a pleasant homely environment for residents. During the visit the interaction between residents, their relatives and staff was friendly and respectful. Residents who live at Wavertree were complimentary about how the home was run and stated, "Everybody is very nice here", "The staff are very kind and caring" and "Meals are very nice, we have plenty to eat and lots of cups of tea". Relatives interviewed stated, "The staff treat my wife very well and I see them treating others well too" and "All the staff are very good and they are really friendly and I know I can talk to all of them". What has improved since the last inspection? The service has improved overall since the last inspection visit in September 2008. Residents and staff are happy with how the service is run now. Staff stated, "Ann, the manager has made a difference" and the manager is really good, things have improved a lot since she came to work at the home". The assessment procedure has improved with documentation showing more information is collated prior to admission. Residents care records including care plan documentation has improved. Review records, which were seen showed that care plans have been regularly reviewed and updated. Checks carried out by the Commissions pharmacist showed that there has been significant improvements in the way medication is managed. Residents are able to enjoy a much better quality of life through the much improved activities programme. Residents interviewed stated, ""We do lots of things and I really enjoy them", "We bake cakes and I stir the mixture" and "I do keep fit". An activities organiser works eighteen hours each week and organises many activities that are suited to residents needs. There were written records showing what activities they have been offered and taken part in. Residents live in a satisfactory maintained pleasant environment. The upstairs dining room has been redecorated and some residents` bedrooms are being refurbished. Requirements given as part of the last inspection report with regard to fire safety have been met. All areas of the service were clear and procedures are followed. Residents have benefited from the improved management of the service. The manager and deputy manager have worked hard to improve the standard of care since the last inspection. They have addressed all the requirements and most of the recommendations that were given as part of the last inspection report. What the care home could do better: Further information needs to be included in the Statement of Purpose to ensure prospective residents have all the information before they make a decision about living there. All information obtained during the pre-admission assessment must be included in the persons care plan to ensure that staff have all the information they need to fully meet their needs. Although improvements have been made in relation to the administration of medication, further improvements should be made to fully ensure residents health and safety. An audit tool in use to monitor the medication is not sufficient and needs further development to cover all aspects of handling, administration and recording of medication. There also needs to be systems in place at the home to ensure that residents who go out have their prescribed medication at the correct time. Resident menus need to show that they are offered a choice of meals. The menu board on display in the dining room showed only one meal choice. One of the residents was found to have a severe communication problem during the assessment process and did not have this addressed in a care plan. This will need to be included in the care plan otherwise the resident may be at risk of isolation. The process of logging complaints has improved but some staff are still not familiar with the type of information that needs to be recorded or how to follow the complaints up to ensure good outcomes for the complainant. Further training will need to ensure that all staff be familiar with the complaints procedure. Staff canvassed for their views commented, "I don`t know what to do if a resident or relative has concerns about the home". The service needs to ensure that residents have access to a lockable facility in their rooms so that they have the opportunity to lock away any personal items. Discussion with the deputy manager and staff showed that induction training has improved and is more structured, however induction-training records needto be more detailed to show this. Equality and diversity training also needs to be improved for staff following commencement of employment. It would benefit the service if an effective and structured quality assurance system was in place to enable residents and their relatives give their views on how the service is run. The registered provider needs to complete monthly visits to the home and record his findings. CARE HOMES FOR OLDER PEOPLE Wavertree Nursing and Residential Home Pighue Lane Wavertree Liverpool Merseyside L13 1DG Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 10th March 2009 09:30 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 Wavertree Nursing and Residential Home DS0000025083.V373707.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. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wavertree Nursing and Residential Home Address Pighue Lane Wavertree Liverpool Merseyside L13 1DG 0151 228 4886 0151 228 4867 wavertreenursing@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) Mr Ilam Din Chaudhry Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate up to a maximum of 36 nursing and 24 personal care within the overall total of 48. To accommodate four named service users under the age of 65, but no younger than 55 years. To accommodate one named service user under the age of 55. Date of last inspection 9th September 2008 Brief Description of the Service: Wavertree Nursing and Residential Home is a purpose built care home providing both nursing and personal care to 48 residents. Bedroom accommodation is provided on the first floor and is easily accessible by a passenger lift. On the ground floor there is a large dining room and on the first floor there is large lounge and conservatory, which could be used for a variety of activities. The home is staffed twenty-four hours a day with qualified nursing staff. All of the accommodation is provided in single bedrooms and many of them are very large. The home has many aids to promote the residents safety such as assisted baths, grab rails and a call system. The home is centrally heated throughout and is fitted with a call bell system. Fees range from £315 to £415. The registered provider is Mr Ilam Din Chaudhry. A proposed manager Mrs Ann Lloyd has been appointed. Wavertree Nursing and Residential Home DS0000025083.V373707.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 star. This means that people who use this service experience good outcomes. A site visit took place as part of the unannounced key inspection. It was conducted over one day for the duration of approximately 7 hours. 38 residents were accommodated at this time. Three inspectors were present during the inspection visit including a Commission pharmacist. As part of the inspection process all areas of the service were viewed including many of the residents bedrooms. Care records and other service records were viewed. Discussion took place with some of the residents, staff and relatives. The inspection was conducted with the manager Mrs Ann Lloyd with the help of the deputy manager Mr Yury Kazlouski and the administrator. The registered provider Mr Chaudhry was present during the inspection also. During the inspection three residents were case tracked (their files were examined and their views of the service were obtained). All of the key standards were inspected and requirements and recommendations from the last inspection in September 2008 were discussed and checked. Satisfaction forms ‘Have your say about….’ Were distributed to a number of residents, relatives, staff and health professionals prior to the visit. A number of comments included in this report are taken from the surveys and from interviews. An AQAA (annual quality assurance assessment) was completed by the proposed manager prior to the site visit. The AQAA comprises of two selfassessment questionnaires that focus on the outcomes for people. The selfassessment provides information as to how the proposed manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The service has improved overall since the last inspection visit in September 2008. Residents and staff are happy with how the service is run now. Staff stated, Ann, the manager has made a difference and the manager is really good, things have improved a lot since she came to work at the home. The assessment procedure has improved with documentation showing more information is collated prior to admission. Residents care records including care plan documentation has improved. Review records, which were seen showed that care plans have been regularly reviewed and updated. Checks carried out by the Commissions pharmacist showed that there has been significant improvements in the way medication is managed. Residents are able to enjoy a much better quality of life through the much improved activities programme. Residents interviewed stated, We do lots of things and I really enjoy them, We bake cakes and I stir the mixture and I do keep fit. An activities organiser works eighteen hours each week and organises many activities that are suited to residents needs. There were written records showing what activities they have been offered and taken part in. Residents live in a satisfactory maintained pleasant environment. The upstairs dining room has been redecorated and some residents bedrooms are being refurbished. Requirements given as part of the last inspection report with regard to fire safety have been met. All areas of the service were clear and procedures are followed. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 7 Residents have benefited from the improved management of the service. The manager and deputy manager have worked hard to improve the standard of care since the last inspection. They have addressed all the requirements and most of the recommendations that were given as part of the last inspection report. What they could do better: Further information needs to be included in the Statement of Purpose to ensure prospective residents have all the information before they make a decision about living there. All information obtained during the pre-admission assessment must be included in the persons care plan to ensure that staff have all the information they need to fully meet their needs. Although improvements have been made in relation to the administration of medication, further improvements should be made to fully ensure residents health and safety. An audit tool in use to monitor the medication is not sufficient and needs further development to cover all aspects of handling, administration and recording of medication. There also needs to be systems in place at the home to ensure that residents who go out have their prescribed medication at the correct time. Resident menus need to show that they are offered a choice of meals. The menu board on display in the dining room showed only one meal choice. One of the residents was found to have a severe communication problem during the assessment process and did not have this addressed in a care plan. This will need to be included in the care plan otherwise the resident may be at risk of isolation. The process of logging complaints has improved but some staff are still not familiar with the type of information that needs to be recorded or how to follow the complaints up to ensure good outcomes for the complainant. Further training will need to ensure that all staff be familiar with the complaints procedure. Staff canvassed for their views commented, I dont know what to do if a resident or relative has concerns about the home. The service needs to ensure that residents have access to a lockable facility in their rooms so that they have the opportunity to lock away any personal items. Discussion with the deputy manager and staff showed that induction training has improved and is more structured, however induction-training records need Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 8 to be more detailed to show this. Equality and diversity training also needs to be improved for staff following commencement of employment. It would benefit the service if an effective and structured quality assurance system was in place to enable residents and their relatives give their views on how the service is run. The registered provider needs to complete monthly visits to the home and record his findings. 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. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 9 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 Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 10 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): OP1, 3 and 4 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment procedure has improved with documentation showing more information is collated prior to admission. EVIDENCE: The Statement of Purpose has been improved since the last inspection visit but still needs further information to ensure all areas are covered including manager and staff details and qualifications. Fees for the home and costs for the services provided need to be more detailed, so that prospective residents and their representatives have all the information they need about the home. Discussion took place with the manager in regard to what areas need to be included. Three residents were case tracked and documentation with regard to the pre admission assessment looked at. Prospective residents are visited and assessed by the manager prior to admission. Assessment documentation evidences information about prospective residents is collated and includes such areas as personal care, previous medical history, prescribed medication, risk of Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 11 falls and their present abilities with regard to how their care needs are managed. Assessments seen were signed and dated. The assessments contained more detail than previously. There are still areas where the assessment has picked up on care needs but they are not addressed in the care plan such as severely impaired hearing for one resident. Relatives interviewed about the admission process stated, We looked at a few homes before choosing this one and We were given information about the home. One resident surveyed commented, We could have been told more information before moving in. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 12 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): OP7, 8, 9,10 have been assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has improved in this area but there are still some problems with the administration of medication. This needs to improve to ensure safe practice. EVIDENCE: Three residents care plans and other care documentation was viewed. Care documentation evidences that each resident had an individual care file and care plan. Care plans are audited on a regular basis with documentation evidencing dates carried out. One of the care plans was signed and dated by the resident. Care plans have shown some improvement from the last inspection. They are reviewed regularly and updated care was evidenced in the care plans viewed. The care documentation evidences health professional visits including GP, opticians, dietician, chiropodist, dentist, community matron, district and diabetes specialist nurses. One resident who was identified on assessment as having a severe communication difficulties had no care plan or further Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 13 information regarding this. A care plan for this needs to be developed so that staff have all the information, which they need to fully meet the persons needs. Most residents are supported in accessing the specialist care that will improve and meet their health and personal care needs. At the time of the inspection none of the residents had any wounds. Therefore this needs addressing to prevent the resident becoming isolated. Most residents are supported in accessing the specialist care that will improve and meet their health needs. None of the residents have any wounds at present. Records evidence that staff complete daily reports, day and night. Two of the residents who had falls had a record of this in the daily report and accident records were completed as evidenced. Risk assessments were in place with regard to falls, nutrition, mobility and pressure areas. Two of the residents had bed rails in place, which was agreed following a risk assessment. Other specialist equipment was in place for residents who need it including pressure relieving mattresses, cushions and hoists. Residents individual preferences with regard to personal care were also recorded. One health professional canvassed for their views confirmed that they were satisfied that the health care needs was well managed and commented, Health needs are addressed, the resident is treated as an individual, staff have done extremely well. There is a separate locked room for the storage of medication including medication trolleys. The Commission pharmacist looked at medication records and storage. Medication is supplied in individual blister packs. All medication was stored securely in locked cupboards and trolleys in the medication room. Medication records are mainly pre-printed from the local pharmacy. When there is a need to record hand written records these are checked by two nursing staff and signed to make sure the information is correct. All medication records evidenced instructions for prescribed medication. All prescribed medication must be signed for when it is administered to show that residents are receiving prescribed medication at the right time. Risk assessments were in place for residents who self medicate but these could be improved by personalising and further developing them to cover all risks, needs and preferences. Warfarin doses and blood results are now kept with medication records so that staff can refer to them. Nurses were observed during the medication round. One of the nurses had not signed the medication administration record immediately the resident was given their prescribed medication. When the nurse became aware that she had been observed she went on to sign for several residents medication. The nurse gave no satisfactory explanation as to Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 14 why she had not signed for each resident prescribed medication immediately following administration. An audit tool is in place to check medication but it is not sufficient, as it needs to be extensively developed to include all aspects of handling, administering and recording medication. One of the senior staff on duty was able to clearly explain how residents are administered prescribed medication through an alternative route. This is also clearly explained on the residents care plan. A copy of the guidelines is in the bedroom for staff to refer to. One of the residents who had been out for the day missed their medication therefore this needs addressing. Staff needs to be aware of who is going out and arrangements should be in place to ensure the resident has the prescribed medication on time. Overall this area of the service is much improved. Most residents receive their medication safely. Residents have their own bedrooms. Residents interviewed confirmed that health professionals visit them in the privacy of their bedrooms. Residents preferred term of address is recorded in their care documentation. During the visit staff were noted to be friendly and respectful when interacting with residents and other staff. Residents interviewed stated, Staff knock on my door, The staff treat me very well and I like living here. Residents were well groomed and dressed in suitable clean clothing. Additional clean and ironed clothing is stored in residents individual wardrobes in their own bedrooms. Relatives interviewed confirmed they were happy with the care provided with one relative stating, The staff treat my wife very well and I see them treating others well too, My wife has her hair done every week by a hairdresser that comes to the home and Her hair and nails are always kept clean. Relatives surveyed for their views commented, The care home always makes sure my wife is as comfortable as possible and They care for my husband so well, he needs constant nursing and attention. A public telephone is available for residents use. One of the residents has their own telephone. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 15 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): OP12, 13,14 and 15 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to enjoy a much better quality of life through the much improved activities programme. EVIDENCE: An activities organiser has been appointed in the service since the last inspection. Discussion took place with the activities organiser during the visit. She confirmed that she worked 18 hours a week over three days. The activities organiser showed the inspector the individual records for each resident. This record evidences which activities have been offered to residents and if they took part or not. Some of the activities that residents have attended include armchair keep fit, skittles, softball activities, arts and crafts, cake making, marbles, quizzes and massage. The activities organiser confirmed that resident birthdays are celebrated and other events including an St Valentines party had been enjoyed by residents. There was also recorded evidence that other entertainment is provided including visiting entertainers such as musical events. The activities organiser told us that residents have their own favourites. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 16 Records also evidence that some of the residents have been out shopping. Other trips arranged for the future include the Albert Dock, Chester Zoo, Speke hall, Southport and T Dance at Lewiss. Residents interviewed stated, We do lots of things and I really enjoy them, We bake cakes, I stir the mixture, I do keep fit and We play soft ball, which I love to do. Residents surveyed for their views commented, I always love doing the armchair exercises with the keep fit man and games and card making with the girls and I always get my nails painted every week, Im happy. Staff confirmed that residents were happier with the activities provided and stated, Residents do much more than they used to, The activities organiser is really good, she knows what the residents like and The residents really seem to enjoy the activities. One relative interviewed stated, There are activities that go on in the home. Residents are able to choose where they wish to spend their time. Staff try to encourage residents to spend their time with others but those who prefer their own company are accommodated. Residents confirmed that they are encouraged to communicate with their family and friends. Relatives interviewed stated, I visit daily, we are always welcomed and offered drinks Residents confirmed that they were generally able to choose when they wished to get up in the morning and retire to bed. Meals are served in either of the two dining rooms at specific times of the day. The menu was displayed in the dining room. The tables were attractively laid out and suitable chairs provided. Residents surveyed about mealtimes stated, I didnt like the lunch today so I asked for something else. Survey results evidenced generally positive responses with regard to meals. One resident interviewed stated, Meals are nice, we have plenty to eat and lots of cups of tea. The menu on display in the kitchen showed only one choice for lunch. The chef told us that he checks what residents want in the morning and if they do not like it they are offered an alternative. The service needs to ensure that the daily menus on display offer choices at all mealtimes for residents. Residents religious needs are recorded in care documentation and residents confirmed that they receive weekly visits form the local church to provide Communion. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 17 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): OP16, 17 and18 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The process of logging of complaints has improved but some staff are still not familiar with the type of information that needs to be recorded or how to follow the complaints up to ensure good outcomes for the complainant. EVIDENCE: The service does not have a copy of the Liverpool Adult Protection Procedure therefore was advised to get one for staff reference. The complaint file was viewed and evidences complaints have been logged since the last inspection. The records have improved but with some of the complaints raised showed insufficient information was recorded or not fully completed. Trained staff has to be aware of how to document and follow up a complaint. Staff surveys evidence some staff were unsure of what to do if anyone raised any concerns and stated, I dont know what to do if a resident or relative has concerns about the home. Therefore further training needs to be implemented so that all staff understand the complaints procedure. The manager was unable to find the complaints procedure. The complaints procedure had been viewed at the previous inspection therefore this needs addressing. Residents interviewed were confident that they could complain to staff when needed. One resident interviewed stated, Yes, I would complain if I was unhappy about something. A relative stated, I have no complaints and Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 18 would complain to the manager if I needed to. One of the health professionals who was surveyed commented, I couldnt think of an aspect of the service that I have been dissatisfied with. The manager continues to meet with residents on a daily basis so that they have the time to discuss with her any concerns they may have. A valuables book is in place to ensure residents valuables handed over for safekeeping is recorded and records kept for both resident and service. There has been one adult protection issue, which has been dealt with by the police. The manager has a clear understanding of how to deal with any such issues. Advocacy details are available for residents who wish their service. One or two of the residents are making use of this to date. Policies and procedures are in place with regard to physical and verbal abuse. Most staff have attended the adult protection training locally. Residents who wish to vote do so using the local ballot box or by the postal system. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a satisfactory maintained pleasant environment. EVIDENCE: A tour of the service took place with the manager. Most areas of the service including resident bedrooms were viewed. One resident interviewed stated, I like my room, it is very comfortable. All areas were clean and odour free. The service has been purpose built and all residents bedrooms are situated on the first floor. A separate dining room and lounge are situated on the ground floor including the hairdressing salon. Repairs had been carried out to the sink and a new blind has been fitted to the hairdressing salon. All fire escapes and stairways were clear. There were no obstructions identified during the inspection visit. Recommendations with regard to the previous inspection had been carried out with a clean carpet to the rear fire escape. Call bells were checked at random and all were found to be in working order. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 20 Not all of the residents had a lockable facility in their bedrooms. All residents should be offered this facility so that they can if they wish lock away any personal items they may have. The maintenance book was viewed and evidenced several regular entries of repairs carried out with signatures included. The laundry was clean and well organised. Red dissolvable plastic bags are now in use for soiled laundry. The floor is impermeable to water. Hand washing facilities for staff are in use. Residents clothing looked to be well cared for. The dining rooms are well presented and both evidenced flower posies on each table. The upstairs dining room has been freshly decorated. There are two garden areas for residents use. Both areas are placed in a courtyard setting and therefore sheltered. One is situated on the first floor with the other on the ground floor. There is easy access for residents to enjoy the shrubs and flowers on display. Suitable garden furniture is in place. Bathrooms checked showed various pieces of equipment for residents use and all were clean and tidy. Staff use bath thermometers to record the water temperature prior to each residents use. Hallways are fitted with handrails to assist residents with their mobility. The kitchen is large and well organised. All areas viewed including storerooms and fridge/freezers were clean. Floors are impermeable to water and walls are painted. The chef told us he had sufficient equipment for his needs. Daily kitchen audits are carried out with records kept. Hot food and fridge/freezer temperatures are logged in the diary. Both staff wore clean uniforms and have relevant food hygiene training. Fresh fruit, vegetables and other foods were in plentiful supply. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This area has improved however staff induction needs to be improved to include more detail and ensure all areas are covered in a structured way. EVIDENCE: The staff rota evidences satisfactory staffing levels are in place. Four staff files were looked at in detail. Two of which are new staff employed since the last inspection visit. There is a big improvement in this area with staff files now well organised. Files now contain all the information, which is required including, proof of identity, completed application forms with detailed full employment history, two written references, evidence of police checks, a statement of the employees physical and mental health and where applicable details and evidence of registration and membership of professional bodies. Records show that staff started only after pre employment checks were completed. Residents and relatives were complimentary about how staff provide care and support. Relatives interviewed stated, All the staff are very good and they are really friendly and I know I can talk to all of them and I think staff are well trained and good at their jobs. Residents interviewed stated, Everybody is very nice here and Staff are very kind and caring. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 22 The service holds a staff-training file, which shows all of the staff training over the past year. Records include details of the courses and dates attended. The records show that staff have attended various training including, health and safety, emergency first aid, POVA (Protection of Vulnerable Adults), fire evacuation, Dementia, moving and handling, infection control, wound dressing, use of a feed pump and NVQ in care to Level 2 and 3. The manager was advised to provide individual training files for each employee, as at present the file is bulky and difficult to access information. There is evidence to show that staff have attended mandatory and specialist training courses and that further training has been planned. New staff are now being issued with information with regard to best practise in relation to respect and dignity. The service needs to further develop this to promote equality and diversity and include this in the staff induction and training plan. There were no individual training and development plans for each staff. This needs to be commenced so that individual training and development needs are identified and planned for. The deputy manager confirmed that new staff take part in an induction programme when they first commence work. He confirmed that the programme lasted approximately three months, when they are shadowed by more experienced staff. The induction programme is not detailed or structured. The service needs to improve this documentation so that it is evident that all staff has had a detailed and structured induction, which is relevant to the residents, and individual staff needs. The other area that needs to be addressed is where some nurses still need to be supervised with regard to the administration and management of medication. Further training may need to be given to ensure nurses fully understand the service policies and procedures with regard to medication. This is to ensure safe practise at all times. Staff were interviewed and stated, I love the job, Residents are well looked after, We have completed a lot of training including pova, health and safety cosh (control of substances hazardous to health), moving and handling and first aid, I would definitely report abuse, I know how to complain, I always see staff knocking on residents doors before going in, The manager is really good, approachable and caring, she always has time for the residents and knows them all individually, Residents do much more activities and Staff communicate well with each other, we work well together. During the visit staff were observed to promote residents dignity, knock on residents doors, assist residents at mealtimes with sensitivity and patience, and promote choices. Staff were relaxed and unhurried when carrying out their duties. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 23 Staff surveyed for their views commented, There is always enough staff, I enjoy working here, The service provides information that is relevant and up to date, We would like more staff and more senior carers at Level 3I think we should provide more choice of meals and We could provide more trips out. Several staff commented, I dont know what to do if someone complains. Therefore this needs addressing in training plans. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 24 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): OP31, 33, 35 and 38 were assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have benefited from the improved management of the service. EVIDENCE: Ann Lloyd was appointed as manager of the home in May 2008. Mrs Lloyd has put forward an application to the Commission to become the registered manager of the home. The manager has many years experience of working in care and is a registered nurse as well as a number of other relevant qualifications including NVQ Level 4 in management and ENB (English national Board) teaching and assessing certificate. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 25 The manager with the support of her deputy has improved the service since the last inspection visit. It is important that improvements continue, as this will give consistency and more stability to the service. Staff were very complimentary about how the manager runs the service. Staff interviewed stated, Ann, the manager has made a difference, she gets involved and is very helpful and The manager is really good, things have improved a lot since she came to work at the home. Residents interviewed confirmed that they knew the manager and one stated, I see her a lot. The manager has told us that she does not have large group meetings with residents and much prefers to spend time with individual residents on a one to one basis. Records commenced in December 2008 show many meetings have taken place with individual residents and their relatives. Two staff meetings have been held since September 2008 and hand written records evidence these meetings. The manager told us that she has sent out surveys to residents families but to date none has been returned. The manager told us that relatives have said there is no need for them to complete surveys as all is okay. It would be of benefit to the service if an effective quality assurance system could be in place. This would then ascertain the views of the residents, their relatives and staff in a structured way and would give the service information with regard to how the interests of the residents are being served. The registered provider does visit the service regularly. The registered provider has not been producing reports on a monthly basis. This needs to be addressed so that a record is kept of his visits to the service and what his findings are. The manager has now begun to audit the service including resident bedrooms and various other areas such as hoist slings and wheelchairs. The records were viewed and evidence dates that checks have been carried out regularly over the past few months. The manager is in the process of updating polices and procedures, some of which were viewed during the visit. Computerised records are used to monitor resident finances. We looked at some of the resident records during the visit. There is evidence of resident signatures on financial transactions. Financial records evidence all financial transactions including hairdressing costs and cash withdrawals. Systems are in place to enable residents whose monies are held on their behalf to withdraw cash when they wish. One of the residents interviewed confirmed they had no problems gaining access to their funds and stated, My money is kept safely in the office, I can ask for it when I want to. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 26 The AQAA stated that all servicing, insurance and contracts related to the systems and equipment are up to date. A few of the certificates were checked at random during the visit including, Legionella, electrical, lifts, gas, hoists, fire equipment, fire alarms, service insurance and emergency lighting. All were up to date. The Commission had requested the fire service to visit the premises following the last inspection, as some of the exit areas were restricted. There were no issues raised during this visit. The manager has told us that a fire risk assessment has been carried out since the last visit but was unable to produce documentation to evidence this. It could not be found on the day of the visit. Accident records are completed clearly. Notifications are completed and sent to the Commission where needed. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 27 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 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Care plans must cover all the care need requirements taken form the pre admission assessment, so that staff have all the information to enable them to fully meet the persons needs. Timescale for action 01/06/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP9 Good Practice Recommendations It is recommended that the Statement of Purpose should be updated to include the information needed for prospective residents to make choices. It is strongly recommended that an improved audit tool should be implemented so that the auditor can pick up on all aspects of handling, administration and recording of medication. It is strongly recommended that staff that do not signing the medication record should have further training and assessment to ensure their competency when administering medication. DS0000025083.V373707.R01.S.doc Version 5.2 Page 29 3. OP9 Wavertree Nursing and Residential Home 4. 5. 6. OP9 OP15 OP16 7. 8. 9. 10. 11. OP24 OP28 OP30 OP30 OP33 It is recommended that systems should be in place to ensure that residents who go out have their prescribed medication on time. It is recommended that resident menus should show a choice of meals that they can choose from each mealtime. It is recommended that all staff should have further training with regard to the complaints procedure so that they understand how to manage any concerns or complaints raised. It is strongly recommend that residents should have a lockable facility in their room. It is recommended that care staff should continue to enrol for the NVQ training programme. It is recommended that a training file should be produced for individual staff to include a training and development programme. It is strongly recommended that the induction programme for new staff should include more detail and structure. It is recommended that an effective quality assurance system should be in place to ensure residents and their relatives views of how the service is run are collated. The registered provider should produce a report following his monthly visits to the service. Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection NW Regional Office 2nd Floor Unit 1 Tustin Court Port Way 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 Wavertree Nursing and Residential Home DS0000025083.V373707.R01.S.doc Version 5.2 Page 31 - 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. 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