CARE HOME ADULTS 18-65
1 Butler`s Drive Carterton Oxon OX18 3HA Lead Inspector
Delia Styles Unannounced Inspection 8th December 2005 10:35 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 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 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 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 Adults 18-65. 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. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 1 Butler`s Drive Address Carterton Oxon OX18 3HA 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) 01993 844923 Harry Watts Linda Eastwood Care Home 4 Category(ies) of Past or present alcohol dependence (2), registration, with number Learning disability (1), Mental disorder, of places excluding learning disability or dementia (1) 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The above categories relate to four named individuals and the Commission will need to review any changes to the above. The total number of service users that may be accommodated at any one time must not exceed 4. 4th August 2005 Date of last inspection Brief Description of the Service: The home is situated close to Carterton town centre and its facilities. Three doctors surgeries provide medical services and chiropody, and dentists and opticians are available locally. Residents accommodation is in a detached house, linked by a covered walkway to the Robert & Doris Watts Care Home for older people next door. The home was converted from private domestic use to a care home for adults in 2003. Because of the domestic nature of the house, it is only suitable for residents who are physically independent and who do not need continuous help and supervision from staff. There are three spacious ground floor rooms, two with en-suite washbasins and toilets and one with separate facilities. There is a shower on the ground floor. A conservatory provides a communal room, overlooking a small patio and garden at the rear of the house. The first floor has a sitting room, bedroom and bathroom with an over-bath shower. Residents do not have their own kitchen facility, but meals are provided from the Robert & Doris Watts Home. Residents of Butlers Drive can join the residents in the adjacent home for their meals and social events as much or as little as they wish. Access to the home is via the Robert & Doris Watts building. The laundry for both homes is housed in the former double garage, off the linked walkway. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection (which means that the home did not know that the inspector was coming) and was done on the same day as an unannounced inspection of the care home next door, because 1 Butler’s Drive is effectively an annexe to the Robert and Doris Watts home. An announced inspection of both homes took place in August 2005. Key standards that were not inspected at the last inspection were assessed at this visit. Key standards are some of the nationally agreed standards for all care homes that the Commission asks inspectors to assess at least once every year. The inspector toured the building, spoke with three of the four residents, the home manager, senior care leader and other care and ancillary staff who look after the residents in both care homes. A sample of residents’ care records, records of medicines given to residents, staff recruitment records and maintenance records were inspected. As the kitchen and laundry service, medication administration and some other standards inspected are common to both homes, the requirement and recommendations made following the inspection are set out in both homes’ inspection reports. The inspector would like to thank residents and staff for their time and hospitality during the inspection. What the service does well:
Residents were very satisfied with the home and their care. They are helped to live as independently as possible and to join in with the social life of the adjacent home as much or as little as they wish. Residents are kept informed about changes in the home and are asked their opinions about ways in which the home can improve or develop the facilities and services. The home manager and staff support and encourage residents to maintain and improve their individual abilities and respect their preferences about their care and how they spend their day. The rooms are of a good size and give residents room to set out their furniture and possessions as they like, so that they have homely, comfortable and private space. Residents are involved in decisions about the running of the home and choices that affect them, such as room colour schemes and activities. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The home’s procedure for the recruitment of staff is not satisfactory - the home’s checks are not thorough enough to make sure that, as far as possible, residents are protected from people who may be unsuitable to look after them. Two interviewers should conduct the interviews for people who apply to work in the care home. A record should be kept of the interviews and whether the home manager and other interviewer were satisfied that the person(s) interviewed were suitable to be employed. The records of medicines given out to residents - the medication administration record (MAR) sheets - should be signed at the time medicines are given to each resident, and any changes to their prescribed medicines that are made by the doctor should be clearly written on the MAR sheet. Handwritten changes to the MAR sheet should be checked and signed by a nurse and care staff member (if the doctor does not do this themselves at the time of asking for a change to the prescription) to protect residents from staff accidentally giving the wrong medicine or dose. The drug fridge should be regularly defrosted and the temperature checked to make sure it is always at the right temperature for storing medicines that need to be kept cool, so that the medicines do not spoil. The lint filters of the tumble dryers in the laundry should be cleaned more often to prevent build up of fluff that could catch fire. It is important for staff to have the opportunity to discuss their progress at work, and any training and development needs they have, in regular, private and planned ‘supervision’ meetings with more senior staff. The manager should make sure that formal supervision meetings with all care staff happen at least six times in any 12-month period. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 7 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. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this occasion. EVIDENCE: All four residents have lived in the home for more than a year and the staff work continually to make sure that their individual needs are met. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10 The home’s staff keep information about residents securely and ensure that residents’ confidences are kept. EVIDENCE: Residents’ care records and any information of a sensitive and personal nature is kept in the manager’s office in the Robert & Doris Watts home. Day to day care notes and observation records are kept at the staff station in a lockable filing cabinet. Staff sign an agreement to keep any information about residents confidential. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12 The staff encourage residents’ opportunities for social and personal development. Family and community carers continue to visit and maintain their contact and support to residents. The manager and staff are keen to follow up opportunities for residents to be able to take part in activities suited to their individual abilities and choices. EVIDENCE: The home’s activities co-ordinator had been absent for several weeks due to ill health but was back at work and busy organising a Christmas show with staff ‘turns’ and karaoke with some of the residents who wanted to be involved. A carer with a particular interest in helping develop activities for residents was looking into possibilities for new activities and outings more suited to this younger client group. The home was bright and festive with Christmas decorations. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 12 Various Christmas events and special church services in the town were advertised. The manager had been out with a resident for Christmas shopping during the morning. Another resident had been out with his/her appointed care supporter - this person regularly visits the resident and makes sure that contact with staff and friends from a former care setting are maintained. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Residents are able to make choices and decisions about the way in which they are supported and cared for by the home’s staff. The system for the administration and control of residents’ medication is satisfactory overall, although recommendations are made to improve written records of medicines given and the storage of medicines kept in the drug fridge. EVIDENCE: Residents’ care plans, and conversation with care staff, showed that they are able to make choices about how they spend their days and that they are helped to be as independent as possible. Residents’ medication is securely stored in the Robert & Doris Care Home next door. They use the Nomad monitored dosage system for medication. The pharmacist sets out each resident’s prescribed tablets in a cassette box with separate compartments for each time of the day when the tablets are to be taken. The Medicine Administration Record (MAR) sheets are printed by the pharmacist. Some of the type-face was smudged. The pharmacy should be contacted and asked to ensure that the printer is producing clear copies to reduce the risk of staff making errors if the printed instructions are indistinct.
1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 14 There were some gaps on the MAR where staff had failed to enter their initials or a code letter to indicate whether the prescribed medicine had been given to residents. There were examples of handwritten changes to the MAR sheets that had not been signed by the doctor who had requested the change or a second staff member. It is good practice, and an additional safeguard against mistakes, to have the GP or a second staff member check and countersign any changes on the MAR sheet. The drug fridge temperature had not been checked daily and some previous recordings showed the fridge had not been working (the temperature recorded was 21°C on some occasions). On the inspector’s temperature probe the temperature measured 8.5°C, which is slightly above the maximum temperature recommended for the storage of medicines needing cool storage (between 2-8°C). The fridge needed defrosting. There were a number of prescribed skin creams stored in the fridge that may not need refrigeration and if applied to a resident when cold may cause them discomfort. The pharmaceutical information about the storage conditions for each medicinal product should be checked and followed. Two residents are partly responsible for storing and/or administering certain items of their own medication. Nursing staff make regular checks to ensure that the residents are confident and able to do this and that the dosages taken are correct. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not assessed on this occasion. EVIDENCE: 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 30 The home is clean, homely and comfortable. Outside there are parts of the grounds that are unsightly for residents to overlook, because the proprietor uses some of the site for the storing of building materials and discarded equipment. Residents have the use of a separate ground floor lounge in their house, and can use the shared dining room and communal rooms of the adjoining care home. EVIDENCE: A partial tour of the home was done – two of the residents were away from the home on shopping trips and were not available to ask permission to visit their rooms. The home was very clean throughout. The ground floor conservatory/lounge room has been equipped with a snooker table. Staff confirmed that residents’ permission is always asked if staff want to use this room for occasional meetings or training sessions. Outside, the link pathway between the laundry, 1 Butler’s Drive and the home was observed to have water draining onto the pathway and some damage to the outside lower wall of the staff smoking room/laundry building, possibly caused from water leakage. This was pointed out to the proprietor, as there is a risk of falls to staff and residents using the link pathway when wet or icy.
1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 17 The grounds at the back of the home were still unsightly with building materials, garden waste and old unwanted equipment. Though somewhat tidier than on previous inspections, the outlook from the shared garden used by residents of both homes gives a poor impression and should be better maintained. However, the proprietor has submitted plans to build a new purpose-built care home on the site and expects to be able to start work on this in 2006. The laundry facilities are located in a converted garage between 1 Butler’s Drive and the Robert & Doris Watts homes, and serves both establishments. The laundry was neat and tidy and staff are provided with protective clothing and alcohol-based hand gel to protect them from possible cross-infection. The filters of the tumble driers had an accumulation of lint. The filters should be cleaned more frequently to prevent a build up of fluff that could ignite and cause a fire. Residents’ meals are prepared in the kitchen in the Robert & Doris Watts Home and residents either choose to have their meals in their own rooms, or join the residents in Robert & Doris Watts in their dining room. An environmental health officer had recently inspected the kitchen and was satisfied with the standards of cleanliness and food handling and storage procedures in place. 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 & 36 The procedures for the recruitment of staff are not robust and do not provide evidence that adequate safeguards are in place to protect residents from potentially unsuitable people being employed to work in the home. The programme of formal supervision of care staff is not fully operational yet. EVIDENCE: The staff work in both the Robert & Doris Watts Home and 1 Butler’s Drive. The files of five staff recently employed by the home were checked, and one for a staff member who left the home several months ago. The home had not undertaken all the necessary recruitment checks to ensure the protection of residents. Criminal Records Bureau checks had not been received for recently employed staff. Two had only one reference on file. There was no recent photo for three of the staff on file. There was no record of interviews of prospective staff having taken place. Ms Eastwood said that the programme for formal supervision of all care staff had lapsed over recent months, but that she will ensure that regular supervision meetings take place from January 2006. Informal meetings and discussions about work topics happen on a daily basis with staff, but the opportunity for regular uninterrupted one-to-one’planned meetings is important - supervisors and supervisees should have the opportunity to discuss their expectations of their work performance and any training and development needs that they may have, and a plan of action be agreed.
1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not fully assessed on this occasion. EVIDENCE: 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 1 X 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
1 Butler`s Drive Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000048045.V271960.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 YA34 Regulation 19, Schedule 2 Requirement The home must not employ workers unless they have obtained satisfactory information and documentary evidence of ‘fitness’ for prospective employees. Timescale for action 22/12/05 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 22 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 YA20 Good Practice Recommendations Ensure that Medicine Administration Records are accurately completed at the time of administration of medicines. Ensure that the printed instructions are clear. Any handwritten amendments to the MAR sheets should be checked and countersigned, preferably by the doctor, or a second suitably qualified staff member. The drug fridge should be defrosted and maintained so that the temperature is consistently within the recommended range for storage of medicines requiring cool conditions. Clear the waste ground area of rubbish and unwanted equipment to improve the environment for residents and neighbours of the home. Ensure that rainwater is effectively diverted from the covered walkway to reduce the risk of staff or residents falling on wet or icy paving. Clean the lint filters of the laundry dryers more frequently to avoid the risk of fire. Maintain a checklist for staff files to ensure that the required checks and references have been received and are satisfactory in relation to prospective employees and that records are held of offers of appointment, terms and conditions and job descriptions. Two people should interview new staff and a record should be kept of the interview schedule and outcome. Implement the programme of formal supervision sessions for staff so that they have at least six sessions in any 12month period. Records of supervision meetings should be maintained. 2. YA24 3. YA34 4. YA36 1 Butler`s Drive DS0000048045.V271960.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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