Inspection on 11/02/08 for Watford House Residential Home

This inspection was carried out on 11th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Watford House Residential Home 24/09/07

Watford House Residential Home 05/12/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Watford House Residential Home 263 Birmingham Road Shenstone Wood End Lichfield Staffordshire WS14 0PD Lead Inspector Pam Grace Unannounced Inspection 11th February 2008 11:30 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 Watford House Residential Home DS0000068404.V359510.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. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Watford House Residential Home Address 263 Birmingham Road Shenstone Wood End Lichfield Staffordshire WS14 0PD 0121 308 1342 0121 308 0429 watfordhouse@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) Watford House Residential Home Ltd Ms Kathryn Sonia Bridgeman Care Home 43 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (43), of places Physical disability over 65 years of age (17) Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th September 2007 Brief Description of the Service: Watford House is a privately owned Care Home registered to provide personal care to a maximum of 43 people. The home is a former farmhouse, which has been altered and extensively extended, and is a building of character. The home, situated on the Staffordshire border near Shenstone, is close to Blake Street railway station and served by a regular bus service. Teams of care assistants, reporting to the registered care manager, provide care. The home is registered to provide accommodation to a maximum of 43 residents, of which eighteen may have dementia, or related conditions and seventeen may have physical disabilities. The buildings are on several floors and have twentyfour single bedrooms and six double bedrooms. A total of seventeen single bedrooms have en-suite facilities. There are five separate lounge and dining areas, which cater for the different groups of people. District nurses, community psychiatric nurses and other professionals are accessed by the home when required. A local GP surgery and pharmacist service the home. NHS facilities and health services are accessed, and assistance is provided for residents to attend, when required. Activities, hobbies and entertainment all take place and transport is provided when required. The manager confirmed that the weekly fees for the home ranged from £338 to £380 per week. These are subject to annual review. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This visit was an unannounced key inspection and therefore covered the core standards. The inspection took place over approximately 9.5 hours by one inspector who used the National Minimum Standards for Older people as the basis for the inspection. Prior to the inspection the registered person completed an Annual Quality Assurance Audit (AQAA) for the Commission for Social Care Inspection. On the day of the inspection, the home was accommodating 37 residents. The inspection included a tour of the building and the environment, an examination of records, indirect observation, discussions, observation of residents who use the service, and discussion with four staff on duty. Case tracking of 4 residents’ care plans was also undertaken. Residents and relatives spoken with were very complimentary about the services that they and or their relative received. Comments such as “ I get on with the staff here”, and “ they always come when I call them”, “It’s very homely here, and I like the lounge”, were received. Due to the complex needs of some residents living in the home, we were unable to communicate effectively with all individuals present during the visit. Medication procedures and storage of medication were inspected. Many of the previous requirements had been met. However there were 2 requirements brought forward from the previous inspection, and 4 recommendations made as a result of this unannounced inspection. What the service does well: People who use the service spoke positively of staff and the support given. Staff were observed appropriately talking and supporting people. Staff welcomed visitors and guests in an appropriate manner. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 6 People who use the service are able to maintain contact with family and friends and are able to receive visitors in private. The home has different communal areas in which people may choose to spend time with friends and family. The residents spoken with and menus examined confirmed that residents do have a choice of either the main meal or another option. The daily menu was written up on the chalkboards, which are located in each dining area. Menus are changed on a regular basis, and residents spoken with said that their preferences are taken into account. This is done via one to one discussion with staff or during resident’s meetings. People who use the service are able to access trips out in the home’s dedicated mini bus. Trips include visits to the tearooms, and or to the local pub. What has improved since the last inspection? The home has a rolling programme of redecoration and the home has been redecorated in parts to maintain standards. A number of rooms have been fitted with new carpets or flooring. Staff training has continued, and almost all staff had either achieved or were working towards an NVQ qualification in care. Staff had recently received training in regard to dementia care, care planning and moving and handling. Care plan training had been undertaken since the previous inspection. The care plan pro forma had also been changed, and was much clearer and more uniformly used. Concerted efforts had been made to improve the information recorded and the quality of the risk assessments contained within care plans. Care plans are signed for by residents whenever possible, and the care manager is also involving family members in the sharing of care plans for residents. The provider had confirmed to the Commission for Social Care Inspection (CSCI) in his improvement plan, that work is ongoing in relation to the following: 1. Providing a locked drawer/cupboard for all residents, particularly in relation to those residents who self medicate. 2. Maintenance records seen clearly showed that checks of upstairs windows and emergency lighting for the home is undertaken on a regular basis and documented. 3. Removal of all extra handles to fire exit doors. 4. All deadlocks fitted to bedroom doors to be de-commissioned, and privacy locks suitable for the purpose to be fitted. 5. Fire detectors to be installed as per the Fire Officer’s recommendations. A certificate of compliance is awaited. 6. Fire doors identified by the Fire Officer are in the process of being fitted with in tumescent strips, which will better protect in the event of fire. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 7 The care manager was able to show the inspector during the visit that the above work is in progress. There is a clear and auditable record of residents’ finances maintained in the home for residents monies. These records were made available for the inspector to examine during the inspection visit. The registered person confirmed that receipts are obtained on behalf of residents, and are kept for auditing and monitoring purposes. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 8 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 Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 4, 5 and 6 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: The Statement of Purpose and Service User Guide were under review at the time of the inspection visit. In line with case tracking the inspector examined 4 resident’s care plans, and spoke with residents and relatives. The inspector noted that there was a new pro forma in place for the assessment and care planning process. Which included a social history, nutritional assessment, and all activities of daily living. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 10 Care plans seen were comprehensive, clear and had been reviewed. The inspector was provided with a copy letter, confirming that the home can meet the resident’s needs. This would be sent out to prospective residents. Preadmission assessments were also made available for the inspector to view, and were appropriately completed. The care manager confirmed that staff had received training since the previous inspection in relation to the new care planning process. Prospective residents and or their representatives are sent appropriate information, and are able to spend a day in the home prior to deciding to move in; residents spoken with during the inspection visit confirmed this. Senior staff would complete the assessment process during the visit. The manager confirmed that an assessment is always carried out by the home to ensure that the home is able to meet individual needs. The care manager confirmed that Intermediate care is not provided at Watford House. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. However, However topical creams for personal use in residents’ bedrooms, must be securely stored, and individual risk assessments must be kept up to date. EVIDENCE: In line with case tracking the inspector examined 4 resident’s care plans. A new pro forma was in place for the assessment and care planning process, which included a social history, nutritional assessment, moving and handling risk assessment and covered all activities of daily living. Care plans seen were comprehensive, clearly completed and reviewed. Since the previous inspection care staff had received care plan training, and a new pro forma had been introduced and adopted for all residents. The Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 12 inspector noted that efforts had been made by care staff to ensure that the information gathered and recorded was more person centred. The inspector discussed the need to provide recorded evidence within the care plan that the resident’s family or representative had been involved in the care planning and review process. The care plan should also be dated and signed. The score of 2 for this Standard reflects this shortfall. Care plans seen, residents and relatives spoken with confirmed that the health care needs of residents were being met. Care plans contained clear risk assessments. Although care plan reviews were being held, some of these risk assessments were not up to date and did not reflect the recent changes in the resident’s condition. This was highlighted and discussed with the manager. It is a requirement of this report that risk assessments are kept up to date. The home has two medication trolleys, one for each part of the home. The Monitored Dosage system (MDS) is used and medication is administered from Blister packs. Medication was stored securely, and examination of the system and Medication Administration Records revealed these had been accurately completed for administration purposes. However, the care manager confirmed that topical creams, were stored in residents’ individual bedrooms at the bottom of their wardrobes, this is unsafe practice, and is inappropriate, and the score of 2 for this Standard reflects this shortfall. The home has a separate medication fridge in a locked room. A small amount of medication was stored. Opened medication was appropriately dated. A daily record of the temperature of the medication fridge was kept, and temperatures were appropriate for the safe storage of medication therefore between two and eight degrees. The inspector observed during the visit that residents were treated with respect and dignity by caring and courteous staff. Residents and relatives spoken with confirmed this. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and are supported to develop their life skills. However, there is only limited access to social, educational, cultural and recreational activities, which may not meet individual’s expectations. EVIDENCE: Care plans seen included a social history of the resident, with individual hobbies and interests listed. This enabled staff to provide appropriate and more tailored activities for residents. The home provides a limited programme of specific in-house activities for people who use the service. Discussions with residents and relatives confirmed “there are also some opportunities for residents to be involved in arts and crafts”, and that “staff sometimes do get involved in running activities for residents, when time allows”. The care manager confirmed that the local mobile library visited the home once a week, and there was a range of books including talking books, for people to borrow. There are a variety of games in the home, and staff spoken Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 14 with said that they encourage residents to play board and card games. There is a movement and exercise session each week. However, the home does not have a dedicated activities organiser. Trips out are organised when the weather is fine, those trips include the use of the home’s minibus. However, during the winter months the residents are not out as much. Due to the complex needs of some residents living in the home, we were unable to communicate effectively with all residents present during the visit. The inspector recommended that some consideration should be given to residents who have dementia and or a limited ability to communicate in relation to activities. Relatives and staff spoken with confirmed that there were no restrictions on visiting from family and friends, and on the day of the inspection. A number of visitors were seen being welcomed into the home. The design of the home provides seating within the communal areas of the home where individuals can entertain their visitors, in addition to the privacy of their own room. There were no individuals in residence from ethnic minority groups or anyone with specific religious needs. Staff reported a representative from the local Church of England Church visits the home monthly, to conduct a service, and individuals are able to receive Holy Communion. This service reflects the religious observance of people in the home. The home has three dining areas; one is adjoined to the main kitchen. Food is transported on a hostess trolley to other areas. The menu for the day was displayed in the home using a chalkboard in each dining room. This was a very positive change brought about since the previous inspection. Residents said that they were “very happy with the choice of meals”, and were “able to see what meals were to be served that day”. They said that the chalkboards were “an excellent idea”. Menus seen included an alternative choice of meal option for residents. The manager and residents spoken with confirmed that residents have their say on a one to one basis in relation to feedback about meals and choices. Residents said that their “views are listened to”. Plans of care recorded that some people needed either a diabetic or low fat diet. The manager reported that the cook has a list of recommended foods for people’s dietary needs. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: The complaints procedure is displayed in the main entrances of the home. The procedure records that individuals can make a complaint at any time, and if not resolved can approach the Commission for Social Care Inspection. The contact details for the Commission were not accurate and the inspector noted that the new CSCI address had not yet been changed. This was highlighted and discussed with the care manager, and will be amended as soon as possible. There had been three safeguarding adults referrals since the previous inspection, two of those three were also dealt with by the home and CSCI as complaints. One complaint was in progress at the time of this report. A recommendation was made in relation to the establishing and maintenance of clear lines of communication and systems between senior staff and the care manager. This was made as a result of the outcome of one complaint, which was partly upheld. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 16 Discussions with staff revealed that staff were aware of the safeguarding adults procedures and how to respond to an alert. Staff spoken with were aware of what constituted adult abuse, and confirmed that they had received training in that area. Discussions with residents and relatives confirmed that they would know who to complain to, although residents did say at the time that they” had no complaints”. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24 and 26 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home must enable people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. EVIDENCE: Watford House is a former farmhouse, which has been altered and extensively extended, and is a building of character. The building is on several floors and has twenty single bedrooms and six double bedrooms. Seventeen single bedrooms have en-suite facilities. The home is operated in two units, the former farmhouse and the extension. The original home has retained many character features and all rooms are of different sizes and styles. Individuals are able to bring personal possessions to the home. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 18 The home has two garden areas, one of which is enclosed. The gardens have raised beds and residents spoken with said when the weather was good they enjoyed spending time sitting outside the home relaxing in the garden. Discussion with the maintenance person confirmed that there is an ongoing maintenance schedule, and that as tasks are undertaken and completed, the work is signed off. He and the registered provider confirmed that the following work was in progress: 1. Providing a locked drawer/cupboard for all residents, particularly in relation to those residents who self medicate. 2. Maintenance records seen, clearly showed that checks of upstairs windows and emergency lighting for the home is undertaken on a regular basis and documented. 3. Removal of all extra handles to fire exit doors. 4. All deadlocks fitted to bedroom doors are to be de-commissioned, and privacy locks, suitable for the purpose are to be fitted. 5. Fire detectors to be installed as per the Fire Officer’s recommendations. A certificate of compliance is awaited. 6. Fire doors identified by the Fire Officer are in the process of being fitted with in tumescent strips, which will better protect in the event of fire. The inspector was able to confirm during a tour of the building that the above work was in progress. It is anticipated that the Fire Officer will visit in March in relation to Fire Compliance and the issuing of a Certificate. The inspector requested that a copy of the Certificate of Compliance is forwarded to CSCI. Each bedroom has two locks on the door, a universal star key and a Chubb style lock. At present only one resident has a key to their room. However, keys are available if a resident requests one. The registered provider is in the process of de-commissioning the existing locks, in consultation with the Fire Officer. The inspector noted that one bed rail remained insecure, despite a number of attempts to secure it. This was highlighted and discussed with the care manager. The bed rail in question will need to be repaired and or replaced, and further risk assessed, advice will need to be sought by the care manager in regard to the suitability of the bed. The care manager and care plans seen confirmed that where bedrails were fitted to a bed, an assessment of risk was completed. The care manager confirmed that the home has four hoists for use in the home. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 19 The home has a number of assisted bathrooms, including a recently fitted whirlpool bath, with hydro jets and shower attachments. There are suitable washing facilities for residents. The care manager reported that the equipment used by staff meets appropriate health and safety, and infection control standards. The laundry area was fully functioning, clean and tidy, with the appropriate separation of clean and soiled linen for infection control. Staff reported that red alginate bags are used when appropriate and placed on a sluice cycle to ensure that infection control standards are met. Hand washing facilities were in place for staff, in line with infection control procedures. The home has a programme of redecoration and the home has been redecorated in parts to maintain standards. A number of rooms have been fitted with new carpets or flooring. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. EVIDENCE: On the day of the inspection the manager was on duty from 7.30 – 2.30pm and worked in a supernumerary capacity. Staff rotas confirmed the following staffing levels: The care team consisted of 1 senior care working 7.00am – 2.00pm 5 Support workers working 7.00 – 2.00pm During the afternoon there was 1 senior care working from 2.00pm – 9.00pm 5 support workers working from 2.00 – 9.00pm. The home has two domestic staff working from 7.00am – 2.00pm. The cook worked from 7.00am – 2.00pm And a maintenance person worked from 8.00am – 5.00pm. At night time Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 21 1 senior care worked from 9.00pm – 7.00am 2 support workers worked from 9.00pm – 7.00am The inspector interviewed 4 staff members. Staff spoken with confirmed that they had completed an application form, and provided appropriate identification and 2 references prior to commencement of employment. The care manager confirmed that the home had recently started using the “Skills for Care” format in relation to the induction of new staff. The care manager discussed a member of staff’s recruitment file, which contained all the necessary checks including CRB and POVA Police checks, however, the file contained only one reference instead of two. The home was still awaiting the second reference. This will be closely monitored and appropriate action taken by the care manager. All staff spoken with confirmed that they were receiving supervision. The inspector was shown the pro forma used for staff supervision. The inspector noted that each member of staff had a staff training record. Records seen were up to date, and evidenced that the following training had taken place: Moving and handling, food hygiene, fire, adult protection, dementia care and care planning. Staff interviewed also confirmed this. The inspector discussed the use of a main training matrix, which would enable all training to be seen `at a glance’. Therefore making it easier to see which staff members had received what type of training. Staff spoken with, were generally satisfied with the management of the home, however, some staff felt that complaints or concerns were not taken seriously by the registered provider. This was highlighted and discussed with the care manager. Complaints and Concerns are monitored through the inspection process, and will continue to be monitored. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. However, Fire Compliance is yet to be achieved, and a more effective quality assurance system must be developed by the care manager/provider. EVIDENCE: The care manager has worked at the home for a number of years and staff reported that she is supportive and is always available if required. The registered provider had reviewed the management arrangements in the home and the home no longer had two deputy managers supporting the manager; however, a senior care worker leads each shift. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 23 Staffing levels, Staff Supervision and Staff Training have all met the National Minimum Standards. Resident’s individual finances are usually managed by their own family, and or their representative. There are exceptions, e.g. in relation to a named resident whose monies are managed by a Local Authority. Resident’s personal monies are held securely by the home, receipts are issued on receipt of cash payments. Records are kept as well as receipts of expenditure. These were made available for the inspector to examine during the inspection visit. There is a clear and auditable record of residents’ finances maintained in the home for residents monies. These records were made available for the inspector to examine during the inspection visit. The registered person confirmed that receipts are obtained on behalf of residents, and are kept for auditing and monitoring purposes. Staff training has continued, and almost all staff had either achieved or were working towards an NVQ qualification in care. Staff had recently received training in regard to dementia care, care planning and moving and handling. Care plan training for care staff had been undertaken since the previous inspection. The care plan pro forma had also been changed, and was much clearer and more uniformly used. Concerted efforts had been made to improve the information recorded and the quality of the risk assessments contained within care plans. Care plans are signed for by residents whenever possible, and the care manager is also involving family members in the sharing of care plans for residents. However, evidence of their involvement should be clearly recorded and documented. The provider had confirmed to the Commission for Social Care Inspection (CSCI) in his improvement plan, that work is ongoing in relation to the following: 1. Providing a locked drawer/cupboard for all residents, particularly in relation to those residents who self medicate. 2. Maintenance records seen clearly showed that checks of upstairs windows and emergency lighting for the home is undertaken on a regular basis and documented. 3. Removal of all extra handles to fire exit doors. 4. All deadlocks fitted to bedroom doors are to be de-commissioned, and privacy locks suitable for the purpose to be fitted. 5. Fire detectors to be installed as per the Fire Officer’s recommendations. A certificate of compliance is awaited. 6. Fire doors identified by the Fire Officer are in the process of being fitted with in tumescent strips, which will better protect in the event of fire. The care manager was able to show the inspector during the visit that the above work was in progress. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 24 Two fire doors had been highlighted within the home as being defective, suitable work had been carried out to ensure that in the event of a fire, persons were not placed at risk. Suitable closures to the doors had been fitted, to ensure that in the event of a fire the doors close. The Fire officer had also previously identified that ‘a number of fire resisting doors were found to be either not fully self-closing, ill fitting within their frames or had ineffective cold smoke seals’. The registered provider confirmed this was in the process of being addressed. The registered provider must forward a copy of the Fire Compliance Certificate to CSCI in relation to works carried out. This is in compliance with British Standards. The registered provider reported that an external agency had been consulted and the home’s fire risk assessment was being reviewed. A copy of the assessment in line with the Fire officers report is to be forwarded to the Commission. The home has a programme of redecoration and the home has been redecorated in parts to maintain standards. A number of rooms have been fitted with new carpets or flooring. An effective quality assurance and quality monitoring system, based on seeking the views of people who use the service, should be put in place to measure the success in meeting the aims, objectives and statement of purpose of the home. There had been three safeguarding adults referrals since the previous inspection, two of those three were also dealt with by the home and CSCI as complaints. One complaint was in progress at the time of this report. A recommendation was made in relation to the establishing and maintenance of clear lines of communication and systems between senior staff and the care manager. This was made as a result of the outcome of one complaint, which was partly upheld. Many of the previous requirements and recommendations had been met. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 25 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 2 3 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 1 X 3 3 2 2 Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 13 (4)(b) Requirement Assessments of risks are to be reviewed to ensure they are accurate and up to date and clearly record how identified risks are to be reduced and people supported. Previous timescale 24/11/07 not met All medication within the home needs to be securely stored including personal medication for use in bedrooms. Previous timescale 25/09/07 not met Timescale for action 31/05/08 2. OP9 13 (2) 11/02/08 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 OP7 OP12 Good Practice Recommendations Plans of care should clearly record evidence of involvement by the individual or their representative and be dated to ensure that people are aware and agree to the plan. Some consideration should be given in regard to activities DS0000068404.V359510.R01.S.doc Version 5.2 Page 27 Watford House Residential Home 3. 4. OP32 OP33 for residents who have dementia and or a limited ability to communicate. Clear and consistent lines of communication should be established and maintained between senior staff and the care manager. A quality assurance system should be developed and implemented, based upon seeking the views of residents and other stakeholders of the service. Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Watford House Residential Home DS0000068404.V359510.R01.S.doc Version 5.2 Page 29 - 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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