Inspection on 18/01/06 for Watersmead

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Watersmead 30/01/08

Watersmead 04/10/06

Watersmead 25/07/05

Watersmead 18/01/05

Watersmead 16/09/04

Watersmead 02/03/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Watersmead White Horse Way Westbury Wiltshire BA13 3AU Lead Inspector Roy Gregory Unannounced Inspection 09:35 18 & 27 January 2006 th th 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 Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 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. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Watersmead Address White Horse Way Westbury Wiltshire BA13 3AU 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) 01373 826503 The Orders Of St John Care Trust Miss Alison Stenning Care Home 49 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (34), of places Physical disability (1) Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than thirty four service users with Old Age at any one time No more than fourteen service users with Dementia at any one time. Date of last inspection 25th July 2005 Brief Description of the Service: Watersmead was purpose built as a care home in 1984. It was originally owned and managed by the Local Authority. The home became part of the Orders of St John Care Trust in 1999. The home is single storey, built in a square figure of eight shape, which has the effect of dividing it up into smaller areas. Some rooms and facilities have views over courtyard gardens, others look over the external garden areas, which means rooms are light and airy. All accommodation is in single rooms, but none have en suite facilities. Watersmead has a secluded location on a housing estate, with sheltered housing next door. The home is a short level walk from the centre of the small town of Westbury, which has good public transport connections including a main line railway station. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9:35 a.m. and 5:35 p.m. on Wednesday 18th January 2006. The inspector spoke at length with six residents, including joining lunch in the dining room, and was also able to talk with some regular visitors to the home. The manager, Alison Stenning, was available through most of the day and made documentation available as necessary. Additionally there were conversations with care leaders, care and housekeeping staff, whilst provisions for safe keeping of residents’ monies were looked at with the home’s administrator. The inspector selected a number of care plans to compare observations and descriptions of care with written records. Other records consulted included those relevant to the administration of medications, and staff rosters. All of the communal areas were visited. The inspector returned unannounced to Watersmead on 27th January 2006 to examine care records for a former respite resident, some concerns having been raised about their care at the home through the local vulnerable adults procedures. Issues and requirements in respect of this matter have been addressed as part of this inspection. What the service does well: What has improved since the last inspection? The provider Trust has increased the staffing complement of the home, both by increasing by one the number of care staff on shift by day, and by creating a “care support” role within the housekeeping roster, to relieve care staff of duties such as bed-making, thereby freeing more time for care duties. A further newly created role is that of activities co-ordinator, a part-time post but one that has had a marked impact on everyday life in the home. There was now a programme of activities for each half-day in the week, plus special events that in January encompassed Burns Night, a film show, a race night and Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 6 a country and western evening. One resident really appreciated having more music in his life, one especially liked the quizzes and exercise sessions, whilst another commented that all had more opportunities to be sociable if they so chose. A gentleman said he had made friends in Watersmead and his life had improved as a result of moving there. In response to requirement at last inspection, pressure area care training had recently been provided to all care staff, to provide a baseline of knowledge on which attention to this area of care can be developed. 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. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 The admissions procedures in place, including assessment of the home’s ability to meet needs, have been by-passed in the case of short-term placements. This creates risk to individuals and the resident group because of lack of guidance to staff on care needs, and exclusion of individuals from the usual process of making decisions about their admission. EVIDENCE: Two instances of short-term placements have raised issues about the need for and nature of assessments in such circumstances. A person who was familiar with the home by way of day care attendance and two very short respite stays was admitted for a week’s respite stay without further assessment. They encountered difficulties that had not been anticipated. There was no “long term needs assessment”, the document on which Trust homes particularly rely for deciding whether the home will be able to meet identified needs, and which leads into formulating short-term care plans. Albeit in this case such an assessment might not have indicated the nature of difficulties subsequently encountered, it would have demonstrated the basis of decision to admit, and would itself have been reviewable in the light of experience. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 9 Another person was admitted on an emergency basis with reliance on their community psychiatric nurse’s assessment only. Other arrangements were required the following day due to non-compatibility of the person’s needs with the home’s provisions, and needs of other residents. In this case the referring professional was unaware of certain information that would have indicated the placement would be inappropriate. The referral was accepted in good faith by the home, and Miss Stenning said she has not allowed it to colour the trusting and supportive relationship existing between the home and the Community Mental Health Team. There had been no delay by the latter in recognising and rectifying the situation created. Emergency situations by nature depend upon such liaison working well, but the Trust might benefit residents’ interests by agreeing with referring authorities on the parameters of acceptance of emergency referrals, including a time frame within which the home would complete its own assessment and could demand an end to any placement thereby assessed as inappropriate. Miss Stenning had appropriately refused an earlier emergency referral of someone who clearly would not fit the home’s categories of registration. It was also noted that the review process within the home enabled identification of residents whose needs had become greater than the home could meet, leading to referrals for nursing assessments and discussions with families and care managers. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 Care planning processes, including review, are good, but all key needs of individuals are not included in care plans, and provision for respite users is inconsistent. There is evidence of close working relationships between the home and health providers, for the benefit of residents. But pressure area care is not based on risk reduction, nor are the home’s procedures for referral of pressure area concerns to nursing attention followed through. Medications practice is sound, but some related issues should be care-planned for individuals in consultation with prescribing doctors. EVIDENCE: Care plans seen showed a good standard of regular evaluation. In one instance, for example, there was clear evidence of a resident’s decline in ability and general wellbeing over time, and of the consequences for staff needs, which helped inform a decision that the home could no longer meet the person’s needs. Arrangements were in hand for their transfer to a nursing environment. Another area of good practice was in relation to risk assessments for falls, again with evidence of review and additions. Weights were regularly recorded for all residents, with significant changes responded to, and manual handling assessments were good. However, for a resident admitted for respite care, there was reliance upon care plans formulated during an earlier respite Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 11 stay, despite care notes showing much greater needs had arisen. The inspector was required through vulnerable adults procedures to examine the care record of this individual, following concerns on the part of family about how their relative had been cared for. A history of falls and other care matters, and staff attention to these, could easily be tracked through daily care notes, together with a record of a request for GP attention and the outcome of that, but the shortfall was in using this information to develop the written plan of care. Daily care records seen for other residents were also objective and gave a good picture of staff observations and practice, and residents’ responses. For permanent residents, one could see the link between recorded experience and reviews of care plans. Following previous requirement, care staff finally received pressure area care training in January 2006 from the area tissue viability nurse. The inspector saw certificates issued and some of the training material used. Feedback from staff was very positive. This needs to be followed by evidence of more consistent practice in this area of care. Care leaders said their expectation of care staff was to always use opportunities within personal care tasks to observe the condition of pressure areas, and to report on any concerns for district nurse attention. In one care record, however, recorded observation of red heels and treatment of them was not backed by the person’s care plan for “skin care”, neither was there any record in daily care notes or multi-disciplinary record of a referral to the district nurse. For another resident, a care plan for skin care said “carers to report any red areas or breakages to a district nurse”, but there was no record of such a referral following an entry that “X has a sore patch on the bottom, have creamed well.” The latter care plan was not informed by any assessment of risk of the person developing pressure area breakdown, which could have in turn led to a pro-active plan for minimising risk rather than the reactive stance of what to do when problems have begun. It was recommended at the previous inspection that “there should be provision within care plans for routinely considering changes in vulnerability to pressure area breakdown.” This recommendation is re-stated. Both the incidents above took place after the delivery of the pressure area training. As district nurses’ notes kept in the home confirmed staff expressions of a close working relationship with them, it may be that some practice including referrals has gone unrecorded by home staff. This is unsafe because accountability cannot be ascertained. The manager reported good working relationships with the community mental health team, with some specific guidance received about working with the mental health needs of some residents. The home is registered to provide care to a proportion of individuals with dementia, but this group are not readily identified from care planning documentation. One person’s care plan had no mention of management of dementia, yet care notes and the long term needs assessment showed clearly there was a condition to be managed, including night time issues in particular. Where “dementia” or “mental health issues” were mentioned, there tended to be no elaboration or even name of the nature Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 12 of the person’s difficulties. So, the strengths identified in the home’s care planning processes need to be extended to ensure they are comprehensive in addressing individuals’ key needs. It was recommended at the previous inspection that “Care plans should be expanded where appropriate, to address the management of behaviour patterns related to dementia or other mental health or communication needs.” This aspect of care is now subject of a requirement from this inspection. Medications were stored in a tidy, organised room. Hand-written changes in the Medicines Administration Record charts referred to doctors’ instructions and cross-referred to entries in care records and plans. Some medications needed to be administered outside the normal rounds, for example by night staff, in which case the reasons to do so were documented. In the few instances of residents’ self-medication, care plans contained risk assessments. There was sound practice in the storage and recording of controlled drugs. There was some inconsistency in how painkillers were administered, with some prescribed to be taken “as needed” (up to a daily limit) but evidently being given routinely, e.g. twice or three times a day. One prescription of paracetamol was for “1 or 2, four times a day”, but was being administered (and was blister-packed by the pharmacy) as 1 tablet twice a day. The resident’s care plan for medication referred only to a short-term course, now finished, of antibiotics. For safety, it is necessary to ensure a match between how any medication is prescribed and how it is taken. In the case of prescriptions “as needed”, there should be a care plan to show how this is to be determined, for example by asking the individual at each medicine round. The home manager had just received a new medications policy from the provider Trust, which appeared to confirm much existing good practice, with the addition of more written accountability. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 Systems and personnel are in place to identify and provide for residents’ social and religious needs and wishes. Provision of meals continues to be of a high standard. EVIDENCE: Since the previous inspection an activities co-ordinator had been appointed and there was evidence of much greater variety and regularity of activities on offer. Several residents remarked upon this. One really appreciated having more music in his life, one especially liked the quizzes and exercise sessions, whilst another commented that all had more opportunities to be sociable if they so chose. A gentleman said he had made friends in Watersmead and his life had improved as a result of moving there. The activities co-ordinator prepared and displayed a weekly list of activity sessions for each morning and afternoon of the week. This included items such as darts, word games, quizzes and reminiscence. As the activities co-ordinator post is for only 20 hours per week, she was using this time flexibly, including some weekend and evening times, to maximise her direct support to activities and special events. On each care shift, a care worker was designated to offer support to the activities co-ordinator, or to ensure the planned activity (or an alternative) took place in their absence. The activities co-ordinator had a role in residents’ meetings. Minutes of a meeting in October 2005 showed that Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 14 ideas were canvassed for outings, events, regular activities and Christmas celebrations. Special events in January 2006 included a Burns night, country and western evening, film show and race night. Records were maintained of activities run and individual participation, allowing for review of what was successful and how well individual needs and wishes were catered for. There was additional useful information, for example on the degree of encouragement a resident might need, or on sensory considerations. There were also social needs inserts in care plans. Residents were aware that participation in activities was a matter of personal choice. It is recommended that further consideration be given to the specific activities needs of those residents with dementia. Residents could refer to notice boards for activity information, also for details of all local churches and their services. The home itself hosted a communion service once a month, and a church service every Sunday, which many residents mentioned as important to them. Many residents went to the dining room for morning coffee, where there was a relaxed talkative atmosphere. New furniture and crockery had been provided since the previous inspection. These surroundings, combined with discrete and efficient service, also contributed to lunchtime being a pleasant sociable occasion. There were three choices of main course, including cold meat and vegetarian options; and two sweets. Staff showed appreciation of a person’s limited perceptions, balancing assistance with allowance for maximum selfhelp, for which a lipped plate was provided. A resident said how much he enjoyed his meal, which he considered typical. Residents’ meeting minutes showed that arrangements trialled last year for serving lunches were endorsed by the resident group as something they wished to remain in place. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 There are good formal and informal means for receipt of complaints, which receive appropriate investigation and action. Issues of risk to residents’ collective and individual wellbeing and security are identified and shared with appropriate agencies to maintain a safe environment. EVIDENCE: There had been one complaint to the home since the previous inspection, for which there was evidence of an investigation and full written reply to the complainant. In response to an alleged theft in the home, Miss Stenning involved the Police through local inter-agency vulnerable adults procedures. There was an inconclusive outcome. At the residents’ meeting in October 2005, there was discussion about keeping valuables safe and exercising the option of locking bedroom doors. The home can provide for safekeeping. There was evidence of informal discussion with residents’ families about support and assistance they could give in this area. An emergency admission to the home had been unsuccessful in that the person admitted unexpectedly presented a range of behaviours that could impinge on the peace and security of others. The placing authority was contacted at the first opportunity and arrangements made for transfer of the individual, primarily for the protection of residents. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 & 26 The environment is comfortable in terms of heat, light and safety, providing it is not allowed to be compromised by cold drafts. The home is kept clean and hygienic. EVIDENCE: All communal areas, including bathrooms and toilets, presented well in terms of décor and cleanliness. Behind many toilet cisterns were steel handrails that seemed to serve little purpose, and many of them were beginning to rust, so it was suggested these be removed in order not to pose a risk to hygiene. The inspector also considered liquid soap and paper towel dispensers to be fiddly to use, and probably not readily identifiable for people with dementia. Residents had been reminded at a residents’ meeting that they could call attention at any time to any toilet requiring to be cleaned before use, which can occur during hours not covered by housekeeper presence. Staff meeting minutes showed staff had been asked to ensure cleaning around bath hoists after every use, and the good condition of this equipment suggested this was being done. The sluice and laundry rooms were well organised and clean. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 17 At morning coffee and lunch the dining room felt cool. A resident at lunch complained of feeling very cold and was visibly so. This seemed less a matter of ambient heat levels, than paying attention to keeping doors closed to minimise drafts during cold weather. Elsewhere the home was warm, with appropriate light levels, and residents expressed no complaints about comfort in bedrooms. All hot water outlets used by residents were regulated to prevent delivery of potentially scalding water. A recently created secure garden area still awaited installation of safety glass in the summerhouse to allow for use as an additional communal area during warmer months. Miss Stenning said consideration was being given to how to create a smoking area within the home. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Residents are supported by a committed and caring group of staff, whose numbers have been increased and reorganised to meet residents’ needs more efficiently. Existing good provision for training has been supplemented by input of dementia-specific training. EVIDENCE: Rotas confirmed that staffing levels of six care staff (including a care leader) on morning shifts, and five on later shifts, were largely maintained. This was a marked improvement on the basic staffing level at the previous inspection, since when the provider Trust had authorised budgeting for additional hours. On the afternoon of the inspection there were only four on duty in the afternoon and efforts were being made to bring in relief cover from the home’s bank of four relief carers. The need to keep staffing levels up was highlighted by disruption to the afternoon staff handover, an important function, by attention to a resident who had fallen; ordinarily there would have been a staff member circulating among residents at that time, whereas all staff were in the care office. At the time of inspection, the total care team was short by 52 hours a week. Miss Stenning was confident that with a full staff team, for which recruitment was in progress, there would be no difficulty covering vacant shifts. As it was, the home had not needed to use agency staff for some time. Existing staff were easily covering a small shortfall of night carer hours. When asked, residents said staff were always available when needed urgently, and quality of care was praised. Good interactions between staff and residents were seen throughout the day. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 19 Care leaders and carers saw the activities co-ordinator role as having taken some pressure off them, directly and through residents being more occupied. A carer support post had also been devised to relieve care staff of duties such as bed making and seeing to commodes. Another newly created post of head of care, intended to support both the manager and care leaders, was subject of current recruitment. The housekeeper team was fully staffed, reflected in the high standards of cleaning around the home, whilst a decision had been taken to reallocate vacant seamstress hours to a laundry person’s post instead. The provider Trust has introduced a detailed training package on dementia care in association with the Alzheimer’s Society. All three care leaders had completed this training, and it was now the expectation that all care workers would do likewise. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35, 37 & 38 Residents experience an open style of management, with good communication channels within the home. Residents are offered transparent and safe support with maintaining control over their personal monies. Essential record-keeping is well maintained. Health and safety of residents and staff are systematically provided for. EVIDENCE: Relationships between residents, staff and management appeared sound and good-natured. Communication was furthered by residents meetings, occasional newsletters and minuted meetings for different groupings of staff, monthly in the case of care leaders. 36 out of 45 residents were making use of safekeeping arrangements for personal monies. They could access cash, kept individually for each resident using the facility, via key workers or direct to the administrator or manager, the latter two being the only staff with direct access. A sampled account Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 21 showed all transactions were double-signed. The administrator reconciled accounts approximately monthly, whilst there were occasional checks by visiting Trust staff and of individual accounts by relatives. At admission it was determined with residents or their families how they wished personal monies to be managed, whilst there were reminders to residents of the facility of safekeeping. The administrator no longer had any involvement with residents’ pensions, all now being subject to direct payment. In response to Fire Officer requirements, the fitting of fire shutters between kitchen and dining room was programmed for March 2006. Records of routine monitoring of fire precautions were very good. Accident records were descriptive and detailed, showing where decisions had been made to call for an ambulance or refer to A&E. The records cross-referred to care records. They showed evidence of monitoring, with a concurrent index allowing residents most at risk to be readily identified. Daily care records for individual residents were objective and gave a good picture of staff observations and practice, and residents’ responses. For example, the inspector was required through vulnerable adults procedures to examine the care record of an individual admitted for respite care, where there were concerns on the part of family about how their relative had been cared for. A history of falls and other care matters, and staff attention to these, could easily be tracked, together with a record of a request for GP attention and the outcome of that. There was a shortfall, however, in using this information to develop the written plan of care. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X 3 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 X 3 3 Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 23 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. 2. Standard OP3 OP7 Regulation 14(1)(2) 15 (2)(b,c,d) 17 (1)(a) 15(2)(b) 12(1)(a) Requirement There must be evidence of assessment of service users admitted for short stays. Care plans for respite residents must be reviewed at the commencement of each readmission. All referrals to district nurses must be recorded in “multidisciplinary notes” and reflected in care plans. For residents with dementia or mental health needs, care records must contain evidence of the nature of the individual’s condition, together with a plan for working with it. Ensure that there is no discrepancy between how any medication is prescribed and how it is administered, and institute a care plan for the use of any “p.r.n.” medication. Timescale for action 27/01/06 18/01/06 3. OP8 18/01/06 4. OP8 28/02/06 5. OP9 13(2) 28/02/06 Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 24 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. 3. 4. 5. 6. Refer to Standard OP3 OP8 OP12 OP25 OP26 OP26 Good Practice Recommendations The provider should consider developing protocols in respect of emergency admissions. There should be provision within care plans for routinely considering changes in vulnerability to pressure area breakdown. (Re-stated from previous inspection report). Consider how to provide activities specific to residents with dementia. Seek to reduce cold drafts in the dining room. Consider using more user-friendly dispensers for liquid soap and paper towels in toilets. Remove rusting steel handrails behind toilet cisterns. Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 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 Watersmead DS0000028279.V275529.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!