Inspection on 24/09/07 for Watford House Residential Home

This inspection was carried out on 24th September 2007.

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

Watford House Residential Home 11/02/08

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 Mrs Mandy Brassington Key Unannounced Inspection 24th September 2007 10:00 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.V349488.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.V349488.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 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.V349488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2006 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 twenty four 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 stated on 28 September 2007 that the weekly fees for the home ranged from £320 to £380 per week. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was an unannounced key inspection and therefore covered the core standards. The inspection took place over nine 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. There were no completed questionnaires returned from people who use the service, relatives or professionals. A tour of the home was undertaken. On the day of the inspection, the home was accommodating thirty-three people. The inspection included an examination of records, indirect observation, discussion and observation of six people who use the service, and four staff on duty. Case tracking of five care plans was undertaken. Four staff records were examined and observation of daily events took place. Due to the complex needs of some people living in the home, we were unable to communicate effectively with all individuals present during the visit. Inspection of the storage system and medication procedures were inspected. An Immediate requirement notice was issued on the day of the inspection in relation to, medication and fire equipment and safe evacuation. Twenty-eight requirements and two recommendations were made as a result of this visit. 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. People who use the service are able to maintain contact with family and friends and able to receive visitors in private. The home has different areas in which people may spend time with friends and family. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The plans of care do not always promote individual care for people who use the service. There is poor information, which is not always up to date or accurate. Monthly reviews are not linked to the information within the plans and people who use the service are not involved with the care planning process. The home accommodates people with dementia, although there are no specific therapeutic activities or support provided in the home for people with dementia. Plans of care do not record the specific needs to support staff to meet provide care to people with dementia. Medication procedures need to be developed and support given to staff. Current practices of recording new medicines and safe cold storage of medicines is not adequate. A record of finances is maintained in the home, but systems in place mean that money is managed within one joint account. A review of the current procedures needs to be carried out and to consider the financial arrangements made in the persons best interests. Staff skills and knowledge for recognising types of abuse and how to record this information and respond to an alert needs to be developed. This will mean that staff will be able to follow agreed safe guarding procedures. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 7 People who use the service have a limited choice of foods, as only one main meal is prepared each meal time. Simple alternatives can be prepared but this means people may not be provided with a suitable nutritious diet. Fire precautions in the home were not suitable and two door closing devices had failed, meaning doors were wedged open. Emergency lights had not been tested and mobility aids stored in corridors. This means that people had been placed at risk as equipment had not been suitably maintained and safe evacuation potentially hindered. 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.V349488.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.V349488.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): 2, 3, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective people who use services have a needs assessment carried out before they are admitted to the home. Individuals are given the opportunity to spend time in the home. EVIDENCE: The manager reported that an assessment is carried out by the home to ensure that the home is able to meet individual’s needs. Individuals are able to spend a day in the home prior to deciding to move in; people who used the service confirmed this. Senior staff complete the assessment process during the visit. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 10 Four plans of care were inspected, and the assessment was not dated or signed, and did not evidence who was involved in the assessment process. It was therefore difficult to establish when the assessment was completed, and the accuracy of the information. There was no evidence that the registered person had confirmed in writing that the home could meet the needs of the assessed person; the manager confirmed this had not been completed. The home does not provide intermediate care. Watford House Residential Home DS0000068404.V349488.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, 10, 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Each person has a plan of care but practice of involving people who use the service in the development and review of the plan is variable; the plans are not detailed or person centred. Practices for ensuring accurate information is recorded on the Medication Administration records is not robust, and cold storage of some medicines are not suitable and could place people at risk. EVIDENCE: Five plans of care were inspected, the plans were not dated and did not evidence who had formulated the plan. The manager and staff stated that Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 12 senior staff completed the plans, and people who use the service were not supported to participate. Upon admission, the home had completed a form, which was signed by a representative of the person, to agree to information within the initial plan, though this had not been reviewed. It is required that plans and reviews of the plans, evidence involvement with people who use the service or their representative. The plans were basic and included poor information about the person and the support required. Information was limited to a few sentences recording an overall summary of needs, and focused upon continence, diet and mobility. Where a person was mobile, a monthly record of their weight was recorded. The plans of care included an assessment of risk for moving and handling. The information was basic and did not give details of the support people required, stating only ‘two carers’ where support was needed. One assessment recorded that the person was able, and also required two carers. Discussion with the manager revealed that this person was not able to mobilise independently, and sometimes required the use of a hoist; the assessment did not record moving equipment may be required. The plans included a nutritional risk assessment and a Waterlow assessment. Two plans stated that people needed a low fat diet, upon questioning, it was revealed that this was due to high cholesterol; this was not recorded. An assessment of risk was completed for whether people required supervision within the home, or in the grounds, and support for eating and drinking. The assessment recorded whether people needed to be supervised or not, but did not record how any identified risk was to be reduced. The home accommodates people with dementia. Information relating to dementia, specific support needs, and information about the person and their life was absent from the plan. The manager reported that senior staff complete a monthly review of the plans, this was done by recording specific events within the progress record, and was not linked to the plan of care. Detailed discussion took place with the manager and provider regarding the need for suitable plans, which addressed individual’s needs. Any review should be linked to the plan of care, and details of any changes recorded, to ensure the plan reflects up to date and accurate information. All people were well presented and dressed in a style of their choosing. From observation, it was evident, that staff have ensured that individuals are able to receive support to address personal care issues and personal hygiene. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 13 The manager reported that a separate record of a person’s preference in the event of death was recorded. On the day of the visit, staff were observed sensitively supporting an individual and family members due to bereavement. The manager confirmed that family members are contacted if there is any cause for concern. 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. Where there had been a change in medication during the month, the Medication Administration sheets (MAR) were completed by staff. All entries on a MAR sheet must be recorded by two people and signed to evidence this to ensure accuracy. The home has a separate medication fridge in a locked room. A small amount of medication was stored. One medication recorded that it was to be disposed of after twenty-eight days; this was still being used, although the box recorded the date of opening. A daily record of the temperature of the medication fridge was recorded. Upon inspection the temperature was twelve degrees; medication inside the fridge was to be stored at between two and eight degrees. The registered person must ensure that medication is stored appropriately, and a record maintained of the maximum and minimum temperature. Suitable checks are to be made to ensure the integrity of the stored medicines. During a tour of the building, within three bedrooms, personal medication was left in the rooms. This was discussed with the manager, as all medicines must be kept securely. An Immediate requirement notice was issued in relation to the current Medication practices. The home must review the current systems and practices to ensure the health and welfare of people who use the service. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 14 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, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home tries to be flexible and attempts to provide a service with opportunities for interaction and events within the current staff and resources. People are able to maintain good relationships with family and friends and receive visitors at any time. The menu provided does not offer people a choice of meals and people are not aware of the planned meals. EVIDENCE: The home provides two, one-hour sessions of specific in-house activities for people who use the service, and there is a movement and exercise session each week. Discussion with staff and people revealed there are opportunities to be involved in arts and crafts, and one person reported they had been Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 15 making a decorative bird house. The craft items were displayed around the home. One person reported that the library van visited the home once a week, and there was a range of books including talking books, for people to borrow. The home has a variety of games in the home and one person stated ‘the staff will play drafts and other board or card games, they often stay past there shift so we can have a game’. Further discussion with people who use the service and staff revealed that during previous years, trips had been organised to a local garden centre, a canal trip. Three people confirmed that trips to places of interest were limited this year; two people stated they had been on a shopping trip. One person reported they enjoyed sitting in the garden when the weather was warm, ‘the garden is lovely, it’s nice to be outside, but I don’t want to go out anywhere.’ Due to the complex needs of some people living in the home, we were unable to communicate effectively with all individuals present during the visit. The Provider reported that a former ambulance had been purchased, and there were plans to renovate the vehicle to support people to go out in the local community. Staff reported 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 the 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 adjoined to the main kitchen and where food is transported on a hostess trolley to other areas. On the day of the inspection the meal served was beef burgers in gravy, potatoes and vegetables, and dessert of semolina and prunes. The menu for the day was not displayed in the home and people were not aware of the meals to be served. Discussion with staff and people who use the service revealed that there is only one meal prepared and individuals are not provided with a choice. One person reported, ‘the food is generally good here, but you can’t expect to like everything.’ Opportunities and choice of meals was discussed with the registered persons. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 16 Plans of care recorded that some people needed a low fat diet. Discussion with the manager revealed that this was due to people having high cholesterol. The manager reported that the cook has a list of recommended foods for people’s dietary needs. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure fails to give clear information about who to complain to, and contains out of date information relating to contact details. Staff have little awareness of abuse and its many forms, how to respond to safeguarding issues in the home and suitable records to be maintained. EVIDENCE: Outside of the provider’s office the complaints procedure is displayed. 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 were five years out of date, demonstrating the policy had not been reviewed. The registered person must review the procedure to inform people that they are able to contact the Commission at any time, and the correct contact details and phone number are to be recorded. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 18 There has been one safe-guarding adults referral since the last inspection, and the registered person carried out an internal investigation, in addition to visits made by the placing authority. This safeguarding referral was still active at the time of the visit. Discussion with staff revealed that people were not aware of the safeguarding adults procedures and how to respond to an alert. Staff need to be supported to deal with suspicion of abuse, how to manage an alert and recording processes. An audit of care practices and support, assessments and daily records was carried out in detail with the manager. The audit could not be conducted comprehensively as there was poor information contained in the plan, daily notes, nursing notes and the assessment as is required. This was discussed in detail with the manager and a review of current recording practices is required. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24, 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use the service are encouraged to personalise their bedrooms and rooms are only shared in limited situations. The bathrooms and toilets are fitted with appropriate aids and adaptations and near to people’s rooms. Specialist equipment to support mobility and keep people safe has not been assessed, and in some cases poorly maintained, and ill-fitted, placing people at risk. EVIDENCE: Watford House is a former farmhouse, which has been altered and extensively extended, and is a building of character. The buildings are on several floors Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 20 and have twenty single bedrooms and six double bedrooms. Seventeen single bedrooms have en-suite facilities. The home is operated in two units, the former farm house 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. The home has two garden areas, one of which is enclosed. The gardens have raised beds and people stated they enjoyed spending time outside of the home relaxing in the garden. Each bedroom has two locks on the door, a universal star key and a chubb style lock. One person has a key to their room. The locks on the door do not meet fire safety requirements; where an individual has a lock to their bedroom a suitable lock must be fitted to the bedroom door, in consultation with the fire officer. The registered person must demonstrate that all existing locks have been decommissioned. Within the extension, wheelchairs were stored in the hallway. All fire evacuation routes must be kept clear of obstructions. Suitable storage facilities must be provided to store equipment. The home has a stock of wheelchairs and walking aids. The manager reported that these are available to people who use the service. Discussion with the manager and examination of plans of care, revealed there was no evidence available that the equipment was suitable, and people were able to use the equipment safely. It is required that people receive an assessment by a qualified and competent person, and suitable equipment is provided based upon the assessment. The two doors to the dining areas and lounge in the original building, and the door to the extension had two door handles fitted, one at a higher level to restrict access. This was discussed with the registered provider and manager in relation to agreement and assessments to this restriction. During the visit two people were observed trying to gain access to the dining area but were restricted as the door had been closed. The registered person stated there was no reason to have these restrictions in place and the second handle would be removed. A number of people at the home use bed rails. One person had a ripple mattress on the bed and bed rails fitted. An assessment for use of the mattress was not available, and an assessment of risk for the bedrail, suitability and usage had not been completed. The bedrail was insecure and let the bedrail move away from the bed. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 21 Where bed rails are used within the home, an assessment of risk is to be completed for the suitability of the bedrail, and the bed and bed base in combination for the person. The bedrail is also to be regularly maintained and inspected. An assessment of risk is to be completed for all individuals requiring bed rails, and suitable safe equipment is to be provided following the assessment, to ensure the person is not placed at risk. An immediate requirement notice was issued in relation to the bedrails. The home has two hoists for use in the home. On the day of the inspection, only one hoist was in use. The registered person stated that parts had been ordered for the second hoist and they were awaiting delivery. Staff were observed having to take the one hoist around the extensive network of corridors. Discussion with staff revealed that people have to wait if they require the hoist to transfer. This is of particular concern when there is an urgent need and when people must wait to address personal care needs. The hoist needs to be suitably repaired or additional equipment be provided. Three bedroom windows were not suitably restricted and there was no assessment of risk in place. One window did not have any restrictor in place. All windows above ground level are to be risk assessed and where appropriate suitable restrictors are to be fitted. The home has a number of assisted bathrooms and the registered person has recently installed a new whirlpool bath, with hydro jets and shower attachments. There are suitable washing facilities and the manager reported that the equipment meets appropriate infection control standards. Staff reported that red alginate bags are used and placed on a sluice cycle where people are incontinent to ensure there infection control standards are met. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 22 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, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a good recruitment procedure that ensures suitable checks are carried out to protect people from harm. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards. Where there are gaps in skills and knowledge suitable training needs to be provided to ensure people are protected and supported. EVIDENCE: On the day of the inspection the manager was on duty from 7.30 – 2.30pm and worked in a supernumerary capacity. The care team consisted of 1 senior care working 7.00am – 2.00pm 4 Support workers working 7.00 – 2.00pm During the afternoon there was 1 senior care working from 2.00pm – 9.00pm Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 23 4 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 1 senior care worked from 9.00pm – 7.00am 2 support workers worked from 9.00pm – 7.00am The manager reported that this was the usual pattern of shifts and numbers for the home. Inspection of three staff files demonstrated that the home has robust recruitment procedures, and for new staff an application is completed, references sought and an enhanced Criminal Records Bureau Check is completed. Discussion with staff and examination of training records demonstrated that staff have received training for dementia care, safe administration of medication, health and safety, fire marshalling and food hygiene. The manager reported that training is to be provided for Mental Capacity Act and managing complex behaviour. As addressed within the Outcome group for complaints and Protection, staff require training for recognising signs of abuse and the safeguarding adults procedure. Discussion with the manager and staff confirmed that people had received training to support people with dementia. The registered person needs to review the practices in the home, to ensure that the skills of the staff are used to incorporate best practice in the home for people with dementia. The manager reported that that three staff are currently undertaking training for a National Vocational Training (NVQ) II, all other staff have already trained to a Level II or III standard, and there is only one person working in the home who does not hold an NVQ certificate. This exceeds the recommendation within the National Minimum Standards. Discussion with staff and observation of practices revealed that staff had a positive attitude and respect for people who used the service. Staff talked to people in a sensitive and respectful way. One person reported, ‘I wouldn’t leave here to go to another home, the girls are really good.’ Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered person needs to promote safeguarding and ensure that health and safety requirements and legislation are met, to ensure the safety of people who use the service. Absence of suitable fire equipment and precautions has placed people of risk, due to poor consideration of safe evacuation procedures and maintenance of equipment. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 25 EVIDENCE: The 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 person has reviewed the management arrangements in the home and the home no longer has two deputy manager’s supporting the manager; a senior care worker leads each shift. Personal allowances are paid directly into a Joint Homes account and a record is maintained of individual balances in the home. It is a concern to the Commission that individuals do not have their own bank account, and the registered person does not support people to maximise their personal monies, and provide opportunities to earn interest. The Care Homes Regulations clearly state that the registered person shall not pay money into a bank account unless the account is in the name of the service user. This practice is to be reviewed. Fire records were examined and emergency light testing had not been conducted since February 2007. An inspection by the Fire officer in January 2007 identified that emergency lights are to be tested monthly. It required that the lights are tested on a monthly basis, as reported by the Fire officer. Two fire doors had been highlighted within the Fire Book as being defective on 21.06.07 and 14.08.07 respectively and were wedged open. Suitable work had not been carried out to ensure the in the event of a fire persons were not placed at risk. It is required that suitable closures to the doors are fitted, to ensure that in the event of a fire the doors close. The fire officer also 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 person confirmed this had not been addressed. The fire officer noted that all required work on the fire warning system to be in compliance with British Standards, should have completion a certificate of installation and commissioning, and a copy forwarded to the Fire Authority. This has not been addressed. The registered person reported that an external agency had been consulted and the 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 and will be inspected on the next visit. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 26 An immediate requirement was issued to ensure the home has suitable equipment to maintain fire equipment and ensure people are protected from the risk of fire. Prior to the Inspection the registered person had completed an Annual Quality Assurance Audit for the Commission for Social Care Inspection. The information recorded did not always correspond to the specific outcome groups. The registered person must ensure that this completed is completed in conjunction with the National Minimum Standards and accurately records the service provided for each Outcome group. Due to the poor outcomes for individuals in relation to health and personal care, complaints and protection, environment and conduct and management of the home, the home will be subject to a Management review by the Commission for Social Care Inspection. A management review is a key part of the enforcement process whereby the Commission sets out what we will do to get the care provider to improve their service. The action the Commission will take will depend upon what effect this is having on the people using the service and how the care service provider responds. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 3 X 1 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 X 2 X 2 X X 1 Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1)(d) Requirement To confirm in writing the home can meet peoples assessed needs in respect to their health and welfare. Plans of care must 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. Plans of care are to be reviewed to ensure that information gathered and reviewed is person-centred and reflects the needs and support required to ensure suitable support is required in a consistent manner. These are to be signed and dated. 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. Timescale for action 30/10/07 2 OP7 15 (1) 24/11/07 3 OP7 15 (1) 24/11/07 4 OP7 13 (4)(b) 24/11/07 Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 29 5 OP9 13 (2) All medication within the home needs to be securely stored including personal medication for use in bedrooms. Where there are any changes entered on a Medication Administration Record (MAR) Sheet must be entered by two members of staff, and signed to ensure accuracy. Where medication must not be used after a specified time to ensure people receive viable medication, safe disposal of the medication must be carried out by the date recorded. 25/09/07 6 OP9 13 (2) 25/09/07 7 OP9 13 (2) 25/09/07 8 OP9 13 (2) A record of the maximum and 27/09/07 minimum temperature of the medication fridge is to be recorded daily. Suitable checks must be carried out to ensure the integrity of the medicines stored has not been compromised. People who use the service must be provided with a real opportunity for a choice of menu in keeping with their plan of care and preferences. A clear complaints procedure is to be produced to ensure that people know how to make a complaint and who to make the complaint to. To ensure that people are protected from harm and abuse, staff must be aware of how to recognise signs of abuse and how to safeguard people and respond to an alert. To ensure safe evacuation for DS0000068404.V349488.R01.S.doc 9 OP15 16 (2)(i) 30/10/07 10 OP16 22 (1)(2)(7) 24/11/07 11 OP18 13 (6) 30/10/07 12 OP19 23 30/09/07 Page 30 Watford House Residential Home Version 5.2 (4)(c)(iii) people who use the service, mobility aids are to removed from corridors First floor windows within the home must be assessed for risk they present to people who use the service and action taken to minimise any identified risk. Where there are any restrictions limiting people’s movement in the home, this must be assessed for risk and any agreement recorded. Doors off the dining room and lounge currently have 2 handles restricting people in the home, as schedule 3 (3)(q) People have been identified as requiring the use of a hoist. Suitable equipment in such numbers to meet peoples needs must be provided in the home. Where people who use the service have difficulty with moving and mobility, suitable assessments by a competent qualified person is to be conducted and assessed equipment provided. 24/11/07 13 OP19 13 (4)(a)(c) 14 OP19 17 (1)(a) 24/11/07 15 OP22 13 (5) 24/10/07 16 OP22 13 (5) 30/11/07 17 OP22 13 (4)(c) Where bed rails are used within 25/09/07 the home, an assessment of risk is to be completed for the suitability of the bedrail, and the bed and bed base in combination for the person. The bedrail is also to be regularly maintained and inspected. Where people wish to have a lock to their bedroom this must be assessed for risk and a suitable lock fitted in conjunction with the Fire officer. DS0000068404.V349488.R01.S.doc 18 OP24 13 (4)(c) 24/11/07 Watford House Residential Home Version 5.2 Page 31 19 OP24 23 (4)(c)(iii) The two different style of locks on all internal doors need to be reviewed in conjunction with the Fire officer. Where a risk is identified the locks need to be decommissioned. The Annual Quality Assurance Audit needs to reflect the standards within each outcome area to ensure the registered person has completed an audit and reflects the actual service provided to people. Individuals to be consulted regarding financial arrangements in the home, including access to an individual bank account and management of personal finances, to ensure people have the most suitable arrangements for maximising financial opportunities. The short corridor at the head of the staircase and the storage area at the end of the ground floor annexe needs to have a system of smoke/heat detectors as identified by the Fire Officer. On completion a certificate of installation and commissioning, as recommended by British Standard, is to be obtained from the installer and a copy forwarded to the Commission for Social Care Inspection and the Inspecting Fire Authority. Two fire doors highlighted within the Fire Book as being defective on 21.06.07 and 14.08.07 respectively need to be fitted with suitable closures to the doors to ensure that in the event of a fire the doors close. 30/11/07 20 OP33 24 (1)(2) 24/12/07 21 OP35 20 (1)(a) 30/11/07 22 OP38 23 (4) 30/11/07 23 OP38 23 (4) 25/09/07 Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 32 24 OP38 23 (4) To test the lights on a monthly basis as reported by the Fire officer, to ensure equipment is suitably maintained in case of a fire. 25/09/07 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 OP3 OP22 Good Practice Recommendations The assessment for prospective people who use the service should be signed and dated and evidence who was consulted. The registered person should consider the advice by the Medical Health Regulatory Agency (MHRA) in relation to bedrails. Watford House Residential Home DS0000068404.V349488.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Regional Office 1st Floor, Ladywood House 45-46 Stephenson Street BIRMINGHAM B2 4UZ 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.V349488.R01.S.doc Version 5.2 Page 34 - 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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