CARE HOMES FOR OLDER PEOPLE
Watersmead White Horse Way Westbury Wiltshire BA13 3AU Lead Inspector
Roy Gregory Unannounced Inspection 11:00 30 January 2008
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.V357443.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. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 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 www.osjct.co.uk The Orders Of St John Care Trust Application pending from Julia Matthews Care Home 50 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (35), of places Physical disability (1) Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th October 2006 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, one premium room having en suite facilities. Watersmead has a secluded location on a housing estate, with sheltered housing next door. The home has ample parking and is a short level walk from the town centre. Westbury has good public transport connections including a main line railway station. Weekly fee levels range between £415 and £490, according to assessed dependency. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes.
The unannounced visit for this inspection was made on Wednesday 30th January 2008 from 11:00 a.m. to 6:15 p.m., with a return visit the following day between 9:00 a.m. and 4:30 p.m. The manager, Julia Matthews, was available during the inspection visits. The home’s locality manager Alison Stenning joined Julia Matthews and the inspector for feedback at the end. The inspector also spoke with two care leaders, the day care co-ordinator, the administrator, and members of the care and support staff teams. During the inspection there was direct contact with a number of residents, in the communal rooms and individual rooms, and by joining three residents for lunch in the dining room. This allowed for observation of the service of meals and administration of medications. The entire home was toured. Prior to the inspection, Julia Matthews had supplied detailed information by way of the Annual Quality Assurance Assessment, as is required by the Commission for Social Care Inspection. Ten residents’ survey questionnaires were sent out, of which eight were returned. Three questionnaires were received from the relatives of people living in the home. It was also possible to look at the results of the home’s annual internal survey of residents’ and relatives’ opinions, from July 2007. Other documentation looked at included records in respect of care planning and delivery, risk assessment, training and recruitment. Time was spent with the care leader who had specific responsibility for the ordering, storage and recording of medications used in the home. A number of instances of care giving were observed. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visits to the home. They take into account the views and experiences of people who live there. What the service does well:
Assessments of people’s needs before they were admitted were very detailed and gave a picture of the “whole person”. Records showed that on their day of admission, people received a lot of staff support and reassurance. This included establishing preferences about things such as bed linen, and introducing night staff. People who were spoken with said they felt included in their initial assessments, and had been helped through the admission process. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 6 Respondents to the questionnaire survey said they received sufficient information to enable them to make a choice to go the home. All staff seen presented as committed and knowledgeable about the residents and their needs. Between shifts there were comprehensive handovers of information, to provide continuity of care. The key worker role was taken seriously. Staff maintained a presence all around the home, whilst keeping in regular contact with each other and their supervisors. Newly appointed staff spent time shadowing experienced staff as a part of induction. The handover system, combined with prompt and objective recording by care staff, meant that deterioration of health was recognised and acted upon quickly. There were good records of liaison with outside agencies, including health professionals. Notifications to the Commission, about transfers to hospital due to illness or concerns following falls, showed that medical or paramedic assistance were called on without delay when needed. All residents who responded to the questionnaire survey indicated that they “always” received the medical support they needed. Care staff kept good notes of observations and of the care they gave. At each shift handover, one carer was designated to support the activities coordinator, or in her absence, to run an activity of some form. Activities included film nights, bingo, arts & crafts, and word games. The activities coordinator reviewed records of residents’ participation every month. This enabled her to check whether individuals’ needs and wishes with regard to social engagement and activity were being met, especially for those who spent a lot of time in their rooms. Residents were invited, individually and through three-monthly “cluster groups”, to suggest activities they would like to see offered. The co-ordinator had built up a stock of resources, and information about venues for trips. She arranged musicians to visit the home. A service in the home every Sunday was very popular. A person wrote in a survey return that their relative was “far more animated than when (they) arrived and receiving much more mental stimulation than when they were home alone. From being very negative and angry X is far more settled and seems to have a good group of friends.” Another relative wrote that the home “does a lot of things with the residents, I highly recommend the home.” There was a steady flow of visitors. One relative wrote on a survey form, “I always feel welcome and feel part of the home when I visit, which is 2 to 3 times a week.” A movable computer was used for email contact with families and to assist people to find information of use or interest to them. Issues of residents’ privacy and dignity were emphasised in staff handovers, so that tasks allocated to care workers would come second to people’s right to make choices. All people had a named key worker, who could particularly consider with them, how they would like to receive care. All residents who responded to the questionnaire survey ticked that “staff listen and act on what you say”. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 7 The dining room offered a pleasant atmosphere and meals were well presented. There was a choice of courses. Second helpings were offered. Where a meal was delivered to a person in their room, there was attention to presentation and to the person’s comfort. The home had received three written and two verbal complaints since the previous inspection. Records of how they were each addressed showed that solutions were actively sought, and apologies made where appropriate. Julia Matthews considered complaints and their outcomes to be an important measure of quality assurance. All areas of the home were clean to a high standard, with no unpleasant odours. All responses to the survey bar one said the home was “always” fresh and clean. Housekeeping staff that were seen considered they were well resourced and trained. There were cleaning schedules for different categories of rooms, with daily, weekly and monthly tasks. There was evidence that the manager and a care leader checked compliance with the schedules, including the quality of bed making. Julia Matthews had produced an overview of responses to the home’s annual quality survey of residents and their relatives. This showed measures that had been taken to address identified areas of dissatisfaction. One person had flagged up a number of individual concerns, in response to which the manager devised an individual action plan with them. As another channel of communication with residents, different staff had responsibility for organising quarterly cluster groups in different parts of the home. Notes from the meetings held in October 2007 showed they were well attended and produced many expressed views, notably about redecoration and food. What has improved since the last inspection?
The Trust had introduced a new format for gathering information on prospective residents, to ensure assessments are conducted in a consistent way. In line with a recommendation at the previous inspection, records of assessments showed where they took place and from where information was obtained. The Trust had introduced a new format of care plan. Some people’s plans were in the new format and the remainder were being worked on. In the newer plans it was easier to see what a person’s priority care needs were. There was a recommendation at the previous inspection that the provider should prioritise introduction of a standard risk assessment for tissue viability and nutritional needs. Such a risk assessment had been introduced as part of the new care-planning format. Julia Matthews had reached agreement with the community nurses that they would review any assessment of high risk, and advise on preventive care. There was evidence of this liaison in individual records.
Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 8 At the previous inspection there was a requirement to incorporate protocols in individual care plans, for the correct use of any medicines prescribed ‘as required’. For a person to whom this applied, there was a care plan showing how the resident and staff would decide together to use the medication, and how it was to be recorded. The dining room had been made a more pleasant and larger room by removal of a shop and bar. This also allowed space for more armchairs, thus increasing choices of communal sitting areas. The hairdressing room had been riskassessed in response to a previous requirement. It was now left unlocked only when in use, to avoid the risk of anyone becoming disorientated there and thus exposed to hazard. From April 2007 the home had benefited from an increased staff complement. The senior team held a formal meeting periodically, as required by the previous inspection. What they could do better:
Some issues that were well recorded in daily notes, should also have been added to care plans. For example, a person had appreciated decaffeinated tea, which they wanted to continue having, but this did not figure in their care plan. One person spoke of needing a description of the food on their plate, and another said they opted out of activities because sight problems got in the way. So there was scope for key workers to further consider the implications of people’s sensory deficits, such as a visual or hearing impairment, that could be addressed by quite small details being added to care plans. Staff identified the morning as the busiest time of day, especially when several residents exercised the choice to get up after night staff left. There was scope to consider whether some morning shifts might begin earlier, to maximise availability of staff when people want it. The number of staff in the dining room during lunch had been reduced. This was in response to residents feeling overwhelmed by staff numbers, but it was now noticeable that the last people to be served experienced delay before receiving their lunch and sweet. Another issue regarding meal times was that at least two residents would prefer a main meal to be served at tea time rather than for lunch. Julia Matthews agreed this was an aspect of meal provision that could usefully be explored further. A sluice had benefited from re-painting, but cleanliness was compromised by a crazed sink with badly rusted brackets, which were leading to staining to the floor. The deteriorated items need to be replaced. A smoking room had been created with some ingenuity, but it struck as cold and had a sloping floor. It had not been risk-assessed to see whether any precautions or supports needed to be implemented to ensure safe and satisfactory use. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 9 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. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 10 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.V357443.R01.S.doc Version 5.2 Page 11 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 & 3 (Key standard 6 does not apply). Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The statement of purpose and service user guide are kept up to date so that prospective residents and their relatives have good information about the home. Each person’s needs are assessed in detail to ensure that their needs can be met. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 12 EVIDENCE: The Trust had introduced a new format for gathering information on prospective residents, to ensure assessments are conducted in a consistent way. Julia Matthews undertook most assessments. Examples of recent assessments showed that comprehensive “whole person” information was gathered, enabling confident decisions that the home could meet the people’s needs. Care plans were developed from the assessments. In line with a recommendation at the previous inspection, records of assessments showed where they took place and from where information was obtained. Where applicable, information from a placing authority formed part of the assessment. Julia Matthews said that where a referral was presented as an emergency, she insisted on completing an assessment and gathering information about the nature of the “emergency”. Respite admissions were made through a centralised booking procedure. One of the care leaders was responsible for re-assessing the needs of people admitted on a regular basis, and for assessing people newly referred for respite stays. Records showed that on their day of admission, people received a lot of staff support and reassurance. This included establishing preferences about things such as bed linen, and introducing night staff. People who were spoken with said they felt included in their initial assessments, and had been helped through the admission process. Respondents to the questionnaire survey said they received sufficient information to enable them to make a choice to go the home. One person could not remember that time, but was pleased to be at Watersmead rather than at another home where they had initially stayed after a stay in hospital. All prospective residents and their families were provided with a readable guide to the home. The Trust had introduced a standard format for the statement of purpose. This was a professional document that had been adapted to the home’s specific needs. It could be amended in response to changes. Some minor amendments were agreed during the inspection. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 13 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): 7-10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal and health care needs were met through care planning. People were treated with respect and their right to privacy was upheld. Residents were protected by the home’s procedures for the safe handling of medicines. EVIDENCE: Care plans that were sampled contained a wide range of information and guidance to staff. The Trust had introduced a new format of care plan. Some people’s plans were in the new format and the remainder were being worked on. In the newer plans it was easier to see what a person’s priority care needs were. Care plans were reviewed regularly, with a particular emphasis on the first review, four weeks after admission. Individual components of care plans were signed by the people they related to, or by a representative. In one instance seen, a member of staff had noted, “X did not want to sign this part of the care plan”. It referred to an aspect of care the person found hard to accept. The frequency of amendments and additions to care plans showed they were working documents.
Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 14 Care staff kept good notes of observations and of the care they gave. Handovers between shifts made sure information was passed on. However, some issues that were well recorded in these ways, should also have been added to care plans. For example, a pressure mat was in use with one person who had an assessed high risk of falling, so staff would know they had to attend the person. The person’s care records had a number of references to this, and the history of it, but the care plan itself lacked detail. It would also have benefited from showing the signed agreement of the social worker who had suggested use of the mat. This would show the shared responsibility for how the person’s needs were being managed. In another example, daily notes showed how much a person had appreciated decaffeinated tea, which they wanted to continue having, but this did not figure in their care plan. There was scope for key workers to further consider the implications where people had deficits, such as a visual or hearing impairment, that could be addressed by quite small details being added to care plans. As examples, one person spoke of needing a description of the food on their plate, and another said they opted out of activities because sight problems got in the way. There was a recommendation at the previous inspection that the provider should prioritise introduction of a standard risk assessment for tissue viability and nutritional needs. Such a risk assessment had been introduced as part of the new care-planning format. Julia Matthews had reached agreement with the community nurses that they would review any assessment of high risk, and advise on preventive care. There was evidence of this liaison in individual records. In a shift handover, a person’s pressure area care needs were discussed. A member of staff confirmed they had submitted a body map, knowing this would prompt further action. Staff in the handover meeting discussed measures that would make the person safer and more comfortable. It was agreed how the care plan should be worded. Another resident’s care plan, agreed by a community nurse, indicated a need for regular turning in bed to minimise pressure damage. A chart was in use to show the care plan was being followed. The handover system, combined with prompt and objective recording by care staff, meant that deterioration of health was recognised and acted upon quickly. There were good records of liaison with outside agencies, including health professionals. Notifications to the Commission, about transfers to hospital due to illness or concerns following falls, showed that medical or paramedic assistance were called on without delay when needed. There was an agreement with the triage nurse at the doctors’ surgery whereby antibiotics were quickly prescribed when dip tests undertaken by home staff indicated suspected urine infections. All residents who responded to the questionnaire survey indicated that they “always” received the medical support they needed. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 15 Issues of residents’ privacy and dignity were emphasised in staff handovers, so that tasks allocated to care workers would come second to people’s right to make choices. All people had a named key worker, who could particularly consider with them, how they would like to receive care. All residents who responded to the questionnaire survey ticked that “staff listen and act on what you say”. Part of a medication round was observed. The staff member was seen to act in accordance with the home’s medication procedures and dealt with residents sensitively, encouraging them where necessary. All medication was stored securely and appropriately. (In common with all homes that occasionally hold controlled drugs, the home is required to obtain controlled drug storage that meets new security standards). One of the care leaders had primary responsibility for medication issues in the home. Her audit procedures had enabled her to address a number of errors from the supplying pharmacy, thus avoiding any impact on residents. She could show that the number of errors had reduced significantly. The home had recently notified an error in administering medication. The member of staff concerned had followed the provider’s procedure for such an event, to ensure the wellbeing of the person affected. At the previous inspection there was a requirement to incorporate protocols in individual care plans, for the correct use of any medicines prescribed ‘as required’. For the one person to whom this applied, there was a care plan showing how the resident and staff would decide together to use the medication, and how it was to be recorded. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 16 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 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was active in identifying and meeting people’s social, religious and recreational needs. People kept in contact with family and friends and had access in various ways to the community. People had a choice of meals, served in a pleasant environment. EVIDENCE: An activities co-ordinator was employed for 25 hours per week. She worked flexibly, sometimes going to the home twice in one day, and often working at weekends. This was partly because one sitting room, with kitchen facilities, which was in use by day care users during weekdays, could be used for simple cooking activities at weekends. Several residents of the home chose to join day care users in some of their activities, during the week. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 17 Records showed a variety of activities were offered daily. Residents were invited, individually and through three-monthly “cluster groups”, to suggest activities they would like to see offered. The co-ordinator had built up a stock of resources, and information about venues for trips. She arranged musicians to visit the home. She was generally directly involved in a service that was held every Sunday. Around twenty residents regularly attended this, with one having a leading role. At each shift handover, one carer was designated to support the activities coordinator, or in her absence, to run an activity of some form. Activities included film nights, bingo, arts & crafts, and word games. The activities coordinator reviewed records of residents’ participation every month. This enabled her to check whether individuals’ needs and wishes with regard to social engagement and activity were being met, especially for those who spent a lot of time in their rooms. The activities co-ordinator attended some shift handovers and liaised in various ways with key workers. A resident said they would prefer to have more opportunities to go out of the home, for example into town or on garden visits. Their relative wrote in a survey return that they were “far more animated than when (they) arrived and receiving much more mental stimulation than when they were home alone. From being very negative and angry X is far more settled and seems to have a good group of friends.” Another relative wrote that the home “does a lot of things with the residents, I highly recommend the home.” Most residents who responded to the questionnaire survey said they considered there were “usually” or “always” sufficient activities to join in. One wrote they preferred to use facilities in their own room, such as TV and radio, and another said they were not inclined to join many activities, but still appreciated knowing what others were doing and being invited to join. There was a steady flow of visitors at the home. One relative wrote on a survey form, “I always feel welcome and feel part of the home when I visit, which is 2 to 3 times a week.” A movable computer was used for email contact and to assist people to find information of use or interest to them. Julia Matthews had conducted a survey of residents purely about meals. As a result she was reviewing meal provision with the chef. They had identified a need for more variety of vegetarian meals. The dining room had been made a more pleasant and larger environment by removal of a shop and bar. It was intended to introduce tablecloths, and menus at each table. The number of staff in the dining room during lunch had been reduced. This was in response to residents feeling overwhelmed by staff numbers, but it was now noticeable that the last people to be served experienced delay before receiving their lunch and sweet. The dining room offered a pleasant atmosphere and meals were well presented.
Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 18 There was a choice of courses. Second helpings were offered. Where a meal was delivered to a person in their room, there was attention to presentation and to the person’s comfort. One person’s care plan noted they had a tendency to skip lunches. It was said that this reflected the person’s history of eating a main meal in the evenings, but this was not explained in the care plan. Care directions were to “encourage to eat at lunch time”, rather than addressing individual preference, or ensuring the person was to receive adequate nutrition. A person who was spoken to during the inspection said their preference would be to have a light lunch and a main evening meal, following on from their history of working life. Julia Matthews agreed this was an aspect of meal provision that could usefully be explored further. Responses to the question about meals in the survey questionnaire showed most people to “usually” or “always” like the meals served. Three people made additional comments praising the variety of choice offered, whilst two thought there should be more choice. There was a similar spread of opinion among people spoken with. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. There is good provision for receipt of and response to complaints. Staff and management understand and exercise responsibilities in respect of keeping residents safe. EVIDENCE: The provider trust has clear systems for receiving and addressing complaints. This is monitored by the manager making a monthly return to the Trust. The home had received three written and two verbal complaints since the previous inspection. Records of how they were each addressed showed that solutions were actively sought, and apologies made where appropriate. Julia Matthews considered complaints and their outcomes to be an important measure of quality assurance. There was experience in the home of engaging an independent advocacy service to uphold individuals’ interests. Julia Matthews and the care leaders have demonstrated competence and cooperation in referring certain matters into local inter-agency safeguarding procedures. All staff received abuse awareness training and were issued with the “No Secrets” abbreviated guide to local safeguarding procedures. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was homely, safe and well-maintained. There were good standards of hygiene around the home. EVIDENCE: The grounds of the home had been landscaped, making it feel more a part of the community in which it is situated. There was some signage to the secure garden area, but not all residents that were spoken with were aware of how to access the garden. The removal of the shop from the dining room had enabled creation of more sitting space. A limited shop facility had been retained by use of a glass-fronted cabinet. A smoking room had been created with some ingenuity, but it struck as cold and had a sloping floor. The hairdressing room had been risk-assessed in response to a previous requirement. It was now left unlocked only when in use, to avoid the risk of anyone becoming disorientated there and thus exposed to hazard.
Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 21 There had been significant refurbishment of some toilets and bathrooms, with some attractive homely touches. Some toilets were awaiting modernisation, the planned work having been put back because of an emergency maintenance issue that had arisen in the same area of the home. In another toilet, the seat was sub-standard. A wet room was being fitted out, to enable people to choose between bath and shower. The Trust provided for routine maintenance in the home. For example, electrical systems and the call bell system had recently been serviced. The manager provided evidence to the Trust that service contracts operated efficiently. The home was kept clean to a high standard, with no unpleasant odours. Housekeeping staff that were seen considered they were well resourced and trained. There were cleaning schedules for different categories of rooms, with daily, weekly and monthly tasks. There was evidence that the manager and a care leader checked compliance with the schedules, including the quality of bed making. Care staff notified housekeepers when they were to help a person to bath, so their bed could be changed at the same time. The laundry was well organised and clean, including behind machines. There was clear guidance displayed about selection of wash programmes. In the sluices, commode liners were numbered, to ensure they were returned to the same users. In some people’s rooms there were reminders to staff about specific preferences regarding laundry arrangements. A sluice had benefited from re-painting, but cleanliness was compromised by a crazed sink with badly rusted brackets, which were leading to staining to the floor. One response to the resident survey was, “I can never find a clean toilet”. This could have reflected those times when housekeepers were not deployed. There was housekeeper cover at weekends, but not during evenings, although night care staff carried out some cleaning so long as care duties always came first. There were plans to introduce evening housekeeping cover. All other responses to the survey said the home was “always” fresh and clean. Watersmead DS0000028279.V357443.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 – 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have support from competent staff who are provided in sufficient numbers. People are protected by sound recruitment practices that ensure nobody works at the home until checks on their background are complete. The provider invests in the development of staff, to maintain a trained and mainly qualified team. EVIDENCE: From April 2007 the home had benefited from an increased staff complement. Rotas showed that a minimum level of six care staff (including a care leader) were on shift mornings and evenings, and five in the afternoons. This was regularly exceeded, with examples of eight staff on shift. This was reflected in the home’s ability to give care staff support to activities, although there was also much goodwill on the part of some staff to support activities in their own time. There had recently been some loss of night care staff, resulting in a need to use some agency staff to maintain night staffing levels. Staff identified the morning as the busiest time of day, especially when several residents exercised the choice to get up after night staff left. There was scope to consider whether some morning shifts might begin earlier, to maximise availability of staff when people want it. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 23 The Trust had introduced a centralised system for monitoring when individual members of staff needed to go on refresher courses. The same system allowed the manager to identify when and where courses were available and to book places on them. There was evidence of training courses booked for several months ahead. All care staff received dementia training, a “Quality Dementia Care package” accredited by The Alzheimer’s Society, as a part of core training. Support staff also received training in understanding dementia. Nineteen out of thirty care staff had achieved National Vocational Qualification (NVQ) in care to level 2 or 3, with a further five working towards this. The Trust had a commitment to ensuring all care workers achieved at least this recognised baseline standard of qualification. All staff seen presented as committed and knowledgeable about the residents and their needs. Between shifts there were comprehensive handovers of information, to provide continuity of care. The key worker role was taken seriously. Staff maintained a presence all around the home, whilst keeping in regular contact with each other and their supervisors. Newly appointed staff spent time shadowing experienced staff as a part of induction. Recruitment records for four people who had been recruited showed the Trust’s recruitment policies were followed in all cases. People had completed application forms with accompanying declarations about health and freedom from convictions. There were records of interview, and two references were taken up in all cases. Where a reference raised questions about suitability, Julia Matthews followed this up. Criminal Records Bureau and Protection of Vulnerable Adults checks had been carried out prior to people starting work. Thus people could be sure staff working with them did not present any known risk to their safety. New staff underwent an induction with the Trust, designed to fit with current expectations of induction. This meant new workers had a reliable introduction to the values as well as skills necessary to work in a care home. Watersmead DS0000028279.V357443.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 good. This judgement has been made using available evidence including a visit to this service. Residents and their supporters experience a competent style of management. The views of people living in the home are sought and acted on to ensure the home is run in their best interests. People have good quality support because the care workers are regularly supervised. People are safeguarded by the arrangements made for handling their finances. The environment is safe for them and staff because of sound health and safety policies and practices. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 25 EVIDENCE: Julia Matthews had recently made application to be registered as manager. She was about to complete NVQ level 4, from which she would progress to the Registered Managers Award. One of the care leaders had completed a supervisory management course. Julia Matthews was giving an effective lead to staff through minuted staff meetings and by a chain of delegation to care leaders. She is supported actively by her Locality Manager Alison Stenning, who supports her in all safeguarding matters. Alison Stenning also provides Julia Matthews with individual supervision, alongside operational visits that include checks on staff supervision, recruitment, health and safety monitoring and complaints. There was a matrix to ensure care leaders gave individual supervision to care staff six times per year. The staffing rota showed where supervision time needed to be taken into account. Night carers were paid to go in early so they could receive supervision from a care leader before starting a shift. Care leaders were supervised by Julia Matthews and had periodic senior team meetings, as required by the previous inspection. There was no change in the good systems used to assist residents with safe keeping of and access to personal money, where this is requested. Home managers are required by the Trust to carry out an annual quality survey of residents and their relatives. This had taken place in the home in July 2007. Julia Matthews had produced an overview of responses, which showed measures that had been taken to address identified areas of dissatisfaction. For example, some residents did not like the quality of new light fittings in their rooms, so options were to be considered with the people affected. Residents wanted better information about activities, so a newsletter was introduced. One person had flagged up a number of individual concerns, in response to which the manager devised an individual action plan with them. As another channel of communication with residents, different staff had responsibility for organising quarterly cluster groups in different parts of the home. Notes from the meetings held in October 2007 showed they were well attended and produced many expressed views, notably about redecoration and food. Trust managers made regular unannounced monitoring visits. These included checks on health and safety procedures and recording, including checking accident records, fire precautions monitoring and staff training in fire procedures. All night staff had received fire training in December 2007. Inhouse health and safety training based on a DVD presentation was seen in use. Accident records were of good quality, and could be linked to care records. Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 26 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 X 4 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13 (2) Requirement All controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007) The sink and brackets in the identified sluice room must be replaced. The smoking room must be riskassessed for safety of access, leading to safeguarding actions for service users if indicated. Timescale for action 31/05/08 2. OP26 13 (3) 31/05/08 3. OP19 OP38 13 (4)(a) 31/03/08 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. Refer to Standard OP7 Good Practice Recommendations Key workers should be encouraged to add details to care plans of people’s preferences, and of needs related to sensory deficits, as son as such needs are identified.
DS0000028279.V357443.R01.S.doc Version 5.2 Page 28 Watersmead 2. 3. OP15 OP15 Consider how best to provide staff at meal times, so that meals are served discretely and with minimum delay. Consult with residents and staff on the desirability and feasibility of offering a choice of timing for serving the main meal of the day. Consider how best to deploy staff at times of highest demand by residents. 4. OP27 Watersmead DS0000028279.V357443.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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