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Inspection on 24/07/07 for Southwater Residential Home

Also see our care home review for Southwater Residential Home for more information

This inspection was carried out on 24th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The food served at Southwater is of a high standard, with a variety of fresh fruit and vegetables, and is much enjoyed by residents. There is good companionship between the more mobile residents in the home, and staff were seen to have developed positive relationships with residents. Relatives who returned comment cards appreciated the `genuine care` offered by the home owners.

What has improved since the last inspection?

Care plans had been written for each resident, recording their health and personal care needs, and social interests. A lockable cabinet had been provided for the resident who administers their own medication. Residents had been given copies of the home`s terms and conditions, and of the Complaints procedure, so they would know how any complaint would be dealt with. The policy on the Protection of Vulnerable Adults was up-dated to include the local arrangements to refer to the Adult Protection team, to ensure that managers would know who must be informed if there were ever an allegation of abuse. An accessible bathroom was being constructed at the time of this inspection. The home owners were preparing to provide care staff at night, though this had not started at the time of this inspection. The recruitment system had been improved, and checks were being made to protect residents from potential harm. Appraisals had been held, to discuss staff members` performance and training needs.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Southwater Residential Home Southwater Residential Home 3-4 Conway Crescent Paignton Devon TQ4 5LG Lead Inspector Stella Lindsay Key Inspection (unannounced) 24th July 2007 7:40 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 Southwater Residential Home DS0000018427.V340557.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. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Southwater Residential Home Address Southwater Residential Home 3-4 Conway Crescent Paignton Devon TQ4 5LG 01803 524140 NONE 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) Mr Thomas Lamont Mrs Mary Lamont Mr Thomas Lamont Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate two named service users with the category DE(E) 12th December 2006 Date of last key inspection Brief Description of the Service: Southwater Residential Home is registered to provide accommodation and care for a maximum of eighteen people in the registration category of ‘Old Age, not falling within any other category’. A condition is in place enabling the home to provide a service for two named service users who have dementia. Southwater is in a residential area of Paignton and is close to the town centre and the bus and railway stations. Information is available from the home on request in the form of a written Statement of Purpose and a Service Users’ Guide. Copies of inspection reports are kept at the Home and are also available on the CSCI website. The current fees range from £310 to £350 a week, although additional charges may be made for extra care, professional hairdressing, newspapers, clothing and all other items of a luxury or personal nature are extra. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days in July 2007. It involved a tour of the premises, discussion with the home owners, twelve residents, three visiting relatives and two staff on duty. Care records, staff files and the medication system were examined. Information about the running of the home had been supplied by the home owners. Surveys and comment cards were received from staff and relatives before the visit, and their views will be represented in the report. An Improvement Plan was sent to the home owners after the last key inspection, and a Random Inspection carried out on 4th April 2007 to check on progress. What the service does well: What has improved since the last inspection? Care plans had been written for each resident, recording their health and personal care needs, and social interests. A lockable cabinet had been provided for the resident who administers their own medication. Residents had been given copies of the home’s terms and conditions, and of the Complaints procedure, so they would know how any complaint would be dealt with. The policy on the Protection of Vulnerable Adults was up-dated to include the local arrangements to refer to the Adult Protection team, to ensure that managers would know who must be informed if there were ever an allegation of abuse. An accessible bathroom was being constructed at the time of this inspection. The home owners were preparing to provide care staff at night, though this had not started at the time of this inspection. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 6 The recruitment system had been improved, and checks were being made to protect residents from potential harm. Appraisals had been held, to discuss staff members’ performance and training needs. What they could do better: The Statement of Purpose still includes some information about the aims of the home which is not accompanied by a description of what the home provides to fulfil that aim. Care plans still need information on how staff will meet the identified care needs. Risk assessments need to be developed to help staff to maintain safety while enabling residents to live more active and fulfilled lives. Suitable arrangements should be made so that residents are not confined to their bedrooms. All medication, including painkillers, must be given at the time as prescribed, with records kept as to whether they were taken. A survey was commissioned from a qualified Occupational Therapist in June 2004. The environment would be better for the residents if her advice were followed, including improved access around the house, and easier access to the garden. The laundry must be kept in a hygienic state, and organised in such a way as to avoid any risk of cross-contamination, to prevent potential risk of harm to residents. Staffing levels at the weekends and in the afternoons should be increased, so that they could meet the social needs of residents who are not able to join in the activities in the lounge. Safety within the home should be improved;There should be no fire door that is not fitted with a closer, so that it will close automatically when the alarm is sounded. No fire door should ever be wedged open – if necessary approved hold-open devices may be provided, to assure residents’ safety. Window restrictors should be effective, where needed to assure residents’ safety. The home should have a registered manager who is up to date with current good practice, develops their own management skills, and has achieved or is Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 7 working towards the nationally recognised qualification known as National Vocational Qualification level 4 in Care and the Registered Managers’ Award. 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. Southwater Residential Home DS0000018427.V340557.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 Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is adequate. Information is provided, but it does not give a clear picture of what is offered at the home, so prospective residents may be misled. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose and Service Users’ Guide have been prepared and are available on request. They contain useful information about the service, but in parts give the aims of the home rather than what is offered. Prospective residents and their families are welcomed for visits to look around the home and meet the staff and residents. It is advisable to visit, to be assured that the prospective resident can move around the house, as there is not level access through the ground floor. The file of a recently admitted resident was examined, and it was seen that information had been received from Health and Social Work professionals to be sure that the admission was appropriate. The Home Owner said that she has a Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 10 standard letter that is sent when the decision is made that the home can meet the person’s needs, though a copy was not kept on file. In this case the resident had not visited the home prior to admission, and no-one from the home had met with them in their previous setting, but the resident said that they were satisfied with the service they were receiving. Residents had been given up to date versions of the home’s terms and conditions, so that they would know what was included in the service. Southwater Residential Home DS0000018427.V340557.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 Quality in this outcome area is adequate. Personal care is given diligently, but promotion of the rights and abilities of the more dependant residents could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident had a care plan, which included information for staff about the residents’ personal and health care needs, any special diet, and some social interests. There was evidence that medical help had been requested and recorded. The care plans would benefit from a summary, agreed with the residents, to tell care staff what care was needed each day, and any preferred times or methods. Staff were seen to respond to resident’s requests. One care plan was seen to have been reviewed, though not checked monthly. No alteration had been made to the plan on behalf of a resident who had become restricted to their room. Bathing records showed that none of the residents being case tracked had had a bath for as long as the records were available – all had body washes. A bathroom with a hoist was being installed at the time of this inspection, to give residents the opportunity of bathing. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 12 Residents said they were happy with the care they were given, and relatives praised the staffs’ kindness and patience. Completion of risk assessments were variable. A format had been supplied to the home for the recording of risks, triggers, and action that could be taken to reduce the risk, and a following page to record incidents. Some files had page 1 completed, some page 2. This suggests that staff training is needed. More thought needs to be given to risks that need attention, for example, risks associated with mobility are a priority where a resident’s movements are restricted and they need help to move around the house. An Occupational Therapist had been involved in assessment of a bed and chair, but the provision had not been resolved, and the resident was currently restrained by being unable to get out of the chair. Further specialist advice should be requested on behalf of a resident with long term mental health needs, whose experience of daily life might be improved. Another resident was hoping to go home, and was receiving professional help to achieve this. Specific advice to staff should be provided to help make progress towards this target. The medication system was examined and found to be properly administered, with two exceptions. Recording of variable dose, or ‘on request’ drugs should include the reasons why they were needed. Painkillers must be offered at the times as prescribed, with records kept as to whether they were accepted or refused. The home uses a Pharmacy controlled system to order, administer and dispose of the resident’s medication. Suitable storage facilities are available in the form of lockable, wall mounted metal cupboard and a controlled drugs cabinet. Medication Administration Records were completed with care, including the proper recording of Controlled Drugs. No homely remedies were in use, or any medication that needed to be chilled. It was recommended that a specific risk assessment for self-medication be produced, to record the person’s competence to manage their own drugs, and their agreement to keep them securely. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. The social, occupational and recreational needs of the most dependent service users are not being identified or met. The meals are good and the residents benefit from being offered a wide range of options. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents who are quite well and mobile are comfortable with this service which, in the words of a relative who returned a survey, ‘provides care but allows people to have their independence’. One resident is able to walk to the seafront and back, while another drives a car. Of the residents occupying rooms on the first floor, only two could easily manage the stairs. One had been offered a ground floor room. Another had been carried up to a first floor room with no access to the stair lift. This person had manicures and family visits recorded as their total social activities this year. Their care plan said that they used to enjoy gardening, and earlier social records show that they joined in singing. A member of staff arranges social activities for one hour each afternoon in one of the communal lounges. Board games were enjoyed during this inspection. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 14 Two residents were joining in. One of the fitter residents had walked to a health appointment, another had gone out. One resident was taken out by their family, as it was a fine day, and one was visited by a relative. None were seen to go into the garden, and the other seven residents were alone in their rooms. One resident who was able to walk with a frame, was not able to get to the garden because of the deep threshold, and said they did not think the staff would have time to take them. Several residents mentioned a Country and Western singer who had performed the previous week, which they had enjoyed. The Statement of Purpose and Service Users’ Guide state that the service users may receive guests at any time. There are a variety of lounges in which they may meet. All residents who spoke to the inspector said that they enjoy their meals. On the day of this inspection a tasty stew was served with a variety of fresh vegetables. Strawberries with ice cream and marshmallow was the popular dessert. A vegetarian diet is currently supplied. No-one knew what they would be given for lunch, though all were confident that they would enjoy it. Some said they would like to have the menu of the day displayed. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. It was not clear whether residents are protected from abuse, as the environmental constraints and low staff levels have an impact on their liberty and opportunity to make choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure had been given to each resident, and copies were seen in their rooms. No complaints had been received by the Commission for Social Care Inspection since the last inspection. The policy for the protection of vulnerable adults was discussed with the home owner. Advice was given and it was up-dated to include the local agreement to refer any allegation of abuse by a member of staff to the Adult Protection team of the Social Services department. Staff training on Safeguarding Adults had been arranged for the week of this inspection. Several residents are isolated in their rooms, and expectations are limited. Management had not referred to good practice in promoting residents’ independence and fulfilment when offering accommodation, showing a limited understanding around restraint issues. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,25,26 Quality in this outcome area is poor. Facilities are being improved, but access around the house is still restricted for some residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Southwater is in a residential area of Paignton and is within a short distance of the town centre and the seafront. The gardens to the back of the home are attractively laid out and there is garden furniture for residents to sit out. The land to the front of the home provides a generous amount of off street parking. The home has five very comfortably furnished and well-decorated lounges and a bright and attractive dining room. Sadly these rooms are under used because some of the residents are unable to use the stair lifts and/or negotiate the steps between rooms to gain access to them. One of the home owners, Mr Thomas Lamont, is an experienced builder and takes responsibility for home maintenance. He has been continually Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 17 developing the home. At the time of this inspection the major project in progress was the provision of an accessible bathroom, with a bath hoist, to enable less agile residents to bathe. The provision of a shower room was also in progress. These will be good assets for the home, increasing residents’ choice and comfort in bathing. The inspector advised consultation with an Occupational Therapist in order to make the best possible arrangements, and in particular, the provision of a hoist that is designed for use in a communal bathroom. In June 2004 a survey by an Occupational Therapist was commissioned. Several of her recommendations remain to be put into practice. In particular, access around the home is restricted for some residents. There is a deep step from the conservatory that runs along the front of the house to all the other rooms. The inspector was informed that the use of removable ramps is being considered. It is significant, because there is no level access to the outside world, so that residents who need mobility aids cannot go independently. A good solid ramp has been built from the back lounge to the garden, but the threshold forms a big step in the doorway. At the Random Inspection in April it had been noted that window restrictors had been fitted to windows above the ground floor, but on this occasion windows were found to open wide, thus causing a potential hazard. This demonstrates a need for checking and maintenance. Radiators had been covered, to prevent risk of residents being harmed/scalded if they were to fall against one. A free-standing heater was seen in a bedroom; it had sharp phlanges, and posed potential harm to the occupant. Risk assessment needs to be carried out, and action taken to make sure the resident is not at risk from falling against it, as well as from combustion. It may need to be fixed to the wall and covered, as has been done with the radiators. No fire doors were seen to be pegged open, which is good. Hold-open devices had been fitted where it was in residents’ interests to keep a door open. One bedroom door did not have a closer on it, or a sign to say it was a fire door, though it was at the top of a flight of stairs and therefore needed as protection. Advice must be obtained from the fire safety officer and prompt action taken, as this poses a serious potential hazard for the vulnerable occupant. Signs for doors should be considered, to help residents and visitors find their way around the house, and to identify private rooms. The laundry floor was found to be dirty, the bin for clinical waste was rusty, and not cleanable, and paintwork on the window and door was flaking. The laundry was full and crowded, and clean clothes were being folded close to soiled laundry. Soluble red bags had been provided for soiled linen, but they Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 18 were not sealed so were not effectively preventing potential cross infection. Staff had received training in the control of infection, but were needing guidance and supervision to uphold good practice. The house was generally clean and well presented, but two rooms were found to have a bad odour. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 19 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 poor. There were still insufficient staff available to meet the specialist physical and emotional needs of some residents. Recruitment processes had improved, and residents were benefiting from being cared for by staff who have appropriate qualifications and have received training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement had been made for waking night staff to be provided, on 12/07/06, 12/12/06 and again on 04/04/07. In the Improvement Plan sent by Southwater on 06/03/07 it was stated that this was happening. The inspector arrived at the start of the inspection in time to meet the Night Care Assistant before they went off duty, but no-one had fulfilled this role. Mrs Lamont had been on-call, and was caring for the residents. One was up and enjoying breakfast. Mr. Lamont and their son who also lives on the premises were providing breakfasts to residents in their rooms. This situation had been agreed as unsuitable, because not all residents are able to call for help when they need it, and need regular checks through the night to assure their safety. The inspector was supplied with the home’s new rota, showing how night care duties are to be fulfilled, and that this was to start when staff were available. Recruitment was still taking place. One of the family who is a qualified teacher and the home’s trainer, had done some night duties, and told the inspector of the useful routine she was developing. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 20 The other concern raised with regard to staffing at previous inspections was the afternoons and at weekends. From Monday to Friday one care worker is on duty between 1pm and 6pm. The rota shows that two care workers are employed on Saturdays and Sundays, one from 9am to 11am, and one from 9am to 12 noon, but there are no staff in the afternoon. It is acknowledged that Mrs Lamont works in the home and provides care on a full-time basis and that Mr Lamont also works at the home on a full time basis, although he deals mainly with the maintenance of the premises, and cooks at the weekends. Seven of the 13 residents were alone in their rooms throughout this inspection, and need a higher level of support either to enhance their lives within their rooms, or to assist them to be less isolated. Of the staff employed, the Deputy Manager (another family member) has NVQ level 3 in Care, and the three main care staff all have NVQ2 in care. This is a good achievement. Two of the weekend care staff normally work in the kitchen and are not qualified in care. The recruitment system was seen to have improved. The files of three recently appointed staff were examined. One included written references and the Criminal Records Bureau clearance, and they had been applied for on behalf of another. The home owner was advised that checks are necessary for 16 year old employees. A new employee told the inspector that she had been given induction training promptly on joining the team. The home owner stated that training had been provided this year on Infection Control, First Aid, and Moving and Handling, and that Safeguarding Adults was booked for later that week. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 21 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): 31,33,35,36,38 Quality in this outcome area is poor. Southwater is not run in the best interests of all the residents, as management systems are not in place to ensure consistent good practice, and progress towards meeting requirements with regard to health, safety and well being of residents is slow. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr & Mrs Lamont have owned and run Southwater Residential Home for 18 years. Mr Lamont is registered as the Manager, but does not have qualifications in care. Mr & Mrs Lamont are both registered as the Service Providers. Mrs Lamont has a qualification in Advanced Care Management, which was undertaken in 1993. Two of their daughters are involved in management of care within the home. The inspector was told that they are planning to undertake NVQ level 4 in care Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 22 and the Registered Managers’ Award, and in due course to apply to the Commission for Social Care Inspection to be registered jointly as Manager. The current management arrangements are not working satisfactorily. The home has an ethos of being a large family home, and the friendliness of the atmosphere is appreciated by some residents. The home owners are hardworking and experienced, but have taken some decisions without referring to professional advice, or keeping in touch with current good practice. Progress in meeting requirements made after previous inspections is taking place, but very slowly. There is not a quality assurance system. Mr & Mrs Lamont are present every day, but residents have said that they do not always feel able to give their views. A Residents’ meeting was proposed, but had not taken place. Audits of the safety and cleanliness of the building had not taken place. The home owners do not handle money on behalf of any resident. They add the cost of hairdressing and chiropody to the bill in arrears. Staff appraisals had been carried out, which is good practice. This process needs to be developed to meet the requirement for supervision of care staff, including all aspects of care practice within the home, and ensuring that staff are familiar with the necessary policies and procedures. The information supplied by the home prior to inspection states that all of the policies and procedures relating to the safety of the premises and safe working practices are in place and that appliances, including fire safety appliances, are regularly serviced. The home owner stated that the electrical circuits and fire precaution system had been professionally serviced and fire training had been provided by a professional trainer. Issues affecting the health, safety and welfare of residents and staff have been recorded in the section on the environment. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 23 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 2 2 X X 2 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 & 6 Requirement The registered persons must review the Statement of Purpose and Service Users’ Guide to ensure that they provide accurate descriptions of the service provided and include all of the items referred to in the standards and regulations. Copies of both documents must be forward to the Commission after they have been revised. The registered persons must ensure that the care home is conducted so asto make proper provision for the health and welfare of the service users; to make proper provision for the care and supervision of service users. Residents’ mental health needs must be monitored regularly and preventative and restorative care provided. Opportunities must be given to enable the residents to take appropriate exercise and Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 25 Timescale for action 30/09/07 2. OP8 12(1) a & b, 13(5) & 23 (n) 30/09/07 physical activity. The registered person must make suitable arrangements for moving and handling the service users so that they are not confined to their bedrooms. Previous timescale for compliance 13/02/07 and 04/06/07- not met. All medication, including painkillers, must be offered at the time as prescribed, with records kept as to whether they were accepted or refused. Reason for giving PRN medication (variable dosage) must be recorded. 3. OP9 13(2) 31/08/07 4. OP10 13(4)(c) & The registered persons must 13(7) ensure that none of the service users are subjected to physical restraint and isolation because they cannot safely access the communal areas of the home. Previous timescale for compliance 13/02/07 & 04/06/07- not met. 30/09/07 5. OP19 23(2)a & e The registered persons must ensure that the premises meet the needs of the service users by providing suitable mobility aids, removing obstacles which restrict the residents mobility (such as small steps) and providing sufficient staff to enable all of the residents to access the communal rooms and to use the baths safely. Previous timescales for compliance 13/04/07 & 04/06/07- not met. 30/09/07 Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 26 6. OP26 13(3) 7. OP27 18(a) The laundry must be maintained in a clean and hygienic state, and the laundry procedure carried out in such a way as to avoid potential crosscontamination. The registered persons must, having regard to the size of the care home and the needs of the service users, ensure that there are sufficient care staff on duty at all times. In particular this relates to the continuing lack of provision of waking night staff, as some of the service users would not be able to use their call bells. Previous timescale for compliance for the provision of waking night staff 30/07/06 & 13/02/07 & 04/05/07- not met. Staffing levels at weekends and in the afternoons must be increased, to meet the social and emotional needs of residents who are not able to access communal areas. Previous timescale for the provision of additional day care staff 13/02/07 - not met. The registered persons make sure that the premises are maintained safely by; Ensuring that all fire doors are fitted with an effective closer. Removing any wedges or other unsafe objects used to hold doors open and if necessary providing approved devices to hold doors open. Ensuring that effective window restrictors are fitted where 31/08/07 31/08/07 8. OP27 18a 31/10/07 9. OP38 13(4) & 23(4) 31/08/07 Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 27 necessary to protect residents from potential harm. Previous timescales for compliance 13/02/07 & 04/05/07 - not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP31 Good Practice Recommendations Care plans should include a summary of care to be provided, agreed with the resident. The home should have a Manager who is qualified to NVQ Level 4 and Registered Manager Award. Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Southwater Residential Home DS0000018427.V340557.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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