Inspection on 18/12/08 for The Doris Watts Home

This inspection was carried out on 18th December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Doris Watts Home 19/12/07

The Doris Watts Home 05/06/06

The Doris Watts Home 29/12/05

The Doris Watts Home 26/05/05

The Doris Watts Home 02/11/04

The Doris Watts Home 10/06/04

The Doris Watts Home 21/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Doris Watts Home 79 Milestone Road Carterton Oxfordshire OX18 3RL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Delia Styles     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: The Doris Watts Home 79 Milestone Road Carterton Oxfordshire OX18 3RL 01993844103 01933844432 linda@robert-and-doris-watts.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Harry Watts Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 29 Number of places (if applicable): Under 65 Over 65 0 0 29 dementia learning disability old age, not falling within any other category Additional conditions: 29 29 0 The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Dementia (DE) Learning disability (LD) Date of last inspection Brief description of the care home The home is situated in a quiet residential area of Carterton. This enables service users ready access to the facilities in the centre of the community nearby - shops, dental and medical surgeries, opticians, banks and a library. There is also a weekly street market. The home offers homely accommodation for up to 29 service users with a range of physical and mental care needs. Care Homes for Older People Page 4 of 35 Brief description of the care home The care home is not registered to provide nursing care. An adjacent bungalow was adapted and linked to the original Doris Watts Home and registered in August 2002. In 2007 the premises were again re-registered to include a two storey house now linked to the other buildings. Eleven of the 26 bedrooms have en-suite facilities. The main kitchen and small laundry room are on the ground floor of the main house. There are enclosed gardens to the rear of the home with ramped path access from the buildings. One garden area has benefited from a landscaping project undertaken in partnership with a local community college in 2003. The garden at the rear of the bungalow annexe accommodation is grassed, with a number of mature fruit trees. The weekly fees for this services range between 350 and 738 pounds. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection visit to review the quality of care and support provided and the outcomes for the people living in the home. The inspection process included a review of the information provided by the manager in their Annual Quality Assurance Assessment (AQAA). Our survey questionnaires were supplied to some of the people using the service, their relatives, staff, and some of the health and social services professionals who visit the home regularly. We received 6 surveys from residents (5 of which were completed with the help of the manager, and one completed independently), 4 from relatives, 2 from staff and one from a health care professional. The inspector toured the building and looked at a sample of the paperwork and records that the home is required to keep. The inspector also talked to residents, 2 visitors and some of the staff during the course of the day. At the end of the inspection, feedback Care Homes for Older People Page 6 of 35 was given to the manager Mrs Jakes, home owner, Mr Harry Watts, and the operational manager, Mr Anthony Watts. What the care home does well: What has improved since the last inspection? What they could do better: We found that the home had not met the requirement we made at our last inspection about providing prospective residents and the people already living in the home with up to date information about the home and the services it provides. The homes Statement of Purpose and Service Users Guide, which include the homes written complaints procedure, must be made available to all residents in formats that can be easily understood. Without this information, people living here and those who may be deciding whether the home is likely to meet their needs, may not have the correct information to help them make an informed choice or guidance about how to make a complaint, should they need to. Routine repair and maintenance jobs are not always completed promptly or satisfactorily so that there is a potential for residents to be at risk and the appearance of some areas of the living environment for residents is unsatisfactory. Repairs and completion of refurbishment work must be promptly carried out. There should be a system of routine audits on the standard of the premises and residents rooms to identify any repairs and improvements needed and check that work is satisfactorily completed within a given timescale. The staffing levels must be reviewed to ensure that residents needs are met and that there are sufficient staff to supervise and monitor all areas of the home, especially at night. Care Homes for Older People Page 8 of 35 Examination of a small sample of staff records of recruitment and employment showed that the home owner had recently employed someone without receiving satisfactory checks and references for the individual and had permitted the person to work unsupervised with residents. This potentially leaves vulnerable residents at risk. The processes for the recruitment and screening of all new employees must always be rigorous, thorough and consistently applied so that residents can be confident that people involved in their care and support can be trusted and are suitable for the work they are employed to do. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current written information about this home and the service it can offer has not consistently been available to prospective service users and their representatives to help them make an informed decision about whether the home is likely to meet their needs and expectations. The pre-admission assessment of peoples needs ensures that service users can be confident that the home is likely to suit them. However more could be done to involve prospective service users and their representatives in the decision making process. Evidence: The operations manager, Mr Anthony Watts, said that the Statement of Purpose and Service User Guide documents (the written information about the service that the home is required to make available to all prospective and current service users) have been updated. He printed a copy of the statement of purpose off his computer to show the inspector. Care Homes for Older People Page 11 of 35 Evidence: Further editing of the new statement of purpose is needed to correct some errors, for example the contact number for the commission is wrong. We also suggest that some of the section wording is more appropriate for inclusion in a staff handbook for example, confidentiality, action to be taken in the event of a fire and the accident policy. At our last inspection a requirement was made to review and update the information because this had not been done since 2004. It is important that all prospective and current residents have the correct information about the home that is accessible and clearly written, so that they can make an informed judgment about the home and whether it can meet their needs. Mr Anthony Watts said that the move to re-brand the organisation had meant that the updating and reprinting of new material had been delayed. In February 2008 Mr Watts said he had requested an extension for the timescale to meet our requirement to update the documents by the end of April 2008. It appears that there has been a lack of written information made available to residents, their families and prospective residents for 9 months, which is unacceptable. Of the four relatives who completed one of our surveys, two felt that they always had enough information about the care home, one usually and one sometimes felt this was so. Two out of 5 residents said they had received enough information about the home before they moved in and 3 answered no. All the survey responses indicated that they had been placed by social services. One person said they had never seen the place before being brought here. At our last inspection, we considered that the home should review the way that it assesses the care and support needs of prospective residents so that staff would be better able to meet their needs. The homes AQAA self-assessment (October 2008) tells us that they plan to continue develop care records to ensure that individual ethnicity and cultural needs are clearly identified and to simplify the service users care records to ensure they understand their contract and the terms and conditions within. The six residents who completed one of our surveys all stated that they had received a contract. The manager or her deputy undertakes the assessment of peoples needs before accepting them for admission to the home. A sample of assessments for 2 current residents was examined. The content and detail of the pre-admission assessments in relation to peoples physical care was satisfactory. One of the sample included a postadmission assessment that ensured that additional information was added to the Care Homes for Older People Page 12 of 35 Evidence: individuals care plans. Assessment information includes input from peoples care managers and family where possible. Risk assessments, for example, relating to peoples risk of being malnourished, falls, and skin damage (pressure sores) are also included. However, in one of the sample seen, the risk assessment information had not been signed. There was evidence of additional information about peoples mental health care needs having been sought. The appointment of a project worker, who is overseeing the development of a new service for people with mental health needs, has meant that the skills of this individual can be used by the home staff when assessing and planning for the care of people who have such problems. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care and medication needs of residents is satisfactorily met and residents and their families are confident about the way in which staff deliver care and respect their dignity and rights. Since our last visit the care plans have improved but more work is needed to ensure that they accurately reflect peoples care and support needs and detail the actions that staff need to take. Evidence: A sample of 3 residents care plans was examined. Two of the three people had only recently been admitted to the home and there was evidence that their care plans were being developed over time. All the care plans include a life history of the individual which described in varying amounts of detail, their family and social networks, interests and hobbies. A health care professional commented in the survey returned to us, that in their experience the home always meets individuals health care needs and are proactive in requesting GP and psychiatric input if required. This professional also felt that the Care Homes for Older People Page 14 of 35 Evidence: home develops very individualised care plans for the clients. The assessment information, care plans and records of review meetings and health care visits are held in individual files for each resident. From the sample seen, it was noted that the risk assessments and care plans are regularly reviewed and mostly contained detailed and relevant information. One persons risk assessments were not dated or signed by their key worker However, one persons records had some important omissions, for example, in relation to how staff should monitor and manage the persons occasional aggressive outbursts. Although the new project worker has considered planning some individual sessions with this individual to help them find ways to control anger, this was not documented. The residents request for a particular activity was included in the care plans, but was not dated or signed, so that it was not possible to see whether their request had been followed up. The management of diabetes was not clearly set out in the care plan so it is not clear who is responsible for routinely checking or supervising the resident, to check their blood sugar. The signs of low or high blood sugar and how these events should be dealt with if observed by staff, were not incorporated in the care plan, so that staff might not know what to do to help a resident. These points were discussed with the managers at the end of the inspection Discussion with the managers and some of the staff on duty showed that in practice they have a good understanding of peoples individual health and personal care needs. The content of the care plans should be improved to show the most recent information so that staff can evaluate what they do and whether or not their actions improve residents health and wellbeing. Of the 6 surveys completed by residents, 4 people stated that they always receive the care and support they need, one usually and one sometimes. Three out of 6 felt they always receive the medical support they need and 2 indicated this was sometimes the case - one person added that they had never asked for any (medical support). Relatives surveys showed similar responses to the question about whether they felt the care home meets the needs of their friend or relative in the home. One person has been unable to visit the home in person but is confident that the home looks after their relative well. Relatives responses about how well the home kept them up to date with important issues affecting their relative in the home were varied, with 2 out of 4 considering that the home always contacted them about important changes, 1 person stated usually and 1 that this never happened. One relative said they only found out about any Care Homes for Older People Page 15 of 35 Evidence: medical problems when they visit the home. The homes systems for the receipt, storage, administration and disposal of prescribed medicines are satisfactory. The supplying pharmacist undertakes regular checks of the homes medicines and is available to advise staff if they have any queries. Observation of staff interactions with residents and residents comments on the day of the inspection visit confirmed that residents are treated respectfully and their privacy and dignity is protected. The 6 residents who completed our survey all felt that the staff listen to them and act on what they say - all the staff are very approachable; always accommodate and very good - but not always on time. Care Homes for Older People Page 16 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are encouraged to continue to have an active and enjoyable social life within the limits of their physical and mental health needs and in accordance with their preferences. Residents have a nutritious diet that suits most peoples individual preferences and requirements. Evidence: From observations, and conversation with individual residents and staff, it appears that peoples individual preferences about their day to day routine and how and where they spend their time is known and respected by staff as far as possible. A member of staff has the key responsibility for organising activities in the home and planned activities are displayed on the notice boards. There was a range of visits to outside and in-house entertainments, including pantomimes, carol singing and social events in the run up to Christmas. Several times a year outside entertainers come into the home and every two months the home makes use of the Cultural Loans Service that has items of memorabilia that provide talking points for residents about their recollections of past important times and events. Care Homes for Older People Page 17 of 35 Evidence: Several of the more physically independent residents are able to walk to the town centre to visit the shops and amenities there. There is a weekly open air market that several residents like to visit. The homes Annual Quality Assurance Assessment (AQAA) tells us that they have introduced a personal advocate for residents to help identify and co-ordinate funds to help residents access more activities in the community and form links with schools and other community groups. The home aims to have its own minibus to give a larger number of residents the opportunity to go on outings. They also plan to develop a small market garden project at the rear of the home for the interest and enjoyment of residents who would like more outdoor activities. The ground has been cleared ready for the start of this project. The AQAA states that the home has made a number of changes as a result of listening to residents. These include increasing the frequency of the hairdressers visits from monthly to fortnightly; putting more focus on activities by having a lead activity coordinator with responsibility for developing a new and more comprehensive range of activities, trips and hobbies; and provision of a digital Bingo machine. From the surveys we received 2 out of 6 residents stated there are always activities arranged that they can take part in. One person stated this is usually the case, 2 sometimes and 1 never. One person stated they would like more outings and one was disparaging about painting and Bingo which they claim are the only activities available. One relative wrote that they would like the home to encourage their family member to take more part in the social life of the home, but recognise this is difficult if the individual does not wish to. Relatives feel welcome when they come to the home - one survey comment described how the family were welcomed at any time of the day or night by staff during my (relatives) last illness and unasked for, were brought tea and refreshments. Of the 6 residents who answered our survey question about meals in the home, 3 answered that they always like the meals, 1 usually and 2 sometimes. Two comments indicated that some residents felt the menus are lacking in variety - one person said that the vegetarian meal options are limited and another that the meals on offer on Mondays, Fridays and Saturdays are always the same. The home has a four weekly rotational menu plan that is developed in consultation with residents and feedback and comments made by residents to the cook and staff. Care Homes for Older People Page 18 of 35 Evidence: Any specific dietary needs and likes and dislikes of residents are listed in the kitchen. The main meal of the day (around midday) is served at two sittings. There is the main dining area, and a small dining room that is preferred by some of the gentlemen who prefer to eat separately in a quieter environment. People can take their meals in their own rooms or the sitting rooms, it they wish. Residents spoken with at lunchtime on the day of this inspection all confirmed that they had enjoyed their meal. Staff were seen to give discreet help to those who needed assistance to eat. Care Homes for Older People Page 19 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not consistently provide the required information about the service and complaints procedure in a way that is accessible to all potential and current residents. This means that some service users and their families may be disadvantaged if they want to make a complaint. People who live here can be confident that their concerns will be listened to and acted upon and that there are systems in place to protect them from possible harm. Evidence: The home has failed to make available a current statement of purpose and service user guide as required by the end of April 2008 after our last inspection. This may mean that not all residents and their relatives would know how to make a complaint because these documents must include information about the homes complaints procedure and how the home will respond. In particular, the way information is presented to residents should be adapted to meet their particular needs, for example, in easy read or picture book symbols for people with a learning disability, and large print for those with visual impairment. From our residents 6 surveys we found that 4 stated they always know who to speak to if they are not not happy and 2 usually. All said they would talk to a staff member or the manager. Four of 6 residents who completed our survey said they know how to make a complaint. One person said that the new manager has explained the process Care Homes for Older People Page 20 of 35 Evidence: and 2 stated they would speak to the manager. Three of the 4 relatives surveys indicate they know how to make a complaint and 1 stated no to this question. Two of those who know how to complain said they had never had need to and the third said they have a telephone contact number for social services. Two of the 4 relatives stated they felt the home had responded appropriately to any concerns - but also pointed out they had not raised any. The third person commented that they receive an annual report of their relatives condition and welfare via social services. Overall we consider that the survey responses show a lack of clarity about the homes policy and procedures if someone wishes to make a complaint. It was noted that there is a summary of the complaints procedure on display on notice boards in the home but this may not be accessible to all residents. The homes Annual Quality Assurance Assessment (AQAA) sent to us in October 2008 states that they could improve on how they make information about their complaints procedure available to residents. They intend to rewrite the complaints procedure and produce a simple glossy handout that can be given to all prospective and current service users, friends, family, advocates and professionals. One health care professionals survey indicates the service always responds to concerns appropriately - very prompt response and action points acted on. Both of 2 staff survey respondents stated they know what to do in the event of a service user raising a concern. One person added they would contact appropriate professional or make a complaint to yourselves (the commission). However, it should be noted that the commission does not take the lead in investigating complaints as this is the role of the provider in the first instance (although the commission can be contacted at any time during the complaints procedure). From observation and discussion with residents it is evident that people feel comfortable with making any concerns known and that they would be taken seriously by the manager. Following our last inspection we recommended that the home improve the way in which it records any comments, grumbles and suggestions so that staff are made aware of and can act on them as part of the quality assurance process. In a written response the proprietor tells us that any minor concerns continue to be recorded in a carers communication book which is handed over daily to the key workers and Monday to Friday (to) the manager. The home has not received any formal complaints in the past 12 months. The commission has been made aware of concerns from one source that related to the environment and failure by the home to provide one agreed aspect of care. The callers concerns could not be investigated by the home as the caller could not be contacted by us. Care Homes for Older People Page 21 of 35 Evidence: The home has policies and procedures in place for protecting residents from possible harm and abuse. Staff are given information about safeguarding and how to identify and report suspected abuse during their induction training and at regular updates as part of their training programme. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since our last inspection the home has invested in replacing the heating and hot water system and upgrading the entrance and reception area for the home. However, there is a lack of attention to attending to repair work and refurbishment promptly, so that residents do not consistently have a well maintained and attractive environment in which to live. Evidence: This home is not purpose-built and has been adapted from its original use as a family house over many years and over time has extended to include a neighbouring bungalow and most recently, a two storey house . The home owner plans to build a new care home on the land he owns nearby. Some progress has been made in the planning application process since our last inspection and Mr Anthony Watts operations director for the company, said that they are hoping to be in a position to start building in 2009. There is evidence of an ongoing programme of refurbishment in parts of the home, for example, the creation of a new front entrance and reception area with a desk was almost complete. This has improved the access and first impression of the home for visitors. Mr Watts said there are plans to have comfortable seating in the reception area with information and leaflets for visitors. Care Homes for Older People Page 23 of 35 Evidence: Other improvements include the new washable flooring in the main dining room - this was decided on in consultation with residents. The heating and hot water system has been replaced which has improved the reliability and ability to vary the room temperatures to suit individual residents preferences. The standard of decor and furnishing was noted to be variable in residents rooms. Whilst some rooms were highly personalised and homely, others were rather institutional and bare in appearance. There was a marked contrast between the rooms in the most recently registered part of the home and the original rooms. It was also noted that small repair and maintenance jobs had not been completed in a number of rooms. For example, leaks around the bases of toilets in the some newer rooms, a loose radiator cover, water pipes around the assisted bath in the ground floor bathroom were not boxed in and the earth wire was not connected. These problems indicate a lack of prompt attention to routine maintenance and repair and apart from being unsightly, are potential hazards to residents. A health care professional commented in our survey that, in their view the home is rough and ready cosmetically - not a selling point and they could improve in this area. A tour of the building showed that the standard of cleanliness is good. Five out of 6 residents survey answers indicated that the home is always fresh and clean (one person stated this is usually the case). Where a few rooms were untidy, cluttered or did not smell fresh, the manager explained this was because residents personal preferences about their living space is respected. Staff do work with residents to agree housekeeping and personal hygiene goals if these begin to have a negative effect on the wellbeing of the individual resident or other people living here. An action plan sent to us in February 2008 following our last inspection report, indicated that the laundry was to be re-sited to a bungalow adjacent to the home and there were plans to provide modern facilities as have been demonstrated at the Robert and Doris Watts home (the providers other home nearby) minimising any risk of cross infection. The re-siting of the laundry had not taken place. A small room used for laundry work at the front of the home is still in use. It has the necessary equipment to deal with contaminated and heavily soiled laundry items, though there is limited space for the separation of clean and dirty laundry work. Since our last inspection the home has acted on our recommendation to fit a small wash basin for staff use in the laundry. However, liquid soap and paper hand towels were not available. The home should ensure that there are always adequate arrangements for hand cleaning in place in the laundry. Care Homes for Older People Page 24 of 35 Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers and spread of this extended home do not always effectively meet the assessed support and care needs of all residents. The staffing levels and shift patterns must be reviewed to ensure that there are sufficient staff to supervise and support residents effectively and maintain their safety, especially at night. Recruitment and employment processes are not consistently robust which potentially exposes residents to risk from unsuitable workers. The recruitment processes must be consistently and rigorously applied. Evidence: The home shares a common recruitment and employment process with its partner home, the Robert and Doris Watts. There are a few care staff that work between the homes as and when required and the housekeeping manager also works at both homes to co-ordinate the housekeeping service and domestic staff. The rota confirmed that there is always a senior care staff (key worker) on duty together with two care staff during the day and a total of two care staff at night. The manager or deputy manager are available during weekdays in addition to the staff providing direct care to residents. The homes AQAA (October 2008) indicates that 16 residents need the help of two staff Care Homes for Older People Page 26 of 35 Evidence: with their care overnight. This means that if one resident requires two people to help them there is no-one available to respond to other residents in an area that now incorporates 3 buildings. The two staff members who completed our survey. One person felt that there are always enough staff to meet the individual needs of all the people who use the service and the other that this is usually so, but added the home would benefit from 1 extra member of staff on each shift. From our residents survey responses we found that 3 out of 6 consider staff are always available when needed and 3 consider this is usually so. The staffing levels should be reviewed to ensure that there are always sufficient staff to support more dependent residents especially at night. All 4 relatives surveys indicate satisfaction with the staff skills and experience. The health care professional commented that staff usually have the right skills and experience to support individuals social and health care needs adding, there is always room for improvement. Importantly they recognise shortfall in skills and try to improve on that. The same professional commented that the care and responses of staff outweigh (any concerns about the appearance of the environment I have). The number of staff who had left the home in the 12 months before October 2008 was 4, indicating that the turnover of staff we found in 2007 has been significantly reduced. As we noted at our last inspection, the rota shows that several staff work more than 5 shifts a week and some people work long days of approximately 15 hours in a twenty four hour period. Staff choose to work these long hours and it does provide continuity of care for residents and means that the home does not use agency workers. If staff work an excessive number of hours, or work a mixture of day and night shifts within each week, there is a potential that they will become overtired and are more prone to accidents and to make mistakes at work, with the potential of harm to residents and their own health and welfare. The recruitment and employment records for three staff were reviewed to assess the quality of the vetting and screening process to ensure that the home carries out the required checks on prospective employees for the protection of residents. Two of the 3 records selected were satisfactory, with the required documentation to show applicants identity, work experience and suitability to work with vulnerable people had been undertaken. Satisfactory Criminal Record Bureau (CRB) checks and references had been sought before these 2 individuals started work at the home. However, one persons file was empty except for the results of the preliminary police check - PoVAFirst - that had been received on 10.12.2008. The individual was already Care Homes for Older People Page 27 of 35 Evidence: employed in the home and had not been supervised when working with service users and had a planned outing with a resident away from the home. The operations manager, Mr Anthony Watts, said that his father, Mr Harry Watts (the registered individual and proprietor) probably had more information about the staff member at his home. Mr Harry Watts was contacted and he explained that there were no references for the employee as he had employed the person because he had known them for a very long time and was satisfied with their qualities and abilities to do the work they had been employed for. He confirmed that a satisfactory full CRB had not yet been received. Mr Watts was reminded of his accountability and that he must ensure that he has obtained all the information and documents required under Regulation 19 of the Care Standards Act 2000 and Care Home Regulations 2001 before employing someone in the care home. The 2 staff who completed our survey varied in their responses to whether they felt they received adequate induction training - one person, who has been working here a long time answered very well and the other partly. Both stated they are receiving training that is relevant, up to date, and helps them meets the individual needs of people living here. Both answered usually to the question about whether they have the right support, experience and knowledge to meet the different needs of people using this service. In terms of what could be improved, one person suggested offer different types of training. The most recent information received is that, of a total of 11 care staff, 2 have a National Vocational Qualification (NVQ) at Level 2 or above, and a further 4 carers are working towards this. The proportion of carers who have NVQ Level 2 is still considerably below the 50 per cent expected by us to have this qualification. However, the home has recently appointed a new manager who is experienced in care and training, so that the development and expansion of training opportunities for staff will continue to improve. Care Homes for Older People Page 28 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements meet the needs of the service. The views of residents and their representatives are sought and acted upon. The homes financial procedures protect residents from abuse. Evidence: Since our last inspection the home has appointed a new manager, Mrs Anna Jakes, who started work at the home in November 2008. In the time that the home has been without a manager, the deputy manager, and Ms Linda Eastwood, registered manager for the Robert and Doris Watts home, have overseen the management of the Doris Watts. The operations manager, Mr Anthony Watts, and a project manager for a new service being developed for people with mental health needs, are both based at the Doris Watts and share an office with new manager. Mrs Jakes has been registered by the commission in her previous work as a manager of a domiciliary care service and will need to re-apply for registration to become the Care Homes for Older People Page 29 of 35 Evidence: registered manager for the Doris Watts care home. She has the Registered Manager Award and National Vocational Qualification Level 3 and is a qualified Risk Assessor showing that she has the necessary qualifications for her role. Feedback from comments in our surveys indicate that the new manager has already had a positive effect on the management and organisation of the home. People were impressed with the loving care and attention given to the residents and the way in which, as one person put it, the owner and manager are always striving to look for ways of improving the lives of their residents. The home admits people with a wide range of care and support needs and do seek the views of residents about the service and facilities. They tell us that they have appointed a person who acts as internal advocate to enable staff to focus on the individual needs and aspirations of residents. The home emphasises the informal and open door access to managers, so that people feel comfortable to share their opinions and suggestions on a daily basis. There are quarterly forum meetings with residents to seek their views and opinions. Minutes of these meetings are made available publicly and some residents have decided they would like their own personal copy. Quality assurance questionnaires are sent to all residents, family and advocates and professionals every year to check peoples views about the quality of the service. The home handles a small number of residents personal spending money where the resident is no longer able or wishes to manage their own allowances. Most residents have relatives or advocates to act on their behalf. The homes records show that they can account for the balances held on behalf of residents and that there is a clear audit trail of expenditure and receipts for monies spent on residents behalf. The requirement we made at our last inspection to protect the health and safety for residents who wish to smoke, has been met. There is a designated room for smoking that is used by residents and visitors. Staff who smoke are now required to do so outside the building. Individual risk assessments are provided for those residents who wish to smoke. Mandatory training for staff includes fire safety awareness, moving and handling, care of substances hazardous to health (COSHH), first aid and adult safeguarding. During the inspection the accident records for a sample of residents and the fire records of staff training and fire equipment checks were examined. These were up to date. Care Homes for Older People Page 30 of 35 Care Homes for Older People Page 31 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4,5 That the Statement of 29/04/2008 Purpose and Service User Guide are updated to include the required information and developed into formats that are applicable to the individuals needs. Care Homes for Older People Page 32 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The home must supply an up to date copy of the statement of purpose and make it available on request for inspection by every service user and any representative of a service user So that service users have the information they need to make an informed choice about where they live. 20/04/2009 2 19 23 The registered person must keep the home in a good state of repair externally and internally. In order for the people living here to have a well maintained, safe hygienic and comfortable home in which to live. 20/04/2009 3 27 18 The staffing numbers must 30/04/2009 be reviewed and increased if necessary to ensure that there are always sufficient numbers of staff to meet the Page 33 of 35 Care Homes for Older People health and welfare needs of service users. To ensure the safety and well being of residents especially at night 4 29 19 The registered person must 30/04/2009 nor employ a person to work at the care home unless the employer has obtained the information and documents required, specified in paragraphs 1 to 7 of Schedule 2. So that residents can be confident that the staff employed by the home have been subject to rigorous checks to make sure they are suitable to care for them Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be updated to reflect changing needs and set out in detail the action which needs of be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service users are met. The home should implement the system of routine audit of the premises and maintain a programme of repairs, refurbishment and renewal of the fabric and decoration undertaken. Records should be kept of the achieved compliance within agreed timescales. 2 19 Care Homes for Older People Page 34 of 35 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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