Inspection on 19/12/07 for The Doris Watts Home

This inspection was carried out on 19th December 2007.

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

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

Other inspections for this house

The Doris Watts Home 18/12/08

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

Similar services:

Hillview Farm

St Vincents

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Winton House

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

CARE HOMES FOR OLDER PEOPLE The Doris Watts Home 79 Milestone Road Carterton Oxfordshire OX18 3RL Lead Inspector Ruth Lough Unannounced Inspection 19th December 2007 11:40 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 The Doris Watts Home DS0000013078.V346420.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. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Doris Watts Home Address 79 Milestone Road Carterton Oxfordshire OX18 3RL 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) 01993 844103 01933 844432 linda@robert-and-doris-watts.co.uk Mr Harry Watts Vacant Care Home 29 Category(ies) of Dementia - over 65 years of age (9), Learning registration, with number disability over 65 years of age (6), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (2), Old age, not falling within any other category (29), Physical disability (3) The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 10 service users aged 55 years or over may be accommodated. Date of last inspection 5th June 2006 Brief Description of the Service: 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 over 65 years of age with a range of physical and mental care needs. 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. Residents accommodation is on two floors in the main house, served by a passenger lift and stairs. The additional annexe premises provide three single spacious rooms, a sitting room and kitchen area. In total there are three shared rooms and 13 single rooms. 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 £525 and £625. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection process to assess the quality of the service provided and that the needs and the expectations of the people who live there, are being met. Information was provided prior to the inspection process through the Annual Quality Assurance Assessment, self-assessment document completed by the manager and surveys returned to the commission. Eleven residents, four relatives, and one member of staff completed surveys. The inspection also included a one-day visit to the service where records and documents were reviewed and the inspector had the opportunity to meet with residents, and visitors and staff. What the service does well: What has improved since the last inspection? There is a programme of refurbishment and renewal and in the last twelve months they have improved the facilities of the bathrooms, dining areas and eight bedrooms. They have ensured that they have complied with the requirements made during the last inspection process in regard to implementing safety measures to protect the people who live in the home from hot surfaces and hot water outlets. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 3. 6 not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information provided to service users in the Statement of Purpose and Service User Guide is not up to date as to ensure that they can make an informed choice to use the home and the home. The home has not ensured that the people who use the service are confident they have a copy of their contractual agreement to stay in the home. Service users needs are assessed before they are admitted to the home. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Statement of Purpose and Service User Guide were reviewed to assess if prospective and current service users are given sufficient information about the service. The Statement of Purpose and Service User Guide documents that are currently used were created in 2004 and although the provider had identified amendments to the information about the service on offer they had not been carried out. The documents gave the key topics of information but some of the content was not up to date with what was currently available such as number of places they can provide, the needs of the service users they can support, and the staff’s skills and qualifications. Parts of the documents still refer to the National Care Standards Commission the predecessor of the CSCI. Both the Statement of Purpose and Service User Guide contain a large amount of information and may not be written in a format that can be easily read or understood by all the people living in the home. During the previous inspection process in 2006 it was identified that some residents were uncertain that they had received a copy of any contractual agreements about their stay in the home. A recommendation was made by the commission to review what they provided and how they made residents aware of the key topics to the terms and conditions of stay in the home. The people who use the service were again, during this inspection process, given the opportunity to comment on whether they received a copy of a contract or terms and conditions and there was a mixed response to the question. Some still expressed that they did not have a copy, and some stated that they were not sure and others confirmed that they had. A copy of a blank contractual agreement was reviewed and although it provides some key information that can be used with the Statement of Purpose and Service User Guide documents it may not be in a format that can be easily understood by some of the residents in the home. The home carries out it own assessment of service users needs process independently of any that may have been carried out by the referring local authority. The records of three people who live in the home were reviewed to see how well this was carried out. At least two of the service users had been living in the home for less than a year. One resident’s records were selected following a discussion with their relatives during the day of the visit. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 10 The assessment process is temporarily carried out by the manager of the other registered service, The Robert and Doris Watts Home, that is owned by the same provider. The process is carried out prior to admission and includes identifying health and medical conditions, medication and the limitations of mobility. A copy of the one assessment process for a gentleman with quite complex learning and behavioural needs was not available but the relatives and staff did confirm that an assessment process including obtaining information from the referring social service department had been carried out. For the other two records reviewed the information was brief and could have been written in greater depth to include details of how the individuals medical and mental health needs affects them such as diabetes and dementia. They also utilise other assessment processes including MUST (Malnutrition universal screen tool) and Barthol’s (For nutrition and health risks) as part of the overall process for identify the person’s level of dependency for social and health care support. The information obtained about the personal religious, ethnicity or cultural needs of the individual’s were not clearly defined in the care records that were seen. This may not be of significance to these particular individuals but by improving the detail this could assist the staff team have a greater understanding of how they could support the person. They do record in detail the contact details of significant professionals and the individual’s relatives and friends. The assessment document tool is detailed but also could be developed further to ensure that sufficient space is given to each topic to record explanatory notes and how the needs may effect the service user concerned. This would then assist with the development of the individuals care planning. Relatives during the day confirmed that there was the opportunity for the person they support to visit the home before they were admitted, where they are able. They also confirmed that they, the relatives, were given plenty of support and were able to visit as often as they wanted before a final decision was made. The Doris Watts Home DS0000013078.V346420.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service and their relatives are confident that their personal and health care needs are being met but the care planning records do not reflect fully the support to be provided by the home. EVIDENCE: The three relatives who responded to the commissions survey thought that the home did meet the need of the person they support and this was further confirmed through discussion with relatives and some of the residents during the day. One relative wrote in a survey, “ My family and I are very pleased with the care Mum is receiving.” The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 12 The care planning records for the three selected service users were reviewed to see how the care and support is provided to them and that their needs are being met. Additional assessments are carried out, by staff, to the initial assessment process within the first few days of stay in the home. These include recording any pain, risk of falls or pressure sores. For these they use body maps and charts to aid staff to visually identify areas of concern and give the service users the opportunity to express the levels of discomfort they may have. The care records in places are quite detailed documents and some of the topics provide staff with a good indication of the aims they wish to achieve with the person concerned. However, there was insufficient information of how they were to do this and what the personal choices of the person concerned would influence how this was to be done. For one individual there was not enough recorded information about the persons leaning disabilities needs, or mental health and how they would need to manage any challenging behaviour that they might have. Some of the risk assessments for personal care that were seen for at least one person did not appear to have been reviewed recently. From discussion with staff and relatives it was apparent that they are usually able to provide the necessary support and manage any behavioural issues that might arise. This was also evident that the information could be improved in another resident’s care planning records but this was in regard to how their medical condition effects them and the support they need from the district nurse. Not all the records reviewed had sufficient information about the ‘Life History’ of the person that would aid staff to understand them and assist with providing support. The deputy manager did confirm that the recording of the personal history for individuals was an area that they were in the process of improving. Records identifying the visits from other health care professionals such as their GP, specialist therapist and other health practitioners are recorded, with brief notes of the reason for the consultation, noted. In the surveys from residents and their relatives they said that they were happy with how the home obtain medical support when it was required. The relatives also said that the staff in the home did inform them in good time when changes occurred in the person they support’s, health and wellbeing. Other comments from relatives were,” Very good care,” and “ We have had no major concerns, but if we have had any concern for our relatives health, the staff are very helpful and are always aware of her health and monitoring her.” The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 13 Staff record in detail the outcomes of each persons day in the care plan records. The home has a policy and procedure for the medication administration practices. Both documents give staff some of the key information in regard to their roles and responsibilities and a summary of the main points are included in the staff handbook. However, the documents give greater reference to the responsibilities of a registered nurse and could be improved to give better guidance and information for the care workers. Through discussion with the deputy manager it was apparent that none of the current people who use the service are able to self medicate however they have the necessary risk assessments and can provided secure facilities for the safe keeping of the personal medications in the individuals own room. The home has safe lockable cabinets for the storage of the medications including a separate unit for any Controlled Drugs they may have. There is a system of recording the movement of all medications in and out of the home and sample signatures of all the staff responsible for medication administration is kept. The designated care workers who are responsible for medication administration may be given training in their induction period or when they are assessed as skilled and experienced to take the responsibility of the role. Staff are given information and instruction about protecting the privacy and dignity of the people they support in the induction and training programme. Staff were seen to be communicating well with the residents in a polite and respectful manner and only used their first name where requested. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be assured that they will be supported to continue with the interests they enjoy and to make choices about how they wish to live. EVIDENCE: During discussion with the inspector the residents did indicate that the staff are flexible to changes in their planned care and their daily routines. This was also reflected in the majority of the surveys returned to the commission. To the question, ‘Do the staff listen and act on what you say?” One resident commented “Mostly” and another said, “ Oh, Yes they do!” The people living in the home were asked through discussion and in the surveys if they thought there were enough activities provided in the home. It was a mixed response from them, some thought there was plenty to do if they wanted to join in and others said there were some things they enjoyed and one stated that she was bored. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 15 Visitors spoken to during the day stated that they were pleased with how the staff have encouraged their relative to join in with what is going on and that there has been a noticeable difference in their interest in their surroundings. The care plans reviewed did have minimal information of how the personal choices of the individual but did not always give enough to tell staff of how they were to support or achieve to meet them. It was evident through discussion with the people who use the service, and staff and relatives that they had a really good understanding of the personal choices and wishes of each person. The assessment documents do give some information about the person’s leisure and personal interests and some indication of their religious observances. This could be improved by greater information in the actual care panning records of how these are to be met by the staff and the home. One relative did state in the survey that staff responded to information about a resident’s faith needs, very quickly and arranged for a local church representative to visit weekly. There is a busy activities programme that is co-ordinated by a specific member of staff who is responsible for both this home and the ‘partner home’, The Robert and Doris Watts, that is located within a short walking distance away. This role was specifically implemented after consultation with the people living in both the homes and their relatives to improve what they can offer. There are small group activities that are provided by the staff and occasionally some that are together with the other home that includes garden parties, visiting performers and musicians. A planned programme of events and weekly activities is put on display in a central area for residents to see they are encouraged to join in if they so wish. The small group activities are a mixture of some physical exercise and others are about continuing and developing new skills such as craft, painting and cooking. In the warmer months residents are able to use the garden areas and the home has hosted some of the events where residents from the other home have joined them. Staff able to assist those who are able to visit the local town centre and church should they wish or need the support to do so. Information in the Annual Quality Assurance Assessment, self-assessment document did give an example of how the implementation of a designated Activities coordinator had assisted to identify one resident’s leisure choices. This was where he had been supported to develop his interest in a local football team and now he regularly goes to matches. One relative wrote in regard to a relative staying in the home, “ I have been impressed with the way the staff, led by management, will make an effort to ensure her well being, such as encouraging her to join the group for meals and activities when she has been getting depressed.” The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 16 During the day visit to the service some of the residents were taking part in a painting activity and some of the comments from those who took part did show that they really enjoyed developing their skills. They also said that they liked the company of the visiting artist who comes on a weekly basis to provide activities. The majority of the residents in the survey did say that they usually enjoyed the meals on offer, one put that they liked the meals sometimes. One comment was, “ Dinner time is the best time.” They also stated that if they wanted an alternative to the planned meal they were able to and that they were able to obtain snacks and drinks between meals should they be hungry or thirsty. Residents are consulted on a daily basis about their choices for the next day’s meals by staff. The home has a four weekly rotational menu plan that is developed through the residents meetings and any feedback or comments made to the staff. Any specific dietary needs of the people living in the service are recorded in the kitchen and personal choices and changes to the planned meals are noted. Meal times occur with two sittings in the dining area that is at one end of the main lounge and there is another small dining room space where some of the gentleman who prefer to eat separately can sit in a quieter environment. Meals can also be taken their own bedrooms, or sitting room areas if they wish. A main mealtime was observed during the inspection visit to the home and residents appeared to enjoy their meals in the company of others. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service 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: Information about how to make a complaint or who to speak to if a resident or their relative is concerned is given in the Statement of Purpose and Service User Guide documents. A summary of the complaints procedure is also on display in central areas of the home. Residents did say that they felt that they could make a concern known to staff and that usually they were acted upon swiftly. This was also the response in the surveys returned to the commission. Some relatives spoken to on the day expressed that they had confidence that any concerns would be listened to and that from experience they were acted upon quickly. The complaints procedure has all the required information and sets out the processes of how a formal complaint is investigated and the timescales that the complainant can expect a response. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 18 The home has not received any formal complaints in the last twelve months and through discussion with staff it was identified that there is not a method of recording minor concerns for quality assurance purposes. However, comments are written in the individual’s daily care plan records. The commission has not received any complaints concerns or information within the last twelve months about the service other than that supplied by the home within their responsibilities of Regulation 37, Care Standards Act 2000. The home has taken appropriate action when concerns were raised and referred one individual to the local authority in regard to a possible safeguarding issue. The home has policies and procedures for protecting residents from possible harm and abuse. Staff are also given instruction in their induction and regular training programme. Staff confirmed in the surveys returned and during the day visit to the service that they had a good understanding of their responsibilities and that they had the confidence to refer and concerns or complaints to the appropriate person or authority. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and can meet the needs of the people who live there. Their well-being is protected by the systems in place for the control of infection and standard of hygiene. EVIDENCE: The home is not purpose built but has been converted over a period of time from domestic dwellings to provide the facilities it currently has. There is a programme of refurbishment and renewal and in the last twelve months they have improved the facilities of the bathrooms, dining areas and eight bedrooms. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 20 A number of bedrooms now have en suite facilities that will give residents greater independence and has improved privacy. The home has also invested in providing improved methods for dispensing liquid soap and paper towels to assist with maintaining hygiene standards that are placed in all bathrooms and areas where staff and residents need to wash their hands frequently. The home has a small laundry area that is able to support the needs of the home and the personal laundry of the residents. It has the necessary equipment to handle any soiled linen and there are systems in place, by the use of ‘red alginate bags’ to transfer soiled items safely through the home. There is not a hand basin directly in the laundry room for staff to wash their hands after handling soiled items they have to use the staff toilet opposite, across a small corridor. They were advised to look at how they could minimise risk to preventing cross infection by improving the facilities to the laundry room with an addition of a hand-wash basin. Residents and visitors during the day visit said they were happy with the standard of care given to their personal clothing. One resident suggested in the survey that personal clothing also had the room number as well as their name to ease the return of their clothes. However, a specific problem with the laundry being returned was not highlighted through discussion with the people who live in the home or from relatives. The home appears to be kept clean and hygienic and residents and visitors confirmed that they thought the standard was good. One resident did state in the survey that their room was kept clean but the lounge area was dirty. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 21 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, and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service can be confident that the staff will meet their needs. 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 there is a specifically employed member of staff works between both homes to co-ordinate the housekeeping service and staff. The Deputy Manager has been managing the home since the Manager ‘s post became vacant in April 2007. The care staff are supported by domestic and catering staff. Information provided in the Annual Quality Assurance Assessment, selfassessment document indicated that there had been a high number of care staff who have left the service in the last twelve months, seventeen fulltime and one part- time. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 22 On observation of the staffing levels during the visit there appeared to be a sufficient number of staff to the ratio of residents and to meet their needs. The home gave information that three of the twelve carers had obtained an NVQ 2 or above and that they continue to provide NVQ training to staff parallel to the mandatory health and safety training. They have commenced using a training needs analysis tool to help identify any support staff may need but this has not been fully implemented as yet. Residents did not indicate during the day that they thought the level of staff in the home was of concern and they confirm that staff were quick to respond when they called for assistance. The recruitment and employment records for three staff were reviewed to assess the quality of the processes carried out and to ensure that the checks to protect residents from possible harm had been implemented. Only one of these members of staff had been employed in the last year, the two others had been working in the home since 2005 and 2006. The records supported that all applicants are required to complete an application form, two references and provide evidence of proof of their identity and have a Criminal Records Bureau check before they commence working in the home. Interviews with applicants are recorded and some information is noted about the planned support such as training that will be provided. The records for one member of staff did not show that the applicants full work history or provide written explanations for any gaps between periods of employment, but all the other necessary checks had been completed. They do have a process for monitoring and ensuring that the required information is obtained but this was not seen in the recruitment records to be used effectively and the method for storing the information in the files could be improved. Residents and relatives did comment that they thought staff were friendly and approachable. One relative stated in the survey in response to the question about the skills and experience of staff, “The staff are confident and deal with a situation promptly and efficiently.” The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 23 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed effectively but the ability to continue to so is compromised by not having a permanent manager in post. The staff and provider do encourage and support the people who live and use the service to voice their opinion of the services provided. The measures in place to protect the health, safety, and privacy of residents living in the home are compromised by the arrangements for managing and supporting people to smoke in the home. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 24 EVIDENCE: One relative stated about the home, “They care well. We have been very please with her care since her move to the home. Concern is shown for my relative as an individual and I have got to know the staff, making it easier to talk if needed.” One relative responding to the question ‘What the home does well?’ said, “ Being attentive to the needs of the residents.” The registered managers post has been vacant for over eighteen months, although a manager was employed temporarily to the post for a short period of time. The Deputy Manager spends approximately two hours per day to carry out the administrative needs of the service with the rest of the working time in providing care and support. The Registered Manager from the partner home, ‘ The Robert and Doris Watts’ has been overseeing the general management of the home throughout this period. She is a registered nurse and has obtained an NVQ4, Registered Managers Award and is skilled and knowledgeable to provide the support required, The home has different activities that are used to seek and monitor its quality of the service it provides. There are the more formal processes that include surveys to residents and relatives and regular residents meetings. What they could improve is to provide written feedback to the participants on a greater regularity than currently occurs. Additionally there is a programme of staff and supervision meetings that can be used to assess and develop the service. Some staff did comment in the survey that they thought that they did have enough opportunity to meet with the senior staff for supervision. The home does handle a small number of the resident’s spending money with the majority of the people living in the home being supported by their relatives and advocates for this. The home has evidence that the money they do handle is recorded sufficiently and there is a clear audit trail that is monitored on a weekly and monthly basis. There has been an incident since the last inspection where there were concerns with how an individual’s money had been managed but this has now been rectified. The home is looking to improve and minimise its responsibilities for handling the resident’s money. There are systems in place for the safe working practices that should ensure that the people who use the service are protected from possible harm. This includes providing staff with the necessary training and equipment for moving and handling residents, first aid, fire, food hygiene, and infection control. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 25 There is a programme of monitoring and servicing the facilities and services to the home that includes checks of the hoists and lifts, water safety and fire equipment. They have also implemented the safety measures for hot surface temperatures and the water outlets that were identified during the last inspection process as a concern. The home provides a designated room for smoking that is used by residents, visitors, and staff. The manager was not able to provide evidence of a copy of any risk assessment for the room to be used for this purpose or individual risk assessments for the specific residents who smoke. They do provide staff with copies of policies and procedures for safe working practices and for guidance for staff to work to. The current policies and procedures in place have been partially reviewed by the manager but like the Statement of Purpose and Service User Guide will need some amendments to meet with changes that have occurred in legislation and how the home functions. This also would be relevant to those for recruitment, service users finances, and smoking. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4,5 Requirement Timescale for action 29/04/08 2 3 OP7 15 13.4.a OP38 That the Statement of Purpose and Service User Guide are updated to include the required information and developed into formats that are applicable to the individuals needs. That they ensure that the care 31/03/08 plans reflect how the care is to be provided. That the provider ensures that 28/02/08 the health and safety of the people who smoke are minimised by the assessment of risks and appropriate action taken. The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 28 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 OP2 OP12 Good Practice Recommendations The proprietor should consider ways in which residents can be made more aware of information about their contract and terms and conditions of their stay in the home. That the home continue to develop the tools they use to record the personal information about the individual including the interests, life history, religious and cultural needs and personal preferences to aid staff to meet their needs. That they improve the method of recording any comments, concerns, and information provided to the home to use for their quality assurance processes. That they look at how they could minimise risk to preventing cross infection by improving the facilities to the laundry room with a possible addition of a hand washbasin. That the management use with greater effect the monitoring tool for recruitment to assist ensuring that they have the required information about the individual employee. That they also implement a system for the storage of the recruitment and employment records to ensure that items are organised and accessible only in accordance to the Caldecott principles. That they look to improve the methods of informing the participants of the quality assurances process such as the surveys and residents meetings of the outcomes and findings in a documentary format that is appropriate to the individuals needs. 3 4 OP16 OP26 5 OP29 6 OP33 The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NL 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 The Doris Watts Home DS0000013078.V346420.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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