CARE HOMES FOR OLDER PEOPLE
The Doris Watts Home 79 Milestone Road Carterton Oxon OX18 3RL Lead Inspector
Delia Styles Unannounced 26 May 2005 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 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 H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Doris Watts Home Address 79 Milestone Road, Carterton, Oxon, OX18 3RL Telephone number Fax number Email 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 steph@robert-and-doris-watts.co.uk Mr Harry Watts Mrs Stephanie Julian Care Home 21 Category(ies) of Past or present alcohol dependence (2), Past or registration, with number present alcohol dependence over 65 years of of places age (1), Dementia (1), Dementia - over 65 years of age (9), Learning disability (1), Learning disability over 65 years of age (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (2), Old age, not falling within any other category (21), Physical disability (1) The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: The total number of persons that may be accommodated at any one time must not exceed 21 To accommodate a named service under the age of 65. Date of last inspection 02 November 2004 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 21 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 accomodation is on two floors in the main house, served by a pasenger 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 Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over three hours. A partial tour of the premises took place and the inspector talked to ten residents and two visitors, the manager and three of the staff on duty. What the service does well: What has improved since the last inspection? What they could do better:
The written records of residents’ care should be further improved. The details of residents’ care needs, the instructions about how the staff are to carry out care and whether care has been given that meets the residents’ needs should be accurate and up to date. The manager has good knowledge of residents’ needs and there is evidence of good communication with the home’s staff, doctors, nurses and other health and social workers. However, information shared between staff verbally should also be written in the care records, to lessen the risk of something being forgotten, especially if the manager or care leaders are not available to check that instructions have been passed on.
The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 6 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 Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4 and 5 The home’s Statement of Purpose and Service Users’ Guide are of a good standard providing people with details of the services and enabling them to make an informed decision about whether or not they might wish to live in the home. EVIDENCE: As well as the Statement of Purpose and Residents’ (service users’) Guide, the home has its own website and electronic version of the brochure available on CD-Rom. Visitors said that they had read the CSCI reports of this and other care homes before visiting the Doris Watts Home. They had been invited to visit at any time without an appointment, so that they could consider how suitable the home would be for their relative. They had appreciated the fact that they were made welcome and had seen the home and met other residents in a relaxed and informal way. Residents’ care records contained information about their individual care needs that had been made before their admission to the home. The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 The health needs of residents are well met with evidence of good contact with doctors, district nurses and other health and social workers on a regular basis. Progress has been made on improving the residents’ care records, although further improvement is needed. EVIDENCE: Residents’ care plans are kept in individual folders. These had an index and were well set out, so that the information could be easily read. There was evidence that the records are regularly reviewed, but some had not been updated with the most recent information or changes in people’s care needs, for example whether a planned outpatient appointment had been kept, or the outcome of a visit from a visiting health professional. Discussion with the home manager, staff, residents and visitors showed that individual resident’s health, social and personal care needs had been accurately assessed and identified in practice, but that the written records did not always have enough information about what actions had been taken by staff.
The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 10 The manager and staff rely on good verbal exchanges of information. In the event of the manager or senior care staff member’s absence, there is a risk that important details could be overlooked, especially as many of the residents are unable to express their own care needs. Care plans and records should be kept up to date and information about any changes to care, whether the agreed plan of care had been followed and had met the person’s needs, should be included. The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 14 Social activities and mealtimes are well managed and appear to suit the individual needs and interests of the residents. EVIDENCE: Staff members take responsibility for arranging activities with individuals and groups of residents daily. The manager arranges for visiting entertainers to come in to the home. A ‘music and movement’ session for residents, led by a qualified therapist, had just taken place in the home; this had proved very successful and enjoyable. Two residents in particular spoke of their enjoyment of drawing and painting that they were busy with during the afternoon. People’s individual preferences about when they get up and go to bed are respected. Visitors said that they were always made welcome in the home. Two said that they appreciated the fact that they can have a meal with their relative when they visit each week. Residents were able to continue their attendance at a local day centre. A separate sitting room with a television is provided for residents who want to smoke. The main lounge/dining room has a television and video. A third lounge in the ‘annexe’ is less used on a daily basis, but provides a quiet and private area for visitors and residents to use.
The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 The home has a satisfactory complaints system with evidence that residents’ views are listened to and acted upon. EVIDENCE: The manager discussed action that had been taken to make sure that residents are helped to raise any concerns or complaints with their care managers (if they do not have a relative). The home’s staff disciplinary procedure had been used recently, with a satisfactory outcome, in relation to an employee who had failed to meet the standard of work expected of them. All staff had been reminded of their duty to ‘whistle-blow’ and report any concerns about the facilities or staff practices if these were likely to affect the standard of care for residents. There are regular meetings between the manager, care managers, individual residents and their relatives to discuss whether the home is providing a satisfactory standard of care. Residents’ families or representatives (if the resident is unable to speak for themselves) make sure that their legal rights are protected, for example through Court of Protection orders. Staff receive training in recognising and reporting suspected abuse. The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 and 26 Overall, the standard of the environment within the home is good, providing residents with a comfortable, homely and clean place to live. EVIDENCE: Since the last inspection two first floor rooms have been recarpeted and redecorated, improving the appearance and layout for residents. The standard of cleanliness was very good and there were no unpleasant odours. The laundry room is very small, but clean and tidy and residents’ clothing looked well laundered. Recommendations made at the last inspection to alter a first floor bathroom and ground floor annexe bathroom to make them more accessible and suitable for disabled residents have not yet been carried out by the proprietor. Outside, work had started to improve the garden pathways and create a new flowerbed area. The garden was attractive with tubs and containers, a fishpond and garden seating. Staff take an interest in helping to maintain the garden to provide a safe outdoor area for residents to enjoy.
The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The staff are enthusiastic, hard working and have a good understanding of the residents’ support needs. The numbers and allocation of staff appear sufficient to meet the needs of residents. EVIDENCE: Residents spoken to were at ease and evidently enjoyed a good relationship with the manager and staff. Since the last inspection the manager has started a further training course in caring for residents with dementia. There is an established staff training and development programme and the manager is committed and enthusiastic about making sure that all staff have opportunities to attend training and updating in care and health and safety topics. The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed at this inspection. EVIDENCE: The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 2 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x x x x x x x The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 17 no Are there any outstanding requirements from the last inspection? 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 Regulation None Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations Ensure that residents care plans contain sufficient detail about their usual care needs and preferences and are evaluated. The daily statement entries should be cross-referenced to the numbered care needs/problem described in the care plan to make the entries more relevant. Replace the small first floor bath with a shower facility. Widen the access to the annexe ground floor bathroom and provide assisted shower/bath facility. 2. 21 The Doris Watts Home H57-H08 S13078 Doris Watts Home V229235 260505 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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