CARE HOMES FOR OLDER PEOPLE
The Doris Watts Home 79 Milestone Road Carterton Oxfordshire OX18 3RL Lead Inspector
Delia Styles Unannounced Inspection 29th December 2005 11:10 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.V275842.R01.S.doc Version 5.1 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.V275842.R01.S.doc Version 5.1 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 Mr Harry Watts Ms Stephanie Irene Julian Care Home 21 Category(ies) of Past or present alcohol dependence (1), 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 (3) The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 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 26th May 2005 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 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 Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second ‘unannounced’ inspection of the home (that is, the home did not know in advance). The inspection lasted five hours and completed the planned inspections for the year 2005/6. The inspector looked at the key standards that were not assessed at the last inspection done in May 2005. Key standards are those that the CSCI inspect at least once every 12 months. During the inspection, the inspector spoke to five residents, the home manager, administrator and senior care staff. A tour of the home was done and a sample of residents’ care records, medication, financial and staff records was examined. The inspector gave feedback to the home manager and administrator at the end of the inspection. What the service does well: What has improved since the last inspection?
The manager and several staff have completed a Dementia Awareness training course that has helped them in improving care of residents who have dementia. The administrator, who deals with the financial matters and residents’ personal money accounts, is improving the systems for accounting and making sure that residents and their representatives are aware of the amounts of personal allowance that they have available. This helps the residents to budget and plan their spending on clothing and leisure and social outings more effectively because the administrator can request funds to be forwarded from ‘money
The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 6 management’ promptly (for those residents who do not have a family member to help them make purchases). Senior staff from the Robert & Doris Watts home have spent time working in the Doris Watts home. The idea of swapping staff around helps everyone to get used to working as one team, in preparation for when the new planned care home is built. The residents’ care plans have improved because they now have an evaluation and comments page, which helps staff to see whether their care has met the residents’ needs, or need to be changed. 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 Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 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.V275842.R01.S.doc Version 5.1 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 the following standard(s): 3. Standard 6 is not applicable. The admission procedures in place in the home ensure that there is proper assessment prior to people moving in so that, as far as possible, residents can be assured that their care needs will be met. EVIDENCE: Examination of a sample of residents’ care records and conversation with the manager showed that the home undertakes a detailed assessment of potential residents and involves the person, their family and other professional carers in the process, so that the home can be confident that they can meet the person’s care needs. The registered manager, deputy manager or senior care leader undertake the assessments. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 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 the following standard(s): 7, 9 & 10 The care planning system has been improved since the last inspection and is satisfactory overall, but needs some further work to make sure that the care plans are kept up to date and evaluation comments are not listed with instructions about the care ‘interventions’ that staff should carry out. The systems for the storage and administration of medicines are satisfactory, but the way in which staff make changes to written medication orders (on the doctors’ instructions) should be improved. Personal support is given in a way that promotes and protects residents’ privacy and independence. EVIDENCE: A sample of four residents’ care plans was examined. The standard of written care records has improved since the last inspection. Key workers (senior care staff) now write the care plans and the care staff are responsible for making sure they record care in the communication sheets for each shift. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 10 There was evidence that staff are now writing evaluations about residents’ care on a communication page in their folders. The information written as ‘evaluation’ was more about the detail of care that should be written in the care plan. This was discussed with the manager. Some care plans had not been updated - for example, a resident who had an exercise programme in place in 2004 is no longer able to achieve this and the care plan should be changed. Another resident who had been in hospital for an operation did not have a written care plan for their ongoing aftercare, although the resident and staff described the extra advice and support they have from a specialist nurse about this. Overall, the system for medication storage, ordering and disposal (of no longer required medicines) is good. The medication administration records (MAR) were correctly completed with two exceptions. One resident had a prescribed medication that was ordered by the doctor to be given on an ‘as required’ basis; this had been written by a carer in a ‘homely remedy’ record sheet with no instructions about when or why the medication may need to be given. All ‘prescription only’ medications should be written and recorded on the resident’s MAR sheet; so that there is a system for checking how frequently any ‘as required’ medicine is needed. There was a handwritten entry (for a prescribed skin cream) to an MAR sheet that had not been signed by the doctor who had prescribed it, or a second staff member. It is good practice, and an additional safeguard against mistakes, to have the GP or a second staff member check and countersign any changes or additions on the MAR sheet. Staff spoke to residents respectfully and kindly. There is a relaxed and comfortable atmosphere, and staff evidently know individual resident’s likes and dislikes well and respect their need for privacy. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 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 the following standard(s): 15 Mealtimes are well managed, and the menus are varied and wholesome to provide a balanced diet for people living in the home. EVIDENCE: Residents spoken to were all very appreciative of the quality of the food and meal choices. The lunch choices were braised steak or sausages, with broccoli, carrots, potatoes and cabbage and lemon meringue or ginger sponge for dessert. Vegetarian options are also available if requested. There was orange or blackcurrant or water to drink. The meal choices looked and smelled appetising, and care staff took care to make sure residents had all they needed to enjoy their meal. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 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 the following standard(s): Standards not assessed on this occasion. EVIDENCE: The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 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 the following standard(s): 23 & 24 The home is clean, homely and comfortable. Residents are kept informed about the plans for a new purpose-built home that the proprietor intends to replace the existing home. Resident’s individual rooms are decorated and furnished to meet their needs and personal choice. EVIDENCE: The home is kept very clean and there were no unpleasant odours. A tour of most rooms in the home showed that residents had comfortable and homely bedrooms. Individual residents spoken with (and who were able to give an opinion) were very pleased with their rooms and were able to join in as little or as much as they wanted, with other residents using the sitting and dining rooms. One resident said that they were looking forward to seeing the planned new home built and that the proprietor had talked to them about the new facilities they would have there.
The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 29 There was evidence that the number of staff and skill mix meets the needs of the residents in the home. The procedures for the recruitment of staff are unsatisfactory and do not provide evidence of a systematic and thorough process to ensure that adequate safeguards are in place to protect residents from potentially unsuitable people being employed to work in the home. EVIDENCE: The manager confirmed that the home is currently fully staffed and they did not have to use agency staff. Staffing levels are flexible enough to provide additional care in the evenings for a resident who needs ‘one to one’ attention at this time. There is one key carer (senior care staff member) and three other care staff (plus a cook, cleaner and laundry worker) on duty in the morning and a key worker and three care staff throughout the rest of the day, with an additional carer to assist one resident for approximately an hour and a half each evening. At night there are two staff on duty. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 15 The files of four staff recently employed by the home were checked. The home had not undertaken all the necessary recruitment checks to ensure the protection of residents. Criminal Records Bureau (CRB) checks had not been received for recently employed staff in two cases. One staff member had been in post for a month before satisfactory confirmation about their CRB had been received. Two had only one reference on file. One employee had no CRB or references or proof of identity. There was no recent photo for three of the staff on file. There was no record of interviews having been undertaken. The manager said that she usually interviewed prospective new staff with a second person but there were no written records of the type of questions asked or of the interviewers’ conclusions about the suitability of the applicants for the job they had applied for. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 The manager is supported well by the senior staff in providing clear leadership throughout the home. She communicates effectively with residents, staff and relatives. The accounting and financial procedures of the home safeguard the residents’ financial interests in relation to their personal allowances. The programme of formal supervision of care staff is not fully operational yet. The home’s system of risk assessments and health and safety checks protect the residents. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 17 EVIDENCE: Mrs Julian has achieved the Registered Manager’s Award. She has considerable experience in managing this care home and visiting professionals to the home state that they have confidence in her abilities. It is evident that she has a good understanding of residents’ care needs and ensures that the stated aims of the home – to support and encourage residents’ independence and individuality – are values that underpin the standards of care expected from the staff. She has recently completed a distance-learning course in caring for people with dementia and is adept at identifying training courses and opportunities for the home’s staff. Many of the residents are unable to voice their own opinions about the home because of their mental frailty, but there is evidence, through their daily informal conversation and care, that staff continually take the residents’ wellbeing and interests into account. An administrator is employed by the proprietor to oversee the accounting and financial systems for all three of his registered care homes in Carterton. She has reviewed and improved the computerised records of residents’ personal allowance accounts, so that residents or their representatives have an up to date record of any funds held on their behalf and can request release of monies from Money Management (Oxfordshire Social Services) to make purchases for clothing or larger items of equipment that the resident may need. The manager said that the programme for formal supervision of all care staff had lapsed over recent months, but that she will ensure that regular supervision meetings will take place from January 2006. Informal meetings and discussions about work topics happen on a daily basis with staff, but the opportunity for regular uninterrupted ‘one-to-one’ planned meetings is important - supervisors and supervisees should have the opportunity to discuss their expectations of their work performance and any training and development needs that they may have, and a plan of action agreed. A random check of hot water temperatures by the inspector showed that the ground floor bath water was above the recommended maximum safe temperature of about 43°C –it measured 47.8°C on the inspector’s probe thermometer – and should be more regularly checked and adjusted to lessen the risk of accidental scalding to residents. The water flow to the bath and hand basin in the annexe shower/bathroom was very poor, and the hot water temperature at the shower was only tepid - 27°C. There was no soap or hand towels. The manager said that only one resident uses this bathroom and uses his or her own toiletries and towels. The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 18 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 The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 19 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X 3 3 X X STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 20 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 OP29 Regulation 19, Schedule 2 Requirement The home must not employ workers at the care home unless they have obtained satisfactory information and documentary evidence of ‘fitness’ for prospective employees. Timescale for action 01/01/06 The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Ensure that residents care plans contain sufficient detail about their usual care needs and preferences and that evaluation comments are not confused with the care actions (on the ‘interventions’ page) to be taken by staff. Care plans should be updated regularly to reflect the changing care needs of residents. 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. Prescribed medications that are to be given on an occasional ‘as required’ basis must be written on the resident’s MAR sheet, with clear indications about the reason for giving the medicine – for example, acute anxiety. Any handwritten amendments to the MAR sheets should be checked and countersigned, preferably by the doctor, or a second suitably qualified staff member. Maintain a checklist for staff files to ensure that the required checks and references have been received and are satisfactory in relation to prospective employees and that records are held of offers of appointment, terms and conditions and job descriptions. Two people should interview new staff and a record should be kept of the interview schedule and outcome. Implement the programme of formal supervision sessions for staff so that they have at least six sessions in any 12 month period. Records of supervision meetings should be maintained. Monitor the hot water temperature in the ground floor bathroom more frequently and adjust it if necessary to ensure that it remains consistently within the ‘safe’ temperature range (close to 43°C) to reduce the risk of accidental scalds to residents. 2. OP9 3. OP29 4. OP36 5. OP38 The Doris Watts Home DS0000013078.V275842.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, 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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