Inspection on 17/12/07 for The Robert & Doris Watts Home

This inspection was carried out on 17th 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 Robert & Doris Watts Home 17/12/08

The Robert & Doris Watts Home 31/01/07

The Robert & Doris Watts Home 08/12/05

The Robert & Doris Watts Home 04/08/05

The Robert & Doris Watts Home 10/03/05

The Robert & Doris Watts Home 10/08/04

The Robert & Doris Watts Home 06/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Robert & Doris Watts Home 32 Black Bourton Road Carterton Oxfordshire OX18 3HA Lead Inspector Ruth Lough Unannounced Inspection 17th December 2007 11:58 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 Robert & Doris Watts Home DS0000027185.V350073.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 Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Robert & Doris Watts Home Address 32 Black Bourton Road Carterton Oxfordshire OX18 3HA 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 844923 01993 844432 linda@robert-and-doris-watts.co.uk Mr Harry Watts Linda Eastwood Care Home 31 Category(ies) of Learning disability (3), Old age, not falling registration, with number within any other category (30), Physical of places disability (3), Physical disability over 65 years of age (1) The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To accommodate up to 11 service users with nursing needs. From time to time service users over the age of 55 may be admitted. Date of last inspection 31st January 2007 Brief Description of the Service: The Robert & Doris Watts Care Home was originally a family guesthouse and was converted for use as a residential care home in 1993. The home is situated close to the town centre and facilities of Carterton. The home offers 31 places - 23 in single rooms, 15 of which have en-suite facilities (a washbasin and toilet) and eight places in four shared rooms, all of which are en-suite. The home is registered to provide nursing care for a maximum of 11 residents of the total of 31 residents that may be accommodated. There are two sitting rooms, a sun lounge, and a dining room on the ground floor. The first floor is served by a passenger lift. Three local doctors surgeries provide medical cover to the home. Chiropody, dental and optician services are available locally, or can be provided by visiting practitioners. A hairdresser visits the home every week. There is a link walkway and access to the neighbouring house, 1 Butlers Drive, which is registered to provide care for four younger adults. The laundry, in a converted garage, and the kitchen in the Robert & Doris Watts Home provide laundry and catering services to the residents of both homes. The fees for this service range from £525 to £725 per week. The Robert & Doris Watts Home DS0000027185.V350073.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 visit to review the quality of care and support provided and the outcomes for those people living in the home. The inspection process included reviewing the information provided by the manager in the Annual Quality Assurance Assessment, self-assessment document completed before the one-day visit to the home. The people who use the service and their relatives were contacted via surveys before and after the visit. Staff were also given the opportunity to comment through the use of surveys. The day visit included a review of the premises and the facilities and any documents relevant to the provision of care and support and some administration processes needed to manage the home. The residents and staff were very helpful in providing comments and information during the day. Ten residents, six relative’s and eight staff returned completed surveys to the commission. What the service does well: What has improved since the last inspection? The home has put better safety measures in place to protect the people who use the service from hot water surfaces and any outlets where they may left unsupervised. The new bath in the downstairs communal bathroom will make bathing a better experience for residents. The Robert & Doris Watts Home DS0000027185.V350073.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 Robert & Doris Watts Home DS0000027185.V350073.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 Robert & Doris Watts Home DS0000027185.V350073.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): 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. Service users needs are assessed before they are admitted to the home. 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. During the last inspection process in 2006 it was identified that there were some minor deficits and that the documents had not been reviewed since their development in 2004. The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 9 The Statement of Purpose and Service User Guide documents reviewed during this inspection process were those that were created in 2004 and the amendments to bring them up to date 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 on offer such as number of places they can provide, the needs of the service users they can support, the staff’s skills and qualifications. Parts of the documents still refer to the National Care Standards Commission the predecessor of the CSCI. Service users during the visit did say that they thought they had received information about the home before they came to live there but they were not sure about what was included. 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. 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. The assessment process is usually carried out by the manager and includes identifying health and medical conditions, medication and the limitations of mobility. For all three 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 effects them such as epilepsy, diabetes and dementia. Some of the medications listed for these individuals indicate that they may have other underlying health needs that are not clearly identified during the initial assessment process. They do record in detail the contact details of significant professionals and the individual’s relatives and friends. 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 nursing 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 very multicultural staff team have a greater understanding of how they could support the person. 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 The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 10 notes and how the needs may effect the individual concerned. This would then assist with the development of the individuals care planning. Some of the service users who spoke to the inspector during the day visit to the service did state that they and their relatives did have the opportunity to visit the home before deciding to take the offer of a place there. The Robert & Doris Watts Home DS0000027185.V350073.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 11. 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 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. The privacy and dignity of the people living in the home is could be compromised by the facilities in three of the bedrooms. EVIDENCE: The six relatives who responded to the commissions survey thought that the home did meet the need of the person they support and this was confirmed through discussion with some to the residents during the day. The care planning records for the three selected service users were reviewed to see how the nursing care and support is provided to them and that the needs are being met. The records reviewed showed that additional assessments are carried out, by staff, to the initial assessment process within the first few days of stay in the The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 12 home. These include recording any pain the person may have, or 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. They have started to look at improving the knowledge of each person by writing a brief life history as to aid staff to have a better insight into the individual they care for. The qualities of those seen were varied and will improve as they get to know the person concerned. From this information obtained in the assessment process they develop the care plan topics that should assist staff to meet the needs of the individual. The home currently provide this though noting an identified need such as personal care or a specific topic such as diabetes, then outlining the aims and then the expected outcomes to be achieved. The records did not show that significant information about the person’s mental health or learning needs were recorded in great detail. This is of specific relevance as the home is registered to provide support to younger adults and those with mental health and learning disabilities therefore there should be greater instruction to staff of how to support the person’s specific need. Neither is much recorded about personal choices or how the care and support is to be provided. They implement where required monitoring processes for any nursing need such as catheter care, fluid intake and output and weight. However, some of the records were out of date an example of this was in regard to one person who had previously needed catheter care who now no longer required this support and the care planning did not reflect this. 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. One relative wrote, “I have always been impressed by the care and respect show to residents.” Another commented about staff meeting the mental health needs of those with specific conditions, “It would be of benefit if more staff were more aware of the issues of mental health, such as Schizophrenia and its affect on the others and how best to inter-relate with them.” The home has a policy and procedure for the medication administration practices in the home. Both documents give staff the key information in regard to their roles and responsibilities and a summary of the main points are included in the staff handbook. Through discussion with the manager it was apparent that none of the current people who use the service are able to self medicate. However, they do have the necessary risk assessments and can provided secure facilities for the safe keeping of the personal medications in the individual’s own room should the need arise. Staff were observed providing medications and were seen to be complying with the requirements of safe The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 13 medication practices. The recording for the medication being given are carried out appropriately and staff note down when any changes occur to the planned administration times for the individual. Photographs of each individual are kept with the medication charts as to assist staff to recognise the correct person. 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 trained nurses who are responsible for medication administration are given training in their induction period. Medication and care records for the separately registered service attached to the home are kept centrally with those for this registered service. Staff are given information and instruction about protecting the privacy and dignity of the people they support in the induction and training programme. On review of some of the physical facilities for three of the bedrooms and the screening for protecting privacy for those residents living there could be compromised by the placement of the toilet directly in the room space and the use of temporary screening. Service users spoken to during the day did not indicate that they thought their privacy was put at risk and did state that they thought staff are respectful to them. Staff were seen knocking on doors before entering and speaking to service users very politely and only used their first name where requested. Staff record in detail the outcomes of each persons day in the care plan records. The current process for holding the information separately from the care plan may not support staff to have a comprehensive understanding or make an assessment that they are actually meeting the person’s needs. The Robert & Doris Watts Home DS0000027185.V350073.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 are encouraged to continue with having an active and busy social life within the limits of their physical and mental health needs and in accordance to their wishes. EVIDENCE: The people who live in the home did indicate during discussion with the inspector that staff are flexible to changes in their planned care and their daily routines. This was also reflected in the surveys returned to the commission. Staff and relatives commented that they thought that the activities on offer usually met the needs of the people living in the home. One relative stated that in regard to what the home does well, “Provides good company.” The care plans that give the staff instruction of how to meet the personal choices of the individual that were reviewed did not always give enough information to staff of how they were to do this. However, it was evident through discussion with the service users and staff that they had a really good understanding of the personal choices and wishes of each person. The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 15 Within the assessment documents the staff are given some information about the persons leisure and personal interests and some indication of their religious observances. But what should be improved is greater information in the actual care panning records of how these are to be met by the staff and the home. 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 Doris Watts, that is located within a short walking distance away. This role was specifically implemented after consultation with the people living in the home 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 for some, knitting blankets. In the warmer months some of the residents have been encouraged to plan and prepare the small raised bed in the courtyard garden behind the conservatory for all to enjoy. Staff often assist those who are able to visit the local town centre and church should they wish or need the support to do so. Some of the residents are able to do this on their own and are requested to inform staff when the leave and return to the premises. Some of the activities have supported service users to be involved with the local community that has included contributing to the local publication called the ‘Carterton Pride’ and visits by the Heritage Cultural Loans service. Relatives and friends are encouraged to take part in some of the larger events that occur in the home. One relative commented that the staff enabled the husband of one of the new residents to continue to visit on a daily basis and invited him to take part in what was going on in the home. The manager provided information about how they support people where they are able to continue managing their own money where they are able. She also stated in the Annual Quality Assurance Assessment, self-assessment document that they planned to obtain an Advocacy service to improve how they listen, identify, and can meet the wishes of the individual. Service users spoken to did say that they enjoyed the meals on offer and that the staff were flexible to changes and could offer alternatives should they wish. They also confirmed that they were able to obtain snacks and drinks between meals should they be hungry or thirsty. They did state that the The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 16 quality and size of the meals was good and that there were good choices on offer. 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. Staff provide information about the planned meals the day before where service users are able to give their choices for the main meals of the day. Any specific dietary needs of the people living in the service are recorded in the kitchen for staff to read and personal choices and changes to the planned meals are noted. The care and nursing staff identify in the care records any concerns about appetite or refusal of meals that an individual may have. Meal times occur with two sittings in the dining area with a small number of tables set up so that residents can sit with a maximum of four people together. Meals can be taken either in the dining area, their own bedrooms, or sitting rooms if they wish. However, staff did point out that they did try to encourage meals to be taken in the dining area. A main mealtime was observed during the inspection visit to the home and staff were seen to give support and encouragement discreetly should it be required. They were also seen to actively promote discussion and chat between residents whilst the meal was taking place. One resident wrote in a survey, “Very good meals all the time.” Another said, “Good food”. The Robert & Doris Watts Home DS0000027185.V350073.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 had confidence to make a concern known to staff and that usually their concerns were acted upon swiftly by staff and the Manager. This was also the response in the surveys returned to the commission from relatives. 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 home has not received any formal complaints in the last twelve months and through discussion with staff and the manager it was identified that there is not a method of recording minor concerns for quality assurance purposes. The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 18 The commission has not received any complaints concerns or information within the last twelve months about the service. 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 any concerns or complaints to the appropriate person or authority. The Robert & Doris Watts Home DS0000027185.V350073.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, 21, and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some of the homes practices for minimising risk of the spread of infection could compromise the health and well being of the people who use the service. EVIDENCE: The home was not purpose built but has been adapted from its previous role as a family guesthouse service provision in the centre of the town of Carterton. The premises has been added to and adapted since this to accommodate the facilities required to meet the needs of frail and less physically active residents. The main building is linked by an open air corridor to a four bedded bungalow that is separately registered with the commission that is able to accommodate four residents that need less personal care assistance but greater social support. The residents who live in these four bedrooms have free access to The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 20 the communal facilities of the home and they can call for assistance using the call bell system. The home has a programme of replenishment and renewal that has some flooring, beds, and bathroom equipment being repaired and replaced when required. There was some evidence of repainting and decorating in parts of the home. The home has a very small, enclosed secure paved and gravelled area to the rear of the conservatory that is used in the summer months by the residents. There is a large open ground space to the rear and side of the property that was originally garden and is now intended to be the site of a new purpose built establishment to replace the current property. This is not suitable for access or use by residents. The provider made the commission aware of these plans to redevelop the home over twelve months ago and as yet these have not been approved or a date given to commence. On a review of the facilities available it was apparent that the majority of the residents are accommodated in single bedrooms with five rooms that could be used as shared accommodation if required. This information has been taken from the Statement of Purpose and Service User Guide documents but there have been minor amendments to the registration status since these were developed. As previously stated, three of the bedrooms have been provided with toilet and sink in the corner of the rooms in order to provide access to the resident living there. However, two of these are placed near the doors of the bedrooms and are only protected by curtains when in use and for both quite intrusive into the room. The other has the toilet placed on a slightly raised platform in an alcove away from the main door. The toilet is screened by a curtain that has been hung from the ceiling rail too close to the facilities to offer space for privacy. The raised platform could cause the male occupant to trip and fall as he is a wheelchair user and has limited mobility. The raised platform is not water resistant and could compromise the control of infection in the home. None of these facilities have sufficient handrails/supports for those with poor balance to use them unaided by staff. Each bedroom has the basic fixture and fittings required such as seating, bedside cabinet and wardrobe space. However, on review of the quality, although not all, of these there are some that are worn and shabby in parts. Particular attention should be made to armchairs to ensure that they are fit for purpose and meet the needs of the individual. It must be noted that for some residents they have been provided with specifically made seating to meet their individual needs. During previous inspections it had been identified that there were insufficient bathing facilities in the home, as an upstairs communal shower was not used. The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 21 The home has one assisted bath that has been replaced within the last six months to improve the experiences and safety of service users. However, through discussion with the provider’s representative and staff it was apparent that this is the only bath used by the majority of the residents who decline or are not able to use the wheel- in shower facility on the first floor. The home do manage to provide a rota of bathing for residents but this planned programme can be effected by the weekly visit by the hairdresser as this is the only area that can be used for this purpose. The home does not have specific facilities for the washing of hair or hair dressing as the hand- basin in this main bathroom is the only one accessible for this. During the day of the inspection visit the hairdresser was preparing residents for the Christmas period and carrying out perms and other tasks in readiness. The home has systems in place for the control of infection including the use of specific laundry bags for soiled linen, ‘Yellow bags’ for the disposal of clinical waste and the provision of gloves and aprons for the staff. During a tour of the building it was identified that greater care could be taken with the volume of items stored in the bathrooms and bedrooms of individuals and in the communal areas where the opportunity for the gloves, aprons, and linen could be used with other residents. This also was with particular reference to soft furnishings in bathrooms, towels and personal toiletries in the communal bathroom. The home does ensure that there are paper towels and liquid soap at all handwashing facilities and has recently installed dispensers for this to minimise contamination. Again it was identified during a previous inspection that the home has insufficient sluicing and disinfector facilities for the disposal of the contents of commodes and catheter bags and the cleaning of commode pans. The home has not made any amendments to the facilities seen previously and although there is one bedpan washer in place that is situated in the staff toilet area on the top floor of the home, it was quite evident that it is not used as frequently as it could be. The other sluice, again situated in the upstairs shower room/ toilet, has not been repaired and is not available for use. The home has the laundry facility that has been installed in what was previously part of the garages adjoining the two buildings and is accessed by the link pathway/open corridor. The home has invested in a laundry system that can maximise the disinfection standards required to handle soiled and contaminated linen as well as the personal clothing of the residents. The laundry area is part of the main storage facilities for all the disposable items and cleaning materials that should be kept under Control of Substances Hazardous to Health Regulations (COSHH). The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 22 Residents were complimentary about the quality and standard of the laundry service and were really pleased with the presentation of their clothing when it was swiftly returned. The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 23 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: A relative did make comment in regard to what they thought they could improve at the home, “Sometimes new staff do not speak English very well which can be frustrating for the resident,” and also added “ I have always found staff especially senior nurses and manager very approachable.” The home shares a common recruitment and employment process with its partner home, The 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 rota shows that there is always a Registered Nurse on duty who manages between the minimum of two to the maximum of four carers per shift and the manager is supernumerary to the staffing levels. The rota also indicates that a number of staff work more than five shifts per week, some on duty in the home for approximately fifteen hours during one time period. The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 24 One carer put in the survey that they thought that four carers per shift in the morning was not enough to meet the needs of the residents. 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. Some staff according to the rota regularly work, split shifts during the day and evening time to accommodate the needs of the service. The manager, as previously stated, is not included in the nursing and care staffing hours and has not only been responsible for the management of this service has been overseeing the other partner care home, Doris Watts since the registered manager left over eighteen months ago. She is supported on a daily basis by the trained and senior staff and spends management part of each week divided between the three registered establishments. The manager did provide information that there had been a high turnover of staff to the service, eleven full-time and two part-time during the last twelve months. She gave information that twelve of the carers had obtained an NVQ 2 or above. The home continues to provide NVQ training to staff parallel to the mandatory health and safety training. There is a training programme for the registered nurse’s that has included medication, tissue viability, and palliative care and catheterization topics. English language courses have been obtained for those members of staff who have been identified as needing extra support to improve communication with residents and colleagues. 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. 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 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. They do have a process for monitoring and ensuring that the required information is obtained. But this was not seen in the recruitment records reviewed, to be used effectively and the method for storing the information in the files could be improved. One resident put in the survey “I think the staff are very good and satisfactory.” Relatives also expressed that the staff were; “friendly and caring,” another said, “very polite and friendly. They also stated that they The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 25 valued that they kept them informed of any changes in their relative’s condition quickly. One relative said, “I have found the staff to be very welcoming. I have also been impressed by their patience, good humour, and compassion. I have been pleased to see the individual attention which they afford to residents.” The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 26 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 for the manager to continue to so is compromised by the added responsibility of managing two other registered services. The manager, staff and provider do encourage and support the people who live and use the service to voice their opinion of the services provided. The measure in place to protect the health, safety and privacy of residents living in the home are compromised by the facilities in some of the bedrooms and the arrangements for providing support for those who wish to smoke. EVIDENCE: The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 27 One relative stated about the home, “ Good care, friendly, caring and good food.” Another said, “Visitors are always made welcome, especially my father who spends a lot of time there and goes every day”. One relative responding to the question ‘What the home does well?’ said; “ My Mum has lived in the home for over eight years and is able to tell us she is happy and contented.” The manager is a registered nurse and has obtained an NVQ4, Registered Managers Award. She has been working in her role for a number of years and has a good knowledge of the responsibilities of the role she undertakes and of the service she manages. The manager continues to have added responsibilities of the second registered service that is attached to the home and overseeing the providers other home in the local area that has been without a registered manager since June 2006. The manager is supported by a team of five registered nurse’s and the provider and other representatives of the company, are in daily contact of the home. The manager carries out all of the administrative needs of the service but is assisted by the new housekeeper for those relevant to the domestic tasks needed to run the home. The manager was praised by residents, relatives and staff for ‘being kind and approachable.’ 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 the residents meetings. What was noticed and commented on by residents was that the manager and the majority of staff did give time to listen to the residents about any comments or feed-back they wanted to give. The manager was able to provide information that any comments made by residents is acted upon and outcomes are usually reported back to residents verbally. What they could improve is to provide written feedback to the participants on a greater regularity than currently occurs. There is a programme of staff meetings and supervision meetings. Some staff did comment in the survey that they thought that they did not always have the opportunity to meet with the manager for supervision as often as they would like. The home does handle a small number of the resident’s spending money. The manager did also indicate that the majority of the residents personal finances are supported by their relatives and advocates. The manager did provide evidence that the money they do handle is recorded sufficiently and there is a The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 28 clear audit trail that is monitored on a weekly and monthly basis. The manager did state that she is looking to improve and minimise the homes responsibilities for handling the resident’s money. The home has 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. 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 required 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, visitor’s and staff. The room can only be accessed via the linked corridor to the annex (registered with the commission as a separate service) and provides a small area with some soft furnishings for people to sit. The area does not have links to the fire or call bell system and there is not any fire safety equipment in the vicinity. The manager was not able to provide evidence 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 Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 29 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 1 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 2 x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 30 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 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 plans reflect how the care is to be provided and are kept up to date with current status of the service users health needs. That the arrangements for the facilities of toilets in the three identified bedrooms are improved so that they do not compromise the privacy and dignity of the person living there or the management of the control of infection. That the home makes arrangements to ensure that the storage of linen, disposable goods and personal toiletries in communal bathrooms ensures that the control of infection is maintained. That the provider and manager ensure that the health and safety of the people who smoke are DS0000027185.V350073.R01.S.doc Timescale for action 29/04/08 2 OP7 15 31/03/08 3 OP10 12.4.a 30/04/08 4 OP26 13.3 31/03/08 5 OP38 13.4.a 28/02/08 The Robert & Doris Watts Home Version 5.2 Page 31 minimised by the assessment of risks and appropriate action taken. 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 OP3 Good Practice Recommendations That the manager review the assessment process and the document tool to record this to ensure that greater information can be noted about how the medical and health needs effect the individual as to assist in the development of the care planning for each person. That the care plan records for each individual are kept together in order for staff to ensure that they are meeting the persons identified needs on a daily basis. 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 the arrangements for the hairdressing service are reviewed to ensure that the access and use of the one assisted bathroom to service users is not restricted. 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. 2 3 OP7 OP12 4 5 6 OP16 OP21 OP29 7 OP33 The Robert & Doris Watts Home DS0000027185.V350073.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone, Kent ME16 9NT 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. 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