Inspection on 17/12/08 for The Robert & Doris Watts Home

This inspection was carried out on 17th December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Robert & Doris Watts Home 17/12/07

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Robert & Doris Watts Home 32 Black Bourton Road Carterton Oxfordshire OX18 3HA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Delia Styles     Date: 1 7 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: The Robert & Doris Watts Home 32 Black Bourton Road Carterton Oxfordshire OX18 3HA 01993844923 01993844432 linda@robert-and-doris-watts.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Harry Watts Name of registered manager (if applicable) Linda Eastwood Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 31 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 33 care home 31 Over 65 31 0 Brief description of the care home 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 393 pounds to 658 pounds per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection visit to review the quality of care and support provided and the outcomes for the people living in the home. The inspection process included a review of the information provided by the manager in their Annual Quality Assurance Assessment (AQAA). Our survey questionnaires were supplied to some of the people using the service, their relatives, staff, and some of the health and social services professionals who visit the home regularly. We received 5 surveys from residents (four of which were completed with help and one independently), 3 from relatives, 2 from staff and one from a health care professional. The inspector toured the building and looked at a sample of the paperwork and records that the home is required to keep. The inspector also talked to residents, 2 visitors, staff and the deputy manager during the course of the day. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Older People Page 8 of 33 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current written information about this home and the service it can offer has not consistently been available to prospective service users and their representatives to help them make an informed decision about whether the home is likely to meet their needs and expectations. The admission criteria for prospective residents is poorly defined, so that there is a risk that some peoples care and support needs may not be adequately met by the number and skills of staff and facilities currently available. Evidence: The deputy manager said that the Statement of Purpose and Service Users Guide documents (the written information about the service that the home is required to make available to all prospective and current service users) were still not updated, but that the home owner was in the process of completing this. At our last inspection a requirement was made to review and update the information because this had not been done since 2004. It is important that all prospective and current residents have Care Homes for Older People Page 11 of 33 Evidence: the correct information about the home that is accessible and clearly written, so that they can make an informed judgment about the home and whether it can meet their needs. During an inspection of the owners other residential care home on the following day, the Mr Anthony Watts, who is a director of the company, explained that the documents would shortly be available and that the move to re-brand the organisation had meant that the updating and reprinting of new material had been delayed. In February 2008 Mr Watts said he had requested an extension for the timescale to meet our requirement to update the documents by the end of April 2008. A relative commented during a telephone conversation with us, that they had requested written information about the home before their relative moved in but this had not been available. The provider had explained that they were still busy re-branding the home and wanted to produce the up to date information when this process was complete. It appears that there has been a lack of written information made available to residents, their families and prospective residents for 9 months which is unacceptable. When asked how people got to know about the home and usual daily routines and the facilities, the deputy manager said this is explained to them in person. The five residents who completed one of our surveys all stated that they had received enough information about the home before they moved in. Four out of five said that they had received a contract. At our last inspection, we considered that the home should review the way that it assesses the care and support needs of prospective residents so that the effects of any medical and health care needs could be considered when drawing up their care plans. The manager or her deputy undertakes the assessment of peoples needs before accepting them for admission to the home. A sample of 3 assessments for current residents was examined; one person has a learning disability and two people require nursing care. The content and detail of the pre-admission assessments in relation to peoples physical care was good. One of the sample included a post-admission assessment that ensured that additional information was added to the individuals care plans. Assessment information includes input from peoples care managers and family where possible. Risk assessments, for example, relating to peoples risk of being malnourished, falls, and skin damage (pressure sores) are also included. The homes AQAA (November 2007) tells us that they planned to work harder and smarter with care managers and family members developing relationships and encouraging attendance of pre-assessment meetings. Care Homes for Older People Page 12 of 33 Evidence: A survey we received from a health care professional indicated they have concerns about the homes admission policy because it accepts people with serious psychosocial problems some of whom pose an enormous responsibility on the care staff. This individual considers that although Robert and Doris Watts Healthcare is a caring organisation they need to improve their admissions policy. This concern was also expressed by a member of staff during the inspection. Our observations on the day and discussion with staff, confirm that there is a wide range of care and support needs amongst the residents living here, and the residents of the neighbouring registered care home, 1 Butlers Drive, who share the facilities of this home. During the inspection Mr A Watts explained that the organisation is planning to develop and improve the assessment of prospective service users with mental and social health needs and to separate the accommodation and facilities on offer to them. Since our last inspection a project worker has been appointed who has specific skills in assessing peoples mental health needs and will be leadiing this new service. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical health care and medication needs of residents is satisfactorily met. The numbers and skills of staff do not consistently meet the psychological and social needs of all residents living here. Personal care is given in a way that promotes and protects peoples privacy and dignity. Evidence: All five of the residents who completed one of our surveys answered always to the questions, Do you receive the care and support you need? and Do the staff listen and act on what you say?. The health care professionals response to the question Does the care service seek advice and act upon it to manage and improve individuals health care needs? was usually. The 3 relatives who completed surveys had mixed opinions about whether the home meets the needs of their friend or relative, whether the home give the support or care that they expect or agreed and being kept informed about important issues affecting them - their answers ranged from always, usually and sometimes. Care Homes for Older People Page 14 of 33 Evidence: One staff member shared their concerns with the inspector about the staffs ability to always meet the needs of current residents who have a wide range of physical and psychological problems. For example, on the day of the visit, one person had become acutely ill and needed transfer to hospital, and an incident of aggression by one resident resulted in injury to another resident. At our last inspection we made a requirement and a recommendation for improvements to be made to the standard of the written records of care - the care plans - that must be drawn up for each resident and with their participation where possible. The care plans should set out each persons individual care and support needs and preferences and should have enough detail for care staff to know what they need to do to assist them. A sample of three residents care plans was examined at this inspection. The assessment information, care plans and records of review meetings and health care visits are held in individual files for each resident. From the sample seen, it was noted that the risk assessments and care plans are regularly reviewed and mostly contained detailed and relevant information. However, one persons records did not have a care plan in relation to a chronic problem with their eyes, though they were regularly seen by the GP and had treatment prescribed and may need to have to have an operation. Staff spoken with were aware of the health care treatment and specific care needed by this person, but this was not set out in a care plan, or evaluated so that there was no written record of the effectiveness or otherwise of the prescribed care or if the problem was affecting the persons usual ability to take part in daily life and activities in and outside the home. This was discussed with the deputy manager at the time of the inspection. Overall, the standard of record keeping has improved and we consider that the requirement made at the last inspection has been met. The medication administration records (MAR) for the same three residents whose care records were examined, were checked. The homes systems for the receipt, storage, administration and disposal of prescribed medicines are satisfactory. The supplying pharmacist undertakes regular checks of the homes medicines and is available to advise staff if they have any queries. The trained nurses in the home are responsible for the medicines administration in the home, and to the residents in the adjacent separate registered home, 1 Butlers Drive. There was no one who wished to, or was assessed as able to manage their own medicines. The medication records seen were largely correctly completed and up to date but there were some examples where best practice recommendations were not being followed. Care Homes for Older People Page 15 of 33 Evidence: For example, handwritten entries on the MAR charts had been made by a nurse where a change in the prescribed medicine or instructions for times and frequency to be given had been ordered verbally by the GP. These handwritten entries had not been countersigned by a second nurse, to show that the instruction had been checked and was as accurate. Where possible the GP should be asked to check and countersign the MAR in person. If not, the nurse who alters the MAR should have the entry checked and countersigned to reduce the risk of misunderstandings and errors. One persons MAR showed that a medication should be given on a regular basis, but it had not been given because the resident declined it. The code letter indicating the reason for omitting the regular dose indicated it was not required. The nurse said that the GP was aware of this and agreed should be requested to cancel the prescription or change it to an as required medication as soon as possible. Staff are given information and instruction about protecting the privacy and dignity of the people who live here in their induction and training programme. At our last inspection we made a requirement that the home should improve the toilet facilities in three rooms, because the toilets were not enclosed and mobile screening was not adequate to protect their privacy and dignity. The home owner has taken action to provide separate en-suite facilities in the identified rooms, although the work was not satisfactorily completed in one of the rooms and minor painting and making good was needed in the others. Staff were observed to be polite, kind and patient when talking with, and assisting residents. Staff knocked residents room doors and awaited a response before going in. One recently admitted resident had requested that he has a lock fitted to his room door and the proprietor was arranging to do this. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are encouraged to continue to have an active and enjoyable social life within the limits of their physical and mental health needs and in accordance with their preferences. Residents have a varied and nutritious diet that suits their individual preferences and requirements. Evidence: Three out of the five residents who completed our survey indicated that there are always activities that they can join in organised in the home and two people felt this is usually the case. However, one relatives survey stated that in their opinion there is no adequate stimulation for residents. The range of responses to questions about whether the home meets the different needs of people ranged from always, usually and dont know. In response to the question Does the care service support people to live the life they choose? the responses were always, usually and sometimes. One person wrote that their relative has certainly been alot happier (since coming to live in the home) even though she is unable to move unaided. From observations, and conversation with individual residents and staff, it appears that peoples individual preferences about their day to day routine and how and where Care Homes for Older People Page 17 of 33 Evidence: they spend their time is known and respected by staff as far as possible. At our last inspection we recommended that the care plans include more information about peoples interests and abilities so that they could be supported and encouraged to continue with these. The sample of care plans seen on this occasion did have more detail and guidance for staff about how to meet peoples social and recreational needs. A member of staff has the key responsibility for organising activities in the home and planned activities are displayed on the notice boards. There was a range of visits to outside and in-house entertainments, including pantomimes, carol singing and social events in the run up to Christmas. Relatives and friends are encouraged to take part in some of the larger social events organised by the home. One of the surveys received commented specifically that the home always makes them welcome and involves them in activities going on in the home. Representatives of the various Christian church denominations visit those residents who request this and if people wish to attend services and meetings at a local church of their choice, they are helped to do so. There is a ground floor dining room where most residents have their main meals, but people can choose to have their meals in their own rooms or smaller sitting rooms if they wish. The menus are planned on a four-weekly cycle and ideas and requests for meal choices are made through regular discussion with residents. Residents are asked to make their choices for the lunch and supper meals on the day before. During the inspection visit, the inspector joined residents at the end of the second lunch time sitting in the dining room. People who needed help to eat their meal were seen to be discreetly assisted by staff. Residents said they had enjoyed their meal and that the food is always good. Four out of the 5 residents surveys we received stated that they always like the meals in the home (the fifth person wrote that they usually like the meals). Relatives surveys also highlighted food and mealtimes as being something that the home does well. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not consistently provide the required information about the service and complaints procedure in a way that is accessible to all potential and current residents. This means that some service users and their families may be disadvantaged if they want to make a complaint. People who live here can be confident that their concerns will be listened to and acted upon and that there are systems in place to protect them from possible harm. Evidence: The home has failed to make available a current statement of purpose and service user guide as required since our last inspection. This may mean that not all residents and their relatives would know how to make a complaint because these documents must include information about the homes complaints procedure and how the home will respond. In particular, the way information is presented to residents should be adapted to meet their particular needs, for example, in easy read or picture book symbols for people with a learning disability, and large print for those with visual impairment. It was noted that there is a summary of the complaints procedure on display on notice boards in the home but this may not be accessible to all residents. All of the residents and relatives who completed one of our surveys stated they know how to make a complaint. One person who indicated they had not had enough information about the Care Homes for Older People Page 19 of 33 Evidence: home prior to the admission of their relative, stated they would phone the registered manager. The homes AQAA (for 2007) tells us that they hold regular resident forum meetings at which residents are encouraged to give their suggestions and raise any concerns about how the home is run. There are also regular review meetings with residents, their relatives and advocates and the homes manager that give the opportunity for people to voice any concerns. From observation and discussion with residents it is evident that people feel comfortable with making any concerns known and that they would be taken seriously by the manager. Following our last inspection we recommended that the home improve the way in which it records any comments, grumbles and suggestions so that staff are made aware of and can act on them as part of the quality assurance process. In a written response the proprietor tells us that any minor concerns continue to be recorded in a carers communication book which is handed over daily to the key workers and Monday to Friday (to) the manager. The home has not received any formal complaints in the past 12 months. The commission has been made aware of concerns from two sources - one related to the environment and failure by the home to provide one agreed aspect of care and could not be substantiated as the caller could not be contacted by us. Another person has taken up their concerns with the manager and a social services care manager. The home has policies and procedures in place for protecting residents from possible harm and abuse. Staff are given information about safeguarding and how to identify and report suspected abuse during their induction training and at regular updates as part of their training programme. Two staff members completed our survey and indicated they know what to do if a resident, relative, advocate or friend has concerns about the home or safety and wellbeing. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since our last inspection some action has been taken to meet the requirements made in our report in relation to improving the toilet and washing facilities in some individual rooms and not using communal bathrooms for storage. However, there is a lack of attention to detail in housekeeping, and attending to repair work and refurbishment promptly, so that residents do not consistently have a well maintained, hygienic and attractive environment in which to live. Evidence: This home is not purpose-built and has been adapted from its original use as a familyrun guest house over many years. The home owner plans to build a new care home on the land adjacent to the current buildings. Some progress has been made in the planning application process since our last inspection and Mr Anthony Watts a director of the company said that they are hoping to be in a position to start building in 2009. The neighbouring registered property, 1 Butlers Drive, is also owned by Mr H Watts and currently can accommodate up to four people who are more physically independent but who join in activities and mealtimes in the Robert and Doris Watts home as they wish. The provider intends to make 1 Butlers Drive a self-contained facility and service for people with mental and social problems, who need help and support to enable them return to live and work independently in the community. Care Homes for Older People Page 21 of 33 Evidence: At our last inspection we made requirements for the home to improve the toilet and washing facilities for residents in three rooms and to the storage arrangements for peoples toiletries and linen in communal bathrooms, to reduce the risk of cross infection. The providers response to our report sent to us in February confirmed that the bedrooms identified had been improved by engineering on-suite facilities and that further training in infection control and a change in housekeeping practices had been made to meet the requirements within the timescales we gave. We acknowledge that the provider is unlikely to commit to major expenditure to improve the current home environment and facilities because of the prospect of the large new replacement building project starting in the next year. However, we were concerned to note that routine maintenance and repair jobs around the home are not completed in a timely or satisfactory way and that the overall impression is one of tired decor and in several areas of the home furniture and carpeting looks old, worn and shabby. A tour of the premises was undertaken, with the deputy manager accompanying the inspector. In several rooms carpets were stained and worn and in one room frayed carpet at the entrance to the room was a trip hazard. The new en-suite room in the ground floor was unfinished, with bare plaster work on the walls and no floor covering or hand rails fitted around the toilet. Ceiling coving and paintwork was also unfinished. The resident living in this room was said to be unable to use an en-suite facility but the work had not been completed by the end of April 2008, the agreed timescale for action. Other examples of poor upkeep and lack of, or unfinished repair work, were evident in other rooms, corridors and communal rooms. For example, the lower panel of a wooden fire exit door to a fire escape on the first floor was badly rotted and the door fitted poorly in the frame, so that in the event of a fire, there appeared to be a risk that door may not function properly. There were no lampshades covering light bulbs in ceiling lights in residents rooms. The proprietor later explained that new energy-saving bulbs have been fitted throughout the home and that new shades will be provided to fit the new-style bulbs. In one persons room there was a mattress on the floor alongside the bed. The deputy manager explained this individual was at risk of falling out of bed at night, and that bed rails were not used as the person was more likely to sustain an injury if they climbed over or around bed rails. The mattress on the floor was a precautionary measure to prevent injury if the person rolled or fell from their bed. However, the mattress was badly stained and the cover damaged, and should be taken out of use as Care Homes for Older People Page 22 of 33 Evidence: it is an infection hazard. We strongly recommend that the home undertakes regular checks of all mattresses in the home to ensure that they meet a satisfactory standard for hygiene and pressure relief purposes. The deputy manager said this will be done. The home should promptly replace any damaged and soiled mattresses and implement a system of regular turning and cleaning of all mattresses in use. Though the home looked clean and was free of unpleasant odours, there was evidence of a lack of attention to deep cleaning and general detail in keeping rooms looking well-cared for. For example, dropped items of clothing, wheelchair foot plates and belongings were left under furniture and dust around the edges of carpets and wardrobes showed that the furniture is not routinely moved to clean under and behind. In several rooms, curtain rings or hooks and curtain pole finials were missing so that curtains were not hanging properly. Mr Watts said that they have introduced a system of room audits so that the housekeeping team can use a checklist to note any repair or cleaning tasks and ensure that they are dealt with promptly. The providers response to our last report and requirement to improve the storage arrangements for linen, disposable gloves and personal toiletries in communal bathrooms confirmed that staff had had received additional infection control training and the housekeeping arrangements had been altered. At this inspection we found that communal bathrooms were tidy and did not have any laundry or personal toiletries stored in them. However, in several residents en-suites it was noted there are no cupboards for people to store their toiletries, so that basin and window ledges or boxed-in water pipes are used to put collected items on. This is unsatisfactory in terms of infection control and hygiene because of the risk of contamination from the toilet being in close proximity, for example, to items used for mouth care. Some of the plugs and plug holes in room washbasins and residents denture pots were noted to be dirty. More attention should be given to cleaning peoples washing and personal toiletry containers to reduce the build up of dust, dirt and mould and risk of contamination and infection. The first floor shower room has a toilet and small handbasin in the corner of the room. There is no soap dispenser provided for hand washing and the positioning of the toilet means that it is unsuitable for use by most residents who have a physical disability and need staff assistance. There were several residents rooms where it was observed that the labelling on prescribed barrier creams containers in use showed that that the contents were out of date. Some pots had the name of the resident for whom the cream had originally been prescribed crossed through and the name of the current room occupant added. Staff Care Homes for Older People Page 23 of 33 Evidence: must ensure that prescribed creams and ointments are discarded when the expiry date is reached and that the products are only used by the person for whom they are prescribed to avoid the risk of contamination or adverse skin reactions. The deputy manager took action to dispose of out of date products found in rooms. No action has been taken by the home to improve the arrangements for sluice disinfection needed for the cleaning of commode inserts and urinals, and disposal of commode contents. The bedpan washer machine in the staff toilet on the first floor was not plugged in and appeared not to be connected to the drainage system. A staff member confirmed it had not been used to her knowledge since she has worked at the home. It is an expectation that homes providing nursing care should have satisfactory and functioning sluice disinfector facilities as part of their infection control measures. The laundry facilities for both Robert and Doris, and 1 Butlers Drive are housed in a converted double garage between the two properties. The laundry processes and systems meet the required standards and the laundry was tidy and well-ordered on this occasion. The storage of cleaning products and chemicals has been improved since our last inspection and products are stored safely in a metal cabinet in line with Care of Substances Hazardous to Health (COSHH) standards. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The knowledge and skills of care staff are variable so that residents cannot always be sure that their diverse range of care and support needs will be satisfactorily met. The management team has plans to improve training. This capacity to improve should result in better outcomes for all service users. Evidence: The rota confirmed that there is always a registered nurse on duty together with four care staff during the day and two care staff at night. The manager or deputy manager are available during weekdays in addition to the staff providing direct care to residents. Residents responses to our surveys indicate that they consider that staff numbers and skills are good and that staff are available when they need them. The 3 relatives responses were varied, ranging from one person who considered that the skills and knowledge of staff always meet the needs of the residents, to another who is not satisfied that the staff are sufficiently trained and skilled to provide the care and support for their relative in the home. The two staff members who completed surveys considered that their induction and on-going training opportunities are good and training is relevant to the work they do. Care Homes for Older People Page 25 of 33 Evidence: The home shares a common recruitment and employment process with its partner home, the Doris Watts. There are a few staff who work between the two homes as required and the housekeeping manager also works between both homes to coordinate the housekeeping service and staff. The deputy manager said that the turnover of staff has slowed in the last twelve months. A resident told the inspector that lots of people (staff) have gone - its all young ones now, men too. But the men are very good. As we noted at our last inspection, the rota shows that several staff work more than 5 shifts a week and some people work long days of approximately 15 hours in a twenty four hour period. Staff choose to work these long hours and it does provide continuity of care for residents and means that the home does not use agency workers. If staff work an excessive number of hours, or work a mixture of day and night shifts within each week, there is a potential that they will become overtired and are more prone to accidents and to make mistakes at work, with the potential of harm to residents and their own health and welfare. In the homes AQAA completed in 2007 the manager identified the difficulty in accessing training for staff and funding for a variety of training options. At this time, the home had started to build up a network of contacts and sources of training. The strategy of the home to overcome the costs and access to training is to target training for key staff, who can then cascade their learning and expertise to colleagues in the home. The deputy manager said there had been some progress made in the training available to staff. The most recent information received is that, of a total of 15 care staff, 3 have a National Vocational Qualification (NVQ) at Level 2 or above, and a further two carers are working towards this. The proportion of carers who have NVQ Level 2 is still considerably below the 50 per cent expected by us to have this qualification. However, it is recognised that there are a number of registered nurses who add to the skills and experience of the staff team. The recruitment files for staff are all kept in the main office at the Doris Watts home and were not available on the day of this inspection but a sample was examined during the inspection of the sister home. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and residents are consulted, and their opinions valued about how the home is run and the services provided. There is some evidence that since our last inspection the leadership within the home has not been consistent and this has had a negative effect on standards. Internal audit systems should be improved to ensure that staff practices consistently follow the policies and procedures in place for the wellbeing and safety of residents. Evidence: The registered manager, Ms Linda Eastwood, is a registered nurse and has achieved the Registered Managers Award (National Vocational Qualification Level 4) and has considerable experience in managing the care home. Feedback from residents confirms that the manager is approachable and available to them if they have any concerns or problems. It is evident that she has a good understanding of residents care needs and ensures that the stated aims of the home Care Homes for Older People Page 27 of 33 Evidence: that is, to support and encourage residents independence and individuality, are values that underpin the standards of care expected from the staff. She has shown great commitment to her own and other staff members education and development and has considerable knowledge and experience about the care of the residents and support for their families and friends. At the time of this visit the manager was not available and had been working part time because of family reasons. The deputy manager had also needed time off, so there was a sense that the management and smooth running of the home had been temporarily negatively affected. The registered manager had been overseeing the management of the Doris Watts home for several months and at our last inspection we commented that if this situation continued it was likely to compromise the effective management of the Robert and Doris home. At this inspection visit we learned that a new manager had been appointed for the Doris Watts home so this should relieve some of the managerial responsibilities for Ms Eastwood. The home distributes satisfaction questionnaires to residents annually. The majority of residents are unable to complete these independently but their relatives or a member of staff not directly involved in the day to day care of residents helps them to complete the questionnaires. There are also regular resident forum meetings with the manager so that she can hear residents views about the service and suggestions about improvements. The home employs an administrator who manages residents personal money allowance records. Most residents relatives help them to manage their financial affairs or have Power of Attorney. The records seen indicated that the homes records of residents personal allowance expenditure are up to date. The requirements we made at our last inspection to protect the health, safety and privacy of residents in some of the bedrooms and improve the arrangements and safety for residents who wish to smoke, have been met. A kitchen inspection was undertaken by the environmental health officer (EHO) in October 2008 and one immediate requirement and 3 other requirements were made by her in relation to the cleanliness of the kitchen. Additionally, the cook, who had no formal qualifications in food hygiene was required to attend a course to the standard required by the Chartered Institute of Environmental Health (CIEH) for all people in a supervisory role in food handling within 3 months. The deputy manager confirmed that action had been taken to address the matters raised by the EHO. Care Homes for Older People Page 28 of 33 Evidence: There remain concerns around the effectiveness of the infection control measures in place in the home because of the continuing lack of functioning sluice disinfection machines, and the failure to ensure that all mattresses and pillows in the home are fit for purpose noted at this inspection (see outcome area 5). Mandatory training for staff includes fire safety awareness, moving and handling, care of substances hazardous to health (COSHH), first aid and adult safeguarding. During the inspection the accident records for a sample of residents and the fire records of staff training and fire equipment checks were examined. These were up to date. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4,5 That the Statement of 29/04/2008 Purpose and Service User Guide are updated to include the required information and developed into formats that are applicable to the individuals needs. Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The home must supply a service users guide that is written and made available in formats suitable for intended residents So that prospective and current service users have up to date information about the home and the services provided. 06/04/2009 2 1 4 The home must supply an up to date copy of the statement of purpose and make it availalbe on request for inspection by every service user and any representative of a service user. So that service users have the information they need to make an informed choice about where they live. 06/04/2009 3 19 23 The registered person must keep the home in a good state of repair externally and internally. All parts of 02/04/2009 Care Homes for Older People Page 31 of 33 the care home must be kept clean. Sluicing facilities must be provided. In order for the people living here to have a well maintained, safe hygienic and comfortable home in which to live. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Staff should follow best practice guidance in relation to transcribing medication instructions on to residents medication administration record (MAR) sheets. The home should implement the system of routine audit of the premises and maintain a programme of repairs, refurbishment and renewal of the fabric and decoration undertaken. Records should be kept of the achieved compliance within agreed timescales. Relocate the sluice disinfector machine to a separate space with adequate ventilation, storage for equipment, clinical waste disposal containers for used protective clothing and hand washing facilities for staff. Ensure that the sluice disinfector is in working order at all times. Adequate hand washing facilities should be provided in the first floor shower room. The procedures and practices in place for the control of infection should include the cleaning and audit of equipment and furnishing, such as mattresses, and the safe cleaning of sanitary equipment and disposal of bodily fluids. Prescribed skin creams and ointments should only be used by the person for whom they have been prescribed and should not be used after the manufacturers expiry date. Ensure that a regular system of audit of the environment and equipment is implemented and that safe working practices are maintained. 2 19 3 26 4 26 5 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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