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Inspection on 31/01/07 for The Robert & Doris Watts Home

Also see our care home review for The Robert & Doris Watts Home for more information

This inspection was carried out on 31st January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This is a friendly and welcoming home, with a family atmosphere. Residents looked comfortable and those spoken with are very satisfied with the care they receive. One written comment from a relative summed this up: `We are very happy with the facilities, staff and the care my [relative] receives. We are always made welcome when we visit`. Residents are kept informed about changes in the home and are asked their opinions about ways in which the home can improve or develop the facilities and services.The home manager and staff evidently support and encourage residents to maintain and improve their individual abilities and respect their preferences about their care and how they spend their day. The home is well managed and there is evidence that residents` views are both sought and acted upon. The management team is committed to making sure that all staff have access to the training and education that they need to help them provide a good standard of care to the residents.

What has improved since the last inspection?

Since the last inspection the standard of vetting and recruitment of new staff has improved so that residents are protected from the potential risk of unsuitable staff being employed to work in the home. Residents` care records and care plans have been thoroughly reviewed and updated. The home`s procedures and practices for the storage and ordering of medicines have also improved. A programme of redecoration and addition of new equipment, such as a chair stair lift and air conditioning to the conservatory and small sitting room, have improved the accommodation and facilities for residents. New laundry equipment has been installed and the laundry floor has been resealed, which is easier to clean and maintain. The home owners have used an external company to review all the home`s policies and procedures to make sure that they are up to date and in line with the most recent legal and employment guidance. They have also looked at the sources of training for staff to improve the way in which staff can access training in a range of topics that are relevant to the care of residents in the home.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE The Robert & Doris Watts Home 32 Black Bourton Road Carterton Oxfordshire OX18 3HA Lead Inspector Delia Styles Unannounced Inspection 31st January 2007 09:30 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.V328938.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.V328938.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 Dementia - over 65 years of age (4), Learning registration, with number disability (3), Old age, not falling within any of places other category (31), Physical disability (3), Physical disability over 65 years of age (1) The Robert & Doris Watts Home DS0000027185.V328938.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 years may be admitted. 8th December 2005 Date of last inspection 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 £510 to £715 per week. The Robert & Doris Watts Home DS0000027185.V328938.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 during which the inspector assessed those standards considered to be most important by the Commission in order to show the extent to which the home is meeting the national minimum standards for care homes for older people set by the government. The inspector arrived at the service at 10.40 and was in the service for six hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. Completed questionnaires (‘comment cards’) were received from one resident, one GP, three health and social care professionals who provide services to residents, and three relatives/visitors. During the inspection visit the inspector spoke to several residents and two visitors to ask their opinions about the home and the care here. A tour of the home was undertaken and a sample of residents’ care plans, staff files, medication records and other records kept by the home to show that the equipment and building are well maintained for the safety of residents, were examined. The inspector also talked with the registered manager, Ms Linda Eastwood, the activities organiser, care staff and a registered nurse on duty. Mr Watts, the registered provider, was on holiday, but his son, who is involved in the management of the home, was also available to discuss the proposed new care home that is planned to replace the existing home. The inspector would like to thank all the residents and staff for their help and hospitality on the day. What the service does well: This is a friendly and welcoming home, with a family atmosphere. Residents looked comfortable and those spoken with are very satisfied with the care they receive. One written comment from a relative summed this up: ‘We are very happy with the facilities, staff and the care my [relative] receives. We are always made welcome when we visit’. Residents are kept informed about changes in the home and are asked their opinions about ways in which the home can improve or develop the facilities and services. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 6 The home manager and staff evidently support and encourage residents to maintain and improve their individual abilities and respect their preferences about their care and how they spend their day. The home is well managed and there is evidence that residents’ views are both sought and acted upon. The management team is committed to making sure that all staff have access to the training and education that they need to help them provide a good standard of care to the residents. What has improved since the last inspection? What they could do better: The home’s Statement of Purpose and Service User Guides should be updated to include the recent changes to the accommodation and facilities provided by the home. Prospective residents, and those already living in the home and their relatives, should be aware of how to access the most recent CSCI inspection report so that they have the information they need to make an informed decision about where to live, and are aware of how well the home is doing in relation to meeting the national standards for care homes. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 7 The home should review the timing of residents’ meals, to make sure that there is enough flexibility for residents to have their meals at times that best suit them (as far as possible) and that there is enough space for residents and staff helping them to eat together in the dining room, if that is what they wish. The source of the unpleasant odour in one bedroom should be found. If the carpet is the cause, this should be cleaned or replaced, so that the resident using this room has a clean and pleasant living space. En-suite rooms should have suitable storage cupboards fitted for residents to keep their personal toiletries and continence products. Other repairs and maintenance matters identified by the inspector in the report should be carried out. Risk assessments for individual residents’ room radiators and hot water supply are in place but had not identified the risk of burns or scalding to the resident living in a new room (formerly the manager’s office). This room had a very hot unguarded radiator and the hot water at the en-suite hand basin was also too hot. Low temperature surfaces or a radiator guard must be fitted, and any hot water outlets accessible to residents should have temperature control valves fitted to provide water close to 43°C to reduce the risk of injury to the resident. The sluice-disinfecting machine has been moved to a first floor room that also accommodates the staff toilet. It is recommended that the sluice machine is relocated to a separate space, because of the additional risk of cross-infection and contamination to staff and then residents. Staffing numbers appear to meet the current needs of residents, but the inspector noted that many of the staff were working additional shifts or extended hours to cover for colleagues’ absences. 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. The home managers should review the staffing levels and ensure that there are sufficient numbers of staff to provide adequate care for residents at all times and to allow for staff to attend necessary training and supervision sessions. 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.V328938.R01.S.doc Version 5.2 Page 8 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.V328938.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedures in place in the home ensure that there is proper assessment prior to people moving in so that, as far as possible, residents can be assured that their care needs will be met. EVIDENCE: The home has a colourful and well produced Statement of Purpose and Service User Guide. The manager is aware that these need updating to show the changes that have recently been made in the accommodation and facilities, and a new draft copy was seen. Two recently admitted residents said that they did not recall seeing a Residents’ Guide or information about the home. The manager said that a copy of the Service User Guide is left in every resident’s room. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 10 Relatives’ and visitors’ comment cards showed that people were not aware of how to access a copy of the most recent CSCI inspection report for the home, although two people said they had not asked to see a copy, but were confident they could, if they requested to do so. The home should ensure that a copy of the CSCI inspection report is available with the Statement of Purpose, so that prospective residents and their relatives have as much information about the home to help them to decide whether the home is likely to meet their needs. Prospective residents are invited to visit and spend some time in the home to give them an introduction to other residents and staff, and to see the home’s facilities and day-to-day activities on offer. Examination of a sample of residents’ care records and conversation with the manager showed that the home undertakes a detailed assessment of potential residents and involves the person, their family and other professional carers in the process, so that the home can be confident that they can meet the person’s care needs. The registered manager or her deputy undertake pre-admission assessments. The GP’s comment card showed some concerns about the home’s admission policy in that s/he considers that ‘clients arrive with complex problems but scanty information’. The home manager is aware of the GP’s concerns and feels this reflects more on the transfer of medical records. These issues should be discussed between the medical, social and health care professionals and PCT, so that the resident’s medical history is available as soon as possible and can be reviewed and updated by the GP as part of the admission assessment process. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of residents are well met with evidence of good multi-disciplinary working taking place on a regular basis. The systems for the administration of medication are satisfactory so that residents’ medication needs are met. Overall the staff have a good understanding of the residents’ care needs, and personal support is given in a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: The inspector looked at a sample of four residents’ care plans and records. These were of a good standard and were well organised in indexed individual files for each resident. Risk assessments for various aspects of residents’ care were completed – for example, risk of falls, injury from hot surfaces or water, pressure-related skin damage (‘pressure sores/ulcers’) and a nutritional risk score – the Malnutrition Universal Screening Tool (MUST). The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 12 The MUST tool was not fully completed in some of the files. The manager said that staff require more training in the use of this method of assessment and this is going to be provided. The senior nurse has undertaken a thorough review and update of the care plans and this was evident to the inspector who noticed the further improvements made since the last inspection. The home’s arrangements for the ordering, storage and administration of medicines were examined and have also been improved. The pharmacy manager wrote, ‘We have seen a vast improvement in the organisation of the medicines ordered and stored’, but added, ‘We do struggle with the language/communication with some members of staff (mainly over the phone)’. The home uses a monitored dosage system for medication. The pharmacist sets out each resident’s prescribed tablets in a cassette box with separate compartments for each time of the day when the tablets are to be taken. The pharmacist prints the Medicine Administration Record (MAR) sheets listing each person’s prescribed medicines. The MAR charts for the four residents chosen by the inspector to ‘case-track’ were correctly completed and up to date. The MAR charts had a photo of each resident attached as a safeguard to help staff identify the correct resident before giving them their medication. The lockable drug fridge has been moved to the small staff office since the last inspection. The temperature has been routinely checked and recorded to make sure the contents are stored between 2 and 8°C. The manager said that the practice nurse at a local medical centre now advises the home’s nurses about the wound dressings to use for individual residents because there had been some concerns about the over-ordering and stocking of prescription items in the past. The new system works well, so that there is an accurate assessment of wounds and staff can use the most appropriate products that will increase the healing rate for residents. The community nurses attached to three local GP surgeries visit residents in the home who need occasional nursing care. Staff will accompany residents to the local surgery for their appointments with the doctor or practice nurse. Visiting professionals to the home provide dental and optical care, or residents can access local dental surgeries and opticians in the town. Residents evidently have a good relationship with staff, whom the inspector saw were friendly, patient and kind when assisting them. The home has an established reputation in caring successfully for people with a wide range of care needs in a way that recognises their individual abilities and preferences. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 13 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed and creative and provide daily variation and interest for people living in the home. Personal support is offered in a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: Residents spoken with were happy with their daily ‘routine’ and the activities and social life of the home. The home has an activities organiser and there are planned activities such as word games, board games and quizzes, baking and gardening (in the better weather) on weekdays and care staff spend ‘ad hoc’ time chatting to residents and arranging individual activities and outings for them at other times. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 14 The manager has achieved good links with the local community and various clubs and adult education centres, and residents are enabled to go out to local church services, community events and walking, or go out in wheelchairs to visit the local market and shops. Social events with the proprietor’s other registered home, The Doris Watts, such as a summer garden party and barbeque, have proved very popular with residents and their families. Residents are encouraged to continue with hobbies and interests and perhaps consider taking up a new activity. One resident, a successful artist, said s/he has ‘lost confidence’ in his/her ability but was considering buying new art materials to try again. Another resident told the inspector about his/her interest in photography and CB radio and how the home had set up his/her room to accommodate equipment so that it was accessible. Relatives’/visitors’ comment cards and visitors spoken with during the inspection confirmed the care their loved ones receive and that they are made to feel welcome whenever they visit the home. As is the case in many registered care homes, there is a much wider cultural and racial diversity amongst the staff group than the residents. Residents spoken with were very happy with the care and kindness shown by staff towards them, but said they sometimes found it difficult to understand them because of their poor spoken English. However, some residents evidently enjoy helping staff with their English conversation. This home has a proven record of caring successfully for residents with a wide range of needs, in a way that recognises and supports their individuality and helps them maintain their independence and abilities as far as possible. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural backgrounds. The lunchtime meal was served at one sitting, in contrast to previous occasions when lunch extended over two sittings. This means that residents are getting ready for lunch at 11.45am and for those residents who prefer a later breakfast, this means that their mealtimes may be too close together. The manager said that she had already considered reverting to the two sitting arrangement because the dining area was too crowded to accommodate everyone who wanted to eat together there. Residents said that generally the food is very good but on the day of the inspection the main course of lamb was tough and difficult to chew. The meal choices looked and smelled appetising, and care staff took care to make sure that residents had all they needed to enjoy their meal. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 15 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 home has a satisfactory complaints system with evidence that residents feel safe and listened to. Staff have a good understanding of adult safeguarding issues so that they are aware of situations that may place residents at possible risk of harm or abuse and the actions that must be taken to protect residents. EVIDENCE: The manager has a good understanding of adult protection issues. The good relationship between the manager, staff and residents encourages open discussion of any matters of concern that may indicate situations where residents could be at risk and results in prompt action being taken to protect residents. No complainant has contacted the Commission directly with information concerning a complaint made to the service since the last inspection. The manager has informed the Commission of one complaint relating to a resident’s room temperature and water supply that has been satisfactorily dealt with by the home within the timescales of their own published complaints procedure. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 16 From the comment cards received and from talking to residents during the inspection, it was clear that people felt confident about how to raise any concerns and that these would be dealt with promptly by the manager and senior staff. All new staff have training about adult safeguarding when they start work in the home, as part of their induction training. The home provides staff with copies of the local Multi-Agency Codes of Conduct for the Protection of all Vulnerable Adults and the General Social Care Council (GSCC) booklet that outlines the responsibilities of employees and employers in relation to ‘whistle-blowing’ and protection of people cared for in the home. The manager said she is arranging for copies of the GSCC booklet in Polish to be provided to new Polish staff. Staff have regular in-house training and access to a local social services training centre for updates in adult safeguarding issues. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the home is clean, well decorated and comfortable, and provides residents with a homely and pleasant environment. Some improvements to the fixtures and facilities are needed in individual rooms to ensure that residents are protected from potential risk of injury. EVIDENCE: The inspector toured the building. Several improvements have been made since the last inspection, such as the fitting of a stair lift to the front stairway for those residents who may temporarily need to use this rather than the passenger lift to the first floor. Two first floor rooms have been altered to provide more space and en-suite facilities (wash hand basin and toilet). The former ground floor manager’s and staff office has been converted back to an en-suite bedroom. A small staff office has been created on the ground floor and the manager now has the use of a temporary Portacabin accessed via the patio garden at the rear of the home. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 18 The home was clean, bright and fresh smelling. Some residents commented that, in their opinion, the standard of housekeeping had deteriorated because of frequent housekeeping staff changes. The small patio garden, with a raised flower/herb bed, is well maintained and neat. Beyond these enclosed areas the car park and ground is unsightly and overgrown, and does not provide a pleasant outlook for residents. The provider has submitted plans to build a new care home on the site but there have been delays and objections from the planning committee that Mr Watt’s son said he is hopeful will be resolved soon, to allow the new build to start. Some recommendations are made by the inspector, in relation to residents’ rooms and these were pointed out to the manager on the day. These included: • • • • The repair of a loose toilet pedestal; Provision of storage cupboards in residents’ en-suite rooms, so that they can put toiletries away and avoid having to store things on window ledges and other surfaces that are difficult to reach; Fitting of a bed head to one bed (so that the pillows do not fall off the bed) Cleaning or replacement of a carpet in one room where there was a strong and unpleasant odour. The inspector visited a resident who had just moved into the newly registered ground floor room. The radiator was very hot to the touch and was unguarded and the hot water at the hand basin in the en-suite was also excessively hot. A radiator guard or low surface temperature heater must be fitted, and the hot water outlet fitted with a device to limit the temperature to close to 43°C so that the resident is protected from contact burns or scalding. The risk assessment for the heater and water for the resident’s room was included in their care records, but did not identify this significant risk. Following the inspection, the manager confirmed that prompt action had been taken to fit a radiator cover and a temperature control valve to the hot water tap. The inspector did not visit the laundry on this occasion. The manager confirmed that new laundry equipment had been fitted and the floor repainted to enable staff to clean and maintain the area more easily. Since the last inspection staff now ensure that the lint filters on the drying machines are frequently checked and cleaned to reduce the risk of fire and increase the efficiency of the dryers. Some residents said that they sometimes have the wrong laundry returned to their room, which was irritating, but otherwise the standard of laundry was satisfactory. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 19 The sluice disinfector machine was not working when the inspector last visited the home. It is an expectation that care homes with nursing have a sluice disinfector machine for the effective cleaning and disinfection of soiled sanitary equipment, such as commode inserts and urinals. A recommendation was made to repair or replace the sluice machine. Since the last inspection, the sluice machine has been moved to the first floor and fitted into the toilet designated for staff use. The manager confirmed that the machine does work. However, it is inappropriate to have a sluice in a shared facility and it is recommended that the machine is fitted into a separate, vented room, to reduce the risk of contamination and cross infection to staff and so to residents, and to provide adequate space for disposal of clinical waste (gloves and aprons) in the sluice room, and hand wash facilities. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skills meet the current residents’ care needs but staff turnover has had some negative effects on the standards of housekeeping and continuity of care for residents. The management team has plans to improve staff training, which should result in better outcomes for residents. Since the last inspection the standard of vetting and recruitment of new staff has improved so that residents are protected from the potential risk of unsuitable staff being employed to work in the home. EVIDENCE: The manager confirmed that a total of 20 staff have left since the last inspection. However, the senior staff team were now established and the roles and responsibilities for each staff group were clearly defined, so that residents receive a good continuity of care. There have been several changes in the housekeeping team, but this is often because people came to the home to undertake domestic roles, but had expressed an interest in changing to become care assistants. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 21 The inspector looked at the duty rota for all grades of staff for the week in which the inspection took place. The rota showed several staff working extended night shift hours, ie 5pm to 9pm and then through the night to 7am. One staff member worked seven consecutive days from 7am to 5pm, making a total of 63 hours worked in one week. One staff member was working for one day of a week’s annual leave to cover sickness leave for another. No agency staff are used. Although the staffing numbers and skill mix appear to meet the care needs of the current residents, the inspector considers that the manager should review the staffing rotas and take action accordingly, to ensure that staff do not work excessively long shifts or periods of work without adequate rest time. There is a danger that staff will become overtired with the potential that they are more liable to have accidents or make mistakes at work, putting residents and the staff themselves at risk of injury. Residents spoken to said that the staff at the home were all very good and caring, although some mentioned that some staff were difficult to understand. The home does provide English language courses for overseas staff who need to improve their confidence and abilities. The files of two staff recently employed by the home were checked, and one for a staff member who is no longer employed. The standard of record keeping in relation to the home’s recruitment and vetting of new staff has improved in line with the requirement made at the last inspection. There was evidence (with one exception – there was only one reference instead of the required two for the ex-staff member) that all the appropriate checks and information had been obtained before confirming the employment of new staff to work in the home. Only two of the current care staff have achieved the National Vocational Qualification in Care at Level 2 or above, so that the percentage of staff with this qualification is 14 - considerably below the 50 target recommended by the Commission to be met by 2005. The manager explained that the percentage has fallen because of staff leaving, and also because overseas staff with relevant qualifications gained in their own countries have not yet received confirmation of the equivalence to NVQ training in this country. There are also first level registered nurses, excluding the registered manager, employed in the home (up to 11 residents with nursing needs may be admitted within the total of 31 residents accommodated). The provider has undertaken a thorough review of the staff training needs and sources of external training through a range of training and education organisations. Future training is planned using distance learning, for topics such as dementia care, infection control, safe handling of medicines and provision of activities in care settings. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The manager is supported well by the senior staff in providing clear leadership throughout the home. She communicates effectively with residents, staff and relatives. The home is well managed and there is evidence that residents’ views are both sought and acted upon. EVIDENCE: The registered manager, Ms Linda Eastwood, is a registered nurse and has achieved the Registered Manager’s Award (National Vocational Qualification Level 4). She has considerable experience in managing a care home, and visiting professionals to the home state that they have confidence in her abilities. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 23 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 – 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. 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 help 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 inspector recommends that the home’s quality assurance system should also include formal feedback from family and friends and other stakeholders in the community (for example GPs, chiropodist, hairdresser and other voluntary organisation staff) about how the home is achieving its aims for residents. The home employs a part-time administrator who manages residents’ personal money allowance records. Most residents’ relatives help them to manage their financial affairs and/or have Power of Attorney; one resident is able to manage their own financial affairs independently. The records seen indicated that the home’s records of residents’ personal allowance expenditure are up to date. Mandatory training for staff includes fire safety awareness, moving and handling, care of substances hazardous to health (COSHH), first aid and adult safeguarding. The inspector checked the accident records for a sample of residents and the fire records of staff training and fire equipment checks. These were up to date. The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 24 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 25 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 OP25 Regulation 13: 4 Requirement Ensure that pipework and radiators are guarded or have guaranteed low temperature surfaces. Ensure that the hot water temperature at outlets accessible to residents is provided at close to 43°C Confirmation was received from the registered manager that the required action had been taken by 02/02/07. Timescale for action 28/02/07 The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 26 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 OP1 Good Practice Recommendations Update the home’s Statement of Purpose and Service User Guide and ensure that residents and relatives have access to the most recent inspection report. Improve the care records by cross-referencing the daily statements to the numbered care plans, to make them more specific and provide evaluation of the care given. Fully implement a nationally validated nutritional risk assessment tool such as MUST. Review the lunchtime sittings, to ensure that residents can eat at a time and in the environment that best suits them. Undertake the repairs identified during the inspection. Provide storage for residents’ toiletries and continence products in their en-suite rooms. 6. OP26 Clean or replace the carpet in the first floor room identified during the inspection, to resolve the problem of the offensive odour. 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. 7. OP27 Review, and amend as necessary, the number and skill mix of staff, to ensure that there are consistently sufficient staff available to meet residents’ care needs, and to avoid staff working excessive hours and mixed day and night shifts in order to reduce the risk of fatigue and potential harm. 2. OP7 3. 4. 5. OP8 OP15 OP19 The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Robert & Doris Watts Home DS0000027185.V328938.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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