Inspection on 08/12/05 for The Robert & Doris Watts Home

This inspection was carried out on 8th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Robert & Doris Watts Home 17/12/08

The Robert & Doris Watts Home 17/12/07

The Robert & Doris Watts Home 31/01/07

The Robert & Doris Watts Home 04/08/05

The Robert & Doris Watts Home 10/03/05

The Robert & Doris Watts Home 10/08/04

The Robert & Doris Watts Home 06/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Robert & Doris Watts Home 32 Black Bourton Road Carterton Oxfordshire OX18 3HA Lead Inspector Delia Styles Unannounced Inspection 8th December 2005 10:35 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.V271969.R01.S.doc Version 5.0 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.V271969.R01.S.doc Version 5.0 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 Mr Harry Watts Linda Eastwood Care Home 30 Category(ies) of Past or present alcohol dependence (3), registration, with number Dementia - over 65 years of age (4), Learning of places disability (3), Old age, not falling within any other category (30), Physical disability (2), Physical disability over 65 years of age (1) The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The total number of service users to be accommodated at any one time must not exceed 30. The above categories relate to eleven named individuals and the CSCI will need to review any changes to the above. The maximum number of places that can be used to accommodate service users with nursing needs must not exceed 11. Service users with a primary diagnosis of dementia (DE) may not be admitted for nursing care 4th August 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 30 places - 22 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 30 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 Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second unannounced inspection of the care home to complete the inspection cycle for 2005/6. Key standards not assessed during the inspection undertaken in August 2005 were looked at. The inspector toured the building, spoke to six residents, the responsible individual, Mr Harry Watts, the registered manager, Ms Linda Eastwood, the activities organiser, care staff, a senior carer and a registered nurse on duty. A sample of residents’ care records, medication records, staff records and maintenance records were inspected. The home was busy, with two residents’ care reviews taking place during the day, so the inspector fed back to the senior carer on duty at the end of the inspection. The inspector would like to thank all the residents and staff for their help and hospitality on the day. The manager has been asked to complete a questionnaire about the home and services, as part of the inspection process and so that CSCI can ask visiting GPs and health and social care professionals for their opinions of the home and service provided for residents. What the service does well: What has improved since the last inspection? The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 6 The proprietor and his son, who is acting as project manager during the planning of the proposed new care home, and the home managers of Robert & Doris Watts, 1 Butler’s Drive and Doris Watts care homes are meeting together regularly to discuss the design and planned facilities for the new home and staff training and development needs, in preparation for the redevelopment of the site. As a result of looking into some of the equipment and systems for the new building, the proprietor has decided to replace the laundry equipment in the existing home. The management and audit systems for the home have also been reviewed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 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. Standard 6 is not applicable. EVIDENCE: Examination of a sample of residents’ care records and conversation with the manager showed that the home undertakes a detailed assessment of potential residents and involves the person, their family and other professional carers in the process, so that the home can be confident that they can meet the person’s care needs. The registered manager, deputy manager or senior care leader undertake the assessments. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 There is an established care planning system in place that is satisfactory overall, but needs some further work to make sure that the care plans are kept up to date and evaluated, so that all staff are aware of the care actions needed, and to assess whether the care given is effective for the residents. The systems for the storage and administration of medicines are satisfactory, but the arrangements in place for cool storage of medication and changes made to medication orders on written records should be improved. EVIDENCE: A sample of three care plans was inspected. The residents’ care plans and records are well-organised and kept in individual named folders in the staff office. Other communication records (daily statements) and additional information such as wound care charts, records of diabetic residents’ blood sugar and fluid balance charts are kept in separate folders in a filing cabinet. There were some omissions from risk assessments; for example, someone’s nutritional risk assessment had not been completed in November although they were considered at ‘high risk’ of being malnourished. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 10 One resident’s wound care record was incomplete and there was no assessment or evidence of whether the wounds were improving with the prescribed dressings. The care plans and daily entries would be improved if each resident’s care records were kept together in their individual folder, because the carers would be aware of the aims of care written in the care plan and could make their comments more specific. The home uses the Nomad 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 Medicine Administration Record (MAR) sheets are printed by the pharmacist. Some of the type-face was smudged. The pharmacy should be contacted and asked to ensure that the printer is producing clear copies to reduce the risk of staff making errors if the printed instructions are indistinct. There were some gaps on the MAR where staff had failed to enter their initials or a code letter to indicate whether the prescribed medicine had been given to the resident. The medication for one resident had been changed by the doctor at a clinic attended by the resident, but the instructions on the MAR sheet were not clear about which medications had been discontinued. This resulted in the resident having received a new combined medication in addition to one(s) that were meant to be discontinued, with the potential for the resident being at risk of having too much of a particular medicine. The nurse in charge said he would make sure the MAR sheet was amended. There were other examples of handwritten changes to the MAR sheets that had not been signed by the doctor who had requested the change or a second staff member. It is good practice, and an additional safeguard against mistakes, to have the GP or a second staff member check and countersign any changes on the MAR sheet. The drug fridge temperature had not been checked daily and some previous recordings showed the fridge had not been working (the temperature recorded was 21°C on some occasions). On the inspector’s temperature probe, the temperature measured 8.5°C, which is slightly above the maximum temperature recommended for the storage of medicines needing cool storage (between 2-8°C). The fridge needed defrosting. There were a number of prescribed skin creams stored in the fridge that may not need refrigeration and if applied to a resident when cold may cause them discomfort. The pharmaceutical information about the storage conditions for each medicinal product should be checked and followed. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: The home’s activities co-ordinator had been absent for several weeks due to ill health but was back at work and busy organising a Christmas show with staff ‘turns’ and karaoke with some of the residents who wanted to be involved. The home was bright and festive with Christmas decorations. Various Christmas events and special church services in the town were advertised. A group of residents had enjoyed going to a Christingle Service earlier in the week. The manager had been out with a resident for Christmas shopping during the morning. Another resident had been out with his/her appointed care supporter - this person regularly visits the resident and makes sure their contact with staff and friends from a former care setting is maintained. The lunchtime meal was served at two sittings. Residents said that the food is very good and they have ‘lovely home-made cakes’ in the afternoons for tea. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 12 The meal choices looked and smelled appetising, and care staff took care to make sure residents had all they needed to enjoy their meal. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has a staff training programme for staff about adult protection issues and there is evidence that systems for reporting and dealing with alleged poor practice or abuse are effective. 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. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 23, 24 & 26 The home is clean, homely and comfortable. Outside there are parts of the grounds that are unsightly for residents to overlook, because the proprietor uses some of the site for the storing building materials and discarded equipment. Residents are kept informed about the plans for a new purpose-built home that the proprietor intends to replace the existing home with. Residents’ individual rooms are decorated and furnished to meet their needs and personal choice. EVIDENCE: A partial tour of the home was undertaken. Discussion with residents in the communal rooms confirmed that they are generally satisfied with the home and facilities. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 15 Some residents said they would like to have separate toilet facilities for men and women, and hoped this would be the case in the proposed new home. Residents said that they brought any maintenance problems to the attention of the manager and proprietor so that they were dealt with. Outside the link pathway between the laundry, 1 Butler’s Drive and the home was observed to have water draining onto the pathway and some damage to the outside lower wall of the staff smoking room/laundry building, possibly caused from water leakage. This was pointed out to the proprietor, as there is a risk of falls to staff and residents using the link pathway when wet or icy. The laundry was neat and tidy and staff are provided with protective clothing and alcohol-based hand gel to protect them from possible cross-infection. The filters of the tumble driers had an accumulation of lint. The filters should be cleaned more frequently to prevent a build up of fluff that could ignite and cause a fire. The home has a small sluice room but the sluice disinfector machine is broken. It is an expectation that care homes with nursing have a mechanical sluice disinfector machine to clean soiled or contaminated equipment thoroughly, in order to reduce the risk of cross-contamination and infection between staff and residents. The machine should be repaired or replaced. An environmental health officer had recently inspected the kitchen and was satisfied with the standards of cleanliness and food handling and storage procedures in place. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 The procedures for the recruitment of staff are not robust and do not provide evidence that adequate safeguards are in place to protect residents from potentially unsuitable people being employed to work in the home. The home provides a range of suitable training courses for staff to ensure that they are competent to care for residents with the wide range of care needs currently living in the home. EVIDENCE: The files of five staff recently employed by the home were checked, and one for a staff member who left the home several months ago. The home had not undertaken all the necessary recruitment checks to ensure the protection of residents. Criminal Records Bureau checks had not been received for recently employed staff. Two had only one reference on file. There was no recent photo for three of the staff on file. There was no record of interviews of prospective staff having taken place. Residents spoken to said that the staff at the home were all very good and caring, though 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. Five care staff have National Vocational Qualifications (NVQ) at Level 2 or above. One carer is developing activities especially for the younger adults The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 17 accommodated in the home and the adjacent home, 1 Butler’s Drive. The manager and several staff have completed a Dementia Awareness Level 2 distance learning course to improve and develop their skills in caring for residents with dementia. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 36 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 programme of formal supervision of care staff is not fully operational yet. EVIDENCE: The manager is a registered nurse and has achieved the Registered Manager’s Award. She has considerable experience in managing a care home, and visiting professionals to the home state that they have confidence in her abilities. Feedback from residents confirms that she 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 resident’s independence and individuality – are values that underpin the standards of care expected from the staff. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 19 The manager said that the programme for formal supervision of all care staff had ‘lapsed’ over recent months, but that she will ensure that regular supervision meetings will take place from January 2006. Informal meetings and discussions about work topics happen on a daily basis with staff, but the opportunity for regular uninterrupted ‘one-to-one’ planned meetings is important - supervisors and supervisees should have the opportunity to discuss their expectations of their work performance and any training and development needs that they may have, and a plan of action agreed. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 20 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X 2 X X 3 3 X 3 STAFFING Standard No Score 27 X 28 X 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X X The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19, Schedule 2 Requirement The home must not employ workers at the care home unless they have obtained satisfactory information and documentary evidence of ‘fitness’ for prospective employees. Timescale for action 22/12/05 The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 22 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. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Improve the detail in residents written records especially in relation to wound care and diabetes, to show evidence of assessment, action plan, review and evaluation of care. Ensure that Medicine Administration Records are accurately completed at the time of administration of medicines. Ensure that the printed instructions are clear. Any handwritten amendments to the MAR sheets should be checked and countersigned, preferably by the doctor or a second suitably qualified staff member. Discontinued medications should be clearly crossed off the list to avoid accidental continued administration of the medication. The drug fridge should be defrosted and maintained so that the temperature is consistently within the recommended range for storage of medicines requiring cool conditions. Clear the waste ground area of rubbish and unwanted equipment to improve the environment for residents and neighbours of the home. Ensure that rainwater is effectively diverted from the covered walkway to reduce the risk of staff or residents falling on wet or icy paving. Repair or replace the sluice disinfector machine. Clean the lint filters of the laundry driers more frequently to avoid the risk of fire. Maintain a checklist for staff files to ensure that the required checks and references have been received and are satisfactory in relation to prospective employees and that records are held of offers of appointment, terms and conditions and job descriptions. Two people should interview new staff and a record should be kept of the interview schedule and outcome. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 23 3. OP20 4. OP26 5. OP29 6. OP36 Implement the programme of formal supervision sessions for staff so that they have at least six sessions in any 12 month period. Records of supervision meetings should be maintained. The Robert & Doris Watts Home DS0000027185.V271969.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V271969.R01.S.doc Version 5.0 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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