Inspection on 16/05/05 for Walton Heath Manor

This inspection was carried out on 16th May 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

Walton Heath Manor 29/08/07

Walton Heath Manor 16/06/06

Walton Heath Manor 12/09/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Walton Heath Manor Hurst Drive Walton-on-the-hill Surrey KT20 7QT Lead Inspector Pat Collins Unannounced 16 May 2005 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 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. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Walton Heath Manor Address Hurst Drive, Walton-on-the-hill, Surrey, KT20 7QT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 814010 Hamilton House Medical Limited Castle House, West Street, Buckingham, Buckinghamshire, MK18 1HL Ms Elaine Dodd Care Home (CRH) 43 Category(ies) of Old age, not falling within any other category registration, with number (OP), 43 of places Physical disability over 65 years of age (PD(E)), 3 Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 For a programme to be instituted for fitting radiator covers to non low temperature surface type radiators, with priority given to areas of highest risk to service users. Completion of the programme must be by 30th September 2005. Date of last inspection 12 January 2005 Brief Description of the Service: Walton Heath Manor is registered to provide personal care for 43 older people. The furnishings, fittings and décor of the home are to an exceptionally high standard. Bedroom accommodation is mostly single rooms arranged on three floors accessible by two passenger lifts. All bedrooms have either full en suite bathrooms or en suite w.c. and wash basin. Suitable aids and specialist communal bathing facilities are provided.The home has a number of communal areas including a private licensed bar lounge and library and elegant dining room. The chefs prepare nutritious meals and ensure individual dietary needs and food preferences are accommodated. There is a large balcony at the rear of the building and some bedrooms have balconies and terraces overlooking the large landscaped garden. This includes a sunken garden, water feature and ornamental fountain. The home is set in large grounds in a peaceful private road and has car-parking facilities to the front of the premises.The care philosophy aims to promote and support individual independence for as long as possible with provision of care in accordance with needs. Facilities include a hairdressing salon and hairdressing and chiropody services are included in fees. The activities programme affords a range of social and leisure opportunities including occupational therapy and arrangements for meeting religious beliefs. Regular outings are organised in the summer using the home’s minibus Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by one inspector over a five hour period. It was the first to take place in the inspection year cycle 2005 - 2006 and since a change of ownership in March 2005 . A partial tour of the building was carried out and discussion took place with the registered manager, the home’s administrator, a care assistant who was also the home’s part –time activity organiser and five service users. What the service does well: What has improved since the last inspection? What they could do better: There was scope to further develop the home’s care plans and other care records. Requirement was made for care plans to be reviewed at least monthly. It is acknowledged that difficulties in appointing a suitably qualified and experienced senior care assistant to this long - standing vacancy had Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 6 placed time management constraints on the manager and deputy manager. Pending the recruitment of a senior care assistant, whose role includes lead responsibility for care planning and the day to day direction and supervision of care staff, the manager and part –time deputy manager had absorbed these additional responsibilities. Also responsibilities of the vacant housekeeper post. They ensured priority was given to maintaining high standards of care. Further attention was required to staff files, ensuring these contained a recent photograph. A recent photograph of service users was also required on their files. A record of Disclosures for staff from the Criminal Record Bureau (CRB) and compliance with CRB policy on the disposal of Disclosures was required. The staff- training programme needed further development and arrangements implemented for care staff to receive formal supervision. The need to ensure hot water throughout the home was regulated at a safe temperature was discussed with the manager. Although systems were in place for monitoring hot water temperatures it was not evident that remedial action had been taken or a formal risk assessment carried out in response to excessively hot water temperatures. 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. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 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 standard(s) 1,2, 3 and 5 Prospective service users had the information necessary and opportunity to visit the home to ensure an informed choice about where they live. Admissions were based on needs assessments and each service user had a written statement of the home’s terms and conditions. EVIDENCE: Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 9 The home had a detailed Statement of Purpose and Service Users Guide, which accurately depicted the services provided by the Home. This was prominently displayed in the reception area. The need to include a copy of the latest inspection report in the binder with these documents was discussed. Service users had a signed statement of terms of conditions of residency on their files. An informal approach to pre-admission needs assessments was noted. It was positive to observe the user led approach to this process, involving consultation with families where appropriate. Discussed was the importance of using a formal assessment tool particularly in response to a significant change in needs. At the time of the inspection care provision included delivery of terminal care for a service user and improvement was advised in the standard of care documentation for this individual. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 10 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 standard(s) 7. 8 and 9 Most service users health, personal and social needs were set out in an individual plan of care. The need for all service users to have a care plan and for these to be further developed was identified. Whilst the health care needs of service users appeared well met this was not fully evidenced through record keeping practices. Service users confirmed that their rights to privacy and dignity were fully respected by all staff. EVIDENCE: Service users did not all have a care plan as required. The manager advised that needs of these individuals were minimal in terms of personal care interventions. A number of care plans were sampled and these identified needs and illustrated how these would be met. Within these care plans, emphasis was placed on promoting independence and how this can be best supported. Service users had allocated key- workers who were expected to update care plans. Observations confirmed these were not being reviewed at least monthly as required. Service users files contained a completed medical history record which was built on after admission, providing a comprehensive medical assessment of Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 11 needs. All service users were registered with a local GP and had access to health care services to meet individual needs. District nurses provided input and support to the home as necessary. Provision was made of equipment for prevention of pressure sores on a needs basis. The need to implement use of pressure sore risk assessments and nutritional assessments as necessary was discussed. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 12, 13 and 14 Suitable arrangements were made for provision of stimulating activities to match service users expectations and promoting contact with families and friends. The home’s management and operation promoted individual autonomy for service users over their own lives. EVIDENCE: The home offered a good range of appropriate activities which included exercise to music, in –house club for games of scrabble, bridge, dominoes, mobile library, communion services, pastoral visits and visits to church. Social events included an annual garden party, monthly shopping trips and theatre outings. Transport was provided. At the time of the inspection service users were involved in planting patio plants supported by the activity organiser. Feedback from individual service users confirmed staff supported and encouraged service users to exercise control and choice over their lives. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 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 standard(s) 18 The home’s recruitment and day – to - day operation safeguarded service users from abuse. EVIDENCE: Robust staff recruitment procedures were evident at the time of the inspection to ensure service users were safeguarded from abuse. Requirement was made for a CRB Disclosure to be obtained for a care assistant who took up post after the date when these were non – transferable. Adult protection and whistle blowing procedure was in place. Requirement was made for the home to have the revised version of the multi-agency adult protection procedures. There was evidence of some adult protection training for staff and the manager was arranging further training at the time of the inspection. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 26 and 26. The size, design and layout of the home was suitable for its stated purpose and matched the home’s philosophy of care. Walton Heath Manor afforded a quality care environment to a high standard. EVIDENCE: The home was situated in large, secluded, well - maintained grounds and was spacious with tasteful, comfortable furnishings. The décor was to an exceptional standard and the home well maintained throughout. Provision included suitable equipment for meeting the assessed needs of service users. The environment was clean and hygienic. A programme for fitting radiator covers throughout the home was in progress. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing levels were adequate to meet the needs of service users however the staff skill - mix required attention. The long-standing senior care assistant vacancy was creating competing priorities on management time. Recruitment policies and practices ensured service users were supported and protected. A programme of staff training was evident though this required further development. EVIDENCE: The staff rota was sampled and it was evident that agreed staffing levels were consistently maintained. Though staffing levels appeared adequate to meet individual needs, the continuing difficulty in recruiting a senior care assistant was creating workload pressures for management and adversely impacting on some aspects of the home’s operation and management. Specifically care planning and staff supervision. Staff were observed to be of smart appearance and professional in their approach to their work. They were observed to respect service users rights to privacy and described by service users to be always friendly and cheerful in their demeanour. A service user commented that she could not wish for better care. Observation of staff files confirmed robust recruitment and vetting procedures however attention was required to the recording and disposal of CRB Disclosures. Also a CRB Disclosure must be obtained for a staff member employed after the deadline when CRB Disclosures became non – transferable. Staff had training portfolios and a new staff induction format had been Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 16 acquired since the last inspection though not yet implemented. The need to ensure staff received all foundation training was discussed. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, 37 and 38. The home was overall considered to be effectively managed however management time was under pressure due to senior staff vacancies. The management style was observed to be inclusive and supportive to staff and service users. Care staff did not receive formal supervision but were informally supervised as part of the normal management process. Record keeping, though mostly satisfactory, required some attention. Though overall the health, safety and welfare of service users was promoted and protected concerns were identified relating to hot water temperatures. EVIDENCE: The management team comprised of a full time registered manager and part – time deputy manager who were suitably qualified and competent to manage the home. The need to ensure effective communication management systems was discussed. These should include some overlap of hours for the manager and deputy manager. Clear lines of accountability existed within the home and Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 18 external management. Management time was under pressure due to the ongoing difficulty in recruitment of a senior care assistant. The management structure had only one senior care assistant post on day duty and the manager was observed to be fulfilling both roles on the day of the inspection. If management cannot recruit to this post there is a need for alternative arrangement to be made. This could be ‘acting up’ arrangements or use of a regular agency worker. The home had very recently changed ownership and was now part of a small group of homes owned by the same organisation, though the other homes were not local. It was suggested that it could be beneficial for opportunity to be made for the managers of the group’s homes to periodically meet to share information and ideas. Consideration could be given to standardisation of records and policies and procedures for the homes and for sharing training opportunities or trainers. The Responsible Individual for the organisation regularly visited the home, at least once a week and was known to service users. He also carried out statutory monthly visits. Reports of these visits were copied to the Commission. No fundamental change had taken place to the home’s operation and management under the new ownership. Record keeping standards were overall satisfactory though attention was necessary to some aspects of care documentation. Photographs of service users and staff must be maintained on individual files. The manager confirmed that formal staff supervision had still not been implemented owing to time constraints. Consideration was being given to introducing group supervision initially as a compromise. Management had invested in the staff first aid training programme ensuring an appointed person on duty on each shift. On the day of the inspection a service user was overheard to report that the water to her en suite facility was excessively hot. Observations confirmed a system for monitoring and recording hot water temperatures on a regular basis. The temperatures ranged from 41 to 55 degrees Celsius. Whilst it was noted that service users were given the option to sign a disclaimer if they did not wish their water temperature to be regulated at about 43 degrees (which is the recommended safe temperature) the inspector was concerned to find no risk assessment carried out on the capabilities and needs of service users to assess risks of scalding. It is required that risk assessments be carried out and regularly reviewed and for the maximum temperature to be set within safe limits for all hot water outlets. Additionally the home must have a safe bathing policy which incorporates use of bath thermometers by staff. Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 2 4 4 4 4 4 2 4 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 3 x x x 2 2 2 Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 20 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 OP 3 Regulation 14(1)(2) Requirement To implement use of an adequate needs assessment tool covering needs detailed in NMS Standard 3.3. For all service users to have a care plan generated from a comprehensive assessment of needs. This must be drawn up with service users and reviewed at lease monthly. For risk assessments for individuals identified to be at risk of developing pressure sores to be documented and regularly reviewed and care interventions detailed in a plan of care. For nutritional screening to be undertaken on admission and periodically on a needs led basis. For the home to have a copy of the revised local multi-agency adult protection procedures. For the home to ensure a CRB Disclosure is obtained for the care assistant employed after the deadline for CRBs to be nontransferable. For review of safety in relation to arrangements for monitoring and regulating hot water temperatures and ensure this is Timescale for action 16/08/05 2. OP 7 15(1)(2) 16/06/05 3. OP 8 13(4) 14(1)(2) 23/05/05 4. 5. 6. OP 8 OP 18 OP 18, 29 13(4) 14(1)(2) 13(6) 19(1)(a) 16/08/05 23/05/05 16/08/05 7. OP 19, 38 12(1), 13(4)(a) (c) 23(1)(b) 23/05/05 Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 21 8. OP 19, 38 9. OP 27 10. OP 29 11. OP 30 12. OP 36 13. 14. OP 37 OP 38 underpinned by risk assessments. 12(1), For radiators not of a low surface 13(4)(a)(c temperature type to be fitted ) 23(1)(b) with radiator covers. (2)(p) 18(1)(a) For review the skill mix of the team to ensure staff are adequately supported and supervised in the delivery of care and care planning pending appointment of a senior care assistant. 19(b) For a record of CRB Disclosures for staff to be maintained in accordance with CRB policy and disposal of Disclosures. 18 ©(i) For review of the staff training programme to ensure staff receive all statutory foundation training to the required specification and within the required timescale. A rolling programme of foundation training must be instituted. 18(2)(a) For care staff to receive formal staff supervision at least 6 times a year. Timescale not met from the last two inspections. 19 Sch2.1 For photos of staff and service 17(1)(a) users to be held on their files. Sch 3.2 12(1)(a) For the home to operate a safe 13(4)(a)(c bathing policy and supply staff ) with bath thermometers. 16/09/05 16/06/05 16/06/05 16/08/05 16/06/05 16/08/05 16/06/05 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 Good Practice Recommendations Walton Heath Manor H58 S63264 Walton Heath Manor V228009 160505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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. 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