Inspection on 12/06/07 for Waratah House

This inspection was carried out on 12th June 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.

Other inspections for this house

Waratah House 12/11/09

Waratah House 24/09/08

Waratah House 18/04/06

Waratah House 28/11/05

Waratah House 23/05/05

Waratah House 08/11/04

Waratah House 10/06/04

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Townley Road, 2-3

Foxley Lane (121a)

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Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOMES FOR OLDER PEOPLE Waratah House Sanderstead Road Sanderstead Croydon Surrey CR2 0AJ Lead Inspector Liz O`Reilly Key Unannounced Inspection 12th June 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 Waratah House DS0000025866.V337660.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. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waratah House Address Sanderstead Road Sanderstead Croydon Surrey CR2 0AJ 020 8651 0222 020 86577694 thewaratah@btconnect.com 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) Mr James Emmanuel Kwabena Safo Mrs Jawaixa Goliath Care Home 42 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (22) Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Bedrooms 24, 25, 26, 27, 28 and 29 registered for service users in the Mental Disorder - over 65 (MD(E)) category. The DE(E) clients currently occupying bedrooms 24, 25 and 26 can continue to reside where they are, however, once they no longer reside in these rooms, the rooms can only be used for MD (E) clients. External, appropriate training in Mental Health Care must be provided for staff within 3 months of the date of this variation being agreed. As agreed on the 25/05/2006, one named Service user with a mental disorder, aged 63 - 65 years, can be accommodated within the home. 18th April 2006 2. 3. Date of last inspection Brief Description of the Service: Waratah House is situated in the Sanderstead area of the Borough. The property consists of a large detached building, with two additional annexes. There is a large patio to the rear of the home, with car parking facilities. The home lies on a very busy main road, (which, it has to be said, is not pedestrian friendly), and is on a bus route and close to a rail station. The home provides care for older people living with dementia or mental health needs. Information on what the home can provide is available in the Service User Guide, which is made available to current and potential Service Users. Additional information can be found in the home’s Statement of Purpose. Fees £450 to £485. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector and included a visit to the home, discussion with people who use the service and staff. Questionnaires were provided for residents and following the visit questionnaires were sent to a sample of relatives. Judgements in this report are made using all of the feedback received as well as observations made by the inspector at the time of the visit. At the time of this visit thirty eight residents were making Waratah House their home. What the service does well: What has improved since the last inspection? What they could do better: Further work needs to be carried out on care planning to make these more person centred. Individual staff clearly have knowledge on the strengths, needs and preferences of residents but this is not reflected in the care plans. Evidence needs to be available to show that residents and or their representatives are involved in the care planning process. Reviews need to be more detailed. Consideration should be given to providing key policies and procedures in more accessible formats. Further work needs to be done to make sure that the activities provided meet the needs and wishes of people who use the service. Where furnishings are showing signs of wear and tear these items need to be replaced. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 6 Care needs to be taken to make sure that the admission process is completed within a set timescale. The training programme needs to be developed to reflect the specialist care provided for people with dementia and mental health needs. Key staff should be provided with training on person centred planning and care. To ensure the safety of residents action must be taken to ensure that the appropriate recruitment checks are carried out before anyone starts work in the home. 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. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use this service receive adequate quality in this outcome area. The service has developed a Service User Guide which gives information on what can be expected from the service. This is made available in a standard format. Pre admission assessments are carried out. Policies and procedures are in place for the admission of new residents but there is evidence that the admission process is not always completed in a timely manner. EVIDENCE: Before anyone moves into the home assessments are carried out by the local authorities involved and by staff from the home. These assessments are used to set up an initial care plan for new residents ensuring that staff have information on the new person from the beginning of their stay. We did note that the admission form for one resident who moved in three weeks previously had not been fully completed. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 9 Each person is given a copy of the user’s guide which gives information on the aims of the home, a copy of the most recent inspection report, the complaints procedure, the views of other people who use the service and their contract. This information is also available to people who are considering moving in. This home does not provide intermediate care. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service receive adequate quality in this outcome area. Each person has a care plan but the practice of involving people who use the service in the development and review of the plan is variable. Care plans do include basic information but are not person centred. The health care needs of residents are mostly met. But records need to show when action has been taken by staff if there are any concerns about someone’s health. Residents felt that their privacy and dignity was respected by staff. EVIDENCE: Each resident is provided with a care plan which sets out their individual needs. Much of the information on care plans is basic. Staff have included some of the more personal particular needs and preferences of individuals. This included some information on how the cultural needs of residents would be met. However this needs to be expanded to provide more person centred care plans. Little information is included in the care planning on the strengths of individuals. The daily notes made by staff did not relate to the care plan. It is recommended that staff are provided with training on person centred planning and care. Care plans were not signed by staff, residents and or their representatives. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 11 Staff were seen to be evaluating the care plans on a regular basis but these tended to be repetitive and did not give any indication as to what was working or where changes had occurred. The manager reported that the home has good relationships with healthcare professionals. Residents are registered with local GP practices and are supported to attend appointments. Arrangements are in place for optical, dental and chiropody services to attend the home. Staff monitor the weight of residents. However we found no information as to the actions taken by staff where there had been a marked difference in the weight of one person within a month. Medication is well managed. Feedback from residents indicated that they felt staff respected their privacy and dignity when helping them with personal care tasks. Staff were observed to communicate well with residents when assisting them and responded in a positive way to comments or requests made by residents. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service receive adequate quality outcomes in this area. A variety of activities are available within the home which are open to all residents. Staff take time to engage in one to one activities. Certain residents also have opportunities to take day trips or a holiday. Residents felt that they could have visitors at any time and that staff made them feel welcome. Further work could be done on the variety of activities. The majority of residents said they enjoyed the food provided. EVIDENCE: A keyworker system is in operation and staff told us that they set aside time in the mornings when they are on shift to support residents on a one to one basis. Activities at this time depend on residents individual wishes. One member of staff gave examples of working with a particular person by reading aloud, sitting talking and giving a manicure. Between three and four in the afternoon is also set aside for activities. Staff were seen to join residents in playing a game of skittles in the afternoon on the day of the visit to the home. An aromatherapist visits the home every week and we were informed that entertainers visit on a regular basis. The home uses taxis or Dial a Ride for outings. Last year seven residents went to Brighton for a five day break. Staff and residents felt that they would like to go out more often. This is something the manager should investigate. Feedback from residents on the activities available was evenly divided. Some felt there were always activities which they would join, others felt that Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 13 sometimes these were available and others said usually there were things they would engage in. This is an area where improvements could be made. Residents were complementary about the food provided and are given alternatives at each meal time. Meal times were seen to be relaxed and unhurried. Residents were allowed time to eat at their own pace. Observations and discussions with residents and staff indicated that staff have a good understanding of the importance of privacy, dignity and offering choice to people. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 14 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 & 18 People who use this service receive good quality in this outcome area. The record of complaints shows actions taken and outcomes. However not all residents or visitors were aware of the complaints procedure. Staff are provided with training on safeguarding adults which ensures that they can recognise abuse and know what action to take. EVIDENCE: The home has a complaints procedure which is provided to all residents in the user’s guide. Systems are in place for all complaints to be recorded and includes actions taken and outcomes for the person making the complaint. Any compliments are also kept. Feedback from residents and visitors to the home indicated that most people were aware of who they should go to if they have a complaint or concern to raise. However some residents could either not remember this or felt they did not know. Consideration should be given to providing the complaints procedure in a more accessible format and or reminding people on a regular basis about what they should do. The majority of staff have received training on the protection of vulnerable adults from the local authority. We were informed that all staff receive some training on safeguarding adults through the staff induction training. All staff should therefore be are aware of, types of abuse, their responsibilities and actions to be taken should they be informed of or suspect abuse. Information on the local authority procedures regarding safeguarding adults is kept at the home. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 15 Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 16 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 & 26 People using the service experience good quality in this outcome area. Residents live in a well maintained environment which is mostly comfortably furnished and meets their needs. The home is being expanded with new rooms being built to a good standard. Residents are happy with their bedrooms and feel that they can meet with visitors in private if they wish. The shared areas are well lit, clean, tidy and smell fresh. EVIDENCE: Residents have access to large lounge and dining areas. There is a very large patio area at the back of the home with seating which residents told us they enjoyed using. Work is in progress to expand the home. The new bedrooms with en suite facilities are being finished to a high standard and will improve the environment. The majority of the home was seen to be well maintained. Plans are in place to refurbish the kitchen which is showing signs of wear and tear. A number of chairs in the lounge areas are showing signs of wear and tear. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 17 All areas were seen to be clean and tidy. Residents told us that they were happy with the way the home was kept clean and fresh. Residents said they were very happy with their bedrooms and did have the opportunity to bring their own things to give the room a feel of being their own space. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 18 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 & 30 People who use the service experience adequate quality outcomes in this area. Residents told us they felt well supported by staff. The recruitment procedures are in place but have not always been followed. Staff are provided with good opportunities for training. This should be further developed to take into account the specialist nature of the home and include more in depth training on dementia care and mental health needs. EVIDENCE: Feedback from residents on the staff group was positive. Residents felt well supported and felt they could trust staff to provide the care they need. Staff were viewed as approachable and caring. The home had sufficient staff on duty to meet the needs of residents in the home at the time of this visit. Six staff are available in the home throughout the day with three waking night staff. There are two core staff groups, one for the dementia care unit and one for the mental health care unit. Staff have a shift plan which makes sure that work is organised on a day to day basis. Separate domestic and catering staff are employed. Staff felt that they are offered good opportunities to take part in training to improve their skills and knowledge. All staff take part in induction training when they are new to the home. At least 80 of care staff have completed or are in the process of completing NVQ level 2. Senior staff in the home have completed NVQ level three. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 19 The training provided on dementia care and mental health needs is basic and needs to be further developed. Consideration should be given to ensuring staff are kept up to date with developments in these areas with the provision of publications and access to relevant web sites. A sample of staff records were examined. Records showed Criminal Records Bureau checks are carried out for staff before they commence work. A full employment history was not available in all of the files looked at. In order to ensure the safety of residents all new staff must be asked to provide a full employment history with an explanation for any gaps in employment. In addition, where staff have been employed in a caring role prior to working in this home written confirmation from their previous employer must be obtained of why they left. One file examined did not have adequate written references. Two references sought by the organisation must be obtained before anyone commences work in the home. References provided by the staff member are not adequate. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 20 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 & 38 People who use this service experience good quality outcomes in this area. The manager has the skills and experience and continues to make improvements in the home. The views of residents and staff are taken into account in the management of the home. Sound policies and procedures are in place. Further work needs to be done to make sure that procedures are followed, particularly in relation to staff recruitment. The health and safety of residents, staff and visitors are protected. The financial interests of residents are safeguarded. EVIDENCE: The manager continues to make progress in improving the quality of care provided. Staff felt they were well supported by the senior staff group. They reported that regular staff meetings are held and that they also receive regular supervision. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 21 A number of systems are in place to monitor the quality of the care provided. Questionnaires are also provided to residents, relatives and other visitors to assess how well the home is meeting needs. The results of the surveys are included in the service user guide. Regular meetings are held at which people can give the management feedback and bring up any concerns. Well maintained records were seen to be kept on any cash held for individual residents. Records showed staff carry out regular checks to ensure the health and safety of residents, visitors and staff. These records were well maintained. A record of any accident is kept which allows the senior staff to monitor any individual risks and take appropriate action. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 22 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15(1)(2) Requirement Timescale for action 01/10/07 2. OP8 13(b) In order to ensure that residents are provided with the appropriate support care plans must be:• Compiled in consultation with residents and or their representatives. • Set out the individual needs, strengths and aspirations of the person in sufficient detail. • Be reviewed appropriately. • Be signed and dated. • To ensure the health and welfare 01/09/07 of residents staff must make sure that records include the actions taken should any resident show a marked weight loss. A review of the activities on offer in the home and the community must be carried out in consultation with residents. This will assist in ensuring that the activities available meet the needs and wishes of residents. 01/10/07 3. OP12 16(2)(m) Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 24 4. OP29 5. OP30 19 In order to safeguard residents 01/09/07 Schedule pre employment checks must 2(3)(4)(6) include:• A full employment history • An explanation of any gaps in employment. • Two written references sought by the organisation. • Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why they ceased to work in that position. 18(1)(c) In order to meet the needs of 01/11/07 residents staff must be provided with ongoing training and up to date information on dementia and mental health care. 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 OP16 Good Practice Recommendations To enable the further development of care planning it is recommended that key staff are provided with training on person centred care planning. Consideration should be given to providing key policies and procedures, including complaints, in more accessible formats. Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Waratah House DS0000025866.V337660.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!