Inspection on 18/04/06 for Waratah House

This inspection was carried out on 18th April 2006.

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

Waratah House 12/11/09

Waratah House 24/09/08

Waratah House 12/06/07

Waratah House 28/11/05

Waratah House 23/05/05

Waratah House 08/11/04

Waratah House 10/06/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

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 Margaret Lynes Key Unannounced Inspection 18th April 2006 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.V289616.R01.S.doc Version 5.1 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.V289616.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Waratah House Address Sanderstead Road Sanderstead Croydon Surrey CR2 0AJ 020 8651 0222 020 86577694 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 - over 65 years of age (22) Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 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. 23rd January 2006 2. 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. These have been registered/re-registered as units for elderly persons with a past or present mental illness. The registration of the main building is for 20 elderly persons with dementia. The total number of registered beds is now 42. 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 information about its services in a 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. The current weekly fees (as provided at the time of this inspection) range from £450 £475 for clients in the elderly dementia category; and between £475 – £485 for elderly clients in the mental health category. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted over the course of eight hours. During that time a number of records and documents were examined, and time spent both observing staff interaction with service users and sitting and talking to both of the aforementioned. Due to concerns about the overall quality of care in this home during the preceding inspection year, Waratah House was subject to a total of five inspection visits. A Statutory Enforcement Notice was also served on the home due to unacceptable staffing levels and poor recruitment practice. As a result of these concerns, the Local Authority placed an embargo on the home, until it could be satisfied that the necessary improvements were forthcoming (which it now is). A new manager has recently been registered, and the visit preceding this one indicated that action was at last being taken to meet the requirements that had been repeatedly made by the Commission; to rectify the issues of concern of the Local Authority; and to raise the quality of the service for the residents of the home. Due to a recent site visit, to discuss the proprietor’s further expansion plans, the premises were not inspected on this visit. At the site visit, a tour was made of the home, and a few minor issues noted. These had all been dealt with by the time of this unannounced inspection. Evidence to support the comments below was gathered from a range of sources – the service users themselves, relatives, members of staff and inspection records. What the service does well: It was pleasing to see that the manager and her staff team had taken note of the serious concerns that had been expressed about the quality of care at Waratah House and consequently had taken steps to improve that care. Of particular note on this visit was evident enjoyment of a large number of residents engaging in afternoon activities. The chairs in the communal areas had been arranged into small groups, so that residents would not feel overwhelmed by being asked to join in with a very large group of people, and also so that they could choose what activity to join. There were several games of dominoes in progress, a card game, skittles, indoor golf and badminton with a balloon. One service user was engaged in knitting, while others were listening to music. It was also evident that the staff were enjoying this important interaction with the service users. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 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.V289616.R01.S.doc Version 5.1 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 (6 is not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home conducts pre-admission assessments so that the needs of potential service users are identified. This means that each service user can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: The files of four service users were examined, two of whom were recent admissions to the home, and two who had been there for between 6 and 11 months. All files contained the home’s own pre-admission form, duly completed, and also information from the placing Authority (where there was one). Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 9 Information on the admission process was also gathered from two service users and one relative. All were positive and said that the process had been handled well and that they felt that the home suited their/their relative’s needs. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service user plans seen did not adequately covered the health, personal and social care needs of the service users. This means that the staff team may not be fully aware of the differing needs of their residents, and know what specific care needs to be given. Incomplete medication administration records means that potentially, service users health may be compromised. EVIDENCE: While all of the service user files inspected contained a care plan, it was noted that not all of them contained reference to the individual service user’s cultural and ethnic needs and preferences. This was actually picked up on a recent (monthly) visit by the proprietor’s representative, and while the plans were amended it was not felt by the Inspector that these amendments were thorough enough. With the exception of the errors found on the medication administration charts, it was felt that service users health needs were being adequately met. The Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 11 manager and the staff team are keen to liaise with external professionals, such as the community psychiatric nurses and members from the local Authority mental health team. This was an area in which the home has been much criticised of late, as it was evident that available expertise in dementia and mental health issues was not being accessed. It was pleasing to note that the staff were receptive to suggestions and advice. Issues with the medication charts have been raised on previous visits and although the visit immediately preceding this found that there had been improvements, this has not been sustained and a number of errors were again found. The service users spoken with were unanimous in their praise of the staff team, commenting that they found them helpful, kind, and respectful. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home now provides a number of recreational activities, so as to satisfy the service users social and recreational needs, and individual choice and control is encouraged. Visitors are made welcome. This means that the lifestyle in the home more closely matches residents’ expectations and preferences. Service users receive a well-cooked and appealing diet, which means that their nutritional needs are catered for. EVIDENCE: Time was spent talking with a number of service users, a relative and also staff. It was pleasing to note the number of varied activities that were now on offer, and the number of service users who wished to participate. Staff were seen to make an effort to find an activity to suit each individual, if they wished to participate. While previous inspection visits have commented that the number of activities were adequate (at least from the service users perspective if not from relatives or visiting professionals), on this visit it was notable that staff had listened to advice from other professionals and had, for example, rearranged the seating so as to break up the very large communal area into Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 13 smaller units. Staff need to continue with these efforts and also explore ways of better involving the service users in the community. Comment has been made in the previous section with regard to the service user plans needing to reflect cultural and ethnic needs. Although it was felt that the plans needed further revision, on talking with service users it was clear that with regard to food at least, efforts were being made to provide them with foods based on their culture. The main lunchtime meal, while not sampled, did look appetizing and was well presented. Service users were given a choice, and the portions were generous. Only one service user made negative comments about the food. This was in regard to the temperature that it was served at. From observation, on this visit at least, the complaint could not be upheld. Only one relative was present during the course of the inspection, and the inspector is grateful that they were willing to spend some of their visiting time talking about their views of the home. These views were positive, with no concerns raised at all. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place, which is accessible to service users. There is also an adequate adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: Both of the aforementioned procedures were inspected on previous visits and found to be acceptable. More than half of the staff team have now attended training in adult protection, and this needs to be an ongoing training initiative. Only one complaint had been recorded since the last inspection visit and this was dealt with, at the Commission’s request, by the home manager. To date there has not been any indication from the complainant that the home’s investigation and subsequent action was unsatisfactory. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 15 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Noticeable improvements have been made to the older part of the home. This has meant that the entrance hall in particular is far more welcoming. While there were a small number of areas that required attention, in general the premises were well-maintained. Service users were therefore being provided with a safe and comfortable environment. EVIDENCE: As mentioned in the summary of this report, a site visit had been made to Waratah House just a week before this unannounced visit. A tour was made of the communal areas then, as well as a number of bedrooms. Some minor areas of repair were noted, all of which had been dealt with by the time of this visit. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 16 A number of service users were asked for their opinion of the home and their own bedrooms. They were unanimous in stating that they were satisfied with the home environment and its facilities. The relative who was present during part of the inspection shared this view. It was particularly pleasing to note that on entry to the home there were no unpleasant odours. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 17 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): 27, 28 and 30 (29 was not assessed as no recruitment had taken place since the last inspection) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. In spite of a Statutory Enforcement Notice served in the course of the last inspection year re the need to increase staffing levels (a notice which had initially been complied with), on this visit the home was again short of staff. This means that because they are overstretched it is unlikely that staff can provide a continuously good level of service, which in turn means that mistakes are more likely to be made. It also means that the needs of service users cannot always be attended to promptly, and impacts on the safety of service users. Training for the staff team has been increased. This means that the staff should have the necessary knowledge and skills to cater for their clients specific needs. EVIDENCE: At the time of this visit there were 10 vacancies in the home. It was expected, therefore, that the number of staff on duty would be adjusted accordingly. Unfortunately, the reduction was too great. The home is expected to provide 15 care hours per resident per week. Allowing for the 10 vacant beds, this equates to 480 care hours per week. On the rotas that were examined, the Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 18 home was falling short by 14 hours per week (and this excludes time taken for breaks). The shortfall is not great therefore, but it does, nevertheless, need to be addressed and has impacted on the overall rating for this section of the report. Staff are able to access a number of training courses including Adult Protection, Challenging Behaviour; Fire Safety; Manual Handling; Medication; Mental Health; Bereavement and Dying and NVQ courses. Over 60 of the care staff have now achieved an NVQ II award, and several have also attained a level III award. This is commendable. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 19 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, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home now has a registered manager, which means that the overall running of the establishment is in the hands of someone deemed, by the Commission, to be able to discharge their responsibilities. This means that service users benefit from her leadership and management. The home now has in place a quality assurance system, which enables the management to identify any areas where the service is sub-standard and then take action to improve it. This means that the home is run in the best interests of the service users. The records relating to service users’ monies (pocket money and allowances) were up to date, and generally satisfactorily maintained. There are ongoing investigations however, relating to service users finances. These do not involve the current management, but nevertheless do impact on the overall judgement. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 20 From discussion with service users, the Inspector judged that their well-being, and that of the staff, was being promoted. EVIDENCE: The benefits to the home of having a registered manager in place are already starting to show. There was a much-improved atmosphere in the home, with the staff team welcoming and the service users stating that they were well cared for and content. The new manager is keen to continue her improvement agenda, and is fully aware of the previous concerns of both the Commission and the local Authority. In view of the recent registration of this manager, the local Authority has lifted its embargo on placing in the home. The manager has put into place a number of new systems to monitor the quality of the service. Some of these, such as those regarding general health and safety (risk assessments) were not fully up to date, so there is clearly some work still to be done. This should not detract, however, from the noticeable improvements that have been made. Comment has been made overleaf with regard to service users’ finances. There is an investigation underway involving a very small minority of clients. This investigation does not involve the manager or the staff currently at the home, and indeed the whole process with dealing with service users’ monies has been reviewed and a more robust system put into place. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 21 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 2 9 2 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 3 X X X X X 3 X STAFFING Standard No Score 27 1 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 1 X X 2 Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 22 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 Requirement Timescale for action 18/05/06 2. OP9 13 3. 4. OP27 OP38 18 13 Service user plans must reflect the individual needs of service users – including their ethnic and cultural needs. The manager must ensure that 18/04/06 medication records are accurately completed at all times. The manager must ensure that 18/04/06 minimum staffing levels are maintained at all times. The manager must ensure that 18/05/06 health and safety risk assessments are carried out at regular intervals, recorded and reviewed. 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 OP7 Good Practice Recommendations It would be good practice to ensure that all service user plans are reviewed on a monthly basis and that this review DS0000025866.V289616.R01.S.doc Version 5.1 Page 23 Waratah House 2 OP19 can be evidenced. Consideration should be given to refurbishing the kitchen. Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Waratah House DS0000025866.V289616.R01.S.doc Version 5.1 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. 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!