Inspection on 23/05/05 for Waratah House

This inspection was carried out on 23rd 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Waratah House 12/11/09

Waratah House 24/09/08

Waratah House 12/06/07

Waratah House 18/04/06

Waratah House 28/11/05

Waratah House 08/11/04

Waratah House 10/06/04

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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 CR2 0AJ Lead Inspector Margaret Lynes Announced 23 & 24 May 2005, 09:30 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. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Waratah House Address Sanderstead Road, Sanderstead, Croydon, Surrey, CR2 0AJ 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) 020 8651 0222 Mr James Emmanuel Kwabena Safo Mrs Bernadette Gibson Care Home 41 Category(ies) of Dementia - over 65 registration, with number Mental disorder - over 65 of places Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31/1/05 Brief Description of the Service: Waratah House is situated in the Sanderstead area of the Borough. The property consists of a large detached building, which has recently had two annexes added. The first of these is registered as a unit for elderly persons with a past or present mental illness. The second caters for elderly persons with dementia. This will complement the registration of the main building, which is for 20 elderly persons, also with dementia. The total number of registered beds is now 41. There is a large patio to the rear of the home, with car parking facilities. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, and was conducted over the course of a day (0935 – 2010). During that time a number of records were examined, the premises were inspected and time was spent talking with service users and staff. Due to ongoing concerns regarding, in particular, staffing levels and the high number of unmet requirements, this home received an additional inspection last year; and has also received an additional visit this year, to investigate a complaint. At the last of those 3 visits (last financial year), it was noted that most of the outstanding requirements had finally been met. Unfortunately, these did not include those relating to staffing levels and staff recruitment. This visit has again identified problems in these areas, and the inspection overall has resulted in a further fourteen requirements being made. The majority of these requirements should not be difficult to meet, and in meeting them the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? There has been a noticeable improvement in the maintenance and appearance of the ‘old’ building, which has resulted in it becoming much more homely and welcoming. This clearly means that the service users have a much more pleasant environment in which to live. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 6 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 G53-G53 S25866 waratahhouse V179954 230505 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 Waratah House G53-G53 S25866 waratahhouse V179954 230505 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) 3 (standard 6 is not applicable in this home) The home has improved its pre-admission assessments so that the needs of potential service users are better identified, which means that the 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 eight residents were checked. Each one contained a pre-admission assessment, albeit three of these were not well filled out. However, each of these had been supplemented by assessments from the Placing Authority, so overall, the amount of information was sufficient enough for the home to determine if the needs of these service users could, in the main, be met. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care needs to be given. Staff ensure that each resident is able to access community based health facilities as and when required. The medication administration records had improved since the last visit, with far fewer errors seen. More attention needs to be given, however, to the way the records are initially filled out, and where changes to medication are made, as clearly any mistakes in giving out medication can have serious consequences for the service users. From observation and discussion, service users were treated with respect, and their right to privacy was upheld. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 10 EVIDENCE: Each service user (in the files inspected) had a care plan, which was being reviewed monthly. The plans were supplemented by a care plan summary and an evaluation sheet. There was good information (again, in the files inspected) regarding health care. A specific sheet was being kept on which staff recorded all contact with health professionals. As mentioned above, on this visit far fewer errors in the medication records were seen. The deputy manager was asked about a number of changes to prescribed medication, and while she was able to confidently and clearly explain the change, the recorded information was not so concise, and needed to be better explained so that staff were not confused. From observing the interaction between the staff and the service users, and having also talked to a number of service users, it was evident that they felt that they were being treated with respect and that their privacy was upheld as much as was possible. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 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 standard(s) 12, 13, 14 and 15 From the comments made by service users, on the questionnaires sent out by the Commission prior to the inspection, and in talking with them, it appeared that the home was providing an adequate amount of activities and social stimulation. It should be noted, however, that a number of relatives did not share this view. The level of and type of activities should be constantly reviewed by staff, with service user and relative input where at all possible. Visitors are encouraged to call. The lunchtime meal was sampled and was well prepared and appetising. Service users said that they found the food to be good. EVIDENCE: Some 31 residents kindly took the time to complete questionnaires prior to the inspection, as did a number of relatives. In the main, the comments were positive. Some issues were raised by the latter group, including the need for more activities tailored to individual residents, and a request (made by several relatives) that staff wear name badges so that service users can more easily identify and remember them. These are valid points and should be given consideration by the manager. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 12 The home does employ a part-time activities co-ordinator, and it is recommended that they review the individual service user assessments to see if there are additional activities that could be included in the programme – such as knitting (as suggested by one relative). Two relatives kindly took the time to speak with the Inspector. They were mainly positive, but raised similar issues to those comments made on the questionnaires. Staff were observed to treat service users with respect, and the service users themselves, when asked, agreed with this. Periodically, service user meetings are held, so that the residents are given the opportunity to comment on dayto-day life in the home. The minutes of these meetings were available for inspection. The inspector appreciated having lunch with the service users. The meal served was well prepared and presented, and the servings were ample. Staff were available to assist residents where needed. Waratah House G53-G53 S25866 waratahhouse V179954 230505 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) 16 and 18 The home has a satisfactory complaints procedure in place, which is accessible to service users, and this is supplemented by a comments box in the main hallway. There was an adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. Unfortunately, this was somewhat negated because the recruitment procedures were still not satisfactory – see comments in Standard 27. EVIDENCE: No complaints had been made to the home since the last inspection visit however two issues had been raised directly with the Commission. The first concerned the problems visually impaired service users and service users with mobility problems would have in certain areas of the home, as the floor, in places, was very uneven. A recommendation will be made in this report for the manager to consult with occupational/physiotherapists to seek ways to reduce the obvious risk that the flooring causes. The second issue related to concerns about the care given to one specific resident. An additional visit was made to the home, subsequent to this inspection, to gather information. At this moment in time, investigations are continuing. Waratah House G53-G53 S25866 waratahhouse V179954 230505 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, 21, 25 and 26 After much prompting, noticeable improvements have now been made to the older part of the home. This has meant that the entrance hall in particular is far more welcoming. While in general the premises were well-maintained, there were a number of areas that needed relatively minor attention. Therefore, in spite of the aforementioned improvements, it was felt that the home was still not being kept as well as it could be. EVIDENCE: Following the last inspection visit, there were a number of requirements regarding the premises that still needed to be met. On this visit, it was pleasing to note that the majority of them had been complied with, including the replacement of the carpet in the dining room. Following a walk around the home, nine areas of concern were noted. This has resulted in 9 requirements and 1 recommendation being made. It should be said that with the exception of the replacement of two bedroom carpets, these issues are quite minor and as such can be easily dealt with. Waratah House G53-G53 S25866 waratahhouse V179954 230505 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 In spite of previous requirements to increase staffing levels, on this visit the home was still considerably 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. Again, in spite of previous requirements, the home has still not sufficiently improved its recruitment procedures. This means that new staff are not properly vetted before being appointed, which places the service users at unnecessary risk. Improvements have been made to the induction programme for new staff, and this is of a satisfactory standard. There is still an ongoing need, however, for the staff team to receive training specific to the client group that they care for. Without this knowledge, it is difficult to see how they can fully meet the needs of their service users. EVIDENCE: It was of considerable concern to find that in spite of a number of previous requirements, the proprietor had still not increased the staffing numbers to an acceptable level. In the feedback from the last inspection visit it was clearly stated that a home of this size should provide 630 care hours per week (15 hours per resident per week). At the time of this visit, only 501 were being provided. It was also made clear that unless improvements were made then Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 16 the Commission would consider enforcement action. The proprietor has left the Commission with little choice but to now follow that route. The files of 6 relatively new staff were examined. Only one of these six had been fully vetted before commencing work. This is contrary to legislation, and has been highlighted as an issue on previous occasions. Enforcement action will now be commenced. All of the files inspected contained details re staff induction. Each staff member is given a booklet to work through which is based on the TOPSS modules. There is still an ongoing need, however, for staff to receive training both in dementia care and caring for service users with a mental illness. Waratah House G53-G53 S25866 waratahhouse V179954 230505 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, 33, 35 and 38 The home does have a capable, registered manager, however there is some uncertainty as to whether she will remain in post at this home, or move to another of the proprietor’s establishments. This uncertainty means that both staff and service users feel unsettled. The proprietor must resolve this matter urgently. The home now has in place a comprehensive quality assurance system, which enables the management to identify any areas where the service is substandard and then take action to improve it. This means that the home is run in the best interests of the service users (to the extent that it is able, given the low staffing levels). The records relating to service users’ monies (pocket money and allowances) were up to date, and generally satisfactorily maintained. One question arose regarding the amount of money a service user paid for meals while on holiday. The deputy manager will investigate this. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 18 To the extent that it is possible with low staffing numbers, the well-being of service users is being promoted. EVIDENCE: The proprietor visited the home during the inspection and informed the Inspector of possible changes to the management structure. This is an issue that needs to be resolved as a matter of urgency as the current manager and deputy, plus the staff team and the service users are understandably becoming unsettled. The quality assurance system includes audits of the various working practices in the home. These audits are carried out at regular intervals and the results were available for inspection. Periodical questionnaires are sent to service users, relatives, staff and visiting professionals. The manager looks after the pocket money for a number of service users, and also looks after the post office books for 3 residents. It was noted in the accounts for one service user that they had paid a large amount for meals whilst away on holiday. The deputy manager was asked to investigate this, and ensure that the resident had not also covered the cost of meals for the staff member who accompanied them. An annual health and safety audit is carried out, and the in-house maintenance checks were all up to date. Generally, the premises were well kept and offered a safe environment to the service users and staff. Comment has already been made earlier in this report for the manager to seek advice from relevant professionals regarding the uneven flooring in parts of the home. Waratah House G53-G53 S25866 waratahhouse V179954 230505 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 x 3 x x x 2 2 STAFFING Standard No Score 27 1 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 x 3 x 3 x x 2 Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 20 yes 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 30 Regulation 18 Requirement The registered person must ensure that the staff team receives training appropriate to the work that they perform. This must include, where necessary, TOPSS based foundation training. The previously set timescale for this requirement has not been met. Risk assessments must be carried out on all radiators, and covers fitted where appropriate. The previously set timescale for this requirement has not been fully met. Staffing levels must be increased so that they meet the minimum levels at all times. The previously set timescale for this requirement has not been met. All new staff must supply the documentation listed in the Regulations before commencing work. The previously set timescale for this requirement has not been met. The manager must ensure that clear instuctions are provided re medication administration. The carpet in bedroom 9 requires stretching so that it no longer G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Timescale for action 31/7/05 2. 25/38 13 31/7/05 3. 27 18 See enforce ment notice See enforce ment notice 24/5/05 30/6/05 Page 21 4. 18/29 19 5. 6. 9 19 13 13 Waratah House Version 1.30 presents as a tripping hazzard. 7. 8. 9. 19 19 19 The loose, hanging cables in bedroom 12 need to be secured. 23 New handles are required for the chest of drawers in bedroom 15. 16, 23 A new carpet is required in bedroom 1, and staff must ensure that the walls are regularly wiped down. 13, 16, 23 The carpet in bedroom 35 requires deep cleaning; the loose socket on the wall requires refixing, as does the fire protection strip on the door. 16 A new carpet is required in bedroom 40. 23 The extractor fan in bedroom 42 requires repair. 13, 23 The rubbish should be removed from the small courtyard adjacent to room 44. 16 There was a noticeable odour in several of the bedrooms. This must be addressed. 13 24/5/05 30/6/05 30/7/05 10. 19 30/6/05 11. 12. 13. 14. 15. 16. 17. 18. 19 19 19 26 30/7/05 30/6/05 30/6/05 24/5/05 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. 2. 3. 4. Refer to Standard 12 13 19 38 Good Practice Recommendations Frequent reviews of the activities available should be carried out to ensure that no identified needs are overlooked. Consideration should be given to providing staff with name badges. The fitting of door stops would prevent a number of holes being made in bedroom walls. Advice should be sought from appropriate professionals re G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 22 Waratah House 5. 38 how to reduce the risks of falls due to the uneven flooring. The proprietor should resolve the management issues at the home as a matter of urgency. Waratah House G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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 G53-G53 S25866 waratahhouse V179954 230505 stage 4.doc Version 1.30 Page 24 - 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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