Inspection on 28/11/05 for Waratah House

This inspection was carried out on 28th November 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 23/05/05

Waratah House 08/11/04

Waratah House 10/06/04

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Abbey Road [53]

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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 Surrey CR2 0AJ Lead Inspector Margaret Lynes Unannounced Inspection 28th November 2005 11:45 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.V256514.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 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 Bernadette Gibson 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.V256514.R01.S.doc Version 5.0 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 May 2005 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, which has recently had two annexes added. 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 41. There is a large patio to the rear of the home, with car parking facilities. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of three hours, and was focused on two main issues. The first was to determine if the 14 requirements that were made/remained outstanding at the last inspection had been met; and the second to see what, if any, improvements the home had made following a recent adult protection meeting. This was the home’s fourth inspection visit this year – a reflection of the increasing concerns regarding the quality of the service being provided. Two of the aforementioned requirements related to staff recruitment and staffing levels. As these were concerns that had been raised on several previous occasions, with no action taken, a Statutory Enforcement Notice was served on the home with regard to these two specific issues. A subsequent visit determined that these two requirements had been met, albeit after a considerable wait for the staff documentation to be brought to the home from the proprietor’s office. It was disappointing to find on this visit that there had again been some slippage, and the requirements have had to be repeated. Of the other (12) requirements that were contained within the report of the last inspection, five have been met and two partially met. Further work is therefore needed to bring the standard of care in the home up to an acceptable quality. A number of concerns were expressed at a recent adult protection meeting regarding the quality of care, standard of recording and thoroughness of staff training. Improvement is needed in all areas. This visit indicated that the proprietor and new acting manager have started to make small inroads into the improvements that are necessary. What the service does well: What has improved since the last inspection? As mentioned above, the home has taken steps to meet five of the requirements (relating to repairs to the building/fixtures and fittings and the environment). It has partially met one of the other requirements relating to Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 6 the environment, and also partially met the requirement relating to staff training. 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.V256514.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed on this visit. EVIDENCE: Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 The previous inspection indicated that the medication administration records were not being kept to an acceptable standard. Unfortunately, a number of errors were again noted. Clearly any mistakes in giving out medication can have serious consequences for the service users. EVIDENCE: One of the two files containing medication administration records were examined. Several gaps in staff signatures were noted, medication appeared to have been omitted, and some of the instructions regarding administration appeared not to be being followed. These matters were brought to the attention of the new acting manager. The requirement has also been repeated. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 10 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): Not assessed on this visit. EVIDENCE: Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Due to the outcome of a recent investigation into allegations of abuse, the Inspector was not satisfied that the staff team had sufficient awareness of the complexities of adult protection. This means that the safety of service users is not as well promoted as it should be. EVIDENCE: The outcome of the aforementioned investigation was that a number of allegations of abuse were upheld. These allegations related to one specific service user. As a result of the initial enquiries, all placing authorities were asked to review their placements at the home. Although the proprietor gave assurances that these reviews had all been completed, this could not be evidenced on this visit. The acting manager was therefore asked to re-check all files and ensure that each client had been reviewed post the allegations being made. A number of the reviews were examined on this visit. None indicated that there were problems with the placements. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 12 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 The previous inspection resulted in eight requirements regarding Standard 19, and one re Standard 26. As 3 of these remain unmet (and one only partially met), the environment is clearly not as well maintained as it could be, in spite of some improvements. EVIDENCE: The environmental issues identified at the last inspection were, with the exception of the need to replace 2 carpets, relatively minor. It is disappointing, therefore, that a number of them remain outstanding, and have been repeated in this report. While it is acknowledged that overall the environment has notably improved, it is often the small things that matter to service users, and staff/the proprietor should strive to ensure that these issues are dealt with. Four new requirements were also made with regard to this section. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 13 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, 29 and 30 In spite of a Statutory Enforcement Notice served 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. One new member of staff has started work since the last visit. It was not possible to assess if the recruitment process had been satisfactory as the paperwork was not in the home. It could not be determined, therefore, that the service users were supported and protected by the home’s practice in this area. Following on from a requirement in the last report, some additional staff training has taken place. From the records this appears to be minimal however, and there is an ongoing need, therefore, for the amount of work specific training (i.e. in dementia and mental health) to be increased. EVIDENCE: The staffing levels were assessed and from the rota provided it appeared that some 533 care hours were being provided per week (excluding meal breaks, and time taken to cover the catering duties in the case of some staff). For a home of this size, there should be at least 615 care hours provided. It is of concern that this has again been allowed to slip. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 14 At the visit to the home to assess if the Statutory Notice has been complied with, it was noted that the staff files were not in the home but in the proprietor’s office. Much time was therefore wasted while waiting for these records to be delivered. It was a little surprising to find on this visit that again the papers relating to the new member of staff were not in the home. This means that the requirement re recruitment has been repeated. Since the last inspection, some of the staff team have undergone training in basic food hygiene and fire safety. There remains an ongoing need for staff to receive training appropriate to the client group that they care for, including training in adult protection. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 15 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): 38 One requirement was made following the last inspection re the need for the staff to assess the risk of having uncovered radiators, and to ensure that covers were installed where appropriate. Much of this work is still outstanding, therefore, once again, the home could not be said to be promoting the health and safety of the residents to the degree required. EVIDENCE: On this visit it was not possible to discover if the previous (acting) manager had carried out the risk assessments that were required following the last inspection. A number of radiators had had covers fitted, but equally a number had not. The requirement has, therefore, been repeated. Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 16 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 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? yes 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 OP9 Regulation 13 Requirement The manager must ensure that clear instructions are provided re medication administration, and that these are followed, and that the records are appropriately signed. The previous timescale has not been met. The Registered Person must ensure that the staff receive adequate training in adult protection. The carpet in bedroom 9 requires stretching so that it no longer presents as a tripping hazard. The previous timescale has not been met. The loose, hanging cables in bedroom 12 need to be secured. The previous timescale has not been met. The missing fire safety strip on the door of bedroom 35 must be replaced. The previous timescale has been partially met. The rubbish should be removed from the courtyard adjacent to room 44. The previous timescale has not been met. The WC in the corridor adjacent DS0000025866.V256514.R01.S.doc Timescale for action 28/11/05 2 OP18 13 28/02/06 3 OP19 13 31/12/05 4 OP19 13 31/12/05 5 OP19 13 31/12/05 6 OP19 13, 23 28/11/05 7 OP19 16 28/11/05 Page 18 Waratah House Version 5.0 8 8 10 OP19 OP19 OP19 23 23 23 11 OP27 18 12 OP29 19 13 OP30 18 14 OP38 13 to room 16 was quite dirty. Thorough cleaning is required, The curtains in bedroom 1 need to be reattached to the rail. The shower curtain in the ensuite to bedroom 44 must be reattached. The resident in bedroom 44 should be provided with a key to the door from their bedroom to the small courtyard. The Registered Person must ensure that staffing numbers meet the minimum levels at all times. The previous timescale has not been met. The Registered Person must ensure that all of the required documentation relating to staff is available, in the home, for inspection. There remains an ongoing need for staff to receive work specific training, including in areas such as dementia and adult protection. The previous timescale has been partially met. Risk assessments must be carried out on all radiators, and covers fitted where appropriate. The previous timescale has not been met. 28/11/05 15/12/05 15/12/05 28/11/05 28/11/05 31/01/06 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Waratah House DS0000025866.V256514.R01.S.doc Version 5.0 Page 19 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. 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