Inspection on 13/07/05 for Watlington and District Care Home

This inspection was carried out on 13th July 2005.

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

Watlington and District Care Home 26/09/08

Watlington and District Care Home 17/10/07

Watlington and District Care Home 24/01/07

Watlington and District Care Home 24/11/05

Watlington and District Care Home 31/01/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Watlington & District Care Home Hill Road Watlington Oxon OX49 5AE Lead Inspector Delia Styles Unannounced 13 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Watlington & District Care Home Address Hill Road, Watlington, OX49 5AE 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) 01491 613060 01491 614314 abdulo@sanctuary-housing.co.uk Sanctuary Care Abdul Okoro Care Home 60 Category(ies) of OP 20; DE 30; TI 2 registration, with number of places Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: A maximum of 10 beds may be used for intermediate care (N). Service users may be aged between 18 and 65 years of age. Service users with dementia (DE) may not be accommodated in places allocated for intermediate care. A maximum of 2 service users with palliative care needs (TI) may be included in the numbers for the 20 places allocated for older people (OP, N). The total number of persons accommodated at any one time must not exceed 60. One named service user, under the age of 65, within the DE category, may be accommodated at the home. Date of last inspection 31 January 2005 Brief Description of the Service: The Watlington & District Care Home is a purpose-built 60-bed care facility, providing nursing care to older people who are physically or mentally frail. The ground floor has 30 single rooms, a dining room and a sitting room overlooking the front of the home, and a quiet sitting room and a sun lounge to the rear of the home, with access to an enclosed courtyard garden with a large raised centre flower/herb bed and paved pathways to a further large garden area. The first floor, with a further 30 single rooms, includes a designated area for the care of a maximum of ten service users requiring intensive short-term rehabilitative intermediate care. The local primary care trust works in partnership with the home to provide physiotherapy and occupational therapy for service users receiving intermediate care. Service users admitted for intermediate care may be in a younger age range (from age 18 years and over). There is a large sitting room/activities lounge and dining room. A third floor is used for staff accommodation. There are passenger lifts and stairs accessing residents accommodation. The home has a range of assisted bath and shower facilities and two treatment rooms. All residents rooms have an en-suite toilet and washbasin. The homes kitchen and laundry facilities are in refurbished and refitted former outbuildings across the approach drive to the homes main front entrance. The home has its own minibus for taking residents on outings. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection by two inspectors, one of whom visited the ground floor nursing unit and the other the first floor. During the inspection, that started at 9.30am and finished at approximately 3.00pm, the inspectors spoke to six residents, four relatives, a visiting GP, a nurse practitioner, the nurses in charge of each of the units, six care staff and a student nurse on placement in the home. What the service does well: What has improved since the last inspection? Counter/service units have been installed at one end of both dining rooms. This improves the way in which staff can serve the meals to residents, because there is more space for staff to use, and it is safer for residents because the hot food trolleys are now positioned behind a counter. The garden planting has matured and, with gazebos provided for shade, and garden seating, the grounds are very attractive and safe for residents to enjoy. The home has appointed a deputy manager. On the day of this inspection the manager and senior manager for Sanctuary Care were interviewing staff, and had appointed a new senior staff member to manage the ground floor unit of the home. The sharing of responsibility for management with the home’s registered manager will help reduce his workload and increase the number of senior staff who are around to advise and communicate with residents, relatives and staff about residents’ care. The appointment of a member of staff who organises activities for residents has increased the opportunities for residents to have more entertainment and things to do. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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 Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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 & 6 There was evidence that prospective residents are assessed by senior staff from the home, so that the residents’ needs are known and that they can be assured that the home will be able to provide the standard of care they require. Residents admitted for short-term intensive rehabilitation have occupational therapy, physiotherapy and nursing support to enable them to return home. EVIDENCE: The inspectors spoke to the registered manager, senior nurses from each unit of the home, two visiting professionals, four visiting relatives and several residents. There was evidence in residents’ care records that information from health care professionals and care managers was also sought as part of the assessment of residents’ care needs before they were admitted. A resident on the intermediate care unit described the programme of physiotherapy that was being received and the way in which room furniture had been rearranged to help the resident to be as independent as possible. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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 & 10 The system of care planning is satisfactory overall, so that staff have adequate information to carry out the care for each resident. Staff have a good understanding of residents’ support needs in practice, although the written information in the care plans should be better organised to make them easier to read. EVIDENCE: The care records seen had numerous ‘risk assessment’ charts - for example, to show whether a resident was at risk of developing pressure ulcers, or becoming malnourished. Several of the records did not show what action had been taken by staff to reduce the identified risk – for example, what kind of equipment had been provided (special mattress and seat cushion) to lessen the risk of a resident developing pressure sores. If a particular risk or need is identified, the action taken by staff should be recorded and updated. As noted at previous inspections, the notes were bulky with ‘daily records’. This makes it difficult to find the most recent information or to follow how the care given has improved the resident’s condition. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 10 The manager said that the company is aware of the shortcomings of the current paperwork, and intends to introduce an improved system in the near future. The care plans focussed mainly on residents’ physical care. The care plans should include more information about social and recreational needs as it is important that residents do not become isolated and bored. Some records seen did include an ‘activities diary’ with a brief comment about the resident’s enjoyment of a planned activity. In practice, the inspectors found that staff were knowledgeable about residents’ care needs and preferences – this was shown in discussion with inspectors and from observation of staff with residents. Staff spoke to residents in an appropriate and respectful manner. The intermediate care unit care records do not contain a clearly set out plan for discharge home (or alternative care setting, if the person needs more time to recover). This was discussed with the nurse in charge. In particular, where someone has new medication it is important that their understanding about the purpose of the tablets, when to take them and their effects, should be clearly explained before the person goes home. The care records should show that the resident has been assessed as being capable of managing their own medicines at home (or that relatives or lay carers are informed about the resident’s medicines, if they are to be involved in care at home). The medication administration system was good, with the records correctly completed and up to date. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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 The home’s staff are welcoming and friendly. The programme of activities has improved since the last inspection and a person is employed specifically to organise individual and group activities. The home has good support from the local trustees and local community. EVIDENCE: Visitors spoken to by the inspectors were very happy with the care and facilities. Relatives spoken to felt that they were always made to feel very welcome and involved in their relative’s care, to the extent that they feel “very much part of a larger family”. One resident told an inspector that they felt there was not enough for the older residents to do. Staff members also said that more activities should be provided for residents or “more staff so that we can give more time to the residents”. The activities worker works throughout the home. Some of the residents’ care plans included an ‘activities diary’ with a brief comment about the person’s participation in, and enjoyment of, a planned activity or entertainment. A fete held at the home on 11th June had been very well supported by relatives and the local community and much enjoyed by residents, visitors and staff. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 12 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) NA Standards not assessed on this occasion. EVIDENCE: Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 & 26 The standard of décor, furnishings and cleanliness in the home is very high throughout. The grounds and gardens are beautifully maintained, providing attractive and accessible outdoor areas. EVIDENCE: A resident commented on the attention to detail in the home – the redecoration that had been done following ‘snagging’ work (the building was completed in 2004). Retiling behind a work surface and repainting of skirting boards was underway in the first floor dining room on the day of inspection In the lounge/dining rooms on both floors servery areas have been built, with hatch access for staff. This has improved the dining and meal service to residents, by having the heated trolleys behind a counter and staff taking the plated meals on trays to the diners. It is also safer for residents using the ground floor dining room as many are confused and were at risk from accidental contact with the hot food trolley surfaces, or spillages when staff were serving food close to the dining tables. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 14 Outside, the garden planting has matured and the lawns and flower beds were very attractive. Gazebo areas provide shade to the courtyard garden and more are planned for the main gardens. There were sunshades providing cover for the garden seating and tables in the courtyard outside the ground floor conservatory room. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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 & 30 Staffing levels meet those agreed at registration and residents looked well cared for. The home has a temporary shortfall of senior nurses causing additional work for existing staff. Staff have a good understanding of residents’ care needs and relatives and visitors are satisfied with the care that residents receive. Care staff feel well supported by managers and feel competent and confident in carrying out their work. EVIDENCE: A senior nurse was working additional hours to cover for a colleague’s absence. This was a temporary measure and was to be reviewed by the home’s manager after a month. Staff interviews to fill a senior nurse vacancy for the Chiltern Suite were underway on the day of inspection. The manager reported that another registered nurse and new care staff had been appointed to fill staff vacancies. A visiting doctor told inspectors that she felt the standard of care of residents was good. The inspectors looked at the staff rotas and saw that many of the staff work long shifts. Staff spoken to said that they felt that more staff were needed to meet the needs of residents at certain times of the day, especially at mealtimes when several residents needed help with eating and this took a lot of time, and in the afternoons when more time was needed for recreational activities with residents. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 16 There was evidence that staff have regular training and updates in health and safety and clinical topics. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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 & 38 The home is well managed, with the manager and staff showing an awareness of their roles and responsibilities. The standard of the environment in the home is good, providing residents and staff with a safe place in which to live and work. EVIDENCE: Mr Okoro, the home’s manager, has more than 13 years of experience in care work and is a registered nurse, qualified in mental health care. He has a Diploma in Healthcare Management and is currently completing a BSc Honours in Professional Practice. He is also an assessor for staff undertaking National Vocational Qualifications (NVQ) in Care. There is a clear management structure within the company that owns the home (Sanctuary Care Ltd, a part of Sanctuary Care and Sanctuary Housing Association, a charitable organisation). Mr Okoro is accountable to a line manager, who undertakes regular unannounced visits to the home and audits the standards of care within the home. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 18 The home employs a full time gardener and a maintenance person. There is a nominated health and safety officer and the maintenance person takes the lead in ensuring fire safety practices in the home are in place. A recommendation made at the last inspection has not been carried out. This relates to the nurses’ office doors. The doors have automatic door closers fitted, and there are no windows, so the offices get very hot. Also, it is difficult to manoeuvre medicine trolleys in and out of the clinical rooms behind the nurses’ offices. Staff then prop the doors open, which is poor practice because, in the event of a fire, flame and smoke spread would not be contained. The doors should be fitted with the type of automatic door closers that allow the doors to be kept open, but would close automatically when the fire alarm sounded. A resident in the intermediate care unit was not aware of routine fire alarm testing, or what action s/he should take in the event of the fire alarm sounding. The fire procedure is mentioned in the Statement of Purpose but the resident spoken to did not recall having been given this information and would need staff assistance to move. There are notices displaying the fire safety procedure throughout the home. All residents (if able) and visitors should be aware of the fire safety procedures in the home. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 4 3 x x x x x 4 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x 3 Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 20 no 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 Regulation None Requirement Timescale for action Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 21 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 The care plans should be sufficiently detailed for care staff to be able to follow and give the care assessed as being required to meet the residents’ care needs. Rationalise the number of risk assessment and dependency forms in the service users’ care records, to reduce unnecessary or irrelevant paperwork for staff to complete. Care plans should include evaluation comments, ie has the care given improved and met the resident’s condition/care need? Wound assessment, measurement and treatment should be more detailed, using current good practice guidance. The ‘daily statement’ entries should be made more specific and relevant, by cross-referencing them to the numbered care plans. Care plans should include assessment of service user’s preferred social and recreational pastimes, and how these will be met in the home. Implement the use of the MUST nutritional risk assessment tool in the home. Care plans should be available for service users who develop acute, short-term health problems – for example chest or urinary infections - and the effectiveness, or otherwise, of any prescribed antibiotics or therapies recorded. Service users and/or their representatives should be involved in drawing up of care plans and should read and sign these if possible. Residents receiving care in the intermediate unit should have a plan of care showing their progress towards planned discharge and the actions needed by the multidisciplinary team to help the resident achieve this. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 22 2. OP9 3. OP27 4. 5. 6. OP38 OP38 Service users in the intermediate care unit should be assessed in relation to their ability to manage and administer their own medicines at an early stage of their stay, to ensure that they understand and can safely manage their own medications prior to and after discharge home. Review the staff rotas, to ensure that staff have sufficient time off to rest between shifts and can adjust to different day and night duty patterns of work. Ensure that there are sufficient staff to meet the additional needs of very dependent residents, and to increase the opportunities for residents recreation and social care. Fit the type of automatic door closers to the nurses station rooms that enable doors to be kept open and improve the accessibility and ventilation to these rooms. Ensure that residents in the intermediate care unit have written information about the fire safety practices (and usual service user guide information) in the home. Watlington & District Care Home H57-H08 S56018 Watlington Care Home V238231 130705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Cowley, Oxford OX4 2SU 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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