Inspection on 17/10/07 for Watlington and District Care Home

This inspection was carried out on 17th October 2007.

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

Watlington and District Care Home 26/09/08

Watlington and District Care Home 24/01/07

Watlington and District Care Home 24/11/05

Watlington and District Care Home 13/07/05

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 and District Care Home Hill Road Watlington Oxfordshire OX49 5AE Lead Inspector Chris Schwarz Unannounced Inspection 09:30 17 October 2007 th 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 Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Watlington and District Care Home Address Hill Road Watlington Oxfordshire OX49 5AE 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) 01491 613400 01491 615115 julieco@sanctuary-housing.co.uk Sanctuary Care Mrs Susan Ellen Morley Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) maximum number 20 2. 3. Dementia - (DE) maximum number 30 The total number of service users to be accommodated is 60. 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 placed allocated intermediate care. 24th January 2007 Date of last inspection 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 Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 5 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. The fees for this service range from £625 to £1045 per week according to information in the current statement of purpose. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were sent to a selection of people living at the home, relatives and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with service users, examination of some of the home’s required records, observation of practice and a tour of the premises. The inspection focussed on care of people with dementia on the ground floor. Because people with dementia are not always able to tell us about their experiences, a formal way to observe people has been used in this inspection to help us understand. This is called the ‘Short Observational Framework for Inspection’ (SOFI) and involved observing up to 5 people who use services for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. The inspection showed that some elements of care provision are good such as information in care plans, risk assessments and regular evaluations to ensure that identified needs are current. The environment is well thought out with space for people to wander and arranged and fitted with adaptations to meet needs arising from physical disability. Improvements to staff training and the approaches used by staff when relating to service users would ensure that equality and diversity are better promoted in other areas of care practice through staff having a better understanding of people’s needs. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and people who use the service are thanked for their cooperation and hospitality during this unannounced visit. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Information needs to be added to the statement of purpose about the arrangements for respecting the privacy and dignity of service users, so that they know what to expect of the service. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 8 The privacy and dignity of service users are to be better promoted at the home to ensure that people living there can be assured that they are respected and that they consistently receive appropriate treatment by staff. A record needs to be kept of verbal complaints made to the home in order that a clear audit trail is in place to see whether the home has responded appropriately. Staff training on adult protection/safeguarding is needed, to ensure that staff have the right skills to protect people from risk of harm. A revised adult protection policy is needed, to make clear that staff are to report abuse within 24 hours to the Commission for Social Care Inspection, in line with legislation and to protect service users. Gaps to training and recruitment records could mean that people using the service are cared for by staff who do not have the right attributes and skills to ensure their needs are fully met. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 9 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 Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is good. Prospective people using the service are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s statement of purpose was seen and found to contain useful information that would assist prospective service users and their representatives make a decision about whether this was the right place for them. The fees were clearly recorded and it was made clear that additional charges are made for services such as hairdressing, chiropody, newspapers and any personal shopping that may be required. The statement of purpose did not contain necessary information about the arrangements in place for respecting people’s privacy and dignity and this needs to be added so that people are clear what to expect. A recommendation is made to address this. A sample of pre-admission records was looked at and reflected assessment of people’s care needs prior to admission to the home. Details covered areas such as people’s communication needs, mental health status, spiritual needs and personal likes and dislikes. The document “Getting to Know You” expanded on Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 11 these details to provide a well rounded picture of people’s personal circumstances and included needs arising from equality and diversity. Feedback from a care manager (social worker) indicated that the service always ensures through its assessment arrangements that accurate information is gathered and that the right service is planned and given to people. Feedback from people using the service and relatives also showed that the service manages intermediate care effectively and provides a valuable rehabilitation resource. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. The healthcare needs of people living at the home are well met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. Attention is needed to promoting dignity, to make sure that people using the service are given the respect they deserve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were in place for each person living at the home; a new preformatted and very comprehensive care planning system is about to be introduced which provides greater prompts for noting the broad range of individual care needs and assessments. The sample of care plans looked at during the inspection gave good all round assessments of care needs and took into account people’s former occupation, their preferred form of address, spiritual and cultural needs as well as up-to-date assessments of care requirements and dependency levels. On going evaluations of weight, baseline observations (temperature, pulse, respiration), pressure risk and nutritional screening were in place and there were accompanying risk assessments for moving and handling and risk of falling. Health care appointments and visits from health care professionals were clearly noted and showed access to medical services as required. A care manager (social worker) said health care needs are properly monitored and attended to, that people are supported to Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 13 manage their own medication and that the service responds to different needs arising from equality and diversity. A doctor expressed satisfaction with overall care and said that staff had been receptive and sensitive to reviewing infection control measures. A health care professional said that staff are “always keen to ask for help and support. Very responsive to all suggestions.” A relative said one of the things the home does well is an “atmosphere of cheerfulness.” Another relative said “We have been very happy with the care and staff in the short time my mother has been in the home. My mother appears to be very happy, eating and much cleaner than she was in her own home.” Medication was being well managed using a monitored dose system of administration. Medication for one part of the home was assessed during the inspection. Storage was in an air conditioned room with cabinets and trolleys securely locked and only trained staff having access to keys and responsible for administration. Medication administration records were in good order with signatures alongside prescribed dose times. The controlled drugs register was being properly and accurately maintained and actual stocks tallied with the recorded entry. During the time spent observing practice at the home, it was clear that staff were consistently using people’s preferred form of address where they used their name. Other positive aspects of promoting dignity included providing people with clothes protectors where needed for drinks and meals and carrying out personal care in private areas of the home. However, significant issues in how staff relate to service users were observed with the majority of sentences used by staff punctuated with inappropriate endearments such as “lovey”, “sweetheart”, “poppet” and “darling”. One member of staff was observed rubbing her head against the service user’s whilst engaging with her and speaking in a way which patronised the person by not treating her as an adult, another staff member was observed to convey little warmth and stood over service users when speaking with them, which could have appeared quite threatening. A conversation about a service user was overheard from the other end of the lounge, with one staff member remarking to another that a bath and shave had caused one person to be very sleepy; a question asking a service user if they would like to go the toilet could be heard easily by others including the need to take the person to their room to “get you changed, washed, freshened up.” In discussion with the manager, the need for staff to receive training in promoting privacy and dignity was highlighted, which needs to be followed up through individual supervision, observation of practice and staff appraisal. A requirement is made to improve this area of practice to ensure that people living at the home can be assured that their privacy and dignity are respected and that they receive appropriate treatment by staff. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. Some activities are available to people using the service to provide them with stimulation although more are needed to ensure regular opportunities for engagement. Contact with family, friends and the community are supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some people who completed comment cards felt that more activities needed to be provided and the manager was aware of this and had already been looking at ways to address this prior to the inspection. The introduction of an art therapist once a week has been a particular success with examples of people’s artwork seen and reflecting new ways of being able to communicate thoughts and feelings. Music therapy sessions had not been as useful and have stopped. The home has a minibus which is used twice a week to take people out to places of interest such as Henley, the Shire Horse Centre and Blue Cross Centre. Arts and crafts materials are available in house, a hairdresser visits three times a week and there are regular church services provided by the local Anglican church. A card in reception advertised the dates and times of the services and also provided details of how to contact the Canon outside of these times and for private communion. Clothes shows take place and visiting artists are periodically arranged such as an opera singer and a group of saxophonists. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 15 A PAT dog has also been to the home. There are very well maintained grounds with areas to sit in and admire views across open countryside. During observation of practice, staff were seen engaging with service users in the lounge through playing with balloons, some individual discussion with people, putting on music and a one to one game stacking plastic discs. For some service users, there was little or no engagement over a two hour period. Apart from one newspaper between the 15 people in the lounge and a couple of dolls, there was little that people could touch, pick up and provide them with stimulation, such as magazines, tactile items or even reminiscence cards which could have provided openings for conversations between more staff and service users. In feedback to the manager, the appropriateness of putting on a compact disc of 1970s disco music was discussed; some people may indeed have wide ranging musical interests but there was no indication from service users through humming, tapping toes, drumming fingers or smiling that they were enjoying this choice. People who completed comment card said that visitors to the home are made to feel welcome and one person said the home “does its best to put relatives at ease and all staff are very welcoming.” Dining tables had been attractively set using table cloths and linen napkins and each table had a laminated menu showing the options for lunch. Some service users who needed assistance remained in the lounge where staff provided help in a gentle and unrushed manner. There was little verbal interaction whilst this assistance was being provided to help make the meal time more of a pleasant and social occasion. One staff member who stopped providing assistance for the time it took to help with a moving and handling manoeuvre, did not say anything to the person they were helping before leaving them, nor apologise for the interruption. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. Complaints and adult protection/safeguarding procedures are in place to listen to views of people who live at the home. These need to be supplemented by staff training to ensure that staff have the necessary skills to reduce risk of harm to vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure which is displayed in the foyer and contains the contact details of the Commission for Social Care Inspection. People who completed comment cards were largely aware of how to make a complaint if need be. In information provided by the manager prior to the inspection, two complaints in 12 months were noted and records of these were asked for during the inspection. One complaint lead to the manager following adult protection/safeguarding procedures, involving the local authority. The other complaint had been responded to as a reply letter was seen, but there was no log of the actual complaint. A recommendation is made to note the details of any verbal complaints received into the home, in order that a clear audit trail is in place. Adult protection/safeguarding procedures are in place although dated 2004. An omission in the policy is that staff need to be aware that any allegation, suspicion or actual occurrence of abuse is to be reported within 24 hours to the Commission for Social Care Inspection. A recommendation is made to update the policy with these details in order that staff are clear of what they must do. For a sample of staff files looked at, there was no indication that they had received adult protection/safeguarding training. A general requirement Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 17 regarding mandatory training, which includes adult protection, has been made under the staffing section of this report. The Commission has not been contacted directly by any service users or their representatives regarding complaints or adult protection/safeguarding matters. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The home is clean overall, well decorated and adequately maintained, promoting a positive environment for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is located close to National Trust open countryside and a short drive or walk from the shops and facilities in Watlington. The building had been purpose-designed to accommodate people with disabilities with wide corridors and door ways, bathrooms and toilets of good size and with the necessary adaptations and non slip flooring. There is single room accommodation throughout with rooms having ensuite toilets and basins. Accommodation is on two floors, with the first floor providing intermediate and older people’s nursing services and the ground floor containing accommodation for people whose primary needs arise from dementia. Rooms have large windows and were being kept warm. The condition of décor was good and those bedrooms seen had been personalised to different degrees. Communal areas had been attractively arranged; one lounge overlooking the garden downstairs was out of action for the duration of the inspection due to cleaning which meant that Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 19 people were a little overcrowded in the main lounge. Fabric samples had been chosen by service users to replace stained chairs in the lounge and new carpet will also be provided. Odour control was being well managed and the state of cleanliness was good, new bins had been provided in bathrooms and toilets to minimise odours. Devices had been fitted to nurse station doors to hold them open safely, as required at the last inspection. The kitchen and laundry are located in a separate building and are well designed and appeared clean and in good order. There is ample parking at the home. The grounds are very well maintained and pleasant to look out at. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. Gaps to training and recruitment records could mean that people using the service are cared for by staff who do not have the right attributes and skills to ensure their needs are fully met. Observation of staff practice showed that there is a need to promote dignity and respect for the people living at the home to ensure that their self worth is realised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had sufficient staff on duty with a mix of qualified nurses and carers, the deputy manager, manager, administrative, catering, laundry and domestic staff. The files of three people on duty were looked at to see how they had been recruited. The full range of checks was in place for one person, for another who had transferred within the organisation there was no evidence of a Criminal Records Bureau or POVAfirst check having been done. The third person had been permitted to start work with preliminary clearance (POVAfirst) but there was no record to show that it had been made clear to the member of staff what duties she would be permitted to carry out and the arrangements for her supervision whilst the full Criminal Records Bureau check was awaited. Information provided by the manager before the inspection showed that there was no current use of agency staff to cover the rota. Twelve of thirty one staff had achieved National Vocational Qualification level 2 or above with a further five working towards it. Eight staff had left in the past twelve months. The induction record for a newer member of staff was available and signed to show completion of required areas. Training records for three staff were looked Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 21 at. Records were in some disarray and need attention to show who has undertaken what and when. There was evidence of only one of the three staff undertaking training in care of people with dementia. There were no records to show that these staff had attended Protection of Vulnerable Adults/ safeguarding training, completion of the full range of mandatory courses could not be seen for two of the three staff and for the third person, most courses had been undertaken but were not up-to-date. Requirements and a recommendation are made to improve these areas of practice. Observation of staff practice showed inappropriate use of endearments as already reflected in the report. There was some appropriate touch when staff were interacting, such as stroking or holding people’s hands but also some inappropriate interactions such as a member of staff rubbing her head against a service user’s when speaking with her and another member of staff standing over a service user and patting his leg roughly. One person was seen to be rather over zealous in encouraging service users to drink their tea which could have had a detrimental effect on their enjoyment of it. Some verbal interactions were positive, using the person’s preferred form of address and bending down to their level or sitting next to them and gently speaking. These instances were in the minority though. Patronising comments such as “I’m going to tell my mum” and “I’m going to cry” were heard when a service user declined to take part in a game. The approach of another member of staff, referred to earlier in the report, came across as intimidating as it conveyed little warmth, was quite direct with people and there was no bending down to the level of the service user. The member of staff was heard speaking inappropriately to a service user saying “you threatening me?” and then laughing. One service user was heard calling out periodically during the two hours of observation and some staff did respond although on most occasions she was ignored. She was left to sit in an awkward position for an hour before two staff assisted her to sit upright. A requirement has already been made in this report for privacy and dignity to be better promoted at the home which will address some of the issues. The manager should consider staff training to look at the approaches of staff, both verbal and non verbal, and ensure that the Protection of Vulnerable Adults/safeguarding training that needs to be provided also covers practice issues such as how care should be delivered. A relative said “My experience of staff looking after my husband is good. Always pleasant when I visit and very helpful.” Another relative said “The staff we have met are very helpful and confident.” A healthcare professional said “The manager and staff know their limitations and will seek the help of other professionals. The holistic care of the residents is at the heart of their work.” A relative said “It is a friendly, clean and caring home. The staff are very good and willing to talk and spend time with patients and visitors.” Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is adequate. The management and administration of the home promote continuity of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has become registered with the Commission for Social Care Inspection since the last inspection. She is working towards the Registered Managers Award and until this has been achieved the standard relating to management/day to day operations cannot be scored as fully met. Required actions from the previous inspection had been attended to. The report has identified weaknesses in various aspects of care provision that are directly within the manager’s control and need to be remedied to improve quality of care for people living at the home. There were reports showing that the provider or a representative visit the home on a regular basis to assess quality of care. Quality audits had been Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 23 carried out in January and March of this year. A number of policies and procedures viewed as part of the inspection were dated 2004 and need some revision to ensure that current good practice is reflected within them. The manager advised that the provider is already working towards achieving this. Service users’ money was being well managed with individual transaction records and wallets in place and regular checks undertaken by the regional manager. A sample of balances and records viewed as part of the inspection were in good order with each balance tallying with the recorded one. Money was being kept secure with limited staff access. There were no items being held for safekeeping. Health and safety was being well managed with a range of checks in place to ensure that the environment was safe for staff, service users and visitors. Certificates showed that hoists are routinely serviced, there was a current gas safety certificate, the fire alarm had recently been serviced and the home had a Legionella risk assessment. All bathrooms and toilets that were seen or used had working locks and were well stocked with all necessary supplies and kept clean. The standard of cleanliness and odour control was particularly good throughout the home. Alginate bags were being used in the laundry to prevent cross infection and there was provision of disposal gloves and aprons for staff to use as necessary. Accident records were being maintained with a falls register in place and oversight by the manager. Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x 2 3 Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 25 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 OP10 Regulation 12(4)a Timescale for action The privacy and dignity of 17/11/08 service users are to be better promoted at the home to ensure that people living there can be assured that they are respected and that they consistently receive appropriate treatment by staff. Evidence of a satisfactory 01/12/07 Criminal Records Bureau and Protection of Vulnerable Adults check is needed for the person referred to in the report who transferred from another home, to ensure that all required checks are in place. Mandatory training including 01/02/08 Protection of Vulnerable Adults/safeguarding is to be attended first time or brought up to date to ensure that staff have the right skills to meet needs. Training on the care of people 01/02/08 with dementia is to be attended by all staff who work with people with this condition, to ensure they are equipped with the knowledge and expertise to meet needs. DS0000056018.V346829.R01.S.doc Version 5.2 Page 26 Requirement 2 OP29 19(1) 3 OP30 18(1) 4 OP30 18(1) Watlington and District Care Home 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 OP1 Good Practice Recommendations Information needs to be added to the statement of purpose about the arrangements for respecting the privacy and dignity of service users, so that they know what to expect of the service. Details of verbal complaints are to be noted in the complaints log book, in order that a clear audit trail is in place. The adult protection/safeguarding policy needs to be revised to include that staff are to notify the Commission for Social Care Inspection within 24 hours of any allegation, suspicion or actual occurrence of abuse in order that they are clear of what they must do. The limitations to carrying out care and the arrangements for supervision need to be made clear in writing to any staff who are permitted to work with preliminary POVAfirst clearance, to make sure that they do not place people at risk of harm. 2 3 OP16 OP18 4 OP29 Watlington and District Care Home DS0000056018.V346829.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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