CARE HOMES FOR OLDER PEOPLE
Watlington and District Care Home Hill Road Watlington Oxfordshire OX49 5AE Lead Inspector
Delia Styles Unannounced Inspection 24th November 2005 10:35 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.V268541.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. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 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 Sanctuary Care Mr Abdul Okoro Care Home 60 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (20), Terminally ill (2) of places Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Condition 1 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. Condition 2 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). Condition 3 The total number of persons accommodated at any one time must not exceed 60. Condition 4 One named service user, under the age of 65, within the DE category, may be accommodated at the home. 13th July 2005 2. 3. 4. 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 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 and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection lasting five hours. Key standards not assessed during the inspection carried out on 13th July this year were inspected on this occasion. For a more complete overview of the home, both inspection reports should be read. The inspector talked to the home manager, staff and senior nurses on duty on each unit, five residents, three relatives and two visiting healthcare professionals. A tour of the building was undertaken and a selection of recruitment, financial and care records was read. The inspector would like to thank residents, staff and the home manager for their welcome, and the time and co-operation given during the day. What the service does well: What has improved since the last inspection?
Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 6 The staffing levels, skill mix and work shifts have been adjusted so that residents have consistency of care from the same staff group looking after them in each unit. The appointment of a senior nurse for the Chiltern Unit has also improved the continuity of care for residents. The home is starting to assess the nutritional needs of residents using the method recommended by the community dieticians that is being introduced to hospitals and GP practices in Oxfordshire. What they could do better:
The standard of residents’ care plans and records has improved but needs further development, especially to show the nursing assessments and care of residents in the intermediate care unit, and how the social and recreational needs of all residents are being met. The manager has already arranged additional training for staff about improving the way they write records. This is important so that staff have enough information to give the residents the care they need. Further training and development of staff skills is needed, and is planned by the home, for staff caring for residents with confusion. Staff should be alert to potentially stressful situations and to take appropriate action to reduce the risk of verbal or physical aggression from residents directed towards themselves or other residents. Care plans should set out in detail the kind of interventions that should be tried by staff to help the resident and reduce the risk of confrontation with others. The home has recognised that the design and layout of the ground floor Chiltern Unit does limit the amount of space for residents using the main communal lounge and this can be a source of frustration if they are close to others whose behaviour upsets them. The reception and administrative office space is also cramped. The manager said consideration is being given to changing the use of some rooms, to increase the number of sitting rooms for residents. The nurses’ stations, reception and administrators’ offices still get very hot and the recommended work to improve the ventilation in the nurses stations, made at the last inspection, has still to be done. If the rooms become too hot staff are likely to prop or wedge doors open, so that there is potentially increased risk to staff and residents in the event of a fire, because open doors will not delay the spread of flame or smoke. The manager said quotes for this work are in hand. There is a problem with an unpleasant odour in some communal areas of the ground floor unit, despite regular cleaning and shampooing of the carpets. The
Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 7 home is taking additional action to try and resolve this problem, which may require a change in the carpeting used. The home still has no deputy manager, but interviews were due to be held to appoint someone to this post. It is important that the home’s manager has a suitably experienced senior staff member to share the responsibility for the management and staff development in the home. 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 and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 8 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.V268541.R01.S.doc Version 5.0 Page 9 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): Standards 1-6 were not assessed on this occasion. EVIDENCE: Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 The standard of residents’ individual plans of care was satisfactory overall, but further work is needed to improve the detail of the actions to be taken by carers and to record evidence that the care has met the residents’ assessed needs. The procedure in place for ensuring that residents in the intermediate care unit are able to be responsible for their own medication before they go home is still in the process of development by the home. EVIDENCE: A small sample of four residents’ care plans was looked at. The individual care folders were better organised and had less bulk of old care records stored in them than at the last inspection. Information about residents’ nutritional needs is now completed using the assessment method recommended by the community dieticians (Malnutrition Universal Screening Tool – MUST). The home has organised further training in the use of the MUST and general principles of good care planning and record keeping. The care plans showed that the individual care needs of residents had been assessed and regularly reviewed, but the detail for how care staff were to meet
Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 11 those care needs was not always sufficient. For example, in Chilterns Unit the care plan for a resident who is confused, and can occasionally be aggressive towards staff and residents, did not show what kind of situations could lead to frustration and anger for him/her, and what specific actions staff had found were effective in diverting the resident and/or reducing the risk of him/her becoming angry. It was not possible to see, from the care records, to what extent the nursing and medical interventions for this resident had reduced the episodes of aggression, although staff confirmed that s/he was now much more ‘settled’. Recommendations made at the last inspection in relation to nursing care plans for residents in the short-stay intermediate care unit have not been acted upon yet. There are instructions for staff in terms of moving, handling and assisting residents with their physiotherapy routines in their rooms. However, there are no care records showing the detail of residents’ abilities to care for themselves in terms of washing and dressing, for example, on admission, and to show their progression to self-care before they go home. If nurses and care staff have no baseline assessment of a resident’s ability to care for themselves without staff assistance, it is difficult to predict what level of help (if any) residents will need in their own homes. All residents should have an individual plan of care setting out their health, personal and social care needs in sufficient detail for staff to be able to assist or enable residents to maintain and improve their level of independence. When assessing someone’s readiness to go home, their social support and access to services after discharge and their ability to manage any medications safely need to be assessed and documented. The senior nurse and other members of the multidisciplinary team are looking at ways to assess residents’ abilities to safely store and take their medication correctly, and have an understanding of the actions and possible side effects of any prescribed medicines. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15 The systems in place in the home ensure that residents’ personal preferences about their care and pattern of their day are respected. The meals in the home are good and offer both choice and variety with evidence that residents and staff views about the catering are listened to and acted upon. EVIDENCE: The administrator confirmed that residents are able to handle their own financial affairs as long as they are able and have the capacity to do so. It was evident that staff had a good understanding of resident’s individual care needs and preferences, for example staff were heard to remind some residents about organised activities taking place, to ask them where they wanted to eat their lunch and whether they wanted to rest in their rooms afterwards. The inspector spent some time talking to residents in the first floor dining room before lunch. The dining room was very attractive with tables laid with
Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 13 co-ordinated table linen, a small vase of fresh flowers and condiments. There were laminated menu cards in holders on each table showing the day’s menu choices. Additional optional dishes were also listed on a separate menu card. Relatives of one resident joined him for lunch in the dining room. Staff confirmed that relatives and visitors are welcome to have a meal and often do, so long as they give some notice to the chef beforehand. Residents were very positive about the standard of the food and the choices available. The manager said that a comment book was available for residents and staff to use, and that the cook has acted on their suggestions. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 The home has a satisfactory complaints procedure and there was evidence that residents feel that their views are listened to and acted upon. Staff have a good understanding of adult protection issues and receive regular training and updates in identifying and reporting suspected abuse. EVIDENCE: Information about Age Concern and advocacy services was on display in the home so that residents and their relatives know how to contact independent advisors to act in their interests if they wish. Residents who are publicly funded have regular review meetings with their care manager or reviewing officer and family representatives to discuss their care and whether it meets the resident’s needs. The home maintains a record of any concerns or complaints. The manager reported that one complaint had been made since the last inspection but this had been resolved. Staff records showed that there is induction and regular mandatory training in place for staff about how to detect and report suspected abuse of vulnerable adults. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards not fully assessed on this occasion. EVIDENCE: Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 16 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 Staffing levels and skill mix in the home are sufficient to meet the residents’ care needs. The home’s vetting and recruitment practices are thorough, protecting residents from potential risk from unsuitable workers. EVIDENCE: The manager said that since the last inspection they have a full complement of staff. Though there are some care staff vacancies, they have built up a reliable local ‘bank’ of staff who are very flexible and can cover any staff absences. The appointment of a deputy home manager has not been achieved, but the manager reported that a promising applicant for this post was to be interviewed in the next week. It is important for the home and manager that a suitable deputy is appointed to share the leadership and management responsibilities in the home. The staff shift patterns and deployment of staff in the three units of the home have been adjusted since the last inspection and this has provided better continuity of care for residents and a more consistent pattern of working hours for staff. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 17 Three staff records were examined. These showed that all the required information had been received about the staff members prior to their starting work in the home. There was evidence that prospective employees and their referees had received details of the post applied for, the skills and qualifications expected of the job applicant and a structured reference form. The procedures in place are thorough and minimise the risk of people who may be unsuitable to work with vulnerable adults being appointed. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 18 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): 33, 35 & 36 The staff have a good understanding of residents’ needs and staff and residents have a positive relationship. Trustees, health and social care professionals and Sanctuary Care managers regularly review the home, seeking the views of residents, staff and relatives to ensure that the home is run in the best interests of the residents. The home has good systems in place to ensure that residents’ financial interests are safeguarded. The home has an established programme of formal staff supervision in place, so that all staff feel supported in their work and career development. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 19 EVIDENCE: A senior manager of Sanctuary Care undertakes monthly monitoring visits to the home and a report of their findings and an action plan is given to the manager to make any improvements where identified. This internal regular audit process is thorough and all the staff are involved in ensuring that follow-up action is taken. Trustees of the charity visit the home regularly and talk to staff and residents about their views of the home facilities and care. Representatives of the Primary Care Trust that funds the intermediate care service also undertake checks to make sure that the service meets the needs of residents admitted for short-stay rehabilitation care. The home’s system for handling residents’ personal allowances, where they are unable to manage their own financial affairs themselves, was examined. There are individual folders for residents, with their personal allowances, invoices and receipts clearly setting out amounts held and spent. The home has secure safe storage for petty cash and residents’ funds. Sanctuary Care carries out its own ‘spot checks’ of the home’s management of financial transactions made on behalf of residents. A small trolley ‘shop’ is taken around the home weekly so that residents can make purchases of toiletries and sweets, etc. Items are individually priced and there is no ‘mark up’ charge to residents. Residents who wish to are able to go out in the home’s minibus to local shops. The system of formal staff supervision is in place in the home. Staff have the opportunity for regular ‘one to one’ meetings with a senior staff member to discuss their progress in their work and any training needs they may have. The list of supervision sessions was seen, with entries for October and November. Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 20 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 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X X NO
Version 5.0 Page 21 Are there any outstanding requirements from the last
Watlington and District Care Home DS0000056018.V268541.R01.S.doc 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. Standard Regulation Requirement Timescale for action 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. Care plans should include evaluation comments, eg has the care given improved and met the residents condition/care need? The daily statement entries should be made more specific and relevant, by cross-referencing them to the numbered care plans. Residents receiving care in the intermediate unit should have a plan of care showing their initial admission abilities and care needs, their progress towards planned discharge and the actions needed by the multidisciplinary team to help the resident achieve this. 2. OP9 Implement and document an assessment and monitoring process in the intermediate care unit in relation to
DS0000056018.V268541.R01.S.doc Version 5.0 Page 22 Watlington and District Care Home 3. OP26 residents’ ability to manage and administer their own medicines. This should commence at an early stage during a resident’s stay, to ensure that they understand and can safely manage their own medications prior to and after discharge home or to identify what level of support may be needed from domiciliary services if they are not able to self-medicate. Continue work to eliminate the unpleasant odour from carpeting in some communal rooms of the Chilterns Unit. Consider change of use of some offices and communal rooms in the Chiltern Unit to increase the communal space for residents to use, and the office facilities for the reception and administrative staff. Implement planned work to improve the ventilation to the nurses’ station offices. 4. OP38 Watlington and District Care Home DS0000056018.V268541.R01.S.doc Version 5.0 Page 23 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: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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