Inspection on 07/12/05 for Waxham House

This inspection was carried out on 7th December 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

Waxham House 30/10/08

Waxham House 30/08/06

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Waxham House Waxham House 1 High Park Road Ryde Isle of Wight PO33 1BP Lead Inspector Mark Sims Unannounced Inspection 7th December 2005 12:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Waxham House DS0000064160.V250190.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. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Waxham House Address Waxham House 1 High Park Road Ryde Isle of Wight PO33 1BP 01983 564326 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Sanjay Prakashsingh Ramdany Mrs Sandhya Kumapi Ramdany Jamie Louise Bunter Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20), Physical disability over 65 years of age (4) of places Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Not applicable. Brief Description of the Service: Waxham House is situated within a residential area of Ryde and is a short journey by car from the facilities and amenities of Ryde esplanade and the town. Walking to these services and conveniences would, however, be beyond many of the clients accommodated at the home, a result of the distance, although public transport (buses) are accessible nearby. The premises is a large period town house, which has been adapted to provide residential accommodation with a lift to the first floor or chairlifts, which can be used to access both the mezzanine and first floors if required, the home having two separate landings accessible by different stairways. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service whilst long established has only been in the ownership of the current proprietors since 12th August 2005, meaning that this inspection is the first and only inspection this home will receive this year. At this inspection all of the core standards, as determined by the Commission, and several additional standards were reviewed, although not every National Minimum Standard was inspected. The inspection was conducted over two days, the first day being unannounced and considering key documents, tour of the premises, meetings with service users, their families and relatives and staff. The second visit was pre-arranged and specifically focused on records not readily accessible during the unannounced visit, employment files, service users’ financial records, etc. What the service does well: What has improved since the last inspection? This was the first inspection under the new proprietors and therefore any requirements or recommendations made were identified when the previous proprietors owned the home. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 6 The most significant issue highlighted at previous inspections involved the location of the laundry and the storage of food, etc. within the same area, an issue the proprietors have plans to address, although to date an issue which remains unresolved. What they could do better: The home has only been owned by Mr & Mrs Ramdany since August 2005, with much of their time in control of the business being given over to familiarising themselves with the service users, the staff and general principles of running a care facility. Whilst generally the home appears to be running well and efforts to introduce new management systems, updated policies and procedures and ensure staff access appropriate training, etc. are being made some areas of the service require attention. Several issues were identified with regards to the home’s management of service users’ medicines: • • The secondary storage cupboard (wall mounted) for service users’ medicines does not fasten securely, and should be replaced or repaired. Large numbers of medicines, i.e. Paracetamol are being held by the home, as it has no homely remedies policy or procedure, which would give greater flexibility and require less stock to be retained. Some environmental issues, in addition to those identified around the laundry, etc. were identified: • The toilet adjacent to the dining room is too small to accommodate a sink and therefore alternative means of cleaning your hands after use should be considered, liquid gels or sanitising rubs, etc. The home’s second bathroom appeared to be being used for storage purposes and not for bathing service users, leading to the main bathroom being used by all service users and reducing flexibility and choice. It is important that all bathing facilities provided by the home be both accessible and usable by service users, which could mean having to consider the suitability of the current bath within the second facility. • Issues were also noted with regards to some of the home’s management structures and systems: • Monies held on behalf of the service users was noted to be properly stored, receipted and balanced, etc. however staff were failing to double sign when they made purchases, etc. on behalf of the service users. DS0000064160.V250190.R01.S.doc Version 5.0 Page 7 Waxham House • The home’s recruitment and selection process was also found to be falling short of the required standards, with references not available and Criminal Record Bureau or Protection of Vulnerable Adults Checks missing. Whilst efforts to enhance the skills of the staff via training is being made, the management has missed the opportunity to develop their own skills through training courses provided by the local authority (specifically around adult protection). The courses provided were designed firstly to equip managers with the skills required to operate and manage an adult protection incident in accordance with the local authority adult protection strategy and secondly for staff to be trained as adult protection trainers, the latter course also coming with its own resource pack and training tools. 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. Waxham House DS0000064160.V250190.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 Waxham House DS0000064160.V250190.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, 2, 3 & 6. Service users are provided with the information they require to help them make a decision about the suitability of the home prior to admission. Each service user has a contract and statement of terms and conditions. Service users are assessed prior to admission to the home and re-assessed as part of the admission process on arrival at the home. The service does not provide an intermediate care facility. EVIDENCE: As the first inspection of the service since registration the inspector decided to review all of the documentation associated with admissions to the home and information sharing with service users. The newly drafted service users’ guide and statement of purpose documentation was found to be nicely presented, clear and concise, containing all of the information recommended or required by the Commission. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 10 In addition to the inspector’s finding through reading the documents, the relative of a newly admitted service user also commented on the usefulness of the service users’ guide and précis of the home’s previous inspection report, which had been provided to her and her relative. The relative also advised that she had visited the home and several others and had decided that Waxham House was the home that would best meet her relative’s needs, which since admission had proven to be the case. The relative also confirmed that the management had visited her relative in hospital prior to her admission, enabling her to meet some of the staff before admission and enabling a pre-admission assessment to be completed. A service user being re-admitted to the home was also spoken with briefly, although the circumstance of his re-admission made it advisable not to inconvenience him for long. However, it was established during the inspector’s time with the service user that the home had introduced admission packs, which contained copies of the documentation required by staff when admitting a new service user, as well as information for the service user and copy of the contract terms and conditions. For service users whose placements are arranged by the local authority the contract is agreed directly between the home and the placing authority and so these clients only receive a terms and conditions of residency agreement, for those parties arranging their own accommodation they have both a copy of the terms and conditions of residency and a signed contract with the proprietors for the service to be provided. This document also appeared well set out, clear and concise on inspection. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 11 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): Standards 7, 8, 9 & 10. All service users have a personal care file containing information relating to their health care. The service users’ health care needs are fully met. The home could improve how it manages service users’ medications. People felt they were treated with respect and that their privacy and dignity was promoted. EVIDENCE: Three service users’ files were reviewed as part of the inspection process, each file containing information specific to the client, including: • • • Pre-admission assessment information, hospital discharge summaries, local authority placement details. Admission assessment information – next of kin, date of admission, medication on admission, etc. Care plans, which had been reviewed and/or updated on the 18th November 2005. DS0000064160.V250190.R01.S.doc Version 5.0 Page 12 Waxham House • • • Daily running records. General Practitioner visiting records and details of treatment plans/requests, etc. Risk assessments, which should be updated to include details of how the risk identified is to be clearly managed. In discussion with service users and/or their relatives and through information gathered using the Commission’s comment cards process, it was evident that people were involved in decision-making about their care and that efforts are made to ensure their individual care needs are met. It was also evident through contact with the staff that they also understand and appreciate the individual care needs of the service users, as they were able on several occasions to discuss people’s personal preferences, etc. without referring to the service users’ files. As indicated the service users’ files contained a specific section relating to the health care needs of the service users and in particular contact with general practitioners and hospital attendance, etc., these records alone evidencing the home’s commitment to the health and welfare of the service users. However, further evidence was highlighted in discussion with the service users and specifically a service user who was attending hospital for rehabilitation and physiotherapy. The individual explained how they had undergone surgery some time back and that initially their recovery had gone well but then they had returned to the home and the support from the hospital had stopped. The home contacted the general practitioner on behalf of this client, whose mobility had suffered as a result of the reduced physiotherapy, and he had referred the person back to the hospital for further treatment, which she felt was working well. Other residents when asked about health care matters, etc. felt the staff were very attentive and that they undertook to ensure that people’s health and welfare was constantly monitored and promoted. Another lady was able to explain how staff ensured she kept her feet up as part of her treatment to reduce or manage the swelling in her legs, the inspector noting how humour was used by staff to ensure compliance with this treatment programme. A lot of good work was also being undertaken with regards to how the home manage the medications of service users, with staff completing a BTEC course in advanced medication administration via the local college and the proprietors Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 13 having recently completed the review and updating of the home’s medication procedure. However, the review of the policy failed to consider the introduction of a ‘homely remedies policy’, which would allow the home to administer over the counter medications such as Paracetamol to the service users without recourse to the general practitioner each time or having to hold an individual stock of prescribed medications for each resident. On inspecting the home’s medication stock it was apparent that by not having such a policy the home was holding far greater quantities of medicines like Paracetamol than was necessary and it is advised that consideration be given to formulation of a homely remedies policy as soon as possible. In addition to the problem of the large quantity of stock medicines held is the failure of the secondary storage cabinet to secure appropriately, a noticeable gap appearing at the base of the cabinet which if left unattended could lead to people accessing the cabinet without having to use keys. The home’s risk assessments process is used to ensure service users who wish to self medicate are enabled to do so, although this process should include reference to the person’s ability to understand and agree to secure medications within their own possession properly. Where possible, as with the above self-medication issue, the staff like to encourage people to make decisions for themselves and to feel respected, etc. Observations enabled the inspector to establish that staff are always polite and respectful when addressing service users and their relatives, a fact substantiated by comments made to the inspector via the comment card process, which describes how people are always made welcome, etc. The service users also discussed at length how they choose what they do each day and were noted through both days in the home moving from room to room and socialising with people as they wished. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. The service users enjoy living at the home and the activities and entertainments afforded them. Service users are able to maintain contact with relatives and friends as they wish. People are able to make decisions for themselves and exercise control over their day-to-day lives. The meals served are well prepared, presented and balanced. EVIDENCE: In discussion with service users it was evident that they enjoy living at the home as they praised the staff for their care and commitment, the new proprietors for the way they had settled into the home and the general environment, which was described as homely. The fact that people enjoyed living at the home and the benefits this afforded them, i.e. entertainment, meals, companionship, etc. were supported by the comments of visitors, who as previously documented felt their relatives were pleased with the service and happy to be residing at Waxham House. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 15 The residents themselves stated in conversation that they enjoyed numerous aspects of life at Waxham House, some appreciating the opportunity to participate in the entertainments provided by external entertainers, whilst others preferred to entertain themselves, as with one service user who clearly showed a preference for her own company and for watching the world go by outside her bedroom window. Other people preferred a mixture of activities and liked to socialise with others on a day-to-day basis, watching TV, reading, books or joining in with visits, etc., the philosophy of the home appearing to encourage socialisation and people to enjoy each other’s company, etc., most people seeming to like to spend their days in one of the home’s lounges chatting and mingling. In fact the home’s entire ethos seems to encourage people to exercise their right to choice and self-determination over many aspects of their day-to-day lives, rising and retiring times, choice of meals, the activities undertaken, control of medications, etc. Although some of the activities require the home to consider the potential harm or risks posed to the service user by the action they are undertaking, as in the case of the person who is self-medicating. The home also encourages visitors or relatives to become active members of the home’s internal community, one visitor in particular discussing how he visits regularly and often stays for meals (teatime), afternoon drinks and biscuits, etc. The visitor also described how he is involved or invited to participate in activities within the home and is looking forward to Christmas within the home, which has always been an enjoyable experience. This particular individual also discussed how he likes to takes his wife home for the day once a week and how staff help to get her into and out of the car, although she can manage reasonably well without assistance. His wife confirmed that she enjoys the trips out, although enjoyed life within the home in equal measure. As with all inspections a brief tour of the premises was undertaken, which on this visit included a visit to the food storage facilities and kitchen, the food stores containing a range of cooking materials including fresh, frozen and preserved or tinned food items. As with previous visits concerns with where the home’s fresh and frozen food stores are located were expressed, as they are housed in the laundry area of the home. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 16 The new proprietors are understood to have plans to address this issue, although the first four months of their ownership of the home has been spent on familiarising themselves with the service users and staff, etc. The meal being eaten during the visit was the main meal of the day, which appeared to be well cooked, reasonably nutritious and well presented. Meals also appeared to be being served in accordance with the person’s own preferences or dietary need, i.e. small portion, large portion, soft or pureed. When asked about the food provided people were more than satisfied with the meals cooked and praised the cooks for the efforts made in providing good wholesome and enjoyable meals. One service user at the end of the meal made a special effort to visit the cook and thank her for a nicely prepared and enjoyable lunch. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 17 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): Standards 16 & 18. Service users and their relatives appear happy with the process for raising complaints or concerns and that these will be appropriately dealt with. Copies of all relevant documents are available, however the use of the local authority adult protection strategy for both the management and staff needs addressing. EVIDENCE: Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 18 Comprehensive details of the home’s complaints procedure can be found in both the statement of purpose and service users’ guide, which as established are provided to service users and their relatives prior to admission and are deemed to be useful documents. The procedure has been specifically created to ensure compliance with both the relevant regulation and National Minimum Standard and is a simple yet effective tool for raising concerns or complaints. Evidence from the service users and their relatives is that they would feel happy to raise concerns with any member of the staff team, although they felt able to speak with either the manager or the proprietors if necessary, as they were all seen to be approachable people. One service user spoke openly about her belief that any problems within the home would be dealt with immediately and that no-one should have concerns about raising issues with the management as they appeared genuine people who took an interest in the people they cared for. In conversation with one of the proprietors it was apparent that neither she nor the manager had been able to secure a place on a recently organised adult protection management-training event arranged by the local authority. The three-day course intended to equip someone within the home with the skills required to become an adult protection instructor. In addition to their failure to secure places on this course the management had also been unable to cement places on a management training course, also arranged by the local authority, which concentrated on managing adult protection referrals within the parameters of the all Island adult protection strategy. However, the proprietor is hoping to secure places on the next tranche and is hopeful of commencing adult protection training with her staff shortly afterwards, although as no dates have yet been set for further training events, it might be prudent to arrange for staff to access some form of updated adult protection training sooner. It is anticipated that this training will build upon the training completed by staff during their induction training, the ‘Skills for Care’ induction units covering adult protection procedures and National Vocational Qualifications, which also considered issues around promoting the safety and wellbeing of service users, although neither course covers issues specific to the Island strategy. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 19 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 19, 21 & 26. The environment within which service users live is well maintained, clean and safe. Unless all bathrooms are accessible and usable the home has insufficient bathing facilities. The downstairs toilet, adjacent to the dining room, is not fit for purpose as it has no hand washing facility. The home is clean and pleasant, although issues of hygiene are a concern within the toilet and laundry areas, as highlighted. EVIDENCE: A brief tour of the premises was undertaken and revealed that the home is well maintained, clean and well decorated throughout. In conversation with service users it was evident that they appreciated living at the home and enjoyed both the well-maintained general environment and their own personal space, which many of them had furnished with objects and ornaments from their homes. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 20 One relative discussed how on admission to the home her relative had gone into a room on a temporary basis whilst waiting for a larger room to become available, however her relative had become so attached to her room and enjoyed the lovely outlook from the room that she has decided to remain within the room and has declined several offers to move to larger accommodation. Another service user likes her room so much that she seldom leaves it, as it affords her views out across the main street where she can watch the world go by, etc., which she seems to enjoy most around school time, when the children are passing by on their way home, etc. Three things that became evident during the tour of the premises which will require attention are the laundry area, which does not directly affect any service user but could indirectly affect them, as the home stores many food items within the same location. As highlighted already within the body of the report, this issue existed prior to the current proprietors taking over the home and plans are in hand for the situation to be addressed. The second issue which crosses over into Standard 26 (hygiene) is the fact that the downstairs toilet has no hand-washing facility within it, meaning anyone using the toilet cannot clean their hands after using the amenity. It is important if this toilet is to continue to be used that the home provide people with some means of cleansing or sanitising their hands after visiting this facility. The issue of cleanliness also brings to the fore the need to ensure all bathrooms, etc. are usable and accessible to service users, thus eliminating the possible over-reliance on one bathroom. During the tour of the premises it was noted that the upstairs bathroom is being used to store equipment, etc. and this could indicate that the facility is not being used, as it is inaccessible or not suitable for purpose. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 21 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): Standards 27, 28, 29 & 30. The skills and mix of staff are adequate to meet the service users’ needs. Staff training is sufficient to ensure service users are cared for by appropriately skilled staff. The home’s recruitment procedure is not being effectively operated. Staff training is good, although specific training around adult protection issues should be considered. EVIDENCE: A significant amount of time during the inspection was spent sat with the service users within the lounges, enabling the inspector to observe the staff and how they are deployed to work within the home. It was evident from these observations that sufficient staff are employed to work with the service users and that time is available to both care for the service users and engage in social interactions, although these might be brief and only last a few minutes, etc. In conversation with the service users it was clear that they appreciate the care and attention provided by the staff and that whilst they would like staff to have more time to chat, etc. they generally believe people have sufficient time to socialise and chat. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 22 The evidence of the staffing roster is that carers are deployed across three shifts: • • • 3 care staff work 08.00hrs to 14.00hrs or 16.00hrs. 2 care staff work 14.00hrs or 16.00hrs to 21.00hrs. 1 wakeful and 1 sleep-in carer work 21.00hrs to 08.00hrs. In addition to the care staff the home also has catering staff, domestic staff and members of the management team available within home on a daily basis. To date 5 of the home’s 14 staff posesses a National Vocational Qualification (NVQ) at level 2 or above with a further 5 staff in the process of completing their NVQ qualification. Currently this means that 36 of the staff team hold an NVQ qualification, which should rise to 71 in 2006 when the remaining staff complete their courses. In addition to the NVQ courses made available to the staff the management is also offering staff the opportunity to attend core-training events: • • • • • Moving and Handling. Health and Safety. Fire Safety. Infection Control. Food Safety. Staff are also afforded the opportunity to attend courses that are not considered core to the business but essential for the care of the service users: • • First Aid. Medication Courses. One area of the staff training programme which requires attention, as previously identified, is access to training around the protection of adults from abuse, a training need that in the future the home might be able to meet inhouse, if they manage to access the local authority training programme. Another area of the home’s practice which directly impacts on the safety and wellbeing of the service users is the recruitment and selection of staff, which should be robust and thorough to ensure suitable staff are recruited and employed. However, on reading through several of the files for staff employed at the home it became apparent that the home’s recruitment and selection process is not being operated appropriately with a reference missing for one staff member, no evidence of the home receiving protection of vulnerable adults Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 23 clearance before carers commencing employment, and criminal records bureau (CRB) checks missing for another two employees. On the positive side all staff had completed detailed application forms, provided photos and documentation to support their application, submitted certified evidence of courses attended and had evidence that CRB clearance had been sought, even if the person had commenced work prior to the clearance being returned. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 24 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): Standards 31, 33, 35 & 38. The home is well run by a manager who is appropriately skilled and qualified. The interests of the service users are safeguarded by the home’s quality auditing process. The financial interests of the service users are not being appropriately managed at this time. Some health and safety issues continue to be of concern. EVIDENCE: The manager is both a skilled and competent leader who possesses both a managerial qualification ‘The Registered Managers Award’ and relevant care qualification ‘National Vocational Qualification level 4 in Care’. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 25 Despite being skilled and competent the manager is relatively new to the position of registered manager and is having to work through a period of change, given the recent purchase of the home by Mr & Mrs Ramdany, although their working relationship appears to be working well currently. One aspect of the manager’s skills that perhaps could be developed are her abilities to delegate some of her responsibilities, as the home has two deputy managers, both of whom have their own areas of expertise, which the manager would be advised to use in supporting her within her own role. One such area could be to co-ordinate the home’s quality assurance programme, which at present relies on face to face feedback from service users on how the service is meeting their needs, although this form of contact seems preferable to the residents who like to spend time speaking to the manager, etc. on an individual basis and who find her approachable and pleasant. In addition to the face-to-face meetings with service users the home is intending to introduce monthly service users’ meetings, which will further enhance the ability of residents to comment on all aspects of the home’s service, identifying both positive and negative areas of the home. Meetings are presently arranged for the staff and for managers (senior and deputies) with the proprietors on a monthly basis to discuss changes that are required and how the service might be improved for service users, etc. Staff are also having regular meetings with the managers and proprietors and minutes of two meetings arranged since Mr & Mrs Ramdany took control of the home were seen during the inspection. In addition to seeking people’s views of how the service is meeting their needs or how the home is operating from the perspective of the staff, etc. the proprietors and manager have entered into a comprehensive review and updating of the home’s records, policies and procedures and have introduced some new management tools, i.e. the admission packs, etc. to make running the home on a day-to-day basis more manageable. The manager and staff of Waxham House support a number of service users with their finances, with 3 files reviewed for the purposes of inspection. Where the home is involved in managing the finances of service users all recommended safeguards and precautions have been adopted, with the exception of double signatures for purchases made on people’s behalf, although receipts for all purchases were available. For service users wishing to handle their own monies the home will provide a lockable cabinet, etc., although this is based on a risk assessment process, Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 26 although in conversation with the residents it was clear that most people elected to have their personal allowances or monies secured by the home. Some issues which affect the home from a health and safety perspective were noted during the inspection and largely related to concerns identified at previous inspection visits conducted before Mr & Mrs Ramdany owned the home. These issues, as mentioned within the body of the report, largely focus on the laundry facility and the practice of storing food items within that location. In discussions with one of the proprietors it was established that plans are in hand to address the problem, although it has not been a priority within the first four months of Mr & Mrs Randamy’s proprietorship, as they have focused on meeting the service users, their relatives and staff and building relationships and trust. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 27 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 28 Are there any outstanding requirements from the last inspection? N/A 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 2 3 4 Standard OP9 OP21 OP26 OP29 Regulation Regulation 13 Regulation 23 Regulation 23 Regulation 19 Timescale for action To ensure medications are stored 05/02/06 within a secure storage facility. All bathing facilities must be 05/02/06 accessible to service users and fit for purpose. All toilets must be fitted with 05/02/06 sinks or supplied with preparations for cleansing hands. Staff must not commence 05/02/06 employment within the home until all suitable and appropriate checks have been completed. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP9 OP18 OP35 Good Practice Recommendations The home should consider introducing a homely remedies policy and procedure. Staff should be afforded the opportunity to attend training on the protection of vulnerable adults from abuse annually. The management should ensure all financial transactions DS0000064160.V250190.R01.S.doc Version 5.0 Page 29 Waxham House undertaken on behalf of a resident, from a client held account, contain double signatures. Waxham House DS0000064160.V250190.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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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