CARE HOMES FOR OLDER PEOPLE
Widecombe House Widecombe House Barrington Road Torquay Devon TQ1 2QJ Lead Inspector
Judy Hill Announced Inspection 11th January 2006 10:00 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 Widecombe House DS0000018452.V263017.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. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Widecombe House Address Widecombe House Barrington Road Torquay Devon TQ1 2QJ 01803 298692 01803 296217 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 Andrew Brandi Mrs Eileen Edith Alicia Brandi Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22nd June 2005 Brief Description of the Service: Widecombe House is a family run home that specialises in providing care for women suffering from Alzheimers Disease and other forms of dementia. The home is registered to provide accommodation and care for a maximum of eighteen people. The home, which is a detached Victorian villa with attractive gardens, is situated in a quiet residential area of Torquay and is within walking distance of the shops and facilities of Wellswood Village. The house well decorated and comfortably furnished and a high standard of cleanliness is maintained. All meals are cooked on the premises. Care is provided on a twenty-four hour basis and a minimum of two care workers are on duty at all times of the day and night. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and was carried out by one inspector on Wednesday 11th January 2006. The information contained in this report was gained in conversation with Mrs Eileen Brandi (Registered Provider), the deputy manager, staff, residents and visitors to the home, from a tour of the premises and from documentary evidence, including a completed preinspection questionnaire, staff rotas, menu plans, service user assessments, care plans, records of staff training and recruitment and the accident report book. What the service does well: What has improved since the last inspection?
The deputy manager has received confirmation from the Pharmacist that the limited use of non-prescribed medicines is safe. The staff are now recording all of the medicines that they administer to the residents on the medication administration record sheets. Regular staff appraisals and supervision are now provided for the care staff. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 EVIDENCE: The key standard, standard 3 was assessed as met at the last inspection and was not inspected on this occasion. Standard 6 is not applicable because the home does not offer intermediate care. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 & 10 The residents and their families can be confident that medicines are administered safely and conscientiously. The management have an excellent understanding of the needs of people with dementia and the service users can be confident that they will be treated with dignity and respect. EVIDENCE: An inspection of the medication administration record sheets demonstrated that checks are being made of all incoming and outgoing medicine. A limited use of non-prescribed medicines is used and this, along with medicines that are provided in liquid form or prescribed on a prn basis and are therefore not included in the pre-packed cassettes provided by the Pharmacist are recorded on the individual service users MAR sheets. Written confirmation was seen to demonstrate that none of the ‘homely’ remedies used is incompatible with the service users prescribed medicines. The MAR sheets had been initialled appropriately as the service users medicine is administered. All of the service users were seen during this inspection and many of them were engaged in conversation. Because all of the service users spoken with are in advanced stages of dementia some of the verbal feedback about the
Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 10 quality of the care provided was limited. However, positive comments were made about the quality of the food provided and about the care staff. Also during the inspection the husbands of two of the residents and a former resident were seen and spoken with and were very positive about the quality of the service. One of the registered owners and her son are responsible for the day-to-day management of the home and both of them demonstrated an excellent awareness of dementia and of the needs of their residents. Both the management and staff were observed interacting with the service users and treated them with dignity and respect. Four of the residents are in the very late stages of dementia and been confined to bed for some time. Although the care provided for all of the service users is good, the respect and dignity afforded to the residents who are bedfast is exceptional. The key standards, 7, 8 and standard 11 were assessed as met at the last inspection and were not inspected on this occasion. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 EVIDENCE: All of the above standards were assessed as met during the last inspection and were not inspected on this occasion. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The complaints procedure is accessible and complaints will be dealt with appropriately. EVIDENCE: The complaints procedure is included in the Service User’s Guide and a copy is displayed in the entrance hall of the home. A record book is kept to record complaints but no recent entries have been made. Feedback from three relatives who were visiting the home at the time of the inspection indicated a very high level of satisfaction with the service provided and positive feedback was received from service users. Standard 18 was assessed as met at the last inspection and was not inspected on this occasion. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 26 The residents can be confident that the home is clean, well presented and safely maintained throughout. EVIDENCE: Most of the service users bedrooms are single rooms and some have en-suite facilities. Two out of the three double rooms are used by service users who are at an advanced stage of dementia and spend most of their time in bed. The owner said that this practice is used because the service users find comfort in the physical presence of another person. The bedrooms were all seen to be clean and suitably furnished. Suitable locks have not been fitted to the bedroom doors but risk assessments have been carried out and recorded to justify this omission. Lockable storage facilities are not provided. Screens are provided in double rooms to ensure that the service users have privacy when washing and dressing. The heating, lighting and ventilation are satisfactory. Windows have been fitted with restraints to prevent them from being opened wide enough to allow
Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 14 someone to climb or fall out of them. Emergency lighting is fitted throughout the home. The hot water temperature was monitored using a valve to prevent it from being too hot but several residents complained that their bath water was too cold. As none of the residents are able to run their own baths, and adapted taps are in place to ensure that taps cannot be left running, the valve was removed and staff test the temperature of bathwater using a thermometer. Some of the radiators have been fitted with covers and some have low temperature surfaces to prevent scalding. A very high standard of cleanliness is maintained within the home. The laundry room is appropriately sited so that soiled laundry is not carried through areas where food is stored, prepared or eaten. One of the washing machines has a sluicing facility and both are able to wash linen at an appropriately high temperature. Standards 19 and 23 were assessed as met at the last inspection and were not inspected on this occasion. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 28 & 30 The staff are trained to understand and care for people with dementia and the service users can be confident that they will be treated with dignity and respect and that their care needs will be met. EVIDENCE: In addition to one of the registered providers, who works at the home on a full-time basis and the assistant manager, there are two senior care assistants and ten care assistants a part-time cleaner employed at the home. The service provider said that two of the staff had completed their NVQ in Care at Level 2 and were currently working towards gaining an NVQ at Level 3. One member of staff is currently working towards gaining an NVQ in Care at Level 2. Although this falls short of the fifty percent target set by the National Minimum Standards, progress is being made and the quality of the induction and other in-house and external training ensures that all of the staff carry out their work conscientiously and with due regard to dignity and needs of the service users. Standards 27 and 29 were assessed as met at the last inspection and were not inspected on this occasion. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 16 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): 31, 33, 35, 36 & 38 The service users and their carers can be confident that the home is well managed and that the premises are safely maintained. EVIDENCE: One of the registered service providers (Mrs Brandi) manages the service on a day-to-day basis. She is very experienced in the provision of care for people with dementia and demonstrated that she has an excellent understanding of the residents needs. It was made evident in conversation with Mrs Brandi, the assistant manager and observations made during the inspection that the quality of the care provided is monitored closely and that high standards are maintained. However there is no formal quality assurance/quality monitoring system in place.
Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 17 It is a policy of the home not to handle the service users personal money and this is adhered to. Evidence was seen of staff appraisals and the assistant manager said that he had started to organise regular one to one supervision for the care staff, although records of this were not available for inspection. Informal supervision is carried out on a regular daily basis and it was evident from observing the interaction between the management, staff, service users and visitors to the home that the staff are receiving adequate supervision. Records of training demonstrated that the staff have received training to ensure that they carry out their duties safely. This training includes First Aid, Basic Food Hygiene, Infection Control, Fire Safety and Moving and Handling and is regularly updated. Gas and electrical appliances are regularly serviced and maintained in good working order. Domestic chemicals are stored appropriately and laundry and kitchen were seen to be clear and well organised. Window restraints have been fitted to prevent residents from falling or climbing out of windows and stairs and corridors are kept clear of items that may represent a trip hazard. Records were seen to demonstrate that accidents to staff and service users are recorded. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 18 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X 2 2 3 STAFFING Standard No Score 27 X 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 24 Requirement The registered persons must establish and maintain a system of quality assurance/quality monitoring. Previous timescales 15.3.05 and 23.10.05 - not met Timescale for action 16/04/06 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 OP24 OP25 OP28 Good Practice Recommendations Each of the residents should be provided with a lockable storage facility in their rooms. All radiators should be covered to reduce the risk of scalding. The service providers must continue to encourage the care staff to complete an NVQ in Care at Level 2 (or above) until fifty percent of the staff hold this qualification. Widecombe House DS0000018452.V263017.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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