CARE HOMES FOR OLDER PEOPLE
Widecombe House Barrington Road Torquay Devon TQ1 2QJ Lead Inspector
Judy Hill Unannounced 22nd June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Widecombe House Address Widecombe House, Barrington Road, Torquay, Devon, TQ1 2QJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 298692 01803 296217 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 D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th January 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 is situated in a residential area and is within walking distance of Wellswood Village. Both the house and gardens are very well presented. The residents accommodation is attractively decorated, comfortably furnished and maintained at a high standard of cleanliness. Meals are cooked on the premises and twenty-four hour care is provided by dedicated care staff. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out from 12.40pm to 4.40pm on Tuesday, 22nd June 2005. The information contained in this report was gained in conversation with Mrs Eileen Brandi (Registered provider) and the Care Manager, from a tour of the premises and from documentary evidence, including the daily report book, the medication administration record sheets, residents needs assessments and care plans. All of the residents were seen during this inspection and several of them were engaged in conversation. As some of the residents are in an advanced stage of dementia they were unable to comment verbally on the quality of the care provided but additional information was gained in conversation the husbands of three of the residents, all of whom are regular visitors to the home. What the service does well: What has improved since the last inspection?
Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 6 The recorded assessment, care planning and review processes have improved and are now very good. The staff are now being given copies of their terms and condition of employment and copies of the Code of Conduct set out by the GSCC. Although one to one supervision is not being provided for the care staff, annual appraisals are now being carried out. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Comprehensive needs assessments are carried out to ensure that each individual residents needs can be identified and met. EVIDENCE: The resident’s individual needs assessments are kept together in a single file, along with their risk assessments, action plans and care plans. Three were selected at random for inspection and each of them were seen to be clearly written, easily accessible to the staff, easy to read and to follow and very comprehensive. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 11 The resident’s needs are being met and the quality of the care provided for people in the final stages of dementia is outstanding. More stringent procedures need to be adopted to ensure that the resident’s medicine is administered safely. EVIDENCE: The residents individual care plans were seen to have been incorporated with their needs assessments, risk assessments and action plans. These documents were seen to be comprehensive, but easy to follow and accessible to the staff. Evidence of regular reviews was seen. The resident’s health needs are identified in their individual assessments and monitored by the staff on a daily basis. Evidence of this monitoring was seen in daily report sheets, which the care staff complete for each of the residents after each shift. Records were also seen of visits by District Nurses, CPN’s and GP’s, which demonstrated that timely referrals are being made when necessary. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 10 The medication administration record sheets demonstrated that checks are being made of all incoming and outgoing medication. A limited use is made of non-prescribed medicines and this is recorded on the backs of the MAR sheets. Discussion with the Care Manager identified that guidance had not been sought to ensure that the non-prescribed medicines used are compatible with the resident’s prescribed medicines. Medicines that were not included in the cassettes, such as liquids and creams, were recorded on the MAR sheets but the record was not being initialled. In some cases this was because the medicines had been discontinued, where this is the case this should be clearly recorded on the MAR sheets. The home continues to provide care for residents as their dementia progresses and the quality of care provided to people in very advanced and final stages of dementia is excellent. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The resident’s are encouraged to exercise choice in their daily lives. Visitors are encouraged and made welcome. Every effort is made to provide meals suited to the resident’s individual tastes. EVIDENCE: The importance of identifying the likes and dislikes of the residents and in finding out about their lives before they developed dementia is clearly identified in the resident’s individual assessments. In addition to recording the resident’s preferences regarding their daily living, such as food preferences, when they like to get up and go to bed and hobbies and interests, brief histories had been included. In conversation with Mrs Brandi, she spoke of the importance of the management and staff knowing something about the resident’s lives before they developed dementia. Visitor’s are encouraged and some of the resident’s husbands visit them on a daily basis. During the inspection three of the resident’s husbands were met and spoken with. All three made very positive comments about the quality of the care provided. The home is currently catering for a resident who is a vegetarian, one who is diabetic and one who will only eat soft food. Mrs Brandi and the Care Manager prepare the resident’s meals and it was evident in conversation with them that every effort is made to provide the residents with meals suited to their
Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 12 individual tastes and preferences and to ensuring that they each have a balanced and nutritious diet. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Every effort is made to ensure that the resident’s are protected from abuse. EVIDENCE: The Care Manager said that all of the staff had applied to attend a six day course on adult protection that is being run by Torbay Social Services. Three Care Assistants have had adult protection training as part of their NVQ course work and the Care Manager and a Senior Care Assistant have attended a training course. The home has a copy of the Department of Health’s ‘No Secrets’ video and a copy of the ‘Alerter’s Guide’. An ‘Action for Elder Abuse’ poster has been displayed in the staff’s locker/coffee break area and the staff are encouraged to discuss any concerns that they have with the management and/or senior care workers. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 23, 24 & 25 The resident’s are provided with an attractive, clean and comfortable home environment. EVIDENCE: Widecombe House is an attractive detached villa with private and welllandscaped gardens. It is in a quiet residential location, but within a short walk of Wellswood Village. Most of the residents need to be supervised by the staff when they use the garden as there are no safe enclosed areas for them to use alone. The home is very well presented. The lounge, dining room and conservatory are attractively decorated and comfortably furnished. The residents bedrooms are furnished according to their needs and a very high standard of cleanliness in maintained throughout. The bathrooms and toilets have been fitted with suitable mobility aids. Stair lifts are provided to aid the resident’s mobility between floors. The rooms all have good natural light and ventilation. The home has gas central heating with individual thermostatic controls. Some of the radiators have been fitted with covers, others still need protecting.
Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 15 None of the residents bedroom doors have been fitted with locks. Mrs Brandi said that none of the residents would be able to use keys and that some of resident’s would become distressed if they accidentally locked their doors and could not get out. Individual risk assessments need to be carried out to justify this lack of provision. None of the residents have lockable storage facilities in their rooms and these should be provided. Valves have not been fitted to the bath taps to control the temperature of the hot water. This does not present a risk to the current residents as all of them need supervision when running and using the bath and the staff test the water temperature. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 The staffing levels are high enough to ensure that the needs of the residents are met. EVIDENCE: On the day of the inspection one care assistant had phoned in sick so the home was a little short staffed. A senior care assistant and a care assistant were on duty and along with the Care Manager and Mrs Brandi and they were able to attend to the residents needs and cope with an unannounced inspection. Night-time cover is provided by two care assistants on waking duty. One member of staff has completed her NVQ at Level 2 and a further two members of staff have finished their course work and are waiting for their results. At there are a total of fourteen care staff the home has not met the target of 50 . Copies of the staffs terms and conditions/contracts were seen on their files and the Care Manager said that all of the staff had been given a copy of the Code of Conduct and Practice set out by the GSCC. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 36 A very high standard of care is provided for the residents but more could be done to involve them, their families and the staff in the development of the service. EVIDENCE: It was made evident in conversation with Mrs Brandi and the three visitors who were engaged in conversation during the inspection that the quality of care provided is closely monitored and that a high standard of care is maintained. However there are no formal quality assurance and quality monitoring systems in place to demonstrate that the views of the residents, their relatives and friends and other stakeholders (eg GPs, District Nurses, CPNs, etcetera) are being sought and used as part of an ongoing review and the development of the service. Evidence of annual staff appraisals were seen. The Care Manager said that he had started to carry out formal supervision with the staff but that this had not been maintained. Formal staff meetings are not held but informal are held on
Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 18 a daily basis and the staff are able to pass on any concerns that they have about the residents through the daily report book. Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x 3 2 2 x STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 2 x x 2 x x Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement Timescale for action 23.7.05 2. 33 24 Advise must be sought from the Pharmacist to ensure that any non-precribed medication used is compatable with the residents prescribed medicines. The MAR sheets must be initialled or coded when all items of medicine are administered, not just the medicines included in the cassettes. If an item of medication has been discontinued, this should be clearly recorded on the MAR sheets. The registered persons must 23.10.05 establish and maintain a system of quality assurance/quality monitoring. (Previous timescale 15.3.05 - not met) The registered persons must 23.8.05 arrange for each of the care assistants to recieve formal supervision on a one to one basis at least six times a year. The purpose of this should be to discuss all aspects of practice, the philosophy of the care in the home and career development. (Previous timescale 15.2.05 - not
D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 3. 36 18 Widecombe House Page 21 met) 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 24 Good Practice Recommendations Each of the residents should be provided with a lockable storage facility in their rooms. Locks should be fitted to bedroom doors unless it can be demonstrated through individual risk assessments that this would not be apprpriate. Arrangements should be made for the water to be stored at a temperature of at least 60 degrees C and distributed ar 50 degrees C minimum, to prevent risks from legionella. All radiators and hot pipes should be covered to reduce the risk of scalding. Arrangements should be made for a further four care staff to take an NVQ at Level 2 in care to meet the recommended minimum of 50 . 2. 25 3. 28 Widecombe House D54-D07 S18452 Widecombe House V221721 220605 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection 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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