CARE HOMES FOR OLDER PEOPLE
Widecombe House Widecombe House Barrington Road Torquay Devon TQ1 2QJ Lead Inspector
Judy Hill Unannounced Inspection 10:00 28 November & 4 December 2006
th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 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.V310429.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th January 2006 Brief Description of the Service: Widecombe House is registered to provide accommodation and care for a maximum of eighteen people in the registration categories of Old Age and Dementia. The Home is situated in a residential area of Torquay and is within walking distance of Wellswood Village, where there are several shops and a bus service to and from the town centre, which is approximately one mile away. Information about the service is available from the Home in a brochure/information pack, which incorporates a Statement of Purpose and Service Users’ Guide. Copies of inspection reports are also available from the Home or can be accessed on the CSCI Website. The current fees range from £320 to £400 a week and cover all care and accommodation costs, food and drink, heating and lighting, any laundry done on the premises and any other service the staff provide. Service users are expected to pay from their own personal allowance or private income for personal items such as newspapers, tapes, books and magazines and for professional hairdressing and chiropody. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was carried out on the 28th of November and the 4th December 2006 the first day of the inspection was unannounced and the second day was announced. The information contained in this report was gained in conversation with the registered service providers, the assistant manager, staff, residents and some of their relatives. Information was also gained from documentary evidence including a pre-inspection questionnaire completed by the assistant manager, the Service Users’ Guide, Statement of Purpose and previous inspection reports. Additional information was gained from an inspection of the premises and an inspection of records, including service users assessments, care plans and reviews and staff recruitment and training records. As part of this inspection the quality of information given to people about the care home was looked at. As the home specialises in providing care for people with dementia, their relatives were contacted and asked about the information they had received from the home prior to admission and how this helped them to make choices. The information included the Service Users’ Guide, Statement of Terms and Conditions and Complaints Procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well:
Prospective service users and /or their representatives are given the information they need to make an informed choice about whether or not the service is right for them. Each of the service users has a contract/statement of terms and conditions and will be given advanced notice of any changes, including increases in fees. Comprehensive needs assessments are carried out with the service users and their relatives. This process begins at the initial point of contact and continues throughout the trial period. Each of the service users has a comprehensive care plan, which has been written by one of the senior care assistants acting as the service users Key Worker. These are reviewed at least once a month. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 6 Widecombe House provides a specialist service for people with dementia and provides a very high standard of personal care. Although nursing care is not provided, the home liaises well with the residents GP’s and the District Nursing Service. All of the staff who administer the residents medication have received training and prescribed medicines are administered safely and conscientiously. The residents are treated with dignity, respect, understanding and kindness. The management and staff take time to get to know and understand the personal histories of the service users and spend time socialising with them. Visitors are welcome at any time that is convenient to the service users and the staff and management have developed close relationships with service users families. The residents are encouraged to exercise choice for as long as they have the capacity to do so. The quality of the meals provided is good and specialist dietary needs and preferences are catered for. The complaints procedure is accessible to the service users, their relatives and visitors to the home and complaints will be listened to and dealt with appropriately. Policies and procedures are in place to protect the residents from the threat of abuse and in - house training is provided. The standard of cleanliness maintained in the home is very good. The communal lounge, dining room and conservatory are spacious and all of the rooms are well presented and comfortably furnished. The laundry facilities meet the needs of the home and the service users laundry is handled with care. The care staffing levels are good. There are usually four care workers on duty throughout the day in addition to one of the service providers and/or the assistant manager and always two waking night staff to attend to the residents needs. Some of the care staff have gained National Vocational Qualifications in Care a levels 2 and/or 3 and other are working towards gaining these qualifications. The assistant manager is working towards gaining the Registered Managers Award. The staff are well supervised and induction and on-going training is provided. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 7 The management team are very experienced in the provision of care for people with dementia, have a very good understanding of the needs of people dementia and provide a good quality service. It is a policy of the home not to handle the service users finances or personal money. The premises are safely maintained and safe working practices are promoted. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 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 Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The brochure and information pack and the assessment process ensure that prospective service users and their families have the information they need to make an informed decision about whether or not the home is right for them. EVIDENCE: The home has produced a brochure and information pack, which incorporates a Statement of Purpose and Service Users’ Guide. This document is well written and informative. The relatives of three service users were contacted and asked if they had received a copy of this document prior to admission on behalf of the service users and all three said that they had. Copies of service users contracts/statements of terms and conditions were seen on the service users files. Relatives of the residents acting on behalf of the residents had signed these. The relatives spoken with confirmed that they
Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 10 had received copies of these documents and were informed in advance of any changes to the service, including fees. Service users assessments were seen at the home. Mrs Brandi said that either she or the assistant manager visited prospective service users in their own homes or in hospital prior to admission to start the assessment process. Service users and their families are also invited to visit the home before deciding if the service is right for them. The three relatives spoken with all confirmed that pre-admission assessment visits had been carried out and that they had been to the home to assess the quality of the service provided before deciding if the service would meet their relatives needs. The initial assessment process begins at the first point of contact and continues throughout the initial trial period. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The resident’s needs are understood and met with dignity and respect by the management and staff. EVIDENCE: Four of the resident’s care plans were inspected as part of a case tracking process. Three of the senior care assistants act as key workers for six service users each. The key workers had drawn up the care plans from Mrs Brandi and the assistant managers needs assessments and from their personal contact with the service users. The care plans were seen to be comprehensive, well written and easy to follow. Mrs Brandi said the care plans were reviewed at least once a month and evidence of this was seen on the care plans. Widecombe House specialises in providing care for people with dementia and although none of the current service users could answer detailed questions
Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 12 about recent events, all of them were seen and the service provided appeared to be meeting their needs. Feedback from three of the service users relatives was very positive about the quality of the care provided. It was demonstrated in conversations with Mrs Brandi and the staff that they have an excellent understanding of the needs of people with dementia and are committed to providing a high quality service. Seven of the service users are in the advanced stages of dementia and spend most of their time in bed. It is a credit to the service that none of these service users have developed pressure sores or infections and that they are kept clean and as comfortable as possible. The pre-inspection questionnaire completed by the assistant manager identifies that most of the service users are incontinent, however, this was not evident during an inspection of the premises, which indicates that the methods used to control continence by the care staff are very effective. It was also noted that incontinence pads or stored discretely and not left on display in the bathrooms and residents bedrooms. All of the service users were seen to be clean and well presented. This was also commented on by one of the relatives of the service users who said that he was very impressed by the way the staff helped to co-ordinate his mothers outfits so that she always looked smart. Widecombe House does not provide nursing care but does work closely with the district nursing service and GP’s to ensure that the service users health care needs are met. Widecombe House uses the ‘Boots’ Pharmacy controlled monitored dose system to order, administer, record and dispose of medication. All of the staff responsible for the administration of medicines had received training and the medication administration records sheets were seen to be satisfactory. Homely remedies are rarely used and the compatibility of their use, with the residents prescribed medication, is checked with the Pharmacy. The residents were observed being treated with dignity and respect by Mrs Brandi and the care staff. Any personal assistance required in carried out in private in the resident’s bedroom, or the bathrooms. Care is taken to ensure that the residents clothing is not mixed up in the laundry and that they always wear their own clothes. During the inspection of the premises Mrs Brandi and the staff were observed always to knock on the residents bedroom doors before entering their rooms. This good practice was even observed when the resident would not be able to respond. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and staff take time to get to know and understand the residents and will tailor the service to meet their needs. EVIDENCE: As part of the care planning process, the resident’s key workers draw up personal histories of the service users. This good practice was discussed with one of the senior care workers who said that she finds the personal histories interesting to draw up and useful, because they enable the staff to develop a good understanding of the service users. The staff and Mrs Brandi recognise that time spent talking and socialising with the residents is very beneficial to their care and the staffing levels are high enough to ensure that the residents do get the quality time they need. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 14 The homes policy of visiting is included in the Brochure/Information pack. Visitors are welcome at any time convenient to the residents. One of the residents spoken with said that her daughters and their families were regular visitors and the relatives of three residents all said that they visited the home regularly. It is also known that relatives of some residents who are no longer at the home continue to keep in touch. Although there are some routines, for example the timing of meals, these are limited and can be flexible. Most of the residents are able to choose when they want to get up and go to bed and as there are always two care workers on waking night duty, this is not influenced by shift patterns. The main meal of the day is served at lunchtime and although there is a set menu, evidence was seen to demonstrate that the service users dietary needs and preferences are respected. The home is currently meeting the needs of several residents who need to have their food pureed and one who chooses only to eat pureed food. Mrs Brandi was able to demonstrate that she had a good understanding about the residents likes and dislikes and that alternatives to the set lunch are always available. Two of the relatives spoken with commented about their mother’s enjoyment of the meals provided. Choices of meals are offered at breakfast and supper time. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible and the residents and their representatives can be confident that any complaints that they may have with be listened to a dealt with appropriately and that the relatives are protected from the threat of abuse. EVIDENCE: The Homes complaints procedure is included in the Brochure/Information Pack and the three relatives spoken with confirmed that they had been given this information prior to admission. All three said that they would know how to make a complaint if they needed to, should this ever be necessary. A copy of the complaints procedure is also displayed in the entrance hall. Very few complaints have been made about this service, but Mrs Brandi and the assistant manager are available to discuss any concerns that a resident or their representative may have. Conversations with staff identified that the quality of supervision and support is of very good and that induction training process covers the recognition of abuse and poor care practices. Policies and procedures in place to protect the service users from the threat of abuse and although not all of the staff have attended formal training courses in the Protection of Vulnerable Adults, the
Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 16 assistant manager said that he was planning to send staff on to the next available course run by Torbay Care Trust. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from living in a clean, spacious, well presented and comfortably furnished home. EVIDENCE: Widecombe House is a large detached house, surrounded by attractively landscaped gardens. It is situated in a residential area of Torquay, close to the facilities at Wellswood Village. The accommodation is arranged on three floors, ground floor, lower ground floor and first floor and stair lifts have been fitted between floors. At the time of the inspection the home was in the process of being redecorated, recarpeted, re-wired and radiator covers were being fitted in the bedrooms.
Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 18 The communal space consists of a large comfortably furnished lounge, a separate large dining room and a conservatory. An inspection was made of the premises and the home was found to be clean and comfortably furnished throughout. The laundry facilities are suitable for the needs of the home and include washing machines with sluicing facilities, dryers and hand washing facilities. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care staffing levels are very good and enable the care staff to spend quality time with the residents. The residents can be confident that the staff are trained and competent, but the process of identifying and recording their training needs and achievements could be improved. The staff are well supervised, but the previously good recruitment practices have slipped, are unsafe and could place the residents at risk. EVIDENCE: The information on staffing levels shows that four care staff are employed to work from 8am to 2pm and four from 2pm to 8pm. Two care assistants are employed on waking duty throughout the night. In addition to the care staff a dedicated kitchen domestic and cleaner are employed. Mrs Brandi and or the assistant manager are on duty throughout the day to oversee the management of the home.
Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 20 Four of the fourteen care staff had completed their National Vocational Qualification in Care at Level 2 and one of these has completed Level 3. A further three are working towards completing level 3 and the assistant manager is working towards gaining a Registered Managers Award. A further four members of staff are considering taking classes to improve their English, before embarking on NVQ courses. The staff spoken with said that they had received induction training and had been taught to work to a high standard by Mrs Brandi. Indirect observation of the staff working with the residents demonstrated that they are caring and patient. Feedback from relatives of service users about the staff and their abilities, was very positive. On-going training is provided but a more structured approach could be used to identify the staffs training needs and achievements. The recruitment files for the two most recently employed members of staff were inspected and safe recruitment practices had not been used. Although the staff had completed application forms and attended interviews, there was no evidence on their files to show that references had been taken up, POVA First checks carried out or CRB checks completed before the staff were employed to work with the residents. This is disappointing, as recruitment practices have always been satisfactory on previous inspections. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident that the management have the experience and understanding needed to provide a good quality service. EVIDENCE: The registered service providers and Mr Andrew & Mrs Eileen Brandi. Mrs Brandi manages the service on a day-to-day basis with the help of an assistant manager. Eileen Brandi is very experienced in the provision of care for people with dementia and able to demonstrate an excellent understanding of the residents needs. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 22 It was made evident in conversation with Mrs Brandi, the staff and relatives of service users that the quality of the care provided is closely monitored and that high standards are maintained. However, there is still no formal quality assurance/quality monitoring system in place. The policy of the home not to handle the resident’s financial affairs or personal money is included in the Brochure/Information Pack and this is recognised as an example of good practice. The assistant manager and Mrs Brandi confirmed that they do not handle any money for the service users and that each of the residents has a family member or legal representative to provide such assistance. Day to day expenses incurred by the residents are paid for by the Home and a bill is sent to the service users representative to recoup the cost. The pre-inspection questionnaire completed by the assistant manager identifies that the home has been rewired and that this included an overhaul of the emergency lighting and fire alarm appliances. This was evident during the inspection as electricians were in the house completing the work. The central heating system and other appliances, including the stair lifts and hoists are regularly maintained. Policies and procedures are in place to ensure that safe working practices are used. Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 23 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 4 X X 3 Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 24 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 OP29 Regulation 19, Schedule 2 Requirement The registered persons must obtain two written references and carry out a POVA First check before employing staff to work with the residents. And, an Enhanced CRB check must be obtained before staff work unsupervised with residents. The registered persons must establish and maintain a system of quality assurance/quality monitoring. Previous timescales 15.3.05, 23.10.05 & 16.04.06. Timescale for action 28/01/07 2. OP33 24 28/02/07 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 OP30 Good Practice Recommendations It is recommended that a more structured approach is used to identify and record the staffs training needs and achievements.
DS0000018452.V310429.R01.S.doc Version 5.2 Page 25 Widecombe House Widecombe House DS0000018452.V310429.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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