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Care Home: The Doris Watts Home

  • 79 Milestone Road Carterton Oxfordshire OX18 3RL
  • Tel: 01993844103
  • Fax: 01933844432

The home is situated in a quiet residential area of Carterton. This enables service users ready access to the facilities in the centre of the community nearby - shops, dental and medical surgeries, opticians, banks and a library. There is also a weekly street market. The home offers homely accommodation for up to 29 service users with a range of 1 8 1 2 2 0 0 8 29 29 0 physical and mental care needs. The care home is not registered to provide nursing care. An adjacent bungalow was adapted and linked to the original Doris Watts Home and registered in August 2002. In 2007 the premises were again re-registered to include a two storey house now linked to the other buildings. Eleven of the 23 bedrooms have en-suite facilities. The main kitchen and small laundry room are on the ground floor of the main house. There are enclosed gardens to the rear of the home with ramped path access from the buildings. The garden at the rear of the bungalow `annexe` accommodation is grassed, with a number of mature fruit trees. The weekly fees for this services range between 371 and 750 pounds sterling.

  • Latitude: 51.752998352051
    Longitude: -1.5989999771118
  • Manager: Mrs Anna-Marie Jakes
  • Price p/w: £688
  • UK
  • Total Capacity: 29
  • Type: Care home only
  • Provider: Mr Harry Watts
  • Ownership: Private
  • Care Home ID: 15708
Residents Needs:
Old age, not falling within any other category, Dementia, Learning disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for The Doris Watts Home.

Key inspection report Care homes for older people Name: Address: The Doris Watts Home 79 Milestone Road Carterton Oxfordshire OX18 3RL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Delia Styles     Date: 3 0 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: The Doris Watts Home 79 Milestone Road Carterton Oxfordshire OX18 3RL 01993844103 01933844432 linda@robert-and-doris-watts.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Harry Watts Name of registered manager (if applicable) Mrs Anna-Marie Jakes Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Dementia (DE) Learning disability (LD) Date of last inspection Brief description of the care home The home is situated in a quiet residential area of Carterton. This enables service users ready access to the facilities in the centre of the community nearby - shops, dental and medical surgeries, opticians, banks and a library. There is also a weekly street market. The home offers homely accommodation for up to 29 service users with a range of Care Homes for Older People Page 4 of 33 1 8 1 2 2 0 0 8 29 29 0 Over 65 0 0 29 Brief description of the care home physical and mental care needs. The care home is not registered to provide nursing care. An adjacent bungalow was adapted and linked to the original Doris Watts Home and registered in August 2002. In 2007 the premises were again re-registered to include a two storey house now linked to the other buildings. Eleven of the 23 bedrooms have en-suite facilities. The main kitchen and small laundry room are on the ground floor of the main house. There are enclosed gardens to the rear of the home with ramped path access from the buildings. The garden at the rear of the bungalow annexe accommodation is grassed, with a number of mature fruit trees. The weekly fees for this services range between 371 and 750 pounds sterling. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection visit to review the quality of care and support provided and the outcomes for the people living in the home. The inspection process included a review of the information provided by the manager in their Annual Quality Assurance Assessment (AQAA) and any other information we have received about the service since our last inspection visit. Our survey questionnaires were supplied to some of the people using the service, their relatives, staff, and some of the health and social services professionals who visit the home regularly. We received 9 surveys from residents (which were completed with the help of the manager, or a staff member), 3 from relatives, 2 from staff and one from a health care professional. The inspector toured the building and looked at a sample of the paperwork and records that the home is required to keep. The inspector also talked to residents and some of the staff during the course of the day. At the end of the inspection, feedback was given to the registered manager Mrs Anna Jakes, and registered individual - the Care Homes for Older People Page 6 of 33 home owner, Mr Harry Watts. The operations director, Mr Anthony Watts, was also available during most of the inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We recognise that the provider is planning to build a new care home to replace the existing building in time, and that there is a balance to be reached in how much investment can be made to improve the current environment. However, we found that the home still needs to improve the attention to detail in the decor, furnishing and appearance of rooms, in some areas. The home should fully put into practice its system of routine checks on the standard of the premises and residents rooms to identify any repairs and improvements needed and make sure that work is satisfactorily completed within a given timescale. More consideration should be given to improving the standard of privacy for residents, Care Homes for Older People Page 8 of 33 especially for those people who live in the older accommodation or who share a room. We discussed these issues and have made recommendations in the body of our report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their families and representatives have sufficient information about the home before they come to stay, to make an informed decision about whether it is likely to suit them. The pre-admission assessment of peoples needs ensures that service users can be confident that the home is likely to suit them. Evidence: The home has developed and improved the information available to prospective service users in a new Service Users Guide, Statement of Purpose and a website. The homes AQAA tells us that further information will be developed in different formats, such as large printleaflets and a brochure and audio version, for people with visual difficulties. The manager undertakes the assessment of peoples needs before accepting them for admission to the home. A sample of assessments for 2 current residents was Care Homes for Older People Page 11 of 33 Evidence: examined. The content and detail of the pre-admission assessments in relation to peoples physical care was satisfactory. Risk assessments, for example, about peoples risk of being malnourished, falls, and skin damage (pressure sores) are also included. Since our last inspection the home has improved the way in which it assesses and plans to meet the social and activity needs of people moving into the home. The AQAA tells us that the home has a good reputation for being able to care for people with a wide range of social care needs. This is confirmed by care managers we have spoken with, who agree that the home does provide a highly personalised approach to assessment of need and involves individuals and their families or advocates in discussing what care and support is required. Three new staff roles have been created in the past 12 months - a Project Support Worker and two Concierges - who work alongside the care staff and manager to focus on peoples quality of life and build on information about their likes and dislikes to develop personal profiles Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, residents health care needs are being satisfactorily met with evidence of good communication between the home and health and social care professionals about ways to improve peoples health and wellbeing. Personal support is offered in such a way that promotes and protects residents privacy. Evidence: A sample of 2 residents care plans was examined. Since our last inspection the home has improved the care plans by creating its own design that centres on peoples individual support and care needs. The home has also developed a 1 page summary care plan, outlining peoples likes, dislikes and a pciture of them that remains in their room for staff to refer to The summary care plans also include space for residents and relatives comments. Another way in which the home ensures that people have individualised care is through developing a Life Options Plan that is particularly useful for staff to learn about the needs aand preferences of those residents who have a limited ability to communicate because of memory or physical health problems. The care assessment information, care plans and records of review meetings and Care Homes for Older People Page 13 of 33 Evidence: health care visits are held in individual files for each resident. From the sample seen, it was noted that the risk assessments and care plans are regularly reviewed and mostly contained detailed and relevant information. One persons care plan had not been updated with recent relevant information about a health problem and this was discussed with the manager who said she would make sure this was done. It was evident from discussion with the home manager and other staff that residents care needs are well known and met by staff. Responses to our surveys showed that people living here, and their relatives and advocates, feel that they are well cared for and that staff listen to them and act upon what they say. Some of the additional comments written by relatives and residents included - It is a pleasure to visit as all her care needs are well met. Looking after people with varying needs. Staff are very good (Staff) make me feel at home and anything I want the home acts on...the staff treat me very well. The homes AQAA states that the have a good relationship with health and social care professionals and they work well together to the benefit of residents. An occupational therapist advises the staff on the correct aids and equipment needed by individual service users so that they can remain as independent as possible. We found that people living here are able to attend appointments or receive visits from health care professionals - podiatrists, opticians, dentists, district nurses and GPs as necessary. Through accessing training for staff with NHS care providers, the manager is encouraging the homes staff to receive a good standard of training, that in turn benefits the residents. One staff members survey identified 4 things that they feel the home does well - Adapts well to the changing needs of service users; provides on-going training for staff; treats service users with respect and dignity; and has good communication with service users, their families, professional bodies i.e. doctors, district nurses, local pharmacist. The homes systems for the receipt, storage, administration and disposal of prescribed medicines are satisfactory. The supplying pharmacist undertakes regular checks of the homes medicines and is available to advise staff if they have any queries. Since our last visit, a new clinical cupboard has been built for the secure storage of medicines and to accommodate a drug fridge. Visiting professionals had pointed out that this room can get too warm for the safe storage of medicines and so the home is taking action to improve the ventilation. Observation of staff interactions with residents and residents comments on the day of the inspection visit confirmed that residents are treated respectfully and their privacy and dignity is protected. People spoken with during the inspection were appreciative that staff do respect their Care Homes for Older People Page 14 of 33 Evidence: individual and varied lifestyles and how they like to spend their time. One care manager told us that in their experience the home is successful in its ability to care for and support clients who might otherwise have been difficult to place in other care settings. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is improving the frequency and range of activities available for residents so that residents have more opportunities to participate in stimulating and motivating pursuits. The meals are good offering both choice and variety and catering for special dietary needs. Evidence: From observations, and conversation with individual residents and staff, it appears that peoples individual preferences about their day to day routine and how and where they spend their time is known and respected by staff as far as possible. A member of staff has the key responsibility for organising activities in the home and planned activities are displayed on the notice boards. There was a range of visits to outside and in-house entertainments, including pantomimes, carol singing and social events in the run up to Christmas. Several times a year outside entertainers come into the home, including displays of Old Time Dancing and musicals. Earlier in the year the home had a falconry display and summer garden party. The home has appointed 2 people who they call concierges. Their role is described as providing transport and accompanying individuals or groups to places of interest, or medical and hospital appointments. The home does make an additional charge for the Care Homes for Older People Page 16 of 33 Evidence: concierge service but aims to minimise this by sharing costs amongst residents who want to go in groups. Several of the survey responses we had particularly mentioned the benefits that people found from having this new service - 2 people, for example, enjoy being able to go to support their local football team at matches. Others like to to out on longer trips to visit local places of interest, attend community events, or revisit the places where they grew up or worked. Other survey responses to our question about whether the activities organised by the home suited individuals needs were mixed, with some comments indicating that more needed to be done for those people who are not able to go out, or who do not want to join in group activities. One resident survey comment requests more outings further afield. Two staff surveys suggested a need for more staff - provide additional staff at certain times of the day for additional activities, due to the broad spectrum of service users, as those who are unable to, prefer not to or refuse to join in with group activities. This would enable more one to one which could benefit the service users being stimulated more. And employ more staff per shift so that the carer has time to attend fully to each service users needs e.g. sometimes a chat, look at photos, write a letter. More activities could be arranged for those not going out. One person complained to the inspector at the end of the day that they were bored and there is nothing to do. This person has had numerous activities offered to them, and the support of the project worker at the home to take up some voluntary work with a local animal charity. The individuals comments were discussed with the home manager and Mr Watts, the home owner, at the end of the inspection. From conversation with individual residents we consider that the home does work hard to discover what sorts of actives and hobbies people would like to try and to provide the means and contacts for these to take place. The weekly activities are displayed on notice boards in the home, recorded in a diary and then a nominated care worker updates the individual service users care plan to show their involvement and enjoyment (or otherwise) of the specific activity. The homes AQAA states that they feel the social and recreational aspects of life of residents has improved in the past 12 months with the development of the role of the concierges because it has resulted in better identification of the wishes of individuals and fulfillment of these to provide a better quality of life for people living here. It has also started to improve the links with schools and other community groups. Of the 9 residents who answered our survey question about meals in the home, 4 answered that they always like the meals, 3 usually, 1 sometimes and 1 dont Care Homes for Older People Page 17 of 33 Evidence: know. One person said that the vegetarian meal options are limited; this was discussed with the person during the inspection. It was evident from the choices that the home has offered that the home is still working hard to try to meet the persons individual likes and dislikes. The home has a four weekly rotational menu plan that is developed in consultation with residents and feedback and comments made by residents to the cook and staff. The AQAA tells us that they have also introduced a monthly Saturday Chinese, Indian, Italian or Pizza evening. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents, relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. There are satisfactory procedures in place to protect residents from abuse. Evidence: Since our last inspection the home has taken action to improve the way it tells people who live here, and their families or representatives, how they can make a complaint should they need to. They have re-written the information about the home and the procedure and paperwork they use to record any concerns or complaints. They have done this in a way that will help the manager and staff to show people how they have followed up any concerns, and to show that they have been thoroughly investigated and satisfactorily resolved. The home has also produced a CD explaining their approach to complaints for those with visual problems. We consider that the home has acted on our recommendations and that people feel confident about raising any concerns or complaints and that these will be followed up and resolved. Residents are all given a copy of the homes Service Users Guide that contains a brief reference to the complaints procedure that is available from the office. Eight of the 9 residents who completed one of our surveys stated that they know who to speak to informally if they are not happy and know how to make a formal complaint. Care Homes for Older People Page 19 of 33 Evidence: The homes AQAA tells us that all staff have training in the Safeguarding of Vulnerable Adults (SoVA) and know how to recognise potential signs of abuse and to report them to the appropriate social services agency. The staff training record shows that most staff had training about safeguarding issues in November 2009. The work of the concierges with individual residents, an open and accessible management approach and regular meetings with residents and their families and representatives, mean that any grumbles or concerns raised by residents are acted upon promptly. The home has a whistle blowing policy and procedure. The manager described the actions taken when she recently had to investigate incidents involving 2 staff members, one of whom was bullying a colleague. This matter was dealt with promptly and effectively, so that staff working here can be confident that any concerns about poor care or unprofessional behaviour are investigated and dealt with robustly. The commission has been made aware of one instance where social services carried out an investigation at the home through their safeguarding procedure, but were satisfied that concerns were unfounded. There have been no formal complaints about the home that we have been made aware of in the past 12 months. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the decor and facilities since our last inspection, and this has benefited residents, especially in the communal areas of the home. More work is needed to ensure that the dignity and privacy of residents in shared rooms, and those who do not have en-suite facilities is promoted and protected. The lack of attention to detail in some aspects of the housekeeping and maintenance detracts from the homeliness and appearance of some of the older rooms in the house. Evidence: This home is not purpose-built and has been adapted from its original use as a family house over many years and over time has extended to include a neighbouring bungalow and most recently, a two storey house . The home owner plans to build a new care home on the land he owns nearby. Some progress has been made in the planning application process since our last inspection and it is now hoped that the new build will start in 2010. Further improvements have been made to the building since our last visit. Notably, the main residents lounge has been extended and decorated with colours chosen by residents. This has improved the lounge by widening it, improving the lighting, and creating a separate area for those who want to take part in music activities or sit comfortably away from the television. Care Homes for Older People Page 21 of 33 Evidence: Two more bedrooms have been fitted with en-suite toilets and hand basins. The reception area has been completed with the provision of easy chairs and a reception desk, and information about the home and services. The heating and hot water systems have been upgraded to make them more efficient and reliable. On the day of the inspection a plumber was servicing the system and ensuring that radiator controls in the communal areas can be accessed to adjust heating levels. The home has employed a maintenance man to help identify and repair any on-going problems in the home. As we noted at our last inspection, the standard of decor and furnishing was noted to be variable in residents rooms. Whilst some rooms were highly personalised and homely, others were rather institutional and bare in appearance. There was a marked contrast between the rooms in the most recently registered part of the home and the original rooms. The manager commented that she would like to achieve the standard of environment in the newer rooms throughout the home. We noticed that there are no lamp shades fitted in peoples rooms and this detracts from a homely and domestic appearance. The home uses energy efficient bulbs and it is not clear whether the provider considers the lower light output from the bulbs would be further reduced if lampshades are added. We recommend that suitable shades are supplied to meet the expected standard of domestic furnishing and fittings, and that allow a good standard of brightness for residents in their rooms. A tour of the building showed that the standard of cleanliness is good overall. Seven out of 9 residents survey answers indicated that the home is always fresh and clean (one person stated this is usually the case and another that they dont know). Where a few rooms were untidy, cluttered or did not smell fresh, the manager explained this was because residents personal preferences about their living space is respected. Staff do work with residents to agree housekeeping and personal hygiene goals if these begin to have a negative effect on the wellbeing of the individual resident or other people living here. We did note some shortfalls in cleaning and maintenance, for example, plug outlets and taps that were clogged and had scale build up, that affect the efficient water flow and drainage at some hand basins. As before, we noted that there are no small cupboards fitted in rooms, so that peoples toiletries are stored on window sills, furniture, or pipe covers. This adds to clutter and is potentially hazardous - for example, where denture cleaning tablets are easily accessible and could be chewed or swallowed accidentally by a confused resident. Care Homes for Older People Page 22 of 33 Evidence: It was also noted that in shared rooms, peoples personal space is only separated by a curtain screen. Metal framed commodes are in view. In some rooms, notices were pinned to the wall, giving instructions about washing, continence products or use of creams to inform staff about residents care. These indicate a lack of sensitivity and awareness of peoples privacy and dignity. Instructions about specific care should be in residents care plans and more discreetly stored. The home should consider replacing the commodes with a type that looks, and can be used as, a chair. These observations were discussed with the manager and Mr Watts, the registered provider, during the inspection. The home has introduced a room audit or tick list to ensure that staff check and mark off cleaning tasks when completed. Some of the check lists were not up to date because of recent staff shortages. There was just one cleaner on duty during the day of the inspection who was working hard to complete the schedule of cleaning in residents rooms. The laundry equipment has been replaced and is now of a standard that meets the laundering needs for residents. The proprietor tells us that they are looking to improve the hand washing facilities for staff in this small laundry room. We discussed with the registered provider, Mr Harry Watts, the timescales for the proposed new building. We recognise that there is a balance to be found in the amount of investment in new equipment and furnishings and other improvements that are still needed in the existing home, and the commitment and investment in providing a new purpose-built home which will meet current standards for residents in the future. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels adequately meet the diverse needs of the people living here, and since our last inspection adjustments have been made to ensure that there are extra staff available at busy times of the day. The home recognises the need for improving and extending the training opportunities for all staff and is working to develop more links with external training organisations, so that residents will benefit from having appropriately skilled care staff. The home has improved the systems in place for the recruitment and screening of new staff so that residents are protected from harm Evidence: The home shares a common recruitment and employment process with its partner home, the Robert and Doris Watts. There are a few care staff that work between the homes as and when required and the housekeeping manager also works at both homes to co-ordinate the housekeeping service and domestic staff. The manager confirmed that there is always a senior care staff (key worker) on duty together with three care staff from 7 am until 2 pm; 1 senior and 2 carers from 2 pm until 9 pm and a senior and one care staff member at night (from 9 pm to 7 am). Since our last inspection, the home has implemented a new rota system for staff and has added another member of staff to work on the morning shifts. This has benefited residents and the way in which care is delivered. The homes AQAA tells that they are looking to provide an additional member of staff at night. We recommended this Care Homes for Older People Page 24 of 33 Evidence: following our last inspection, because at that time the dependency of the residents, and the spread of the building meant that it was difficult for 2 staff to attend to the needs of more dependent people. This year the home has fewer residents requiring the assistance of 2 staff during the day and night. The manager is available during weekdays in addition to the staff providing direct care to residents. Mr Anthony Watts, operational director and his father Mr Harry Watts, registered provider, are also readily available to discuss any queries or concerns with residents or their visitors. Of the 9 residents surveys we received, 4 people stated that there are always staff available to them when needed; 3 said this was usually the case, and 2 answered dont know. Additional comments made by residents in writing and made on the day of the inspection were complimentary about the staff and the care they receive. One person said that certain members of staff have communication problems. The two staff members who completed our survey gave mixed responses about the information they receive in order to give the appropriate care and support to residents - both stated that they usually find that the way information about residents care needs is shared is satisfactory. One person felt that the information was only sometimes up to date. One person felt that there are always enough staff to meet peoples needs and the other that this is usually the case. As noted earlier in this report, the staff responses also suggested that there should be more staff on duty to allow more time with individual residents to meet their social and recreational needs. One person said that the home should give new employees a chance to watch, chat, read case notes, before being left alone. Pay better, look after staff to reduce turnover, therefore the home would be more settled and happier. One staff member felt the home was good at providing training for staff, but the other person indicated that their induction training and ongoing training was not entirely satisfactory. The responses to questions about the opportunities given to staff to meet with the manager for support and discussion about their work also varied between often and sometimes. The homes AQAA, completed on 01.10.2009 indicated that 3 out of 11 staff had left the home in the previous 12 months. The manager also told the inspector that a further 3 overseas staff had left their employment without notice on 31.10.09 allegedly because they had concerns with the agency that had recruited and supplied them. The commission had not been informed about this event and the manager was reminded that the commission must be notified of any event or incident that could adversely affect the care of residents (Regulation 37 of the Care Homes Regulations Care Homes for Older People Page 25 of 33 Evidence: 2001). The recruitment and employment records for three staff appointed since the last inspection were reviewed to assess the quality of the vetting and screening process to ensure that the home carries out the required checks on prospective employees for the protection of residents. All of the 3 records selected were satisfactory, with the required documentation to show applicants identity, work experience and suitability to work with vulnerable people had been undertaken. Satisfactory Criminal Record Bureau (CRB) checks and references had been sought before these individuals started work at the home. The home has improved the documentation in staff files, so it is able to demonstrate that they have a systematic and more robust approach to recruitment, selection, induction and training of new employees than was the case last year. The manager has been working hard to set up training for staff with a number of external training organisations, including some distance learning packages. She has also worked with a Care Advice Service, and Skills for Care organisation to draw up a skills analysis programme. This has helped develop an individualised development and training plan for each staff member. The home is committed to improving the training available to staff in order to provide the best standard of care and support to people living here, who have a wide range of needs. the manager has identified that further training for staff is needed in some of the more specialised areas of care, such as caring for people living with dementia, and in relation to promoting and protecting peoples rights under the terms of the Mental Capacity Act. There is now a dedicated training room. The manager has also created new systems to record staff supervision and appraisals, and for the guidance of key workers. She told us that staff have formal supervision meetings every 2 months. There are general staff meetings held every 2 to 3 months and the minutes from these meetings are recorded and circulated. The manager confirmed that 3 of the 11 permanent care staff employed have achieved National Vocational Qualification (NVQ) at Level 2 or above, and a further 2 carers are working towards this. One carer is working towards Level 3. The proportion of carers who have NVQ Level 2 is still considerably below the 50 per cent expected by us to have this qualification. However, the development in the training opportunities and efforts of the manager indicate that the proportion of staff who will attain a formal qualification in care is on track to increase. Care Homes for Older People Page 26 of 33 Evidence: Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed effectively by a suitably experienced and qualified registered manager. The staff and provider do encourage and support the people who live and use the service to voice their opinion of the services provided. Since our last inspection the home has improved the arrangements for monitoring risks and health and safety issues in the environment to protect residents and staff from harm. Evidence: The home manager Mrs Anna Jakes has been at the home now for a year and has successfully completed the process to become registered with the commission. She has the Registered Manager Award and National Vocational Qualification at Level 3 and is a qualified Risk Assessor showing that she has the necessary qualifications for her role. Feedback from comments in our surveys indicate that Mrs Jakes continues to have a positive effect on the management and running of the home for the benefit of the people living here. From the written and verbal comments we received, and Care Homes for Older People Page 28 of 33 Evidence: observations and discussion with staff on the day of the inspection visit we consider that the home is well managed and organised. As noted earlier in this report, the home manager and operations manager have worked well together to improve the written procedures and policies for the home. They have introduced audit systems to monitor the quality of the service and the standard of care provided by the staff. The home had recently had a contract monitoring inspection undertaken by social services and this was made available to us. The findings of the report also support our view that the homes managers are open to suggestions and take action to improve the service for residents. The home admits people with a wide range of care and support needs and do seek the views of residents about the service and facilities. They tell us that the people they have appointed as project managers and concierges also act as internal advocates to enable staff to focus on the individual needs and aspirations of residents. The home emphasises the informal and easy access to managers, so that people feel comfortable to share their opinions and suggestions on a daily basis. There are quarterly forum meetings with residents to seek their views and opinions. Minutes of these meetings are made available publicly. Quality assurance questionnaires are sent to all residents, family and advocates and professionals every year to check peoples views about the quality of the service. The home intends to further improve their quality assurance programme by amending the format and the response time to get more accurate feedback from relatives, advocates and professionals. The registered individual Mr Watts completes monthly unannounced visit reports as required under Regulation 26 of the Care Homes Regulations 2001. This is another opportunity for residents, staff and visitors to provide feedback about the service. The home handles a small number of residents personal spending money where the resident is no longer able or wishes to manage their own allowances. Most residents have relatives or advocates to act on their behalf. The home records show that they can account for the balances held on behalf of residents and that there is a clear audit trail of expenditure and receipts for monies spent on residents behalf. Mandatory training for staff includes fire safety awareness, moving and handling, first aid, Infection control, pressure area care, falls safety, and adult safeguarding. The training matrix seen did not show that staff have attended mandatory training in Care Homes for Older People Page 29 of 33 Evidence: health and safety or food hygiene in 2009. The manager should ensure that all staff have training in these topics also. Though the internal audit paperwork is in place for checks to be made on the maintenance and housekeeping aspects of the service, we found that the processes are not consistently followed through in practice, according to the records seen and observations of unfinished repairs that we mention in the environment section of this report. We found that there were no window opening restrictors fitted to some first floor room windows. All casement windows above ground floor level should have limiters fitted to prevent the windows being opened too widely and the possibility of accidental falls. This was pointed out to the manager and operations manager, who took prompt action to have suitable fasteners fitted before the end of the inspection. We consider that more work is needed to monitor and ensure that all staff are adhering to the standards set and that any maintenance and repairs are reported and addressed more speedily. The home has acknowledged this as an area for improvement in its AQAA. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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