Care Home: Watford House

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What the care home does well There are systems in place to assess prospective service users and allow them to visit the home before being admitted to ensure they are happy to move in. There are dedicated staff who provide a range of regular activities to residents. The food offered to residents was said to be ‘good’, a choice of meals was always offered and the dining rooms were attractively presented.Watford HouseDS0000064910.V377447.R01.S.docVersion 5.2 What has improved since the last inspection? A new manager has been appointed who has applied to be registered with the CQC, this process is near completion. The Manager has a suitable managerial qualification. Residents are benefiting from an upgrading of the environment which includes redecoration, new furniture and carpets in communal areas and some bedrooms. New signage to aid residents with dementia has also been ordered and fixed to aid residents find their way around the home. In each residents file a personal evacuation plan had been developed to ensure staff had information on the residents needs should a fire occur. What the care home could do better: The care plans in place were very brief, did not describe fully what care the residents required and did not consider the abilities or preferences of the residents. Some medication which had been signed for was partially found in the monitored dosage pack which meant the resident had not received all of their prescribed medicines. Recruitment procedures were not robustly being followed and staff had commenced in post without Criminal Records Bureau or Pova First checks being in place. This was also an unmet requirement from our last visit. After our visit we have written a serious concerns letter to the Provider regarding this asking them to tell us how this is being addressed. The home is not using a skill based induction pack which would ensure staff have access to information and learn the skills required to meet resident’s needs The systems for ensuring the five year periodic electrical check is completed on time are not in place as this was out of date. There are unmet requirements relating to individual risk assessments being in place for radiators and checks to ensure window restrictors are in place and effectively limiting opening to a suitable distance. After our visit we have written a serious concerns letter to the Provider regarding this asking them to tell us how this is being addressed. Key inspection report CARE HOMES FOR OLDER PEOPLE Watford House Watford Road New Mills High Peak Derbyshire SK22 4EJ Lead Inspector Bridgette Hill Key Unannounced Inspection 9th September 2009 10:10 DS0000064910.V377447.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 2 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 Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Watford House Address Watford Road New Mills High Peak Derbyshire SK22 4EJ 01663 742052 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) watford.house@btconnect.com JTV Care Homes Limited Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (40) of places Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following categories of service only:Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE(E) - Maximum 10 The maximum number of service users who can be accommodated is 40. 10th September 2008 2. Date of last inspection Brief Description of the Service: Watford House is an extended Victorian building situated on the outskirts of New Mills where a wide range of facilities are available. The home provides accommodation for 40 service users. The home is registered for older persons including up to 10 service users with dementia. Accommodation is provided on two floors, which can be accessed by a shaft lift. 34 of the bedroom are single; the home has 3 double rooms. 29 single and the 3 double rooms have en-suite facilities. A range of communal sitting and dining rooms are available to service users. The home is served by a commercial type kitchen and laundry. A garden area is provided at the front of the building where service users may sit out in clement weather. Support services are provided locally with choice of G.P. Other support services are provided on request. The fees charged by the home range from £410.00 - £450.00. Items not covered in this fee include dry cleaning, hairdressing, chiropody, newspapers and toiletries. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means the people who use the service receive adequate quality outcomes. The inspection visit was an unannounced one and additionally time was spent in preparation for the visit, looking at previous reports and other relevant documents and preparing a plan for the inspection. As part of the inspection a sample of residents care files and a range of documents were examined. This process is called ‘case tracking’ where we examine in detail a sample of residents to assess how care is documented and delivered to residents. The communal areas were viewed along with some bedrooms, bathrooms and the laundry area The Annual Quality Assurance Assessment which the home completes was considered as part of this inspection. Surveys were sent out prior to the visit to residents and staff and where these were returned to us the information received has been included in this report. For most of the surveys staff had assisted service users to complete them. Few comments were included on the surveys however a general level of satisfaction about the service was expressed. There were people living at the home on the day of the inspection with all residents being assessed as having personal care needs. During our visit we spoke to some of the residents in the home and observed part of the lunchtime meal. Information sent since the last inspection told us that any incidents that have to be reported to us such as events that affect the well being of residents appear to have been sent. The Manager Helen Hague on duty during the visit. The Responsible Individual Jason Sykes also arrived later during the day. What the service does well: There are systems in place to assess prospective service users and allow them to visit the home before being admitted to ensure they are happy to move in. There are dedicated staff who provide a range of regular activities to residents. The food offered to residents was said to be ‘good’, a choice of meals was always offered and the dining rooms were attractively presented. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Watford House DS0000064910.V377447.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are arrangements in place prior to admission to ensure that resident’s needs are assessed and the home has information to ensure residents needs will be met EVIDENCE: Since our last visit the main entrance to the home has been changed and now the main front door to the property. Disabled access to the home remains via the side entrance. A gate operated by staff is in place to provide a secure environment for residents. In the entrance hall there was a range of information available this included the last inspection report and a combined Statement of Purpose/Service User Guide. The Statement of Purpose had been updated as part of the registration Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 9 application for the Manager however details of how residents could contact the Provider/Responsible Individual were not included. The manager told us the Statement of Purpose could also be made available as a large print version to aid residents access to it. We discussed the admission procedures with the manager during our visit and were informed that each new resident would be assessed either in their present location or at the home during a visit. We looked at the file of a recently admitted resident in the home. The resident had visited the home with a relative and spent a day there. The assessment information was recorded on a form designed for the purpose and had been completed using information from medical letters and relatives. We spoke to one resident about how they chose the home. They told us that their relative had viewed a number of homes but had liked this one the best. The resident told us that they were happy with the choice made for them A range of information was made available to residents and visitors on various notice boards. The home does not offer intermediate care as defined by the National minimum Standards. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were limited in content giving only an overview of the residents needs which may lead to inconsistencies in the care being delivered. EVIDENCE: Since our last inspection a new care plan format and range of risk assessments have been introduced. We examined two care plans of residents with different needs and of different lengths of stay at the home to assess how needs were being documented. All of the care plans we viewed were brief in content. They generally identified where there was an area of need for example incontinence but did not describe what assistance was to be delivered by staff. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 11 Deficits in the care plans had also been identified on the Providers monthly quality monitoring visits. A range of up to date risk assessments were in each residents file. This included moving and handling plans which described the techniques used and the number of staff required to assist the resident. A system for ensuring care plans were reviewed was in place although this did not extend to all of the risk assessments although some were reviewed monthly. Staff completed daily notes on each resident to describe how they had been and how they had spent their day. There were records in care files where it had been necessary to contact GP’s and some health care needs such as dressing were done by District Nurses. Separate files were kept to record the visits made to residents by the visiting chiropodist and optician. Many of the residents we observed were wearing glasses and hearing aids to aid their vision and communication We looked at how medications were stored and handled at this visit. The storage arrangements were found to be suitable however security of medications was compromised by unattended keys being in the vicinity of the cupboards, this was rectified during our visit. The senior staff who undertook all of the medication rounds had all received medications training. The medication administration records indicated that all were appropriately signed. However one of the monitored dosage packs we looked at contained part of one dose which had been signed for as given. The records indicated recording of medicines received and we were told that returns were documented although the book was at the supplying pharmacist during our visit so was being used. Controlled drug storage and administration was acceptable and topical preparations with a short expiry date were dated on opening and replaced at each monthly ordering cycle. Residents told us that their privacy was respected by staff knocking on their bedroom doors before they entered. All residents we observed were clean and well dressed. One survey completed by a relative told they felt the resident was cared for ‘very well indeed’. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15 People using the 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 benefit from a range of activities that are offered and have opportunities to go out of the home. EVIDENCE: The home employs an activities coordinator who works 9.30 – 2.30 on weekdays to provide activities to residents. Some completed craftwork was on display in the home which residents had done. The range of activities in the home include movement to music, trips out to local pubs for lunches, and external entertainers. Some clothing parties were also held to enable residents to choose their own clothing. A Summer Fayre had been held where residents had made bunting/decorations and helped on stalls, a further event to celebrate Bonfire night was being planned. One resident told us they liked to go a walk out of the home each day. Some residents attended a local club on a weekly basis. A monthly church service Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 13 was held at the home and some of the care records we viewed described in residents were interested in this. The care files we looked at contained social care plans and detailed the resident’s preferences. In files where residents had been in the home some life story booklets had been given to relatives to complete to find out more about the resident social histories. The home received a number of visitors during our inspection and the ones we spoke with said they were pleased and highly satisfied with the care given to their relatives. Most relatives took time to pop in to see the Manager for a chat demonstrating that the open door approach offered by the Manager is being used. One resident told us that relatives are made welcome and after going out with their relative they returned to find a teatime meal laid out for their family. All residents we spoke with said the food at the home was ‘good’, ‘very nice’ and they were ‘always satisfied’, a choice of meal was cooked and offered to residents at every mealtime. Two sittings are served and the dining was attractively presented with table cloths and flowers on the table. We observed part of the lunch time meal and saw plate guards being used to help residents eat independently. A choice of drinks was offered with the meal. Additional staff are employed to specifically work in the dining room at breakfast; this ensures residents do not have to wait for staff to tending to other residents before breakfast is served. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for handling complaints and allegations are in place however a lack of staff training may adversely affect the reporting or management of events that affect the welfare of residents. EVIDENCE: The complaints procedure was on display on the wall in a corridor and formed part of the Service User Guide. There were different versions of the complaints policy seen in each location and some review of it was required to update the address of the care Quality Commission (CQC). The home has not received any complaints directly however the CQC has received 3 complaints, 2 similar in content. We referred the complaints to the Provider for investigation under their complaints procedures. The investigations progressed promptly and responses were sent us on time. Due consideration was given to the concerns raised and the investigations were considered robust. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 15 The surveys we received from residents told us that residents knew who they could talk to at the home to raise concerns but were not clear on the formal complaints procedure and how to access this. Residents we spoke to during our visit told us they felt able to speak to any of the staff if they had complaints. There was a Safeguarding Adults policy in place which referred to the locally agreed Social Services procedures. A whistle blowing policy was also in place for staff, this was not explicit however in describing to staff that they can raise concerns with appropriate agencies outside of the home if they do not feel able to speak to anyone in the home. The staff training files we looked at indicated that of the 21 care staff 5 staff had not completed any safeguarding adult training, some training dates for this were booked. The Annual Quality Assurance Assessment told us there had not been any safeguarding adult concerns since our last visit. The Manager told us that since this was completed one concern had been referred to Social Services safeguarding adult procedures, this concerned the care a resident received at a home prior to moving to Watford House. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Investment into refurbishing parts of the home is benefiting the residents who live there. EVIDENCE: The home is set within beautiful grounds with stunning views over neighbouring countryside. The residents we spoke with told they enjoyed the gardens of the home, which were well tended, and loved the views. The home does have some double rooms although all rooms at the time of our visit were being used for single occupancy. Some rooms have en suite bathrooms with toilets. Some new bedroom furniture was seen in bedrooms, some with rounded edges to prevent accidental injuries should falls/trips occur. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 17 Residents said their rooms were kept clean, one resident told us their room was like a ‘little flat’. A sample of rooms we viewed was found to have the resident’s personal belongings in. One room we viewed did have an unpleasant odour and a duvet in another room was soiled and staff were asked by the manager to change this immediately, the standard of cleanliness apart from this was considered satisfactory. Since our last visit here has been a range of improvements made with further one planned. This includes new lounge carpets and furniture. A new large screen television was in the lounge which would make it easier for residents with visual impairment to enjoy this. The dining room had been refurbished with new chairs were in place, some with sliders and tables were on order. The flooring had also been replaced. Redecoration of corridors has been done and new carpets fitted. The doors of resident’s rooms have been painted different colours to make corridors more interesting and each residents room more identifiable. A range of new signs have been introduced around the home to aid residents with dementia to find their way around. We examined how the records to establish how fire safety was being managed. In each residents file a personal evacuation plan was in place to be followed should a fire occur. The fire records indicated that regular checks were made and servicing was in date. The Manager told us the fire risk assessment was currently being reviewed. The laundry area was clean and tidy with hanging space for clothing. There was one washer and one dryer which we were told were reliable with a service contract in place to deal quickly with any breakdowns. The clothing residents were wearing clean clothing which appeared to be well cared for. Residents we spoke said they were happy with the laundry service. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Poor recruitment practice and gaps in staff training do not ensure that residents needs will be met by suitably recruited and trained staff. EVIDENCE: The home had 35 residents during our visit. There has been a 4 weekly rolling staff rota developed since our last visit and a regular number of staff was scheduled on this. The typical levels on duty was one senior staff member and 5 care staff for morning shifts and one Senior staff member and 3 carer each afternoon. At night there was 3 care staff on duty. The home has additional staff for the kitchen, domestic staff, a handyman and administrative staff in the office. During our visit we examined three staff files to assess how recruitment procedures were implemented. One file did have all the required checks in place prior to the staff member commencing work. For two of the files the dates of checks indicated that both staff members had commenced and induction day and four shifts prior to the date of the Pova First check being returned. At the time of our visit the Manager was also still unaware if the Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 19 checks had been returned and had checked these. It is an outstanding requirement from our last that recruitment checks must be in place prior to staff commencing work. After our visit we have written a serious concerns letter to the Provider regarding the ongoing poor recruitment practice at the home. The home has 21 care staff of whom 12 have achieved NVQ level 2. Some staff have exceeded this and completed their NVQ level 3 in care; this included all the senior staff. We examined the training records for staff at the home. The Manager told us they were aware of some gaps particularly in moving and handling. We found that of the 21 staff 8 had no in date moving and handling certificates. The Manager told us they were going on a course the following week to enable them to train staff in safe moving and handling. Other gaps evident in the training planner were for food safety training and this included some staff working regularly with food. The Annual Quality Assurance Assessment indicated that a skill based induction pack was in place but discussions during our visit confirmed that only a checklist was being used. We asked if the General Social Care Council Code of Conduct was made available to staff and was told it wasn’t available in the home. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Inconsistency in management and practice may lead to the home not being run in the best interests of residents. EVIDENCE: Since our last inspection a new manager has been appointed and the CQC registration process is near to completion. The Manager of the home has already achieved their Registered Managers Award and is planning to do further training to enable them to train staff in moving and handling. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 21 One of the surveys completed by a relative considered that the Manager welcomed direct discussions and was highly approachable and helpful. Since our last inspection we received an improvement plan which informed us how the previous requirements were going to be addressed. At this visit there has been a change of management and the improvement plan has not been completed as it was described. Therefore there are unmet requirements and additionally gaps in staff training which may directly impact on residents. The Provider has contracted out responsibility to a consultancy agency for the monthly visits to monitor quality at the home. These had been completed regularly each month and highlighted areas where work was required to ensure standards were being met. Some of the findings echoed ours as these too identified that care plans were not sufficiently detailed. An external agency also conducts a quality assurance assessment of the home each year and produces a report which is available at the home. Alongside this quality assurance surveys are completed on a six monthly basis. The last surveys completed in July 2009 indicated that residents/relatives regarded care at the home as being good/very good. The manager told us that one residents meeting had been held at the home since they started but the minutes could not be located. One survey from a relative indicated that this was generally poorly attended. No staff meetings were formally being held at the home however the manager told us they were going to be arranging these. Accidents that occurred in the home were audited by the Provider on a monthly basis to try to identify particular times or trends. The Manager told us that no monies are stored safely on the resident’s behalf however a system of invoicing residents on a monthly basis was in place to cover the costs of services received such as hairdressing and chiropody. A check of servicing records indicated that the majority were in date, the exception to this was the periodic check of the electrical circuitry. No records could be located in the home for this and last date recorded on the previous Annual Quality Assurance Assessment was March 2004 which would make the service check out of date. We discussed with the Manager the previous requirement relating to the checking of window restrictors and the individualised risk assessments for uncovered radiators. It was confirmed by the Manager that these had not been addressed. This may have a direct impact on residents as we viewed a room with a pressure mat to alert staff if the resident got out of bed as they tended to during the night, near to this was an unguarded radiator which could potentially cause burns or injuries if the resident fell against it. Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 22 Watford House DS0000064910.V377447.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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x N/A x x 2 Watford House DS0000064910.V377447.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 OP7 Regulation 15 Requirement Care plans must be sufficiently detailed to ensure that staff know how to deliver care to residents. This will ensure residents receive the care they are assessed as needing. Medications must be stored securely at all times. This will ensure that medicines are not stolen or tampered with. Medications must be given to residents as they are prescribed by the GP This will ensure residents receive their prescribed treatments. All staff must receive training in the safeguarding of adults This will ensure staff have suitable knowledge to enable them to identify and report any concerns. Staff must not be confirmed in post unless all the required recruitment checks as described DS0000064910.V377447.R01.S.doc Timescale for action 30/10/09 2 OP9 13 30/09/09 3 OP9 13 30/09/09 4 OP18 18 30/11/09 5 OP29 19 30/09/09 Watford House Version 5.2 Page 25 by Schedule 2 are completed This will ensure staff are suitably recruited to work with vulnerable adults. This is an unmet requirement from our last visit, We have sent a serious concerns letter to the Provider regarding this following our visit 6 OP38 13(4) There must be a review completed and ongoing checks made of the window restrictors to ensure they restrict opening to agreed limits and are in good working order This will ensure the risk of falls from heights is suitably managed and limited. An extended timescale has been given for the Manager in post to meet this requirement This is an unmet requirement from our last visit, We have sent a serious concerns letter to the Provider regarding this following our visit 7 OP38 23 The electrical circuitry of the home must be checked by a person/s who are suitably trained and competent This will ensure the home is safe for staff and residents. A robust and individualised approach to risk assessing radiators must be in place to ensure residents are not placed at risk of burns This will ensure there is robust identification and management Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 26 30/10/09 30/11/09 8 OP38 13(4) 30/10/09 of risk to protect residents from harm This is an unmet requirement from our last visit, We have sent a serious concerns letter to the Provider regarding this following our visit RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP30 OP33 Good Practice Recommendations The Statement of Purpose and Service User Guide should include details of how to contact the Provider/Responsible Individual Staff should be given copies of the General Social Care Council Code of Conduct Staff meetings should be held to ensure there is communication with and feedback from staff Watford House DS0000064910.V377447.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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). 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