We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

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1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Watford House Residential Home 263 Birmingham Road, Shenstone Wood End, Lichfield, WS14 0PD Tel: Date of Inspection: 06 March 2014 Date of Publication: April 2014 We inspected the following standards to check that action had been taken to meet them. This is what we found: Care and welfare of people who use services Meeting nutritional needs Cleanliness and infection control Staffing Records Inspection Report Watford House Residential Home April

2 Details about this location Registered Provider Registered Manager Overview of the service Type of service Regulated activity Watford House Care Home Limited Mrs. Charlotte Emma Bristow Watford House is registered to provide accommodation and personal care for up to 43 people. Care home service without nursing Accommodation for persons who require nursing or personal care Inspection Report Watford House Residential Home April

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 5 Our judgements for each standard inspected: Care and welfare of people who use services 6 Meeting nutritional needs 8 Cleanliness and infection control 9 Staffing 10 Records 12 About CQC Inspections 14 How we define our judgements 15 Glossary of terms we use in this report 17 Contact us 19 Inspection Report Watford House Residential Home April

4 Summary of this inspection Why we carried out this inspection We carried out this inspection to check whether Watford House Residential Home had taken action to meet the following essential standards: Care and welfare of people who use services Meeting nutritional needs Cleanliness and infection control Staffing Records This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 6 March 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and talked with commissioners of services. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. What people told us and what we found When we completed our last inspection of this service in September 2013 we found that the service was not compliant with all the regulations. We identified concerns with the care people received, the management of mealtimes, the cleanliness of the home, staffing levels and record keeping. We carried out this inspection to check the progress the home had made to address these concerns. People we spoke with were happy with the care they received. One person told us: "I am very happy with the care. I haven't been well and staff made sure they called the doctor. I am having some treatment". People were well supported when having their care needs met. We saw changes had been made at mealtimes to ensure that people were supported and encouraged to eat a nutritious diet. A decision had been made to remove the birds from the home. This decision was made because there was no one available to ensure the birds and their cages were kept clean at all times to prevent the risk of cross infection at the home. Staffing levels had improved since our last inspection and staff made aware of the availability of bank staff when needed. We found that the manager had added additional tasks to be undertaken by staff at night, which could impact on people not having their Inspection Report Watford House Residential Home April

5 care needs met in a timely manner. The manager planned to monitor this. We saw that improvements had been made to people's care records to ensure that they reflected people's current care needs and the care provided. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Watford House Residential Home April

6 Our judgements for each standard inspected Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Reasons for our judgement When we completed our last inspection we identified that people did not always receive care that met their needs. We judged this to have a moderate impact on the people that lived at the home. At this inspection we found that improvements had been made. We spent time in each of the different units at the home known as Grange and Watford. We spoke with people about the care they received, spoke with two relatives and five staff. We spent time observing in the lounges of the two units. This enabled us to see how people's needs were being met. We saw that people were spoken to kindly by the care staff. We observed that the care staff were patient with people in their care. We saw smiles from the people who lived at the home in response to staff conversation with them. We saw that people engaged in conversation with each other. We spoke with two relatives. They told us that they were happy with the care their relative received. They told us that the staff kept them informed and up to date with their relatives' wellbeing. At our last inspection we found that people with skin damage, for example pressure sore did not have a care plan for skin care. We found at this inspection that improvements had been made. We examined two care files and found that both contained care plans that showed what skin care should be provided. We saw that information received from health professionals was included in people's care files. This meant that there was guidance for care staff on the action they should take to meet people's skin care needs. We saw at our last inspection that where there were concerns about people's weight that action had not been taken to manage significant weight loss. At this inspection we saw that people's weight were being monitored. Care records we looked at showed that significant weight loss was appropriately managed. We saw that foods people had to eat and drink was monitored. This meant that appropriate action was taken to identify and manage people's potential health problems. At the time of our last inspection there were two couples living at the home. Both couples Inspection Report Watford House Residential Home April

7 were supported to maintain their relationship. We noted that staff referred to each person's husband or wife when engaging in conversation with them. This meant that people were supported to have their individual needs met and live as a couple in the way they wanted to. We found that personal emergency evacuation plans had been updated where needed. This ensured that the level of support each person required in the event of an emergency would reflect their current care needs. This meant that the service had plans in place to deal with unforeseen emergencies safely. Inspection Report Watford House Residential Home April

8 Meeting nutritional needs Food and drink should meet people's individual dietary needs Our judgement The provider was meeting this standard. People were protected from the risks of inadequate nutrition and dehydration. Reasons for our judgement At our last inspection we observed that people were not offered flexible mealtimes to meet their needs and that there was a lack of staff to support people to eat their meals. At this inspection we found that improvements had been made. At this inspection we saw that the support people needed at mealtimes had been reviewed. We saw that each person's nutritional needs had been assessed. A plan of care was in place to support people to eat and drink sufficient amounts. Information recorded included the food people preferred to eat. We saw for example that people with poor appetites had the amount of food they ate and the fluids they drank recorded and monitored. This meant that if there were concerns about people's nutritional intake these would be identified and acted on promptly. People we spoke with said that they were happy with the quality of the food provided. We saw that people were offered a choice at lunch time. We saw that the meals given to people were well presented and looked appetising. We saw that people were reminded about the meal choices on the day. This meant that people were offered a choice of foods they liked to eat and met their nutrition needs. We saw that there were sufficient staff available to support people with eating. Staff supporting people included the manager. We saw that during lunch one of the carers was designated as the nutrition champion. We were told that it was the responsibility of this member of staff to support people with eating their food. We observed that the member of staff did not get involved in any other care tasks at this time. Inspection Report Watford House Residential Home April

9 Cleanliness and infection control People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were protected from the risk of infection because appropriate guidance had been followed. Reasons for our judgement At our last inspection we had concerns about the storage of substances hazardous to health and the cleanliness of some areas of the home. At this inspection we found that improvements had been made. We saw that substances hazardous to health such as detergents and cleaning products had been stored in a secure location in a locked cupboard. We saw that excess stock of these products had been removed from the laundry area. We found at our last inspection that a bird cage which housed two birds was dirty and looked as had if it had not been cleaned for some time. At this inspection the manager told us that the two birds had been removed and re-homed. The manager told us that the decision to remove the birds was taken because there was no one to look after them. We were told that the people living at the homes did not miss the birds. Inspection Report Watford House Residential Home April

10 Staffing There should be enough members of staff to keep people safe and meet their health and welfare needs Our judgement The provider was meeting this standard. There were enough qualified, skilled and experienced staff to meet people's needs. Reasons for our judgement At our last inspection we had received concerns that there was not sufficient staff working at the home. We observed at our inspection in August 2013 that more staff were needed to support people to eat at meal times. We saw that people were left unattended on more than one occasion. On one of these occasions we noted that this was for twenty minutes. The provider sent us an action plan which explained the steps they would take to meet the requirements of the regulations. At this inspection we found that that there were sufficient staff to meet the care needs of the people who lived at the home. At the time of this inspection 29 people were using the service. The manager told us staffing consisted of one senior care staff, five care staff, catering and domestic staff on the day shifts. Staff told us they felt the staffing levels were sufficient for them to meet the needs of people who used the service. The manager told us the staffing levels were based on the dependency needs of the current service users. This meant that there were enough staff to meet the needs of people in a consistent and reliable way. We had not received any further concerns about staffing levels at the home. Visitors to the home told us that they did not have concerns about staffing at the home. One visitor told us: "The carers provide the care my mother needs. I have every confidence that they care for her properly". One person living at the home told us: "They look after me very well, I am very satisfied. They are always there when I need them". During our inspection we spent time in the communal areas observing people during the day. We saw staff were very busy attending to the care needs of people. We did not see or hear anyone waited too long for assistance when it was needed. We saw that most people who used the service used the communal areas during the day. We saw that staff were in regular attendance in the communal areas to ensure they were able to support and help people when it was needed. At this inspection the manager told us that all senior staff had been told about the bank list of staff that could be contacted to fill any gaps in staffing. A copy of this list was kept in the staff room. Staff confirmed this. This meant that staff were informed of the procedures to follow to ensure that there were sufficient staff available to meet the needs of people living at the home. Inspection Report Watford House Residential Home April

11 We saw that the duty rota had been reviewed to clearly show the time allocated to cooking, assisting in the kitchen, cleaning and laundry work where staff had dual roles. However the manager showed us a cleaning log which detailed cleaning jobs for night care staff to undertake during their night shift. There were ten identified cleaning jobs to be carried out each night. These included mopping the lifts, corridors, dining rooms, kitchen, lounges, cleaning all toilets and replacing toilet paper, cleaning the staff room, ironing and laundry. The log indicated that this work was to be completed each night. Staff initialled to state the work had been done and the senior in charge signed to confirm this. This meant that at night people were at risk of not having their care needs consistently met in a timely manner. The manager told us that it was not intended that care staff completed all the cleaning tasks every night, but that care staff would ensure that the areas were clean. The manager should note that the log did not detail this instruction. The night duty rota showed that there were three care staff on duty at night, one senior carer and two carers. The duty rota did not indicate when these tasks should be carried out. The manager told us that staffing had not been increased at night to accommodate these tasks. The manager could not confirm that the care of people at night was not at risk by care staff undertaking these cleaning tasks at night. The manager told us that the people living at the home were always the first priority and the care staff are aware of this. The manager reassured us that she would monitor this practice to ensure that there was not an adverse impact on people's care. Inspection Report Watford House Residential Home April

12 Records People's personal records, including medical records, should be accurate and kept safe and confidential Our judgement The provider was meeting this standard. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. Reasons for our judgement At our last inspection visit to the home we found that care plans needed to be improved so that they were personalised and individualised. We found that the manager had addressed this and taken action to improve the care records. We looked at the care records of four people living at the home. We found that people's care needs had been reviewed to ensure that they had care plans for all their assessed care needs. We saw that assessments had been completed. We saw that the instructions received from health professionals were cross referenced into each person's care record. We found that all of the care records contained sufficient information on peoples care needs. We saw that care plans contained information that told staff what people could do for themselves. We found that information in care records related to people's individual risk assessments had been completed. This meant that information in people's care records provided a clear explanation of how their care needs should be consistently and safely met by care staff. The records of two people we checked showed that they had been referred for medical treatment. The records recorded this intervention and showed the outcome of the treatment. This meant that the documents contained up to date information to make sure that people received the care they needed. We read daily reports written by care staff. We found that the information described how people spent their day. Staff had recorded information about people's wellbeing and what care they had received. We found that that most daily record statements were appropriately signed with a full signature, dated and timed to show when the record was made. The manager had included the ongoing monitoring of this information in her care plan audit. We found that it was not clearly identified in care plans when a person's care needs had changed. We found that there was no date or signature to show when a change in care was identified. The manager reassured us that this would be reviewed. The manager showed us a document that she had developed to ensure that sufficient information was Inspection Report Watford House Residential Home April

13 documented when people's care was reviewed monthly. The new document allowed for the recording of who was involved in the review and details of the conversations. This meant that people could be sure that their views are listened and their changing care needs are clearly identified. Inspection Report Watford House Residential Home April

14 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Watford House Residential Home April

15 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Watford House Residential Home April

16 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Watford House Residential Home April

17 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Watford House Residential Home April

18 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Watford House Residential Home April

19 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Watford House Residential Home April

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