Inspection on 12/07/06 for The White House

This inspection was carried out on 12th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The White House 08/12/08

The White House 05/06/08

The White House 19/06/07

The White House 22/02/06

The White House 20/07/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The White House 219 Green Lanes Wylde Green Sutton Coldfield West Midlands B73 5LX Lead Inspector Joe O`Connor Unannounced Key Inspection 12th July 2006 11:15 The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Address 219 Green Lanes Wylde Green Sutton Coldfield West Midlands B73 5LX 0121 355 0908 0121 355 0908 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) Robinia Care West Midlands Limited Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65. Date of last inspection 22nd February 2006 Brief Description of the Service: The Whitehouse is a large detached property in the Wylde Green area of Sutton Coldfield. There are communal areas on the ground floor, consisting of a dining room, lounge bathroom, toilet, laundry and kitchen. There are seven single bedrooms, two of which are on the ground floor and five on the first floor. Three of the bedrooms on the first floor have en-suite bathrooms. The office/staff sleeping in room is also on the first floor. There is a pleasant garden to the rear of the property, which consists of a paved patio area and a lawn. There is some off road parking for a few cars to the front of the premises. The Whitehouse is located close to local amenities in Wylde Green and Sutton Coldfield. It is also close to bus routes for Sutton Coldfield and Birmingham. The service provides care and support services for up to seven adults with learning disabilities. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced key inspection was carried out over a day The Inspector spoke to two service users and a member of staff. Comments were received from two relatives after this visit who completed a CSCI relatives survey card. Care plans and risk assessments were inspected. A number of health and safety records were also inspected. The Inspector also spoke to a newly appointed manager who has been in post since April 2005. Additional information was also examined in what is known as a pre-inspection questionnaire that is sent out to the home before the fieldwork visit, along with details of significant events occurring in the home during this and the previous inspection year. Observations of care practices were also undertaken. To find out how the service has been performing since the last inspection then this report should be read with the unannounced inspection report 22 February 2006. The range of fees charged by the organisation range from £603.72 – £1,268.35 per week. What the service does well: What has improved since the last inspection? Some improvements had been made to the building since the last inspection. There was new floor covering in the hallway and new showers had been fitted in both of the bathrooms. One person was keen to show her newly decorated bedroom and said she chose the colour scheme with the help of her parents. The driveway at the front of the building had been made more level and the The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 6 wall had been lowered so there was better car parking space for the vehicles used by the home. The kitchen had been re-painted. There is a new manager in post since April and she has been making arrangements for each person to have a review of their physical and mental health care needs. The manager and the staff had up to date training in epilepsy awareness and how to give a particular type of medication in an emergency when someone has a seizure. The training was provided to help one particular person whose epilepsy was becoming unstable which was resulting in a number of admissions to hospital. When examining the care records there was some evidence that other people were having specialist support from a Consultant Psychiatrist and Community Nurse to look at other people’s changing needs. A number of staff had been registered to undertake accredited medication training. The new manager has had a wide range of experience working with people who have autism and has been working with the staff to improve their knowledge and understanding those people living in the home who have various degrees of autism. What they could do better: The CSCI is concerned that the home has been operating with low numbers of staff since the last inspection. Information provided by the manager before this inspection found staff were working extra shifts to cover gaps on the staff rota were there were vacancies. The manager has provided assurances that new staff would be starting at the end of this month. In the meantime agency staff have been brought in to cover shifts. Two complaints have been made about the home one of these was received by the Commission. Two relatives contacted the CSCI following this inspection to say that they were unhappy about the low levels of staffing and that people were not going out enough. One said there was poor communication with the home and felt that the care was overall not good. When examining the daily records to see what activities had taken place there were only a few examples of when people had gone out during the day and evening. The manager will need to provide the CSCI with an update to confirm when staffing levels are to the required numbers. The people living in the home need to have stability in their lives. Because of the difficulties with the staffing levels not all staff have been receiving up to date training in areas such as food hygiene, first aid and manual handling. Comments were received from a relative who was very unhappy that their daughter had not been on holiday during 2005 and so far 2006. There was not enough information on the care records to say whether people had recently been seen by a dentist or a chiropodist. There was no record to confirm people were being weighed regularly. The fire alarms were not being tested every week and the emergency lighting The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 7 was not being tested every month. The risk assessment for the prevention of fire had not been reviewed and this needs to be addressed. The care plans for each person and the manual handling assessments had not been reviewed since the last inspection. The home receives visits from a representative from the organisation who checks the record and is supposed to talk to service users and staff about how they think the service is managed. There were reports these visits available for inspection but these did not provide enough detail from the people and staff about what they thought of the service. The CSCI acknowledges the new manager has been working hard to ensure the people living in the home are safe and well. She identified a number of areas where the staff have to improve their practice such as better communication for those people who have autism and enable everyone to have activities in the evenings and at the weekend. However, there are requirements and recommendations from the last inspection that have not been addressed. The home will have another inspection later in the year to make sure that these have been actioned and to ensure there are adequate numbers of staff on duty. The concerns around low staffing levels had been raised at the last inspection in February 2006. It is expected improvements will have been made by the time of the next visit. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 Quality outcome in this area is poor. This judgement has been based on available evidence including a visit to the service. Service users needs are being reviewed but low staffing levels mean some aspects of their daily lives are being unmet. Service users do not have up to date information about what they are contributing towards their accommodation. EVIDENCE: The service has undergone a period of change with a new manager in post since April 2006. In discussion with the manager she was making arrangements for each service user to be reviewed by a Community Nurse. This included one person whose epilepsy had become more, unstable, resulting in an increasing number of seizures. A Community Nurse who specialises in the treatment of epilepsy had provided training for the administration of rectal diazepam. Another service user was having a Community Nurse assessment due to changes in his behaviour and had a medication review with a Consultant Psychiatrist. One of the service users had recently been re-assessed by a Social Worker as part of a financial review and a copy of the assessment was on file with an updated care plan also completed by the Social Worker. When examining the pre-inspection questionnaire and talking to the manager it was evident staffing levels were insufficient in meeting the needs of the service users, which has limited their opportunities for activities in the evenings and at the weekends. Comments were received from two relatives following this inspection. One stated that while he was overall satisfied with the The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 10 care and support being provided for his daughter, he was very concerned that three staff had left in such a short space of time and that the service was struggling with low numbers of staff on duty. Another relative expressed dissatisfaction with the care provided by the service and said the service users were having to put up with different staff, which was unsettling. The manager gave assurances that the organisation was working hard towards resolving the staff shortfalls and that four new staff had been recruited for the service and would be starting towards the end of July 2006. A requirement from the previous inspection for the service users to have up to date contracts or statement of terms and conditions had not been addressed. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality is outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Service users care plans must be reviewed to reflect any changes in need and how these will be addressed. Service users are involved in making decisions about the running of the home but the minutes for these do not evidence whether their wishes or requests have been addressed. Improvements are needed with individual risk assessments ensuring they state in more detail how service users should be supported in the home and community. EVIDENCE: The manager stated that she currently updating service users care records in to the system used by the organisation. It was noted that none of the care plans seen had been reviewed since the last inspection. The Me and My life books that were introduced by the previous manager had not been developed further, which must be addressed ensuring the service users have their own person centred care plan. The manager stated that she would be approaching the organisation to see if they can access Person Centred Planning training for all of the staff before undertaking work on the Me and My Life books. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 12 There were a number of detailed guidelines in place for service users with specific requirements. One service user had guidelines developed by a Community Nurse with regard to reducing incidents of behaviour where the service user would try and dismantle objects. Another had a detailed risk management strategy for their epilepsy and how the service user should be supported during a seizure. Each service user had a risk assessment of care but the information on these was basic in their content and for one service user did not refer to how risks should be minimised when bathing. There are service users meetings every week and the minutes seen for these indicated they were involved in choosing their menus for the week. It was noted that some service users had made requests to go out on trips to places such as the cinema and Stratford Upon Avon. However, there was no evidence to confirm whether their requests had been acted upon. The manager commented a new minutes format would be introduced where staff will have to record what action is being taken with an evaluation at the next meeting. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality outcome in this area is poor. This judgement has been based on available evidence including a visit to the service. Service users do not have enough opportunities to participate in activities during the week because of low level of staffing. Service users are able to maintain contact with their families and good relationships with staff. Service users must be encouraged to be more independent in preparing their own meals. Service users are offered a range of nutritious meals but the records for these do not always indicate what has been eaten. EVIDENCE: At the time of this inspection four of the service users were in the home during this inspection while the remaining three were out at day services provided by the Local Authority. Three of the service users had gone out shopping with a member of staff one of whom was celebrating their birthday the following day. Another had celebrated their 40th birthday the day before and there were birthday cards on display on the mantle piece in the lounge. However, comments received from a relative following this inspection stated that service users birthdays were not being celebrated. The relative also said that due to low staffing levels service users were not going out enough and that the home The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 14 would be crowded when they visited. An examination of three service users records indicated that one of them attended a Gateway social club during the week in the evenings. An examination of the daily reports and activity records indicated there was little evidence service users were going out on a regular basis. The home does have a budget where the organisations pay for the majority of activities provided. The manager acknowledged that staffing levels have been low since the last inspection, particularly drivers and that the service users have not had much opportunity to go out more often than they would like to. The manager went onto say she would be introducing a new rota where the service users would have greater opportunities for them to go out during the evenings and at the weekend. An examination of staff meeting minutes found there had been discussion about obtaining a new accessible vehicle for all the service users. During the inspection one of the service users was observed to be involved in preparing Beef Stroganoff tea with a member of staff. Another service user showed certificates she was awarded by the college she attends for cookery. When asked if she was involved in cooking in the home the service user replied sometimes. An examination of daily records did refer to where service users had been involved in domestic tasks such as clearing the tables, dusting in some cases laundry but no evidence of any meal preparation. There was no evidence on the service users care plans to indicate whether or not they had a key to their bedroom. Service users’ daily records did indicate they were able to maintain contact with their relatives. One of the relatives was visiting at the time of this inspection. A service user spoke of how much she was looking forward to going to a wedding for one of her relatives in September and that she enjoyed going out Greyhound racing with her brother. The interaction between service users and staff was generally friendly and supportive. The pre-inspection questionnaire included menus from the previous four weeks indicated service users were being offered a healthy, varied food and it was noted service users were offered a choice of cooked breakfast. However, when examining the food records it was noted some of the meals being provided during the week tended to be repetitive and some entries on certain days not completed. The manager stated that she is working towards the service users having wider choices of when to eat their meals rather than everyone all coming in at set times. She was also considering replacing the dining room furniture where people would not necessarily have to sit all together on one table. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Changes in service users’ health are generally reviewed and monitored by staff on a day to day basis. Clearer records are required in ensuring appropriate arrangements are in place to evidence they are having contact and treatment from all healthcare professionals. Risk assessments stating how service users should be transferred and guided must be reviewed to reflect individual requirements. Medication management requires improvement ensuring service users’ health is promoted and maintained. EVIDENCE: Three service users’ care records sampled had manual handling assessments, but these had not been reviewed which was a requirement from the previous inspection. An examination of service users daily recording indicated where service users had received support with a shower or bath and when they chose their clothes when getting dressed or had a lie in. Generally service users were observed to be dressed appropriately for the climate of the day. The service currently accommodates seven service users who are all from a White European background. There are four females and three males. The staff team supporting the service users are predominantly white female and there are no males on the staff team apart from those who are day service staff and The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 16 do not work in the home. The care plans do not specify gender care preferences. The organisation must give consideration when recruiting for staff in the future that reflects the gender mix of the current group of service users in the spirit of equality and diversity. A recommendation from the previous inspection for service users to have individual health action plans had not been addressed. There was little in the way of information confirming whether service users had recently accessed a dentist and chiropodist. It was noted that it was difficult to track the information being recorded. Some evidence was available confirming that some a number of service users had visited their GP for treatment and was receiving specialist involvement from a Consultant Psychiatrist for medication reviews while two service users were being assessed by Community Nurses for. There was evidence that the service had been addressing concerns with one service user whose epilepsy had become unstable that resulted in a number of admissions to hospital. A record was being maintained of the kind of seizures that had occurred. Action had been taken by the manager for all staff to receive updated Stelosilid or rectal Diazepam training from specialist Community Nurse. The manager commented that the feedback she was receiving from the Community Nurse was positive and thought the staff were competent in how they should support the service user when she had a seizure. A revised and detailed rectal Diazepam protocol had been drawn up which was had been signed by the Community Nurse and the service users relative and GP. The manager stated there had been a marked improvement with the service user’s condition and that air conditioning had been provided in the bedroom for the service user as the recent hot weather has affected the service user’s sodium levels. It was noted however, that when examining the daily recording notes there was a reference to the service user having aromatherapy and there was no risk assessment confirming whether this was an appropriate activity given this person’s history of seizures. A concern was raised with the manager when a letter written by a GP stated that it was in order for staff to conceal medication in the service user’s food during mealtimes. The manager stated that since her arrival she had discovered this practice had always occurred. There was no evidence of a multi –disciplinary meeting agreeing to covert medication. An Immediate Requirement was issued for the manager to arrange such a review. At the time of writing this report the manager had drafted a protocol that was being sent out to various professionals and the service users relative. Since this inspection a copy of a letter was provided by the manager from the service user’s GP instructing that the medication should now be administered via her peg feed tube. The manager stated that work was in progress for the service users to have a nutritional assessment from a dietician but there was no documentation The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 17 confirming this, nor was their evidence to indicate service users were being weighed regularly. Medication management was in need of some improvement. An examination of the Medicines Administration Records found each service user had updated homely remedies authorisation signed by their GP. There were written protocols in place for service users who were prescribed PRN medication. When examining the Medicines Administration Records it was noted there was one gap in recording where medication had been given but not signed for. A boxed medication sampled found there were tablets more than what should have been left after administration. Rectal Diazepam tubes had not been booked on to the MAR sheet. The manager’s signature was not on the list of staff qualified to administer medication. It was also noted that Salbutamol inhalers did not have date of opening on the labels and containers. In discussion with the manager it was identified that she must undertake a staff medication audit to monitor their competency and address any issues of poor practice. At the time of publication of this report the manager forwarded copies of medication audits that occurred following this inspection. The manager stated four staff were enrolled for accredited medication training. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality outcome in this area is good. The organisation responds positively to any complaints made about the service, which is transparent and open in the interests of the service users and their relatives. Service users interests are well protected with good management of service users’ personal monies. EVIDENCE: The commission had received one complaint from a former member of staff, which, concerned the current low levels of staffing and the lack of daytime activities for the service users. The complaint also referred to the manager making staff work a new rota that did not give any consideration to their personal circumstances. This was investigated as part of the key inspection with the outcome referred to in the Staffing section of this report. A complaint had also been received by the service from a relative who raised concerns about how staff were supporting her son’s personal care and about the low levels of staffing. In discussion with the manager she had already drawn up documentation to ensure all staff recorded when the service user was assisted with his personal care and for any reasons if this had been declined. This included a chart for staff to record when they had encouraged the service users to wear his spectacles, which the manager said he was reluctant to do this. The complaint was currently being investigated by a senior manager for the organisation who was arranging to meet the relative. The outcome of their investigation would be forwarded to the CSCI. There was evidence the complaint from the relative had been recorded in the complaints log and that the manager responded to the complaint promptly in writing. When talking to one of the service users she stated with the manager present that one of the service users’ kept pushing her spectacles in her face and asked the manager to stop the other service user from doing this again. The The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 19 manager responded to this in a positive manner and gave the service user reassurance that she would address this. An examination of two service users financial records found these were being managed and recorded appropriately. There were receipts for individual personal expenditure. Each service user has a financial profile, which includes information about service users’ benefit entitlements and who acts as an appointee. The service users have their own cash boxes and these were locked in a secure place. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Service users live in a clean, homely environment with some minor improvements needed. EVIDENCE: The building was clean, tidy and free from any unpleasant odour. There are a lot of photographs of service users around the building that gives it a homely environment. Some improvements have been made to the premises since the last inspection. The kitchen had been re-decorated and the front driveway had been re-laid and a wall reduced to improve the parking space for the vehicles. New showers were fitted in both bathrooms. There was new floor covering in the hallway. One of the service users showed her bedroom which she said had recently been re-decorated. The service user said she chose the colour scheme with some assistance from her parents. It was noted the carpet on the stairs and landing was badly marked and in need of replacing. It was noted one of the service users’ bedroom had yet to be re-decorated which was a requirement from an inspection in February 2005. The Commission will require a plan of future refurbishment and redecoration of the premises for the current financial year. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Service users are not receiving consistency of care and support from appropriate numbers of staff on duty, but action is being taken to recruit more staff. Staff receives and participate in training enabling them to undertake their duties but this needs updating. Service users interests are protected with appropriate, robust, recruitment practices in place. EVIDENCE: An examination of the pre-inspection questionnaire and staff training records indicated that out of nine care staff employed in the service, six were qualified to NVQ Level 2 and above. This is over 50 of its workforce. The preinspection questionnaire stated that three staff had completed NVQ Level 3 in the last twelve months while another had completed NVQ Level 4 and was due to compete the Registered Managers Award. Two staff had completed food hygiene in the last twelve months. An examination of the staff training records indicated a number of staff were due for updated mandatory training. The manager stated that due to low levels of staff it had been difficult to organise updated training. However, some training has been arranged in areas such as fire safety, safe handling of medicines, person centred planning and physical intervention. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 22 Observations at the time of this inspection indicated the service users were comfortable in the presence of staff. An examination of two staff recruitment records including one for the manager indicated all the required documentation was in place including job application form, CRB check, proof of identity, two references, contract, job description and record of induction. Since the last inspection two members of staff have been promoted to senior carer. One has recently left employment with the service due to proposed changes in the staff rota. The manager explained that she is introducing a new rota that would because there was a practice of staff working long shifts during the week when the service was owned by another company and had so far found that after 20:00pm the service users had no opportunities for activities in the evenings. In implementing the rota this would enable the staff to work shifts that are of a more reasonable length and improve the service users’ quality of life. The manager also commented staff would be given a month’s notice to implement the rota but could not do this until there is a full complement of staff in place. The pre-inspection questionnaire stated that during the previous eight weeks agency staff had covered 8 shifts while bank staff covered 27. An examination of the rotas for the last four weeks found that staffing levels have been low with some staff including the manger working overtime to cover shortfalls. There are currently four full time posts vacant, which the manager stated Robinia were addressing this as a matter of urgency. In the interim two agency staff have been recruited and the manager stated she has ensured these were asked for regularly as they were committed and provided some consistency of care to the service users. It was noted the names of the agency staff were not recorded on the rota. There was evidence that an induction checklist had been completed prior to the agency workers commencing their shift. The manager stated that the organisation were now in a position to put into post four new staff who following their induction would be commencing employment in at the beginning of August once accommodation has been arranged and they have completed their induction. The new staff members have been recruited from Poland. While it is good to see the organisation is addressing the staffing shortfalls it is evident from an examination of the staff meeting minutes and in discussion with staff, that the last two months have had an impact on their morale. This has also had a significant impact on service users who must have a stable staff team and wider opportunities for activities. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality outcome in this area is adequate. This judgement has been based on available evidence including a visit to the service. Service users are supported by a manager who is committed to improving good practice in the home. Service users and staff must be regularly encouraged to comment on the management of the home during visits made by a representative of the organisation. Improvements are need in ensuring the health and safety of service users is promoted and maintained effectively. EVIDENCE: The new manager has been in post since April 2006. She has had previous experience in a residential setting as a senior carer and has also had experience with working with people who have autism. The manager stated she was completing an application to be Registered Manager with the CSCI. She was also commencing her training for the Registered Managers Award having already qualified to NVQ Level 4 in Care. In discussion with the manager she has identified a number of areas where the service needs to improve. These included ensuring staff had a wider knowledge The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 24 in communicating with those service users who have non verbal communication and develop a wider knowledge around autism. There was also a need for staff to ensure they regularly maintained basic aspects of service users’ personal care. Recording systems were also another area, which the manager identified that needed improving. She acknowledged that the last two months had been difficult due to the low levels of staff and as previously mentioned a number have worked long shifts out of good will but they are tired. The manager said she was well supported by the organisation and also felt she had good supportive senior carers. The manager did admit there were some staff who were having difficulty in managing the changes needed to improve the service users quality of life. One member of staff commented she found the manager to be supportive thought the manager needs time to improve the situation for the service users. While it is good to see the organisation is addressing the staffing shortfalls it is evident from an examination of the staff meeting minutes and in discussion with staff, that the last two months have had an impact on their morale. Comments received from a relative following this inspection thought there was poor communication between the staff and relatives. This has also had a significant impact on service users who must have a stable staff team and wider opportunities for activities. There were reports available for inspection of visits made by a representative of the organisation. It was noted that there was not enough detail in the comments made by service users. There were also no comments recorded by staff about the management of the service. Given that a former member of staff contacted the CSCI with regard to the low staffing levels in the service it is of concern no one felt they could raise any issues or concerns with the representative from the organisation. There were no reports for the months March and June this year. Service users’ surveys had been completed and the formats used for these were consisted of illustrations, print and symbols. One had been completed by a relative. An examination of health and safety records found some improvements were needed. There was documented evidence indicating that the fire alarms were not being tested weekly and the emergency lighting had not been tested every month. A risk assessment for the prevention of fire had not been reviewed since March this year. There was evidence indicating a fire drill had occurred prior to this inspection and that fire training was scheduled for 8 August 2006. The service had received a visit from the fire safety officer and it was noted the requirements identified from his visit had been addressed. These included a smoke detector fitted in the COSHH cupboard and a development of an emergency plan. There is a risk assessment for the premises but this did not include the front driveway and back garden. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 25 The accident book was examined and it was noted two had occurred since the last inspection. However, one of these had not been notified to the CSCI under Regulation 37. The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 N/A 2 N/A 3 1 4 N/A 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 N/A 26 N/A 27 N/A 28 N/A 29 N/A 30 3 STAFFING Standard No Score 31 N/A 32 3 33 2 34 3 35 2 36 N/A CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 N/A LIFESTYLES Standard No Score 11 N/A 12 1 13 1 14 1 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 N/A 3 N/A 2 N/A N/A 2 N/A The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 27 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 YA33 YA3 Regulation Requirement Timescale for action 12/09/06 2. YA5 12(2,3,4ab) The Registered Person must 18(1a) ensure all staff vacancies are recruited and action must be taken in ensuring staff does not work long hours in covering shortfalls on the staff rota and that service users with complex needs are adequately supported. Outstanding Requirement. Timescale 22 April 2006 not met. 5(1)(b) The Registered Person must ensure service users’ statement of terms and conditions are signed and include information of the fees to be paid. Outstanding Requirement Timescale 22 April 2006 not met. 12/09/06 The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 28 3. YA6 YA16 15(1,2) The Registered Person must ensure service users new care plans detail in full how service users’ objectives are to be met. They must demonstrate the involvement of service users in their draft and review. Timescale 22 April 2006 not met. The Registered Person must ensure service users Me and My Life books are further developed to provide service users with information that is more person centred. Care plans must state whether or not service users have a key to their bedroom and the reason for not having one. Service users must be given opportunities to access an advocate to assist them with making more choices independently. Not assessed. Outstanding requirement brought forward. The Registered Person must ensure service users meeting minutes document action taken following any requests made by service users. Outcome of action taken must be recorded at the next meeting. The Registered Person must ensure individual risk assessments for care include more detailed information as to how individual risks should be minimised including tasks such as bathing. 12/09/06 4. YA7 YA8 12(2,3) 12/09/06 5. YA9 13(4) 12/09/06 The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 29 6. YA17 12(2,3) 16(2i) Sch4(13) The Registered Person must ensure service users are provided with opportunities to cook their own meals. Outstanding Requirement. Timescale 22 April 2006 not met. Service users food intake records must be recorded on a daily basis to confirm service users are receiving a wholesome varied diet. The Registered Person must ensure service users manual handling assessments are reviewed to reflect any changes in their needs. Outstanding Requirement. Timescale 22 April not met. The Registered Person must ensure service users care plans refer to individual gender care preferences. The Registered Person must ensure service users are nutritional needs are assessed by a dietician and that they are weighed monthly. Any reason why this has not been done must be documented. Partly addressed. The Registered Person must undertake drug audits ensuring staff competency in administering medication. All medication administered signed for on the MAR sheet. The Registered Person must ensure all medication is booked in on the MAR sheet prior to administration. All inhalers must have date when opened on the container and box. 12/09/06 6. YA18 13(5) 12/09/06 7. YA19 12(1ab) 12/09/06 8. YA20 13(2) 12/09/06 The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 30 9. YA42 13(4) 37(1e) 13(4) 23(4v) 10. YA42 11. YA42 13(4) 23(4d) The Registered Person must ensure any accident in the care home is reported to the CSCI without delay. The Registered Person must ensure the emergency lighting is tested every month. Outstanding requirement. Timescale 21 August 2005 and 22 April 2006 not met. The Registered Person must ensure the fire alarms are tested every week. The Registered Person must ensure the risk assessment for the prevention of fire is reviewed. The Registered Person must ensure it provides service users more opportunities for activities during the week and at weekends. There must be a clear record of activities confirming that service users had participated in these. The Registered Person must ensure all staff have received updated mandatory training. The Registered Person must ensure it provides the CSCI with a plan of future refurbishment and decoration, evidencing how the premises will be maintained to a safe, presentable standard. The carpet on the stairs must be replaced. The Registered Person must ensure that the monthly visit reports by a representative of the organisation provide more detail of comments from service users and staff about the running of the home. 12/09/06 12/08/06 12/08/06 12. YA12 YA13 16(2m) 16(2n) 12/09/06 13. 14. YA35 YA24 18(1c) 23(2b) 12/09/06 12/09/06 15. YA39 26(1) 12/09/06 The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 31 16. YA14 16(2i) The Registered Person must provide the CSCI with an action plan confirming when arrangements have been made for service users to have a holiday of their choice. 12/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations It is recommended that the Registered Person include more photographs in the statement of purpose, and service user guide. Not assessed. Outstanding recommendation brought forward. It is recommended that the registered person arrange for all staff to have training in person centred planning. Outstanding recommendation brought forward. It is recommended that the Registered Person provide opportunities for service users to access an advocate who could facilitate their weekly meetings if this is possible. Not assessed. Outstanding recommendation brought forward. It is recommended that the Registered Person develop individual health action plans in line with the Department of Health’s Valuing People Guidelines. Outstanding recommendation brought forward. It is recommended that the Registered Person considers including using more photographs in the complaints procedure. Outstanding recommendation brought forward. It is recommended that the Registered Person monitor future recruitment of care staff that reflects the service users’ gender within the service reflecting a more diverse and equal workforce. 2. YA6 3. YA8 4. YA19 5. YA22 6. YA33 The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The White House DS0000064612.V298229.R01.S.doc Version 5.2 Page 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. 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