Inspection on 13/10/05 for The White House

This inspection was carried out on 13th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 but made no statutory requirements on the home.

Other inspections for this house

The White House 22/01/09

The White House 15/02/08

The White House 30/08/07

The White House 28/02/07

The White House 10/03/06

The White House 29/03/05

The White House 06/01/05

The White House 29/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The White House 11 Coggeshall Road Braintree Essex CM7 9DB Lead Inspector Gaynor Elvin Unannounced Inspection 13th October 2005 11.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The White House Address 11 Coggeshall Road Braintree Essex CM7 9DB 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) 01376 326847 01376 345966 micky._-@tiscali.co.uk Avidcrave Limited Mrs Kathleen Teahon Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th March 2005 Brief Description of the Service: The White House is a care home registered to provide accommodation, personal care and support to fourteen people over the age of 65 years, not falling into any other category. The home is not registered to meet the needs of people with dementia. The White House is a detached two-storey property, accommodation is provided on the ground and first floor in eight single rooms and three double rooms. Access to the first floor is by the stairs or a passenger lift. However due to the size of the rooms and corridors the home is not suitable for wheelchair users. The site is shared with a nursing home and both units share the gardens at the rear of the building, which comprises of a patio and grassed area with seating. There is a car parking area at the front of the building. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place one day in October 2005, over four hours. This was the first inspection undertaken without the manager present. The Registered Manager was on Annual Leave and Mrs Miriam Webber accommodated the inspection. Mrs Webber, a long serving member of staff was primarily employed as the home’s cook, with minimal care work included in her role. She indicated she took the senior role in the manager’s absence. A carer took over the cooking of the main meal during the inspection. The inspection process included a tour of the home, a discussion with two service users and two relatives, an informal discussion with three care staff and Mrs Webber, examination of service user records and documentation. The White House is situated in a prominent location in the town centre of Braintree, on a main street, surrounded by various shops, a supermarket and food outlets therefore visible to the majority of visitors to Braintree. Two large clinical waste bins were situated in the front car park adjacent to the public footpath with ‘HUMAN WASTE’ painted in large white letters across each bin. This did not form a positive impression of the home to members of the public and is derogatory and demeaning to the individuals who live there and did not reflect the aims and philosophy of the home as described within the Statement of Purpose. It was noted during the course of the inspection that many residents who had resided at The White House for some time were experiencing changing and/or increasing needs associated with the ageing process. As highlighted in the previous inspection report some were developing mental health needs, which presented in varying degrees of cognitive impairment and short-term memory loss related to early signs of dementia. As the home is not registered for this category of care and in the light of the development of some of the current service users’ needs, a variation to the condition of registration is required to enable the home to continue to provide care to those individually named service users, as long as their assessed needs can be met. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Positive progress in upgrading the premises and facilities of The White House is urgently required to improve outcomes for service users with regard to health, safety and welfare and safe working practices for staff. This relates to sluicing facilities, bathrooms, laundry facilities and some bedrooms, hand washbasins and toilets. In light of the changing and increasing needs of the service users, the home needs to review staffing arrangements with regard to employing domestic staff and increase current care staffing levels, to promote and protect the health, safety and welfare of the service users and safe working practices for staff. Little progress had been made on individual care plans to address requirements made in the previous inspection report; to ensure that all aspects of physical and mental health needs are planned for, that staff have the information to deliver appropriate and consistent care and be aware of how to manage and reduce identified risks, to better reflect the standard of care given. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 7 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 DS0000017980.V258948.R02.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Appropriate written information is available for prospective service users, enabling informed choices. Pre admission assessments were carried out but required more detail with regard to relevant needs. EVIDENCE: Revised copies of the Statement of Purpose and Service Users Guide had been submitted to the Commission. They were seen to reflect the aims and objectives of the home and to have been updated to meet a requirement identified at the last inspection. The files of two newly admitted service users were inspected. There was clear evidence of a completed pre admission assessment although the information contained was brief. A personal profile was evident on each file written by a relative informing staff of the personal history of the service user, their past working life, details of family, likes and dislikes, hobbies and favourite pastimes. Standard 6 is not applicable to The White House. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 10 The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8. More development work is required to ensure understanding and implementation of the care planning and risk management process to enable staff to provide structured and mutually agreed support. Individual care plans required detailed information of the action required of staff to meet the service users’ assessed needs consistently and reduce risks. EVIDENCE: The quality and content of individual records varied and did not reflect the actual care being given, which the service users and relatives spoken with said was good. Care plans viewed did not reflect a person centred approach to care, they did not identify psychological needs, detail mobility needs or inform staff of ability or appropriate assistance required to enable the individual to participate in personal care or activities. Staff spoken with indicated they did not contribute to the care planning process, however in a later discussion the manager said that the residents’ key workers did contribute to the care plans. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 12 Daily records were task orientated and gave little indication of individual interaction, feeling or well-being. The file of a service user, admitted three months previously, did not have a completed admission assessment, a care plan or a risk assessment. An entry on the daily report stated this individual was very upset; there was no mention as to the reason or how this was managed. This individual had a leg ulcer, the files did not contain any information for staff on how to manage or monitor this or any strategies in place to prevent further deterioration. The ulcer was being dressed by District Nurses. The file of a service user admitted three weeks previously did not have a care plan or risk assessments and risk management strategies in place. Weight was not recorded on admission. This individual had mobility needs and required a Zimmer frame, a moving and handling assessment had not been carried out and information was not available to staff on how to meet mobility needs. Entries in the daily report referred to a catheter being removed, however there was no information recorded within the file for staff on this individuals continence promotion and management. Reference to a continence assessment or guidance from the Community Continence advisor was not evident. Other care plans examined contained a brief identification of needs but lacked further detail on how to meet the needs. One care plan just stated ‘sometimes gets confused’. The last review of the care plan was December 2004. The last weight recorded was six months previous. One service user was observed walking with a Zimmer frame. A carer was reaching around the individual from behind and also had her hands placed on the Zimmer frame, taking control of the frame and with her body encouraging 1the service user to walk faster. This practice reflected a lack of knowledge in moving and handling, person centred care and promotion of optimal independence and risk assessment and risk management strategies within a care planning process. Staff expressed concern that service users were only offered a bath once a week. This was due to the lack of appropriate bathing facilities and low staffing levels. Care plans did not reflect service users’ choice and preference with regard to agreed bathing arrangements. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Although group activities were organised on a regular basis, there were limited one to one opportunities for service users to participate in personal interests or stimulation of thought and social interaction, particularly for those individuals presenting with varying levels of cognitive impairment. Visiting arrangements were open and relaxed and staff welcomed visitors to the home. The home supplied sufficient quantity and quality of food, and provided a well balanced diet that met individual needs. Mealtimes were a dignified, social occasion looked forward to by all service users. EVIDENCE: Communion Service is held monthly at the home. Although social interests and hobbies were recorded on admission there were no examples of staff supporting service users to maintain these. Staff described some good elements of practice with regard to engaging with service users during an organised weekly rolling programme of group activities. These included seated exercises, carpet bowls, carpet snakes and ladders and bingo for approximately an hour each afternoon except week ends. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 14 Staff indicated the importance of spending time individually with the service users, particularly with regard to stimulation for those developing cognitive impairment, but said they were unable to do so within the restraints of the staffing levels and the additional workload of domestic duties. Relatives visiting a service user were enjoying refreshments, they confirmed they always received a warm welcome by the staff and were able to visit any time. Resident meetings were held and relatives were also invited. The minutes recorded from the last resident meeting were available for visitors to view in the lounge and all views from service users and relatives were positive with regard to the home. Meal times were observed to provide a valuable opportunity for social contact. Service users expressed great satisfaction in the quality and quantity of food provided. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for these standards were not assessed on this occasion. EVIDENCE: The White House DS0000017980.V258948.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21, 22, 23, 24, 25 & 26 The White House provided a homely warm environment, however the accommodation and bathing facilities were failing to meet a safe standard for the individuals with increasing physical and cognitive needs. Offensive odours were noticeable in the majority of the bedrooms. The home did not provide appropriate laundry, washing machine and sluicing facilities to meet disinfection standards and control risk of infection to protect the health, safety and welfare of service users and staff. EVIDENCE: The home was bright and airy and had a homely feel. All bedrooms clearly presented individuality with personal possessions and photographs around them. Offensive odours were noticeable in the majority of bedrooms and were stronger in some en suite toilets, particularly those requiring new seats. The person in charge said carpets were cleaned upon request. Work had been completed providing radiator covering to protect service users. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 17 As an older style building, the layout is not suitable for wheelchair users due to the width of corridors and size/shape of some of the rooms. It has been noted on this and previous inspections that the size/shape of some rooms restricts options for the minimal furniture requirements, accessibly placed furniture and may prevent the use of hoists and access for carers: this may limit the use of some rooms, particularly double rooms. The majority of service users had varying and increasing mobility needs. The communal bathrooms did not provide suitable facilities to cater for service users with higher dependency needs requiring the assistance of staff and the manoeuvre of moving and handling equipment. Further consideration needs to be given to the provision and installation of assisted baths capable of meeting the assessed needs of the service users incorporating moving and handling risk assessments and policy. Staff indicated that only one out of two bathrooms were operational for fourteen service users with moderate to high needs, which were changing. The first bathroom had an assisted bath with a fixed chair for lowering the individual into the bath. Over time the chair had damaged the bath, this had been re-enamelled and was now peeling. The bath needs to be renewed, as it could be a source of infection. The second bathroom was only suitable for individuals who were fully mobile, therefore due to the current service user’s high dependency needs was no longer in use. This bathroom was carpeted, the bath was low and the room did not provide sufficient space for safe access for carers and the use of a hoist. The small downstairs toilet housed an older seated shower unit. Staff indicated the unit was no longer used for service users but the unit was used to sluice down soiled clothing and bed linen, as there were no other facilities for this purpose. A bucket with soiled linen soaking was observed in this toilet. During a later telephone discussion, following the inspection, the manager, not present on the day of the inspection, indicated the shower facilities were sometimes used for service users. The home needs to review effective risk management programmes and safe working practices to ensure the safety of service users and staff. The shower room is not suitable for its stated purpose and is also not appropriate to substitute its use as a sluice. The seated weighing scales were also stored in this toilet/shower room. Staff indicated that commode pans had to be rinsed in the service users’ rooms and were soaked in the second bath intermittently. A separate sluice must be provided and located separately from the service users’ toilet and bathing facilities. No further action had been taken to address four previous repeat requirements with regard to the provision of appropriate laundry facilities to meet National Minimum Standards. This is now of immediate concern particularly with the The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 18 high urinary and faecal continence needs managed within the home. However it has been recognised that the home had put in place interim arrangements in an effort to address previous requirements with regard to this ongoing situation. Laundry facilities are situated in a small room within the main building but can only be accessed from outside. Two very steep red tiled steps lead out of the back door down into the external passageway of the main building out to the laundry room. It was raining, the steps were very slippery and the passageway had many puddles. Facilities were not appropriate or in line with infection control guidelines to promote health and safety of the service users or staff and meet the continence needs managed within the home. Soiled clothing soaked in buckets was carried by care staff through the home, out through the back door, down the steps to the laundry room. The laundry facilities did not provide appropriate sluicing facilities to rinse soiled bed linen and clothing. The washing machine was domestic and did not provide a specified programming ability for dealing with soiled clothing and linen. The room did not provide enough room to keep an appropriate space between soiled and clean linen for infection control purposes. Two baskets of soiled linen took up the only available space within the room. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30. The home needs to establish appropriate staffing levels to meet the assessed needs of the service users. Current staffing levels do not promote and protect the health, safety and welfare of the service users particularly with the additional domestic duties to be carried out within their role as a carer. EVIDENCE: The staff spoken with demonstrated a cheerful and positive attitude towards the service users and all felt they worked well within their team. The current staffing levels and arrangements only allow for basic needs to be met. From observation and discussion with staff it was apparent the needs of the service users were changing and increasing due to the ageing process, the majority were in their eighties and nineties and one was one hundred years old next month. Staffing levels had previously been calculated using the recommended Residential Forum tool, however this had not been reviewed to take into consideration the increasing needs of the current service users and the high needs of new admissions. One member of staff said the residents were far more dependent now and many have cognitive impairment and additional staffing hours had not been allocated to manage this. She was not sure why the home was unable to recruit additional staff. The rota indicated there were three staff on duty throughout the day and two members of staff at night. Staff indicated the home was mostly short staffed The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 20 and at times there were only two members of staff on in the evenings and at weekends. Mornings were extremely busy and it was not always possible to give the amount of time a service user may require, as they have to clean and make beds as well as provide personal care. The home does not employ domestic staff. Staff also indicated that it was not possible to maintain a safe environment or implement safe working practice with only two or three members of staff on shift, particularly when one member of staff has to prepare the tea and supper and another is providing personal care upstairs or when supporting service users in the bath, as many required two members of staff. A cook is employed to prepare the main midday meal, the care staff prepare other meals. The home had recently recruited two new members of staff; files were not available for inspection. The two staff had commenced an induction workbook which did not fully meet with National Training Organisation specification, Skills for Care (formally TOPSS) Training Organisation for Personal Social Services and did not include training in the principles of care, particular needs of the service user group or the influences and particular requirements of the service setting. Mrs Webber was unaware of a training and development plan to establish the level of training received or required for the staff team collectively and was unable to locate individual training and development files. Staff spoken with could not recall training with regard to dementia and acknowledged a deficit in their knowledge and skills to meet the needs and apply therapeutic approaches to the care of service users with dementia. The Manager indicated, in a later conversation following the inspection, that all staff had received an introduction to dementia training, and further training in this area was planned for the New Year. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,37,38. Attention needs to be given to formalising appropriate arrangements in the home during the Manager’s absence. There are concerns highlighted in respect of increasing requirements and failure to take the home forward in ways expected by the National Minimum Standards and in the best interests of the service users. EVIDENCE: The person in charge, accommodating the inspection, has many years experience in health and social care, however her main role within the home is the cook. Her knowledge was limited in relation to the records and documentation required to efficiently and safely run the care home. The office was disorderly and the person in charge was unable to locate documentation such as risk assessments, complaints log book, training and development plans and files and maintenance records. Service user files and care plans were not The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 22 up to date and staff did not have a clear understanding of the assessment and care planning process. While the person in charge accommodated the inspection process, a carer took over the cooking of the midday meal. Health and Safety and Infection Control policies and procedures were in place and located in the staff room, however these were not followed with regard to the management of foul linen and laundry. The home must review and adhere to infection control guidelines with regard to staff preparing food and providing personal care. Appropriate protective clothing was not worn in the kitchen during the preparation of food. The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X 2 2 2 2 3 1 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X 2 2 The White House DS0000017980.V258948.R02.S.doc Version 5.0 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. Standard OP7OP14 1. Regulation 15 Requirement The Registered Manager must improve the care planning system for service users and set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, psychological and social needs of the service user are met. This is a repeat requirement not addressed within the timescale of 1st August 2005. The Registered Manager must give consideration to how the service users can receive a more individualised service tailored to meet identified needs and promote optimal independence with regard to health and social needs. This is a repeat requirement not addressed within the given timescale of 1st August 2005. The Registered Manager must ensure that service users have the opportunity to exercise their choice in relation to leisure and social activities and routines of daily living, and given DS0000017980.V258948.R02.S.doc Timescale for action 07/01/06 OP8 2. 12,13,16. 07/01/06 OP14OP12 3. 12,14,15, 16, 23. 07/01/06 The White House Version 5.0 Page 25 OP21 4. OP22 5. 23 23, 16. OP24OP23 6. 12, 23 OP26OP24 7. 16,23 OP26 8. 12,16,13 opportunities for stimulation through activities which suit needs, preferences and capacities, with particular consideration given to people with dementia. This is a repeat requirement not addressed within the given timescale of 1st August 2005. The Responsible Person must ensure sufficient number of functional baths to the number and assessed needs of the service users. The Responsible Person must provide suitable equipment and facilities as may be required for service users who are old, infirm or physically impaired and ensure appropriate assisted baths are installed which are capable of meeting the assessed needs of the service users. The Responsible Person must ensure room dimensions and layout options ensure that there is room on either side of the bed, to enable access for carers and any equipment needed, particularly in shared accommodation and rooms accommodating service users with high mobility needs. The Responsible Person must ensure private accommodation is equipped with furnishings to assure comfort and privacy and maintain or replace sanitary facilities, as needed paying particular attention to vanity sink units and en suite toilets. The Responsible Person must ensure the premises are kept free from offensive odours and ensure systems are in place to control the spread of infection. DS0000017980.V258948.R02.S.doc 31/01/06 31/01/06 31/01/06 31/01/06 07/01/06 The White House Version 5.0 Page 26 OP26 9. OP26 10. OP27 11. OP27 12. OP30OP38 The White House The Responsible Person must ensure washing machines have the specified programming ability to meet disinfectant standards and foul laundry is washed at appropriate temperatures to thoroughly clean linen and control the risk of infection. 23, 13, 16 The Responsible Person must ensure having regard to the number and needs of the service user, appropriate sluicing facilities are provided separate from service users’ toilets and bathing facilities. 13,16. The Responsible Person must provide details as to how and when appropriate laundry facilities will be provided to meet National Minimum Standards. This is a SIXTH repeat requirement not met within the given timescales of Mar 2005, Jan 2005, Jan 2004, July 2003, Sept 17/18 2002. 18 The Responsible Person must ensure staffing numbers and skill mix of qualified staff/unqualified staff are appropriate to the assessed needs of the service users, the size and layout and purpose of the home at all times and ensure the number of staff hours in respect of service users needs. 18 The Responsible Person must ensure domestic staff are employed in sufficient numbers to ensure that the home is maintained in a clean and hygienic state free from unpleasant odours and releasing care staff to give their full attention to meeting the assessed needs of the service users. 12, 18, 13 The Registered Manager must DS0000017980.V258948.R02.S.doc 31/01/06 01/12/05 01/12/05 01/12/05 Version 5.0 Page 27 13. ensure that all new members of staff receive an induction training to NTO specification, followed by a foundation training which equips them to meet the assessed needs of the service users accommodated, as defined in an individual care plan. The Registered Manager must ensure all staff access appropriate training pertinent to meeting the needs of the service users particularly relating to dementia. The Responsible Persons must ensure that action is progressed within agreed timescales to implement requirements identified in CSCI inspection reports. The Registered Manager must ensure records required by regulation for the protection of service users and for the effective, efficient running of the home are maintained, up to date, accurate and available. The Registered Manager must ensure safe working practices including moving and handling, and understanding and implementing measures to prevent spread of infection and communicable diseases and ensure risk assessments are carried out for all safe working practice topics and that significant findings are recorded. 01/12/05 OP33 14. 10,12 01/12/05 OP37 15. 17 01/12/05 OP38 16. 12, 13. 01/12/05 The White House DS0000017980.V258948.R02.S.doc Version 5.0 Page 28 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 OP23 Good Practice Recommendations The Responsible Person should consider ways to provide personal accommodation which are fit for purpose in respect of appropriate of useable floor space. 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