Inspection on 15/02/08 for The White House

This inspection was carried out on 15th February 2008.

CSCI found this care home to be providing an Adequate service.

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 30/08/07

The White House 28/02/07

The White House 10/03/06

The White House 13/10/05

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 15th February 2008 12:00 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.V359977.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 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.V359977.R01.S.doc Version 5.2 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 kathy.whitehouse@tiscali.co.uk Avidcrave Limited Mrs Kathleen Teahon Care Home 14 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (14) of places The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 14 persons) Three persons, over the age of 65 years, whose names are known to the Commission, who require care by reason of dementia The total number of service users accommodated in the home must not exceed 14 persons 7th December 2007 Date of last inspection 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, corridors and passenger lift 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. Current scale of fees confirmed at the inspection in February 2007 is from £426.55 to £450.00, There are additional costs for hairdressing, chiropody, toiletries and newspapers. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection commenced on the 15th February 2008 over a period of five hours. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. The inspection process included reviewing documents required under the Care Home Regulations. We looked at a number of records relating to the residents, staff recruitment, staff training, staff rosters and policies and procedures. This report has been written using accumulated evidence gathered prior to and during the inspection. Comment cards were left at the service to circulate to residents, relatives, healthcare professionals and staff to complete and return to the Commission. The responses received are included within the contents of this report. What the service does well: The White House provides a homely and relaxed atmosphere for the people living there. Comments received from residents through questionnaires indicated general satisfaction with the care and support received, staff listened and acted on what they said and were usually available when needed; there were usually activities arranged by the home that they could take part in and that the home is always clean and fresh. Comments received from relatives through questionnaires were positive and indicated general overall satisfaction with the service their relatives received, that they were always welcomed to the home at any time and were kept informed of their relatives changing needs and when medical intervention was required. Comments received from a healthcare professional and a GP through questionnaires indicated that the home communicates clearly and works in partnership with health care professionals and the staff demonstrate a clear understanding of the needs of the residents they care for. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The overall management of the service towards compliance with National Minimum Standards and Regulation, requires a greater sustained effort through the daily leadership of the home particularly in relation to essential elements of management such as care management, records and documentation, staff supervision and quality monitoring and assurance. The management and staff’s knowledge of regulation and standards should be developed; this will enhance the quality of care provided by the home and achieve a greater level of compliance. A more robust approach must be taken to implement an active care planning process that is person centred and tailored to the individual. Care plans in place at the home do not provide sufficient direction for staff. More 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 to improve outcomes for residents in this area. Opportunities for staff training and development must continue to be encouraged, developing skills and awareness of staff in areas specific to residents needs. Regular structured supervision would benefit staff in maintaining and developing their working practice to support residents and achieve quality outcomes. Outcomes for residents would be improved by robust quality assurance and monitoring systems to assess, monitor and review the quality of the care and services provided at the care home. This would inform future development in addressing and improving standards and services where needed and ensure the home is run in the best interest of the people who live there. The White House DS0000017980.V359977.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. The White House DS0000017980.V359977.R01.S.doc Version 5.2 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.V359977.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is adequate. People using the service are assured that their needs will be assessed prior to moving into the home and that they will receive a clear and informative contract/statement of terms and conditions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has a pre-admission assessment system in place. The manager undertakes all the assessments of potential residents to ensure their assessed needs can be met by the home. There had been no new admissions to the home since the last inspection due to the extensive building works taking place and therefore the admission process could not be fully examined on this occasion. However the manager, in response to the last inspection report, informed us that she was in the process of reviewing the assessment process and documentation to improve the level of information obtained to fully determine individuals’ needs, strengths and The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 10 abilities to enable a more person centred approach to care planning and ensure people receive an individualised service. The pre admission process will be fully assessed at the next key inspection. In response to a repeat requirement made in the last inspection report resident’s contracts had been revised. The sample viewed set out the terms and conditions of residence; the breakdown of total fees payable including any contribution where applicable, identified responsibility for payments and method of payment. This will give a clearer understanding of the process to residents and their representatives. The White House DS0000017980.V359977.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. People who use this service cannot be sure that staff are fully aware of all their needs or that the care and support they require will be delivered in a structured and personalised way. Healthcare needs are generally met and medication systems are well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are still areas of the care planning process and systems in the home, identified in previous inspection reports, that require further work and increased staff input to ensure that all residents have a proactive and organised approach to their care at all times. We noted on this, and previous inspections, not all assessed care needs had a plan of care in place and this relates to staff not using information gathered at the time of assessment and oversights on aspects of care. Recording of useful and critical information obtained from assessments could be improved and used to inform effective management strategies that are incorporated into the The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 12 care planning arrangements. This would promote staff awareness and guide them in consistent monitoring and promptly identifying any change. One resident, an older person with a learning disability, in the main was fully independent, accessing the Community and maintaining educational needs. Strengths, abilities and dependency levels were not identified or planned for to enable staff to support this person in maintaining these. Communication needs identified in the Care Management assessment such as ‘difficulty expressing one self and being understood’ were not reflected within a plan of care. This does not ensure a consistent approach and, enable staff to meet assessed communication needs in the most supportive manner. Advice and guidance for staff was too general/brief and did not provide a clear basis upon which to review care practice. Care planning arrangements to support continence needs only recorded the type of pads to be given and ‘ensure toilet used regularly’. A care plan relating to dietary requirements for one individual simply stated ‘does not like salads and soup’ and yet we noted from the assessment that the individual had high blood pressure, a condition usually helped by a healthy eating plan such as no salt, low fat and high fibre. The weight records indicated a consistent weight loss since admission. The manager told us that the weight loss was due to the individual cutting out sweets as per advice received from a healthcare professional. A care plan relating to nutritional needs should record all specific dietary requirements to enable appropriate monitoring and subsequent evaluation. More work needs to be done on the social aspects of care planning to ensure that individual social and emotional needs are being met effectively to promote well being. The care management assessment for one person identified that they had suffered from depression in the past, worried a lot and is a very private person. The action, to be taken by staff, recorded in the care plan, briefly stated ‘medication’ and ‘look for change in mood’. More detailed information to guide staff as to the level and type of support required to help prevent isolation and anxiety would improve outcomes for the individual. Risk assessments relating to moving and handling were seen. Again these were brief in the detail with regard to management strategies. The team need to work on linking any identified risks into the care planning system so that any action to be taken is detailed and clear and subsequently evaluated when reviewed. Staff should be aware of information gained at the time of assessment that may identify the need for a risk assessment. Paying particular attention to nutrition, pressure areas and falls, all areas of potential risk in the frailer and older person. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 13 A record of date entries was kept in the care documents indicating when a review of the care plan had taken place. The records did not demonstrate a re assessment of needs or care planning arrangements. Daily records were not sufficiently detailed to reflect the level of care and support provided or that linked to a plan of care. Whilst we were at the home, we observed and heard staff interacting well with residents. Staff had a friendly and respectful approach. Comments received from a GP and healthcare professional, through completed questionnaires, told us that the service always sought advice and acted upon it to manage and improve individuals’ healthcare needs and that individuals’ healthcare needs were usually met by the service, and privacy and dignity was always respected. Medication was received from the pharmacy in Monitored Dosage Systems and individually named containers and was appropriately stored in locked facilities. A sample of Medication Administration Records (MARs) was examined. The records were accurately completed, signed and dated. Each of the care plans has a section for the resident’s ‘end of life wishes’. In the sample viewed this section was not completed. We discussed this aspect of care planning with the manager and the importance of determining the end of life needs of residents, including their choice to remain in the home or be admitted to hospital at their time of death. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. The majority of people using this service are provided with choices and are encouraged by staff to participate in stimulating activities within the home. Those people with more specialist needs are not provided with the same opportunities. The meal provision in the home is generally good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The sample of care plans examined showed that more work is required in order to demonstrate that residents’ individual and social care needs are being met. No real assessment of social need was evident in the care records viewed and therefore it was not clear that the social activity programme was based upon residents’ needs and choices. The home has not progressed in this area since the last inspection. Unclear care planning limits the prospects of people maintaining their optimal strengths and abilities and residents cannot be sure that their ability and needs are fully considered to enable them to participate in activities more suited to their needs. Some care needs assessments reflected individuals’ choices, past lifestyles, hobbies and preferred leisure activities. Better use of this The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 15 information at the time of assessment and from family histories would enable staff to plan for identified social needs and inform staff in how to appropriately engage each resident in maintaining and stimulating social and recreational interests linked to individual needs. This important information would enable appropriate planning and support provision for the frailer resident with more complex support needs, who are unable to participate due to their varying cognitive abilities. Resident meetings were held although infrequently. A record of the minute’s taken from the last meeting held in July 2007 were examined. They did not contain an agenda or a review of any actions taken as a consequence of the previous meeting. They indicated that food and entertainment was discussed and that residents who expressed an opinion were satisfied and had no concerns. Activities organised within the community since the last inspection included two trips to a garden centre, by minibus accompanied by staff and a visit to a show put on at the local Institute for Adult Education. An entertainer visited the home in September and at Christmas. Relative comments, through questionnaires, indicated that the service encouraged relatives to maintain an active role in the residents’ life following admission. Relatives informed us that they were warmly welcomed and kept informed about the resident. This and previous inspections have always found the standard of food provided to be good and mealtimes enjoyed. Ingredients of fresh and good quality were used and meals were home cooked, well balanced and nutritious. Although some residents expressed satisfaction with the meal provision in the home no further work had been undertaken by staff to demonstrate how choices are offered to those people with cognitive impairment and communication difficulties and this is an area that remains in need of development. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents can be confident that their views will be listened to and acted upon. Residents can expect staff to respond appropriately to allegations of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure continues to be robust and fulfils the criteria required. Residents and relatives who commented stated that they knew how to make a complaint if the need arose and knew who to speak to if they were not happy. Neither the Commission, nor the home, have received a complaint about the service since the last inspection. The home’s policy and procedure for Safeguarding Adults, as seen on previous inspections, is satisfactory, clear and precise and includes local procedures. Staff are made fully aware of safeguarding issues. The sample of staff training files examined showed us that staff receive awareness training in safeguarding vulnerable adults and local procedures as part of their induction, and recent update was undertaken in September 2007 accessed from the Local authority, Essex Vulnerable Adult Protection Committee (EVAPC). Staff records also showed us that staff were in receipt of a copy of the General Social Care Council (GSCC) Code of Practice and booklet two of the EVAPC guidance, for staff safeguarding adults. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 17 The manager, in previous inspections, has demonstrated a good understanding of issues in this outcome area. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24 and 26 Quality in this outcome area is poor. The White House is clean and homely but environmental issues requiring urgent improvement to essential facilities affect the ability of The White House to provide a completely suitable environment that fully meets the residents needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were pleased to see during our visit to the service that extensive building works had commenced in December 2007 to update and improve the physical environment of the home and to provide suitable laundry, sluicing and bathing facilities. This will improve standards and outcomes for residents in this area. The summer of 2008 was given as an anticipated date of completion and therefore we look forward to fully assessing this outcome area at the next key inspection. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 19 Hot water outlet thermostatic valves are included within the refurbishment improvement plans. Water temperature testing of a prepared bath continues to be carried out by staff prior to bathing a resident and recorded, however residents remain at risk of scalding if in direct contact from hot water outlets and when using hot water from hand wash basins in their rooms. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Residents are in safe hands however outcomes for residents could be improved by further development of staffs’ skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Recruitment documents were checked for the two most recently recruited care staff. The required documents were in place to ensure suitable staff were appointed for the job. Information received from staff through questionnaires told us that appropriate checks had been carried out on them prior to their commencement of employment. Comments received from staff through questionnaires indicated that the induction training received at the commencement of their employment covered every thing that they needed to know to enable them to do the job. Information from the questionnaires also indicated that staff receive training that is relevant to their role and helps them to understand the individual needs of the resident’s keeping them up to date with new ways of working. The manager told us that 50 of the care work force has attained NVQ level 2 in care and that all new staff undertake an induction that incorporated the Common Induction Standards. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 21 A sample of five staff files was examined. They showed us that training provision in mandatory subjects had improved over the last year although shortfalls were noted for some staff in updating their knowledge and skills in some mandatory subjects. The manager told us that she maintained an annual training matrix that identified planned training but this was not available for inspection. Staff files did not contain an available individualised training profile generated from an appraisal and supervision process to determine specific annual training and development plans in relation to the staff members’ assessed training needs and requirements. The manager said she would be addressing this in the near future. This, and previous inspections, continues to highlight the need for staff to develop their skills and understanding in care planning and person centred care to enable them to effectively meet all individualised needs and deliver planned and consistent care. This will improve quality outcome areas for people who use the service. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. The home is not managed in an effective way. A lack of commitment to continuous improvement in quality services, support and outcomes does not ensure that the service is run in the best interests of the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Overall, responses received from residents and relatives, through questionnaires, were positive and expressed satisfaction with regard to the home, the staff and the care received. The managers’ position remains unchanged and in addition to many years experience in caring for older people at The White House, the manager, Mrs Teahon, has achieved the Registers Managers Award NVQ Level 4. Mrs Teahon The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 23 has also undertaken periodic training to update her knowledge and skills whilst managing the home. This, and previous, inspections continue to highlight a wide range of areas that the manager needs to address in the home that will improve standards and affect outcomes positively for residents. These include care planning, social aspects of care, and essential elements of management such as quality monitoring and assurance and staff supervision and development. The manager has still to develop and fully implement a quality assurance programme for the home. Since the last inspection the manager has been developing a questionnaire to obtain views of the service from residents, relatives and other stakeholders. Consideration must be given as to how residents with cognitive impairments are able to contribute. Ways of obtaining their views and experiences needs to be explored to ensure the home is run in their best interests and their quality of life is promoted. We discussed with the manager that a more structured approach is required in addition to the questionnaires to identify strengths and weaknesses in the service and monitor standards. Quality audits need to be addressed to provide sufficient evidence to demonstrate an open and analytical review of the service currently provided, and identify the actions required that would impact on outcomes for residents and ensure continuing improvement in the areas identified. The manager, on discussion, did not demonstrate an understanding in this subject area and training may be of benefit. A stronger emphasis on regular formal recorded supervisions is required to enable staff to reflect and develop their working practice. The manager had only just addressed a requirement from the last inspection undertaken in August 2007. The manager told us that supervisions had re commenced as from this year; records were not available for inspection as they were stored on the computer and were not accessible due to a computer virus. Staff surveys indicated that the manager met with them regularly to give support and discuss how they were working. The manager indicated that residents had their own arrangements in place for the management of their financial interests. The homes manager supports residents in managing small amounts of money left by relatives for every day use such as hairdressing and personal items. The system for the safekeeping and management of this money was secure, records identified transactions with corresponding receipts and a running balance was confirmed by signature. The balance was checked and correct. The home had achieved the Gold Standard Award from Braintree District Council, for the second time, for their excellent standard of food safety and hygiene found on inspection in June 2007. Training update for all staff in food hygiene and handling was booked for this year. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 24 Fire safety audit undertaken by Essex County Fire and Rescue services on 13/02/08 found risk assessments and safety measures in relation to maintaining fire safety in the home satisfactory. Fire safety equipment inspection is undertaken yearly and last inspected 09/03/07. Records indicated that checks of fire extinguishers, alarms and emergency lighting undertaken weekly. An inspection by Environmental Health in relation to health and safety in the workplace not undertaken since 22/12/05. Risk assessments still not in place with regard to the risk of hot water temperatures or individual vulnerability to hot water. The management of the hot water system in the home remains an issue requiring attention. Temperatures were noted to be very hot and control is difficult posing a health and safety risk for residents. The manager assured us that this is included in the improvement plans currently being undertaken. We will continue to monitor progress in this area. The manager showed us a statement of additional control measures to be taken during building works to the premises. The statements instructed staff to be vigilant, not to walk under scaffolding and to ensure building contractors do not leave tools around. Appropriate and comprehensive risk assessments and risk management strategies were not in place that looked at the wider issues and implications of increased risk from building works. The new extension was being erected externally and eventually knocking through into the existing main building. Residents windows were not protected from the building works directly on the other side and curtains had to remain closed throughout the day to maintain their privacy from workman directly outside their window. These issues were discussed with the manager who gave her assurances that she would bring them to the attention of Mr Dixon, the responsible person, identified as the representative for the company that owns the home and is also the builder. The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 2 2 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 2 X 2 The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 26 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. OP7 Standard Regulation 14 Timescale for action Recording of useful and critical 30/04/08 information obtained from needs assessments must be improved, used and regularly reviewed, to inform effective management strategies that are incorporated into the care planning arrangements. This would promote staff awareness and guide them in consistent monitoring and promptly identify any change. The home must provide a 30/04/08 sufficient number of functional baths to the number and assessed needs of the residents including suitable facilities that are capable of meeting the assessed needs as may be required for residents who are old, infirm or physically impaired such as an assisted bath. This is a repeat requirement not met within timescale of 31/01/06, 01/09/06 and 01/08/07. The Responsible Person must ensure sufficient number of functional baths to the number and assessed needs of the DS0000017980.V359977.R01.S.doc Version 5.2 Page 27 Requirement 2. OP19 OP21 OP22 23 The White House service users. Requirement still within previous given timescale. Building works not yet completed to meet this requirement. Room dimensions and layout 30/04/08 options must enable room on either side of the bed, to enable access for carers and any equipment needed to meet the assessed and changing needs of the resident, particularly in shared accommodation and rooms accommodating people with high mobility needs. Communal space must be sufficient to cater for residents assessed needs and the home stated purpose. Requirement still within previous given timescale. Building works not yet completed to meet this requirement. Sanitary facilities and vanity 30/04/08 units must be maintained or replaced as needed to ensure the health and safety of residents. Requirement still within previous given timescale. Building works not yet completed to meet this requirement. The home must ensure 30/04/08 appropriate laundry facilities are provided to meet National Minimum Standards and control the risk of infection. Requirement still within previous given timescale. Building works not yet completed to meet this requirement. Having regard to the number 30/04/08 and needs of the service users, the home must ensure DS0000017980.V359977.R01.S.doc Version 5.2 Page 28 2. OP23 23(2)(f) 3. OP25 23 4. OP26 13(3) 5. OP26 13(3) The White House appropriate sluicing facilities are provided separate from service users’ toilets and bathing facilities to control the risk of infection and meet with infection control guidance. Requirement still within previous given timescale. Building works not yet completed to meet this requirement. The home is required to establish 01/08/08 and maintain a system specific to reviewing and improving the quality of care provided and outcomes for service users to ensure the home is run in their best interests. The service must develop tools to gather the views of residents with cognitive impairment and include this in the quality assurance system as well as in consultation with regard to choices This is a repeat requirement not met within given timescale of 01/11/07. Residents must be supported by a staff group that is appropriately supervised. This is a repeat requirement not met within given timescale 01/11/07. 6. OP33 24(1)(a) (b) 7. OP36 18(2) 01/06/08 The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 29 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 OP7 Good Practice Recommendations There remains scope for developing a more person centred approach to care planning, with greater focus on identifying more preferences, maintaining strengths and abilities and detail on promoting independence and self worth. Consideration must be given to how the service users can receive a more individualised service tailored to meet all assessed needs. Health related risk assessments should be completed for residents, and link into the care planning process, so that management of the identified risk is clear. Social care aspects of care planning needs to develop in order to consider how best meaningful interaction can be provided according to individualised social needs to promote well being. The development of individual training and development profiles that use information gathered from supervision and residents needs assessments would further enhance the skills base of the service. 2. 3. OP8 OP12 4. OP30 The White House DS0000017980.V359977.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000017980.V359977.R01.S.doc Version 5.2 Page 31 - 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. 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