CARE HOME ADULTS 18-65
The White House 74 Reddown Road Coulsdon Surrey CR5 1AL Lead Inspector
Barry Khabbazi Unannounced Inspection 16 June 2005 10:00am 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 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 Stationary 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 G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The White House Address 74 Reddown Road, Coulsdon, Surrey, CR5 1AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 553 230 01737 553 230 Thw White House Megalen Govindan Care Home 5 Category(ies) of Learning disability (5) registration, with number of places The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1.The certificate is for 8 service users, adults 18-65 with variations for 3 older adults. 2.A letter is held on file confirming that, if a double room service user moves on, the remaining service user has the right to refuse to have another service user move into the room. Date of last inspection 11 April 2005 Brief Description of the Service: The White House is a detached two-storey house situated in Coulsdon, Croydon. There are three double and two single bedrooms as well as a dining room, kitchen and lounge. The home’s stated aim is to create a home with a warm and friendly atmosphere. There is easy access to local shops, library and places of worship. The home offers care to eight people with learning disabilities, some of whom have additional sensory impairments. The home is not adapted for and is not suitable for people with physical impairments affecting mobility. All residents attend local day resources. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 10.00 a.m. The inspection took place over 2 hours. During the last announced inspection the residents had decided to cancel their day centres for the day of the inspection, to facilitate meeting the inspector. This enabled all the residents to meet with the inspector during that inspection. During this inspection four residents were met and comments from residents at both inspections will be included in this report. At this inspection the manager/owner was interviewed. Records, policies and care plans, and the building were examined, as were the residents’ bedrooms. Only one existing requirement had been met since the last inspection. Although the last inspection occurred only two months ago, 4 out of the 8 remaining requirements were set at the 2004 inspection giving more than adequate time to be implemented. An action plan describing how and when the home intends to meet these requirements is therefore required. If this is not satisfactory further inspections may be made. What the service does well: What has improved since the last inspection?
The Statement Of Purpose now contains all the information required as set out in Standard 1. This will assist relatives and placing authorities in having a fuller understanding of what the home provides. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 6 Care plans are now more holistic and also cover social care needs. This should improve how well staff, particularly new staff, know a resident’s need. The home has produced a written risk assessment for the knives displayed in the kitchen. This will help to avoid unnecessary restrictions and risks. All staff now have medication administration training. This will reduce errors in medication administration and help staff identify any side effects to medication. Residents’ rooms now contain all of the items listed in Standard 26.2 unless the resident has made a positive choice not to and this is evidenced in their files. This will ensure that all the residents have the furniture they are entitled to and do not have to keep furniture in their rooms just because the Standards require it. The home has now acquired and filled in, the health and safety at work poster. This will ensure that all staff, particularly new staff, know who is responsible for health and safety at the home. The registered manager is now informing the Commission, in writing, of any event affecting the well being of a resident. This will allow the Commission to monitor and respond to incidents at the home. Since the last inspection, a damaged carpet has been replaced. More diligence is being practiced in the taking up of staff references as without these there is a higher risk of employing unsuitable staff. What they could do better:
The Service Users Guide is still not fully satisfactory, as it does not contain the views of the residents. This is important so that new residents are clear about how other residents feel about living in this home. Reviews are not occurring with a satisfactory frequency. This could affect the staffs’ knowledge of the changing needs of the residents. Although there has been progress in making relevant policies accessible to the service users more needs to occur in this area so that all service users can access relevant policies. Restrictions of liberty or pre-planned restraints are occuring without being fully recorded and evidenced, this could allow unnecessary restrictions of liberty for the residents. Each service user should be offered a seven-day holiday paid for by the home as a part of the contracted price. This would facilitate more funding and additional holidays for service users.
The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 7 Although there has been progress in implementing the induction training programme, the home has not completed staff foundation training within Sector Skills Council training specifications and timescales. This could also affect the home’s ability to meet all of a resident’s needs. Only limited progress has been made with regards to the frequency of staff supervision. This area therefore remains unsatisfactory. Only limited progress has been made with regards to the home implementing a quality assurance system and an annual development plan, with both involving service users. Although this could limit the involvement of the residents and relatives, residents have commented about being involved in decision making in practice. Further work needs to be done to confirm the water quality in the cold water storage tanks. This will protect residents from many infections, for example legionella and e-coli. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 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 standard(s) 1, and 2. The Statement Of Purpose now contains all the information required as set out in Standard 1. This will assist relatives and placing authorities in having a fuller understanding of what the home provides. The service users guide is still not fully satisfactory, as it does not contain the views of the residents. This is important so that new residents are clear about how other residents feel about living in this home. EVIDENCE: The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 10 The home has a new Statement Of Purpose and a new Service User Guide. These are clear and well laid out and reflect the changes in ownership. The last inspection report recorded that the Statement Of Purpose did not contain all the elements of Schedule 1, including, whether nursing is provided, the fire evacuation procedures, the specific relevant qualifications of staff and their experience in the field. This had occurred by the time of the last announced inspection and the Statement Of Purpose now meets the National Minimum Standards. The last inspection report also recorded that the Service User Guide did not contain all the elements of Standard 1.2 and 1.4, including the views of the service user, a copy of the complaints procedure, the fees and costs for extras, and this document needs to be also produced in more accessible formats. Most of the above was in place at the time of this inspection including pictorial cues to the guide, however the service users’ views were still not present. The home has not had a new service user start for at least 6 years. A completely new placement will need to be made before Standard 2 can be fully assessed. It was therefore not possible to assess Standard 2 fully at this time. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 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 standard(s) 6, 7, 8, and 9. Care plans are now more holistic and also cover social care needs. This should improve how well staff, particularly new staff, know a resident’s need. Reviews are not occurring with a satisfactory frequency. This could affect the staff’s knowledge of the changing needs of the residents. Although there has been progress in making relevant policies accessible to the residents, more needs to occur in this area so that all residents can access relevant policies Restrictions of liberty or pre-planned restraints are occuring without being fully recorded and evidenced, this could allow unnecessary restrictions of liberty for the residents. EVIDENCE: The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 12 The residents chose to stay at the home instead of attending their Day Centres as they wished to participate in the inspection process. This was supported by the home and additional staffing was provided to facilitate this Care planning follows a number of internal comprehensive assessments. The last inspection report recorded that: Plans of care were available for all service users but they did not all record all of a service user’s needs and how these are to be met. For example educational and training needs and family/social contact. This information was observed to be present in care plans inspected at the last announced inspection. The existing requirement is now met. The last inspection report recorded that Standard 8.2 requires the home to provide service users with accessible information regarding its policies activities and services. E.g. pictorial menus and complaints procedures. Although there are now pictorial menus, and pictorial cues to the service user guide, more work needs to be done, for example taped policies to facilitate access to those with a visual impairement. This requirement remains in force. The last unannounced inspection report contained a requirement for the kitchen knives on a rack on the wall of the kitchen to be risk assessed. These had been risk assessed by the last announced inspection and that existing requirement is now met. The last inspection report recorded that the risk assessment form does not contain the information required under Standard 9.4, in particular details of how training and other options have been explored before any restrictions of liberty are applied, and the involvement of relatives or independent advocates. This had not been fully implemented by the time of this inspection and this requirement therefore remains in force. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 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 standard(s) These standards were not assessed on this occasion. Please see the last announced inspection report for details of these standards. EVIDENCE: These standards were not assessed on this occasion. Please see the last announced inspection report for details of these standards. Residents commented positively about the home’s activities, talking or signing about recent outings, singing activities and visitors. The residents have been consistent in their views that they liked the meals. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 14 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 standard(s) 20. Residents’ medication is well managed to ensure maximised good health. All staff now have medication administration training. This will reduce errors in medication administration and help staff identify any side effects to medication. EVIDENCE: Residents are supported to attend outpatient appointments and other medical appointments. All staff now have medication administration training. Residents can self-administer medication subject to risk assessment. It is suggested that blister packs would facilitate better practice in administration of medication. The following evidence of good practice was presented: Residents all have pressure sore risk assessments. This also meets the Standards for Older People, as required. As the home accommodates only 3 residents over 65, is seen as good practice for the rest. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 15 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 standard(s) 22 and 23. On the whole this home manages complaints well. Although the complaints procedure is now more accessible, further developments would facilitate better access to the complaints system for the residents. The home’s policies and procedures relevant to this Standard currently facilitate protecting residents from abuse. EVIDENCE: There had been no official complaints at or since the last inspection. The complaints procedure was clear and contained all of the elements required to meet Standard 22 including a minimum response time of less than 28 days. Policies were observed that protected the service users, and records were in good order. The home has a Restraints Policy, a Whistle Blowing Policy, a Gifts/Gratuities Policy, a Bullying Policy and a copy of the Local Authority Adult Protection Procedure on site. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 16 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 standard(s) 26, and 30. Residents’ rooms now contain all of the items listed in Standard 26.2 unless the resident has made a positive choice not to and this is evidenced in their files. This will ensure that all the residents have the furniture they are entitled to and do not have to keep furniture in their rooms just because the Standards require it. The home is clean and hygienic which promotes a pleasant environment, the residents health, and emotional well-being. EVIDENCE: The residents have been consistent in their views that they liked their rooms. The premises were clean, and free from offensive odours at both the announced and this unannounced inspection. The home has specific policies covering the disposal of clinical waste, control of infection, use of cleaning materials, hygiene, storage and preparation of food, communicable diseases, disposal of clinical waist, and dealing with spillages. There are Control Of Substances Hazardous to Health data sheets in their own file. Protective clothing was observed to be present. Laundry facilities have easily cleanable non-permeable walls. Washing machines had appropriate programmes over 65 degrees to control risk of infection and a sluicing cycle. The laundry room was positioned so that laundry does not need to be carried through the kitchen.
The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 17 Files and rooms samples showed that residents’ rooms now contain all of the items listed in Standard 26.2 unless the resident has made a positive choice not to and this is evidenced in their files. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35, and 36. Although there has been progress in implementing the induction training programme, the home has not completed staff foundation training within Sector Skills Council training specifications and timescales. This could also affect the home’s ability to meet all a resident’s needs. More diligence is being practiced in the taking up of staff references as without these there is a higher risk of employing unsuitable staff. Only limited progress has been made with regards to the frequency of staff supervision. This area therefore remains unsatisfactory. EVIDENCE: The 2004 annual inspection report contained a requirement for the home to implement a new 6-week induction and 6 month foundation training programme, and ensure that this meets Sector Skills Council training specifications. This induction training had occurred by the time of this inspection but did not then go on to foundation training. This requirement will remain in force until fully met. This home has an equal opportunities recruitment policy. Criminal Record Bureau checks were present for all staff. External volunteers are not currently used at this home. The staff files sampled also contained interview notes, statements of terms and conditions and staff photographs.
The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 19 The last inspection report contained a requirement for staff files to contain two references. This had occurred by the time of this inspection and that requirement is now therefore met. The last inspection report contained a requirement for staff to receive a minimum of six supervision sessions per year. Extra sessions are being provided to facilitate catching up with the required frequency. The existing requirement will remain in force until fully met. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, and 42. Only limited progress has been made with regards to the home implementing a quality assurance system and an annual development plan, with both involving service users. Although this could limit the involvement of the residents and relatives, residents have commented about being involved in decision making in practice. Further work needs to be done to confirm the water quality in the cold water storage tanks. This will protect residents from many infections for example legionella and e-coli. EVIDENCE: Although the last inspection occurred only two months ago, 4 out of the 8 remaining requirements were set at the 2004 inspection giving more than adequate time to be implemented. An action plan describing how and when the home intends to meet these requirements has therefore been required. If this is not satisfactory further inspections may be made. The last report recorded that quality assurance tools currently include service user meetings, user/relatives satisfaction surveys, auditing and a complaints
The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 21 system. Residents and relative satisfaction surveys and an annual development plan were identified as quality assurance tools that were still required. Although questionnaires have now been developed they still need to be sent out and the information included an annual development plan where applicable. The existing requirement remains until fully met. Bacterial analysis certificates for the cold water tank were out of date and need to be re-tested. A new requirement was set regarding this. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9
The White House Score 2 2 2 2 Standard No 24 25 26 27 28 29 30 Score 3 x 3 x x x 3
Version 1.20 Page 22 G53 S58633 WhiteHouse V227438 160605 Stage4.doc 10
LIFESTYLES x
Score STAFFING Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 23 yes Are there any outstanding requirements from the last inspection? 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 1 Regulation 12[3] Requirement The Service User Guide must contain the views of the service users. {Previous timescale of 1/3/2005 not met} Residents care plans must be reviewed every 6 mnths and this must occur on a monthly basis for those residents over 65. The home must provide service users with accessible information regarding its policies, activities and services. Specific risk assessments must be produced where any restrictions of liberty or preplanned restraints are assessed as necessary for the protection of service users. These risk assessments must contain details of how training and other options have been explored and the involvement of relatives or independent advocates. {Previous timescale of 1/10/2004 not met} The home must now implement its foundation training programme and ensure that this meets Sector Skills Council training specifications. [35.3] {From the June 2003 inspection} Timescale for action 1/7/2005 2. 6 15[2]b 1/12/2005 3. 8 12[4]b 1/12/2005 4. 9 17[1]a 1 3[7] 1/7/2005 5. 35 18[1] 1/7/2005 The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 24 6. 7. 36 37 18[2] 36 8. 39 24,1,2,3 9. 42 13[1]3 Recorded supervision must occur at least 6 times per year. The home must supply the Commission with an action plan which specifies how and when existing requirements will be met. The home must pull together its Quality Assurance tools into a structured Quality Assurance system that makes the service users central to the process. The home must also introduce an annual development plan that is open to the service users, to allow measurement of achievement in improving quality.{Previous timescale of 1/4/2005 not met} The home must send the water testing certificates to the Commission.{Previous timescale of 1/7/2005 not met} 1/10/2005 1/8/2005 1/10/2005 1/7/2005 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 14 Good Practice Recommendations Each service user should be offered a seven-day holiday paid for by the home as a part of the contracted price. The White House G53 S58633 WhiteHouse V227438 160605 Stage4.doc Version 1.20 Page 25 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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