Inspection on 20/03/06 for The White House

This inspection was carried out on 20th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The White House 22/07/08

The White House 30/08/07

The White House 24/01/07

The White House 08/11/05

The White House 14/02/05

The White House 14/09/04

The White House 18/02/04

The White House 04/09/03

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

CARE HOMES FOR OLDER PEOPLE The White House 95 Maidstone Road Chatham Kent ME4 6HY Lead Inspector Robert Pettiford Announced Inspection 20th March 2006 9:15 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 DS0000029048.V278993.R01.S.doc Version 5.1 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 DS0000029048.V278993.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The White House Address 95 Maidstone Road Chatham Kent ME4 6HY 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) 01634 848547 01634 845320 Mr Chistos Adamou Nicolaou Mrs Lynn Nicolaou Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2005 Brief Description of the Service: The White House occupies detached premises, with accommodation provided over 2 floors; there is a shaft lift installed to the first floor. The home is on a bus route and is situated within easy reach of Chatham town centre. Within the home there is a large communal lounge, with a further lounge/dining area adjacent. There is a garden to the rear of the property for residents’ use; at the front of the building there is space available for car parking. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced Inspection at The White House took place on 20th March 2006. The Inspector agreed and explained the inspection process with the owners. Documentation and records were read. A tour of premises was also undertaken. The focus of the inspection was to assess The White House in accordance to the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. As this report was made following an announced visit and may not cover the standards in sufficient depth for the reader to make a judgment about the home, it is recommended that a copy of the last unannounced inspection report dated 8th November 2005 also be obtained. What the service does well: What has improved since the last inspection? Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. Residents benefit from being given opportunities to participate in a wide range of activities. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 6 What they could do better: 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 DS0000029048.V278993.R01.S.doc Version 5.1 Page 7 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 DS0000029048.V278993.R01.S.doc Version 5.1 Page 8 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): Not inspected on this occasion EVIDENCE: The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 9 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): 7,8,10 Service users do not always benefit from having clear and in-depth care plans that identify their individual needs, identify risks and give clear guidance to staff. Service users can feel confident on the whole that they have full access to healthcare professionals and that the home ensures that all their needs are met. Service users are treated with respect and their dignity and independence is promoted. Service users’ privacy and dignity are promoted within the home EVIDENCE: The service users’ plans are generated from the assessment. The service user plans seen detailed limited actions required in some cases in order to meet the service users needs. The presentation was seen to be confusing with details of care split amongst several folders. The care plan file contained many out of date assessments and documentation that was in need of some degree of reorganisation and filing. The actions required to support the level of care was The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 10 not detailed and showed comments like “needs some support”. Evidence of regular reviews was noted. Evidence of risk assessments was seen however following a review of the accident forms not all accidents had been translated into revised risk assessments to reduce the risk of injury. It was apparent that ‘communication’ is an area that has been particularly focused upon; in addition to ‘in-house communication’, emphasis has also been given to ensuring that outside agencies involved in the residents’ care are kept informed of the residents’ progress or any situation that has arisen which may affect their welfare. The home is to be commended on its efforts to translate the basis of the care to be given in a format more readably understandable by many of the service users. It was recommended by the inspector and following discussion that a clearer system should be considered that draws in all the information into one document to assist the care worker in delivering the care. It was suggested by the inspector that it follows the following headings. Needs (What are the assessed needs?) Objectives (What do you want to achieve? Action (Agreed action and by whom?) Comments, Review Date The inspector viewed a sample health care records relating to several service users. Records viewed confirmed service users had access to a range of health care input as and when required and as part of regular health checks. This included access to their chosen G.P (where possible), and Chiropodist in addition to identified specialist health care input. The community district nurse has undertaken regular visits to the Home to address healthcare issues. No evidence was available however that all service users had been regularly weighed. Service users’ needs are not identified with regard to dental and opticians. The home presently relies on family and friends to ensure that this healthcare need is met. The home was requested to review this practice and ensure that the home takes responsibility to ensure that all needs are met and that service users have full access to services without the reliance of relatives or friends. Facilities and procedures at the Home seek to ensure service users’ privacy and dignity at all times and when providing health and personal care. Service users receive their mail unopened and have easy access to use a telephone in private. Staff were observed to address service users in a respectful manner and were observed to knock and seek permission before entering service users’ rooms. Records are kept in a secure locked facility. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 11 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, Service users benefit from being given opportunities to participate in a wide range of activities. Service users are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. EVIDENCE: Service users’ interests and preferences have been and are ascertained on an ongoing basis. A varied range of activities has been arranged on a day-to-day basis including games, quizzes, movie afternoons, arts and crafts, visiting entertainers and Church visits. Several of the service users visit the local Church on a Sunday morning. A record had been kept of service users taking part in activities that indicated a fair take up of those on offer. The staff there show an understanding of the residents motivational needs and are proactive in finding new activities that interest them an individual and group basis. Involvement in the home by local community groups accords with service users preferences. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 12 Service users may receive visitors and family /friends at any reasonable time. The home encourages visitors and is proactive in making them feel welcome. and the activities on offer incorporate activities within the community. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 13 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): 16,18 Service users know that their concerns and complaints are taken seriously and that policies and procedures are in place. Service users are not fully protected from the risk of abuse due to the lack of training for some of the staff with regard to Adult Protection and an updated Adult procedure policy. EVIDENCE: The home is proactive in dealing with any complaints or concerns. The home has a complaints procedure that clearly outlines the service users rights to complain and who to contact should they wish to take the mater further. The procedure has now been presented in a more easily understood format and contains information for referring a complaint to the Commission for Social Care Inspection. The inspector also suggested that it also contains the telephone and addresses of Social Services. The homes knowledge of Adult Protection principles and practice was not commensurate with the required standard. Staff training in this area has been provided, but not all staff have received said training. Future provision has been planned for. However the homes adult protection procedures was in need of revision and updating to ensure that it follows the Kent and Medway Adult Protection Protocols. The home’s procedures needs to describe the functions and purpose of the local area adult protection team and make it clear that they should be The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 14 contacted as soon as possible after any adult protection concerns / suspicions have come to light. The inspector reviewed recruitment procedures with regard to ensuring that all staff had been suitably vetted and a CRB (Criminal Records Bureau) check obtained. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 15 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): 19,25 Service users benefit from living in a home which is decorated and maintained to a high standard. Service users cannot feel confident that the home provides a wholly safe environment where water temperatures are regulated to meet the National Minimum standards. EVIDENCE: Over the last two years extensive redecoration/maintenance to the premises has been carried out, with new carpets having been laid throughout the communal areas and within some bedrooms. The work undertaken has helped to create a ‘bright and welcoming’ feel to the home, offering residents a comfortable and ‘homely’ environment. Within the home there is a large lounge, with an adjacent dining/ lounge area. Residents are able to freely use all communal areas including the entrance hall area, where seating has been placed; during the Inspection residents were seen to be using all the communal areas of the home including the entrance hall and adjacent corridor areas. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 16 On viewing the home residents’ bedrooms were noted to offer a comfortable environment, with many bedrooms having been ‘personalised’ by the resident occupying the room, creating a ‘comfortable and homely feel’. The Manager commented that a personal telephone line could be installed within any service users bedroom upon request. On evidence seen during the inspection and following discussions with the owner the home does not currently meet with standard 25.8 which requires that water is stored at a temperature of at least 60 C and distributed at 50 C and prevent risks from scalding with the installation of pre-set valves of a type unaffected by changes in water pressure and which have fail safe devices that are fitted locally to provide water close to 43 C. o o o The home was requested to include within the homes action plan the actions to be taken to meet with standard 25.8 The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 17 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 Service users can feel confident that their care, social and emotional needs will be meet by sufficient staff on duty at all times who have on the whole the training and skills they need to meet their needs. EVIDENCE: From discussions with the acting manager, observations and reviewing the staff rotas sufficient staff were on duty at the time of inspection to meet the service users basic needs. The staff training records indicated planned and undertaken training. The manager evidenced that individual and group staff training needs had been identified. A wide range of training has been identified for all staff over and above core skills courses. Dementia training has been provided to support service users further although not all staff have received such training. Some shortfalls were noted with regard to training for night staff. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 18 First Aid, Food Hygiene, Health and Safety and other core courses are undertaken to maintain current qualifications and for protection of service users. The number of staff having attained or who are working towards attaining a relevant National Vocational Qualification demonstrate commitment to ensuring there is a suitably trained workforce. A copy of the induction programme was inspected. The topics reflected those set out by the National Training Organisation. However not all staff have received induction training to the required guidelines. The home was requested to review its training and induction programme and include within the homes action plan. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 19 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): 38 Service users on the whole can feel confident that their health and safety is protected. EVIDENCE: The inspector viewed records relating to Health and Safety Procedures, maintenance and servicing, and risk assessments. The inspector viewed the Fire Log book, which was on the whole up-to-date, reflecting that checks and servicing of fire safety equipment had been undertaken at the required frequency. Procedures are available for the reporting of accidents and incidents (Regulation 37). Shortfalls were noted with regard to actions taken to minimise identified risks to service users with regard to the regulation of hot water temperatures. Some further shortfalls were noted with regard to staff training with regard to COSH (containment of hazards hazardous to health) and infection control, environmental risk assessment. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 20 Following a review of accidents and incidents occurring within the home a pattern of minor injuries had been identified that had not been translated to the risk assessments for the identified service users concerned within the home. The home was unable to demonstrate that steps had been taken to minimise such risks. The home was requested to review standard 38 to ensure that it meets with said standard. The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 21 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x 2 x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 2 The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement 15.—(1) Unless it is impracticable to carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. 12.—(1) The registered person shall ensure that the care home is conducted so as— (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. 13.—(1) The registered person shall make arrangements for service users— (a) to be registered with a general practitioner of their choice; and (b) to receive where necessary DS0000029048.V278993.R01.S.doc Timescale for action 20/09/06 2 OP8 12(1) 13(1) 20/06/06 The White House Version 5.1 Page 23 3 OP18 12(1) 4 OP25 13(3) 5 OP27 18(1) 6 OP38 12(1) 13(2) treatment, advice and other services from any health care professional. 12.—(1) The registered person shall ensure that the care home is conducted so as— (a) to promote and make proper provision for the health and welfare of service users; 13.—(3) The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (4) The registered person shall ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, 18.— (1) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; 12.—(1) The registered person shall ensure that the care home is conducted so as— (a) to promote and make proper provision for the health and welfare of service users; 13.—(3) The registered person shall make suitable DS0000029048.V278993.R01.S.doc 20/06/06 20/09/06 20/09/06 20/09/06 The White House Version 5.1 Page 24 arrangements to prevent infection, toxic conditions and the spread of infection at the care home. (4) The registered person shall ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The White House DS0000029048.V278993.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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