Inspection on 22/01/09 for The White House

This inspection was carried out on 22nd January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The White House 15/02/08

The White House 30/08/07

The White House 28/02/07

The White House 10/03/06

The White House 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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The White House 11 Coggeshall Road Braintree Essex CM7 9DB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Love     Date: 2 2 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: The White House 11 Coggeshall Road Braintree Essex CM7 9DB 01376326847 01376345966 kathy.whitehouse@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Avidcrave Limited Name of registered manager (if applicable) Mrs Kathleen Teahon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of old age only. The total number of service users accommodated in the home must not exceed 16 persons. Three persons, over the age of 65 years, whose names are known to the Commission, who require care by reason of dementia Date of last inspection Brief description of the care home The White House is a care home registered to provide accommodation, personal care and support to sixteen people over the age of 65 years, not falling into any other category. The home is registered to meet the needs of people with dementia. The White House is a detached two-storey property, accommodation is provided on the Care Homes for Older People Page 4 of 33 3 0 Over 65 0 16 care home 16 Brief description of the care home ground and first floor in ten 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 weekly fees confirmed at this inspection, are from 444.94 to 500.00. There are additional costs for hairdressing, chiropody, toiletries and newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 8.5 hours, with all but one key standard inspected. Additionally, progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the manager had submitted an Annual Quality Assurance Assessment. This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the Care Homes for Older People Page 6 of 33 general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for residents, relatives, staff and healthcare professionals were forwarded to the home for distribution and for people to complete and return to us. Where surveys have been returned to us, comments have been incorporated into the main text of the report. The manager, deputy manager and other members of the staff team assisted the inspector on the day of inspection. Feedback on the inspection findings, were given as a summary to the manager/deputy manager. The opportunity for discussion and/or clarification was given. What the care home does well: What has improved since the last inspection? What they could do better: Further development is required in relation to care planning and risk assessing processes, so as to ensure that individual plans of care are comprehensive, up to date and reflective of peoples current care needs. Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that residents are protected. Further training and personal development is required for staff to ensure that they have the skills and competence to meet peoples needs. Staff supervision needs to be improved as currently this is not undertaken regularly for some people. Outcomes for people would be further improved by the implementation of a quality assurance system, which monitors and reviews the quality of care/service and facilities provided at the care home. This would ensure that the care home is run in the best interests of the people who live there. Care Homes for Older People Page 8 of 33 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current and prospective people are provided with sufficient information so they can make an informed decision as to whether or not The White House is the right choice for them. The care needs of individual people are assessed before they are offered a placement. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff team are able to meet the prospective service users needs. Admissions are not made to the home until a full assessment is undertaken. The pre admission assessment document was noted to be comprehensive and detailed and where appropriate additional information had been sought from the persons placing authority and or hospital. The AQAA details that the above format has been developed since the last inspection so as to include a wider range of information. Care Homes for Older People Page 11 of 33 Evidence: On inspection of 2 care files for those people newly admitted to the care home, evidence showed that pre admission assessments were completed by the management team of the home prior to the persons admission. Information recorded was observed to be detailed and informative. There was clear evidence to show that where appropriate the pre admission assessment process had been undertaken with the service user and/or their representative. Only one pre admission assessment recorded that the service user and their representative had been provided with an opportunity to visit the care home prior to admission, however we were advised by the management team of the home that a visit had been conducted. One service user spoken with was able to confirm that they had been involved in the above process and had found this to be a positive experience. The AQAA details we encourage prospective service users and their representatives to visit the home, enjoy a cup of tea and a chat with existing service users. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the services/facilities provided. The home does not provide intermediate care. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that their care needs, wishes, preferences and risks to their well being will be clearly recorded within a plan of care. Shortfalls were identified in relation to some aspects of medication practices and procedures. Evidence: As part of this site visit 3 care plans were examined. Records showed that there is a formal care planning system in place to help staff identify the care needs of individual service users and to specify how these are to be met by care staff. We were advised by the registered manager and deputy manager that a new care plan format has been introduced since the last key inspection. In general terms the care plans were seen to be detailed and informative, recording service users physical, healthcare, emotional and social care needs. Additionally there was good information depicting individuals personal preferences, likes and dislikes e.g. the sleeping care plan for one person recorded specific information relating to the number of pillows they required, their choice of night time drink, their preferred time Care Homes for Older People Page 13 of 33 Evidence: for retiring to bed/rising in the morning, whether or not they wished to have their door open/shut and if they wished to have a light on/off. Some further development in care planning/risk assessing is required to ensure that the care needs of individual people are clearly recorded and staff have the most up to date information to ensure appropriate levels of care delivery. This refers specifically to the weight monitoring record for one person showing a weight loss of over 5KG in two months. The weight monitoring record stated that at the beginning of January 2009, the persons weight was to be undertaken weekly and not monthly, however records showed this had not been undertaken at the time of the site visit. The manager advised that the rationale for this was that the service user was unsettled. The plan of care recorded the person as requiring encouragement to eat their meals, having a small appetite and to be weighed monthly. The latter did not concur with instructions as detailed on the weight monitoring record. Daily care records evidenced on several occasions that the service user refused their meals on occasions, however this was not recorded as part of the plan of care. A risk assessment was in place in relation to the persons nutrition, however additional information is required detailing the steps to be taken to minimise the risk. The care plan for the above person also recorded them as being breathless and mobilising with a walking aid. No manual handling assessment was available. Another plan of care also recorded the person as requiring a soft diet and having drinks thickened. The rationale as to why they required a soft diet was not recorded, however staff were able to advise the inspector as to the reason. Records showed that the person was weighed monthly and since April 2008, the person was recorded as having lost approximately 10KG in weight. No information was recorded detailing how the above was being proactively managed. There was evidence to show that for a 4 month period (May to August 2008 inclusive) the above was not reviewed. No risk assessment was devised for the above. Additionally the persons care plan recorded that they should be regularly stood up so as to relieve pressure on their sacrum. The manual handling assessment had not been updated since May 2008 and during the site visit, there was no evidence to show that the above instruction was being regularly carried out by staff. Daily care records evidenced that in December 2008 the person developed a pressure sore and that appropriate healthcare professionals were providing interventions. A body chart was completed detailing the above, however no plan of care and/or risk assessment was devised. An instruction was recorded detailing that the person should have their bodily position changed during the night, however records showed that this was not being undertaken consistently. In general terms of those care files inspected, risk assessments were not devised for all areas of assessed risk and in some cases records had not been reviewed/updated Care Homes for Older People Page 14 of 33 Evidence: for several months depicting peoples current care needs. Daily care records were observed to be written daily, however records were seen to be inconsistent, with some records providing informative and detailed information, while others did not reflect staffs interventions and/or outcomes. Both the manager and deputy manager concurred with this observation and stated that staff had been reminded to address the above. Staff meeting minutes provided further evidence that the above issues had been discussed in May and November 2008. The AQAA details under the heading of what we could do better, Residents reviews need to be kept up to date. Changes in needs need to be identified and documented. More risk assessments need to be put in place. The AQAA also details that within the next 12 months it is hoped that staff will receive care planning training and risk assessments will be put in place. Interaction between the people living at The Whitehouse and staff was observed to be positive. Staff were noted to be friendly and to provide care and support in a respectful and dignified manner. It was evident that staff had a good understanding and knowledge of peoples care needs and their personal preferences, likes and dislikes. Surveys returned to us from service users and their relatives, recorded positive comments about the care provided at the care home. People felt that the support and care they received was appropriate and that people are treated with kindness, friendliness, respect and dignity. One relatives survey recorded, Provides an excellent level of care for my [name of relative] which means we have complete peace of mind about their wellbeing. Medication practices and procedures were examined. The majority of medication is managed through a monitored dosage system (blister pack) and individually named containers. Medication was noted to be stored securely. Where medication required cold storage, the temperature of the fridge was recorded daily and this was noted to be within recommended guidelines. The manager and deputy manager were advised that a daily temperature should be kept where other medication is stored, so as to ensure this does not deteriorate and/or lose its effectiveness. On inspection of Medication Administration Records (MAR) these showed that an individual profile has been completed for each person and this includes a photograph. Evidence showed there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR record had been left blank and not signed or initialed by staff. Records for one person showed that one of their medications was not being administered in line with the prescribers instructions. This refers specifically to one medication having an instruction for this to be administered three times daily, however records showed for a consecutive period of 10 days this was administered twice daily. On inspection of their care file/daily care records/healthcare records, there was no evidence to show that the above instruction Care Homes for Older People Page 15 of 33 Evidence: had been reviewed by the persons GP. The MAR record for one person showed they were prescribed once weekly medication (Alendronic Acid). Following discussions with one senior member of staff who administers medication, it was unclear as to whether or not the specific instructions pertaining to this medication (to be administered 30 minutes before food/other medications and to be sat up) were consistently being followed. They confirmed that this medication had on occasions been administered at the same time as other medication. Where PRN (as and when required) medication is prescribed, as part of good practice procedures, an individual protocol should be devised and implemented. Appropriate storage facilities were available for Controlled Drugs. Records and actual medication available was examined for one person and records/actual medication were noted to be accurate. A list of people who administer medication was provided by the manager. Training records showed that not all had up to date evidence of medication training and the majority of staff have not been assessed as to their continued competence to carry out the above task. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the care home can be assured that they will have their social care needs met and will receive a satisfactory diet according to their individual needs. Evidence: Each of the care files examined included information relating to individuals social care needs and their personal preferences, likes and dislikes and past interests. It was positive to note that since the last key inspection, information relating to family histories and past interests has been clearly recorded. Information seen was observed to be detailed, informative and undertaken in conjunction with the service user and/or their representative. All staff working at the care home are responsible for promoting and engaging service users within a varied programme of activities. The AQAA details that it is hoped within the next 12 months for an activities co-ordinator to be recruited. Activities to be undertaken on any given day are recorded on a notice board in the main lounge. The manager and deputy manager were advised to consider devising the activity programme in larger print and/or pictorial format so as to enable people in the home to make an informed choice. Activities available to people include chair exercises/keep Care Homes for Older People Page 17 of 33 Evidence: fit, sing-a-long, ball games, word games, hairdresser, board games, down memory lane, carpet bowls, bingo, whats in the news, religious observance and television/films. On the day of the site visit, people were observed to be encouraged to participate in chair exercises and whats in the news during the morning. Service users were observed to enjoy these and afterwards to undertake other personal interests e.g. watching television, reading a newspaper/magazine. There was limited evidence from the records inspected on the day of the site visit, to show that people have the opportunity to engage in activities outside of the home environment. However it was noted that one person was taken out by their relative for lunch and the manager advised that one person attends adult education classes three times a week and another person goes to church once weekly. The AQAA details that it is hoped within the next 12 months for people to access the local community more frequently. There is an open visiting policy at the care home, whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the care home are actively encouraged and supported to maintain friendships and relationships. The manager advised that one person visits their family most weekends. There is a rolling 4 week menu within the home. The menu for the day was displayed on a notice board in the main lounge. The manager and deputy manager were advised to consider devising the menu in larger print and/or pictorial format so as to enable people in the home to make an informed choice. Some service users when asked, were able to confirm what was available for the lunchtime meal. The lunchtime meal was observed and this showed that meals provided to service users were attractively presented and portions of food seen to be appropriate. The table was attractively laid with a tablecloth, placemats, serviettes, cutlery and condiments. Where assistance and support to individual service users was required, this was seen to be both respectful and sensitive. A choice of drinks was readily available for people. Positive comments relating to food/meals were provided by people within the home and included, Oh, the food is very good, I have no complaints and its lovely. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their complaints will be listened to and they will be protected from abuse, neglect and self harm, however they cannot be assured that staff working at the care home are appropriately trained in safeguarding. Evidence: There is an appropriate complaints policy and procedure in place at The White House. Since the last key inspection 3 complaints/issues have been raised, pertaining to environment and food. Records showed that the management team of the home dealt with the above and all issues were resolved in a timely manner. From speaking with people and from evidence detailed on service user/relative surveys, there was evidence to show that people know how to make a complaint and if the need arose, knew who to speak to. People advised that they had confidence in the management team of the home. As seen on previous inspections to the home, there is an appropriate safeguarding policy and procedure in place, including local guidelines. No safeguarding issues have been raised since the last key inspection. Staff spoken with demonstrated a basic understanding and awareness of safeguarding procedures and advised that should an issue arise, information would be passed to the person in charge and/or manager/deputy manager. Of those staff training records sampled, the majority of staff do not have up to date safeguarding training. The manager advised us that Care Homes for Older People Page 19 of 33 Evidence: safeguarding training is planned for March 2009. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is comfortable, safe and homely which meets their needs. Evidence: A partial tour of the premises was undertaken at this key inspection with the manager. We were advised that since the key inspection, improvements to the environment have been undertaken and these include, the lounge area has been extended (so as to create a quiet lounge/television room), a loop system has been introduced for those people who are hard of hearing, 4 bedrooms with en-suite facilities have been newly created, a new bathroom has been installed, thermostatic valves have been fitted on all baths/wash hand basins and a sluice room has been created on both the ground and first floor. The AQAA details that within the next 12 months it is hoped that redecoration will be undertaken throughout the home, to create a sensory area within the home and for the garden to be redesigned. A random sample of service users bedrooms were inspected and all were observed to be personalised and individualised. People spoken with confirmed that they like the premises/their own private space. One health and safety issue was raised at the time of the site visit and this related to hot water emitting from a wash hand basin on the first floor (sluice room). This was Care Homes for Older People Page 21 of 33 Evidence: alerted to both the manager and deputy manager at the time and as a result of this, they were advised to put appropriate measures in place to ensure that people living within the home were safeguarded and not placed at risk. We were notified the following day that the maintenance person had visited the home shortly after the inspection visit, and a lock had been placed on the door. We were advised that a maintenance person is employed at the care home Monday to Friday (08.00-17.00), however their hours are flexible and on call arrangements are in place. A random sample of maintenance records/certificates were examined and these showed that fire drills are undertaken regularly, fire alarms, emergency lighting and fire extinguishers are tested once weekly, and following the fire officers visit to the home in February 2008, a satisfactory standard of fire safety had been attained. Other certificates were examined in relation to the passenger lift, gas and electrical safety installation, hoists and employers liability and all were noted to be in date. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are in safe hands, however they cannot be assured that staff are appropriately trained to meet their care needs. Evidence: We were advised that the staffing levels at the care home are 3 members of staff (including designated shift leader) between 07.45 a.m. and 21.45 p.m. and 2 waking night members of staff (including designated shift leader) between 21.30 p.m. and 08.00 a.m. each day. In addition to the above a cook and housekeeper is employed each day. The manager is on site Monday to Thursday 06.30 a.m. to 16.30 p.m. and is supernumerary to the above staffing levels. Since the last inspection a deputy manager has been employed at the home to provide additional support to the manager. On inspection of 4 weeks staff rosters, these showed that staffing levels as detailed above have been met. The deployment of staff to meet service users care needs were observed to be appropriate according to the numbers of people living in the home and their dependency levels at the time of the site visit. Service users were observed to receive care and support in a timely manner and staff were attentive to individuals needs and wishes. Staff morale within the home was observed to be positive and this was confirmed by 3 members of staff spoken with at random. Care Homes for Older People Page 23 of 33 Evidence: At this site visit, 2 staff files were inspected for those staff newly appointed. The majority of records as required by regulation were evident, however no recent photograph was available for either person and no proof of identification was available for one person. Additionally a record of induction was not available for either person. The manager advised that a 3 day induction was being undertaken the week of the inspection, however whilst we recognise this, both people had commenced employment at The White House in December 2008. Records showed there is a low turnover of staff and several members of staff have been employed at the care home for a significant period of time. A random sample of 9 member of staffs training records were examined (including records for the newest people employed). Gaps in training pertaining to both core and specialist subject areas were apparent for some people as these were either out of date or had not been undertaken. It was of concern that not all members of staff have undertaken dementia awareness training, yet the care home is registered to admit people who have a diagnosis of dementia. This, and previous inspections, continues to highlight shortfalls pertaining to staff training. At the time of the site visit, 10 people had attained NVQ Level 2, 1 person had attained NVQ Level 3, 1 person was currently undertaking NVQ Level 3 and we were advised that 1 person is interested in commencing NVQ Level 3. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general terms the home is well run and provides positive outcomes for people, however there is a lack of sustained improvement in several key areas. Evidence: The manager has many years experience in caring for older people. The manager has attained the Registered Managers Award NVQ Level 4, City and Guilds Advanced Management in Care and other relevant courses. The deputy manager has many years of experience in the care sector (Social Services) and has attained NVQ Level 2. The AQAA details that the management team of the home operate an open door policy whereby service users, relatives and other interested parties can meet with the management team of the home to discuss any issues in an open and transparent way. The Statement of Purpose details that the ethos of the home, is to promote a homely, comfortable, friendly and happy environment in which good practices are adopted and residents are individually supported to meet their ever changing needs. At the White House we aim to provide consistently high standard of professional care in order that Care Homes for Older People Page 25 of 33 Evidence: those we care for can live normally as possible where their individuality, independence and dignity are respected and upheld. It is evident from this inspection that environmental issues as highlighted at the last key inspection have been addressed and that work was undertaken to improve the homes care planning/risk assessing processes. It is evident at this inspection that further development is required in relation to some aspects of care planning/risk assessing, medication practices and procedures, that there is an appropriate training programme in place for staff which enables them to update their existing knowledge and ensuring that staff receive regular supervision. It is evident despite the above shortfalls that people living within the care home are provided with a good level of care and support. The atmosphere within the home is relaxed and positive and service users benefit from this. Several surveys returned to us recorded that people felt the manager was very approachable and understanding, that the service provided at The White House, makes the residents feel important and nothing is too much trouble and things are as they should be, its a well run home. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was generally informative and detailed and it gave an accurate account of the current situation within the service. A random sample of staff supervision records were examined. Records showed that for some staff there is no record of supervision and that for others, these are not happening in line with National Minimum Standards recommendations. Both the manager and deputy manager confirmed this and advised that following the last key inspection, emphasis was placed on care planning/risk assessing. While we recognise this, the above remains outstanding from the previous inspection to the home. The manager advised that questionnaires have been devised pertaining to Quality Assurance, with a view to seeking the views of others about the quality of the service/facilities provided at The White House. It is disappointing that no further progress has been made prior to this inspection, as the previous key inspection to the home recorded that questionnaires had been developed and no further action had been undertaken. The AQAA details under the heading of what we could do better, quality assurance needs to be fully addressed to meet requirements. It also details that within the next 12 months it is hoped for a consultant in to train management on quality assurance. Records showed that staff and resident meetings have been undertaken, however records showed that these do not take place regularly. We were advised that the registered providers visit the home most days, however only 2 Regulation 26 reports were available (7/2/2007 and 5/1/2009). Care Homes for Older People Page 26 of 33 Evidence: The AQAA provides a list of policies and procedures currently available within the home. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24(1)(a) (b) The home is required to 01/04/2009 establish 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 timescales of 1/11/07 and 1/8/08. 2 36 18(2) Residents must be supported 16/03/2009 by a staff group that is appropriately supervised. This is a repeat requirement not met within given timescales of 1/11/07 and 1/6/08. Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be 13/03/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps to be taken to reduce the risk. So as to ensure that risks are minimised for people and there are clear guidelines for staff to follow to ensure peoples safety and wellbeing. 2 7 15 Care planning at the home must identify, and be effective in meeting all residents assessed needs and ensure these are regularly updated and reviewed to reflect the most up to date information. This will ensure that staff have the most up to date information and can provide 13/03/2009 Care Homes for Older People Page 29 of 33 appropriate care to meet their needs. 3 9 13 Residents must be protected 20/02/2009 from harm by having their medication administered safely and in accordance with the prescribers instructions. So as to ensure residents safety and wellbeing. Medication must be stored under suitable environmental conditions and records of the temperatures of the storage areas must be kept to show this. This will ensure that residents receive medicines that are effective. Ensure that when medication is not administered to residents, records clearly record this, the rationale why they are not and any action taken to address the above. This is to ensure a clear audit trail and to ensure peoples health and welfare. 6 9 13 Ensure that all staff who administer medication are appropriately trained. Ensure that staff who administer medication remain competent to undertake this task. The latter refers specifically to regular competency assessments. 20/02/2009 20/02/2009 4 9 13 5 9 17 20/02/2009 Care Homes for Older People Page 30 of 33 So as to ensure that staff remain competent and confident to undertake this task and to ensure residents safety and wellbeing. 7 18 13 Ensure that all staff receive appropriate training relating to safeguarding. This will ensure that staff feel confident and have the skills to deal effectively issues raised and residents are protected from harm. 8 30 18 All staff to receive 01/05/2009 appropriate training to the work they perform. This refers specifically to core subject areas and those conditions associated with the needs of older people. This will ensure that staff have the competence, confidence and ability to meet residents care needs and people living at the care home will feel assured that their care needs will be met by suitably trained staff. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 9 Daily care records should be detailed and informative and reflective of how people spend their day. Where people are prescribed/administered PRN (as and when required) medication, a protocol for each person should be devised providing specific instructions and Page 31 of 33 Care Homes for Older People guidelines to staff as to the circumstances that this medication should be administered. This will ensure consistency. 3 12 Consider devising the activity programme in larger print and/or pictorial format, so as to enable people to make an informed choice. Consider devising the menu in larger print and/or pictorial format, so as to enable people to make an informed choice. Induction for newly employed staff to be undertaken as soon as possible after they have commenced their employment. Regulation 26 visit visits should be conducted monthly and a report written and made available. 4 5 15 29 6 33 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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