Inspection on 24/01/07 for The White House

This inspection was carried out on 24th January 2007.

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 20/03/06

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 Marion Weller Key Unannounced Inspection 24th January 2007 10:15 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.V327828.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The White House DS0000029048.V327828.R01.S.doc Version 5.2 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.V327828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th March 2006 Brief Description of the Service: The White House is registered to provide services for up to 25 older people who have Dementia. The home occupies detached premises on a main road and is situated within easy reach of Chatham town centre and railway station. The home is also on a main bus route. Residents’ bedrooms are arranged over two floors and offer a mix of double and single accommodation. There is a shaft lift installed to the first floor. The home has a large communal lounge, with a dining area adjacent. There is a garden to the rear of the property for residents’ use and at the front of the building there is space available for visitors car parking. The Proprietors, Mr and Mrs Nicolaou have many years experience in the caring profession. The home employs care staff working a roster, which provides 24hour cover. Ancillary staff for catering and domestic duties are also employed. The home offers residential care and accommodation but does not offer nursing care. Current fees range from £408 - £500 according to assessed personal need. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector between 10:15 am and 4:30 pm. During that time the inspector spoke with some residents, the two proprietors, the senior carer and some of the staff on duty. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Due to the nature of the service provided it was sometimes difficult to reliably incorporate accurate reflections of the residents’ views in the report and therefore greater emphasis has been given to relatives/representatives views of the service provided. 10 survey returns were received prior to the inspection and a further seven following the inspection. Responses from relatives and health professionals indicated they were generally satisfied with the standard of care the home provided. Two respondents made comments that on occasions the food offered to residents lacks variety and is sometimes overcooked. Five respondents felt that the provision of a separate visitors room in the home would help to make their visits there a more comfortable, private and pleasurable experience. One survey respondent had issues involving the conduct of a member of the staff group that the proprietor will investigate outside of the inspection process. Six respondents were unaware of the home’s complaints procedure and a further five were unaware that they can have access to the Commissions most recent reports about the home upon request. Five individuals felt the home did not offer sufficient activities. The remaining respondents felt that activities in the home happen ‘sometimes’ Statements on comment cards included: “Staff are caring to the people in the home, and friendly to me when I visit. I have no complaints or concerns. If I had to go into a home, I would be quite happy to be in the White House.” “My relative is now safe, settled and well cared for.” “The food provided is not always tasteful, more often than not, cooked too much and often dried up. There is definitely not enough variety.” “I never know what activities go on - people just seem to sit, my relative needs to be kept interested and active.” The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 6 “It would be useful to have a separate, comfortable and more private seating area for visiting. The main residents lounge or a bedroom is not particularly appropriate or suitable.” The owners and staff gave their full cooperation throughout the visit. What the service does well: What has improved since the last inspection? What they could do better: Some residents would benefit from the home’s information documents being made available in a format that would meet all levels of capacity. The home’s care-planning system has some inadequacies and does not consistently provide staff with all the written information they require. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 7 Residents’ protection would be enhanced by improvements to procedures for the administration, storage and handling of medication, which currently has the potential to put them at risk. A full activities programme would be beneficial in ensuring that residents view the diversionary arrangements in the home as being sufficiently regular and varied to meet their wishes, capacities and expectations. Residents would benefit if it were made more apparent that there was always an alternative choice of main meal offered on a daily basis and not just an alternative offered if the one main meal on the menu is not to their taste. The facilities provided for visitors to the home could be improved upon to ensure that visiting arrangements are provided in the best interests of the whole of the resident group. The home must continue to focus on the induction, training and development of staff to ensure they can meet residents’ needs at all times. Residents’ welfare would be better promoted by improvements to water temperatures, which are regulated to meet the National Minimum Standards in the home and water being delivered at a temperature that avoids risk of injury. Unguarded radiators in the home must be formally assessed for the risk they present to people that use the service and action must be taken to minimise any identified risk. The risk assessments must be written down and reviewed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 123456 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People accessing and using this service have written information available that helps them make an informed decision about whether the service is right for them. Some residents would further benefit from the home’s information documents being made available in a format that would meet all levels of capacity. Not just when the documents are initially required, but as a reminder to them once in residence. The personalised pre admission assessment means that residents’ diverse needs are identified and planned before they move into the home and they are given a contract that clearly tells them about the service they will receive. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has a Statement of Purpose and Service User Guide. The documents are comprehensive and easy to read. They meet all the requirements of regulation. The Statement of Purpose includes the home’s complaints procedure and gives contact details of the local Social Services Department and the Commission. The wording of the document currently leads a complainant to believe that contact with the Commission is a last resort. A discussion with the proprietor took place, it was clarified that individuals raising concerns and complaints have a right to contact the regulator at any stage of a complaint. The proprietor stated his intention to revise the wording of the document. Some residents spoken with were unaware of the home’s information documents available to them, although they felt that they or their relatives had received information before moving into the home. They understood most of the things they needed to know about the home and stated that staff reminded them of things sometimes. Some residents had insight into their forgetfulness and one said, “I need a reminder!” It was suggested that in the interests of good practice for this client group, the home might consider developing information documents in a format that would benefit all levels of capacity and make it more available to everyone as aide memoirs. Residents and their representatives are able to visit the home before deciding to move in and longer trial visits can be arranged with the proprietor. Records indicate that relatives are involved in this process as much as possible to support residents in their choice. Residents have a full assessment of their needs prior to moving in to ensure their needs can be fully met. Evidence of the home’s pre admission assessments and information gained from professionals involved with the individuals care prior to them moving in, were seen in residents’ files. Each resident has signed a contract with the home for their care, this clearly outlines the terms and conditions of their stay, rights and responsibilities of both parties, allocated bedroom number and the fees payable. The home does not provide intermediate care and therefore standard 6 is not applicable. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were being met, although the care planning system has some inadequacies and does not consistently provide staff with all the written information they require. Residents’ protection would be enhanced by improvements in procedures for the administration, storage and handling of medication, which currently has the potential to put service users at risk. EVIDENCE: Each resident has a care plan generated from the home’s pre admission assessment. The practice of involving them or their representatives/ relatives in the formulation and review of the plan is variable. It is evident that care plan content has been improved since the last inspection. A new format has been introduced that draws information into one document. A very innovative The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 12 pictorial front sheet had been developed which identifies needs and hazards for the individual on a traffic light system. This is a simple and dynamic tool for staff to follow. The plan itself was written out, but still lacked full follow through. On some occasions, the safe systems of work for staff had been assumed, but not detailed. Neither was the carer always made aware why they were doing something for the individual or what the aim of the task was. Changes to the main plan had been made in some instances following review. It was noted that reviews take place regularly. The plans need further development. Although senior staff had a good knowledge of what was required for individuals, information was sometimes not contained in the plan. Where there was a gap in care plans individual carers, when spoken with, could fill in the gaps on written information. Weight monitoring is undertaken regularly for residents and actions taken to rectify issues of concern. Records show that on occasions this involves discretely assisting the resident at meal times or trying to find out more accurately their dietary likes and dislikes. If these measures fail, then recourse to medical professionals for their opinion is sought in a timely manner. The requirement in relation to care planning awarded at the last inspection is partly met. Records showed that the home continues to liaise with specialist and local health care professionals in supporting residents in their health care needs. One GP survey respondent recorded that staffs understanding of the care needs of service users is ‘variable’ and there is not always a senior member of staff to liaise with. Staffing rosters viewed did not support this view and staff spoken with confirmed that either a senior or the two proprietors are in the building to support less experienced staff with professional visits. It would be prudent to view the doctor’s comments objectively and for the home to review how visiting health professionals are met and assisted during their visits. This action will ensure practice is to the required standard and health professionals have detailed information and someone competent and well informed to assist them in meeting the health needs of residents. There were some good examples of daily records of care, which largely reflected care plan demands. Entries were dated and the time of incidents were clearly recorded. The staff member completing the record had signed them. Medication administration and storage was audited. The medical room doubles as an office. The room was found to be appropriately locked. There were two metal storage cupboards on the walls, one of which was used for storage of Controlled Drug’s. There was one mobile medication trolley that was secured to the wall when not in use. A window runs along the exterior wall of the room. One part of the window has a full size opener. The window was lockable, but was found to be unlocked on inspection. The home’s medication procedures state the window is fitted with a window restrainer. The window opened to its fullest extent quite easily. The window is situated at ground level The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 13 and close to an outer walkway, which leads to an entrance door. The window glass was not obscured and therefore the casual viewer could see into the room. This is not very secure. At the minimum the window should be kept locked, a window limiter fitted and the window painted over or the view into the room obscured in some way. The home must consider that any actions taken to resolve this issue must ensure lighting levels in the room remain at an acceptable level for dealing with medicine administration and records. The Proprietor should seek advice and take action to improve security measures for storage of medicines in the home. The home uses a monitored dosage system for the administration of medicines to residents. The medication administration sheets were basically sound except for one recent signature gap. A second staff signature had not been obtained for hand written drug dosage instructions and therefore accuracy of transcription could not be evidenced. One resident had not had their prescribed night medication for two nights, as sufficient stock had not been obtained. The senior carer stated this was being attended to. No residents were assessed to self-administer medicines and yet prescribed topical medicines were seen in residents’ bedrooms. This issue was discussed. The home must refer to good practice guidance and risk assess this practice. It has the potential to cause harm to some residents who lack capacity. Particularly as the majority of residents bedroom doors were seen to be kept open during the day. Controlled drug balances were checked for three residents. Other items such as a purse were seen to be stored in the CD drugs cupboard. The balance of all CD drugs was found to be correct. Administration of controlled drugs had been recorded properly and clearly showed the remaining stock level. The controlled drug register was an ordinary hardback exercise book. The pages were not sequentially numbered and it would be possible to remove individual pages. There was no dedicated lockable drugs fridge. The senior carer stated that medicines for cold storage are kept in the home’s kitchen fridge. There were no ambient storage temperatures being recorded for the medical room, the catering staff took the kitchen fridge temperatures daily. There was a hole in the wall finish where the medication trolley restrainer had continually been allowed to hit against the wall. The manager stated this was to be repaired. One prescribed night medication for a resident was recorded as 1 or 2 at night. The senior carer stated that if one tablet didn’t work, then night staff gave a further tablet. A record of the time that the second tablet had been given by staff on occasions had not been recorded on the back sheet of the administration record. This could have unfortunate consequences if the resident was given medicine too near the time for rising in the morning and was still affected by the drug – unnecessary accidents/falls could occur. It was suggested that the senior carer liaise with the residents GP for further advice. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 14 The senior carer stated that the home currently accepts verbal instruction for changes to drug dosages over the telephone. It was suggested that the home reviews this procedure in line with good practice advice. Some staff had received one day medication training and more training was planned. The home’s two senior carers are largely responsible for medication administration and it was suggested that they should both attend a more comprehensive medication course in the safe administration of medicines. Both to update their skills and revisit good practice guidance. The home has a medication policy and procedure document to inform staff and could evidence guidance from the CSCI website which they had been referring to and found useful. Medicines were being correctly recorded for return and disposal to the pharmacy where it was necessary. Some medication administration issues clearly have the potential to put some residents at risk and must be addressed as a priority. The senior carer spoke of her intention to address them. Staff were seen to treat residents with dignity and respect. The privacy and dignity of individuals in care practice and the handling of privileged information is largely sound. It was noted that screening in some double bedrooms does not extend the full length of the area between the two beds. The senior carer evidenced satisfactorily how privacy for residents who share accommodation is managed in the individual’s best interests. Ensuring the compatibility and the continuing agreement of residents to share bedrooms is managed well, but the process needs to be evidenced on care plans and the situation regularly reviewed and evidenced. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Social activities and opportunities for mental stimulation for residents are variable. An opportunity to further review the activities offered and produce a full activities programme would be of benefit to the residents. Dietary needs of residents are well catered for with food available that largely meets their tastes and preferences. Residents would further benefit if it was made more apparent that there is always an alternative choice of main meal and not just an alternative offered if the main meal to be cooked is not to their taste. Residents are enabled to maintain contact with friends and family. The facilities for visitors to the home could be improved upon to ensure arrangements are made in the best interests of the whole of the resident group. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 16 EVIDENCE: The home evidenced that they are in the process of improving the activities offered to their residents and are aware of current shortfalls in this area. The senior carer and other staff had been working on a list of the resident groups capacities to undertake various types of activities. They explained that they could then offer more suitable diversions to each identified group if they wished to take part. They were also looking to extend the range of activities they could offer and were equally formulating a list of these. The proprietor stated that he has arranged for one carer to facilitate activities who will have dedicated time to offer a consistent programme. He envisaged some group activities and some time spent with individuals on a one to one basis. Involvement in the home by local community groups accords with residents’ wishes and preferences. Local church groups visit and some offer Holy Communion to interested individuals. Residents are supported in visiting local churches. Residents spoke favourably of the meals and said they had plenty to eat. Two survey respondents made comments that on occasions the food offered to residents lacks variety and is sometimes overcooked. The menus seen however were varied and alternatives were being offered. The meal of the day was displayed on the notice board in the residents lounge. It was not immediately apparent that there was an alternative choice of main meal offered on a daily basis. Residents spoke of being offered an alternative if they didn’t like the main meal. Residents may receive visitors at any reasonable time. The home encourages visitors and seeks to make them welcome. Five survey respondents felt that the provision of a separate visitors room in the home would help to make their visits there a more comfortable, private and pleasurable experience. Currently resident’s visitors sit in the one communal lounge/ dining room with the resident group, or go to the residents’ bedrooms for visits. The dissatisfaction of not having a dedicated visitors room may be an area the home needs to include in future quality assurance exercises, particularly if they are looking to improve the quality of service offered, and to ensure that other residents are not unnecessarily disturbed by visitors to the home unknown to them personally. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s complaints procedure. They would further benefit if it were made more freely accessible to them and their representatives and made available in other formats to meet all residents’ capacities. The home continues in its efforts to train staff in adult protection to fully protect residents from the potential risk of abuse. EVIDENCE: The home has a clear complaint procedure, which gives contact details and the process for investigating complaints with timescales. The wording of the document currently leads a complainant to believe that contact with the Commission is a last resort. A discussion with the proprietor took place, it was clarified that individuals raising concerns and complaints have a right to contact the regulator at any stage of a complaint. The proprietor stated his intention to revise the wording of the document. A number of survey respondents appeared unaware of the home’s complaints procedure. Residents spoken with knew whom they would speak to if they had concerns, but couldn’t remember seeing the procedure. Most said they would The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 18 speak with staff or their families in the first instance and they would help them if they were concerned. It is therefore imperative that those acting on residents’ behalf are aware of the procedure. As with other information documents in the home they could improve residents understanding of information and access to documents if they produced it in formats that suited all capacities and it was readily available to them as an aid memoir. The Proprietor evidenced that he seeks to resolve issues of concern for people wherever possible and is proactive in dealing with concerns brought to his attention at an early stage and therefore avoids formal complaints being made. The home states that they have received no formal complaints since the last inspection. The proprietors and senior carer demonstrated a sound understanding of adult protection procedures and stated that any allegation of abuse would be referred to the concerned agencies without delay. The home could evidence use of Kent & Medway’s revised Adult Protection Policy and other safeguarding guidance documents. The home has their own Adult Protection policy, which was revised in January 2006 and is based on the lead agencies procedures. The manager stated that all of the home’s policies and procedures are reviewed annually and this document is now due for further review to ensure it reflects current good practice and legislation. Access to Adult Protection training for staff has improved since the last inspection. Three staff are still to attend training. This has been arranged to take place in March 2007. The Requirement issued at the last inspection to train all staff in Adult Protection has therefore been partly met. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 25 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean and largely comfortable environment where they are able to access the home’s communal areas. Residents cannot be confident that the home provides a wholly safe environment where water temperatures are regulated to meet the National Minimum Standards. EVIDENCE: A tour of the premises was undertaken which included several residents’ bedrooms and communal WC’s and bathrooms. The home was clean and fresh apart from one communal toilet area where used continence pads, placed in a The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 20 disposal bin, were causing an unpleasant odour. This was dealt with immediately when brought to the attention of staff. Residents liked their environment and said they were largely happy with it. The home has been refurbished in some areas but others are now in need of redecoration and are looking a little tired. Some bedrooms viewed fell into this category, although they had been personalised to reflect residents’ tastes and interests. One communal bathroom had an aged bathroom suite in brown, which made it look dull and uninviting. A mobile hoist was stored in the alcove of this bathroom, covered with a blanket. The proprietor stated it was old and needed to be disposed of. A carpet shampooer had been left on the other side of the bath and not stored away after use. The proprietor stated that he has redecoration and refurbishment work for the home planned on a rolling programme. The last inspection report details the home’s non compliance with the National Minimum Standard 25.8, which requires hot water be stored at a temperature of at least 60 C and distributed at 50 C. – This is to aid infection control measures in the home. o o To prevent risks from scalding to residents installation of pre-set valves of a type unaffected by changes in water pressure and which have failsafe devices should be fitted to provide water close to 43 C at the point of delivery. The proprietor stated that this work is planned and should be completed by the end of 2007. This work is now a priority and the home will be required to provide the Commission with an assurance that it will be completed within an agreed timescale to protect residents from the potential for harm. o The home has the majority of radiators and pipe work guarded to protect residents from any risk of harm. The radiators, which remain unprotected, have been assessed as of minimal risk to the people who use the service and the proprietor keeps these at a lower surface temperature. They are sited mainly where staff are in regular proximity. The proprietor states that work to protect all radiators is included in the home’s programme of refurbishment. Some residents’ bedrooms are accessed via stairs, so those residents have to be mobile. Should their mobility decline the proprietor said they would be found bedrooms in an area of the home that had a passenger lift access to the first floor. Some privacy screening does not extend the whole length of the room in shared accommodation and has the potential to compromise resident’s privacy and dignity. Staff explained the efforts they make to ensure that commodes are placed in a position where it affords privacy for the individual. Screening is provided around washbasins in the rooms. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 21 Staff had access to liquid soap and paper towels in all communal areas. No soap or toiletries were seen in communal bathrooms or toilets. The home could evidence an infection control policy. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by staff who have a good understanding of their needs and who receive regular supervision. The home continues to focus on the induction, training and development of staff to ensure they meet residents’ needs at all times. Residents are protected by the home’s robust recruitment procedures. EVIDENCE: There was sufficient staff on duty to meet residents needs on the day of the site visit. Staffing rosters were seen. The home uses no agency staff, which ensures residents receive continuity of care from individuals they know and trust. To achieve this substantive staff take on additional hours to cover vacant shifts on the rosters. Access to staff training has significantly improved since the last inspection and the night staff was seen to have received some training. The home has training records, which are clear and detailed. The home’s training matrix evidences a list of mandatory training courses and other specialist training completed by individuals. There is however no clear overview of training The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 23 planned, completed and updates necessary for individuals. The matrix could be improved upon. Adult Protection training has yet to be fully completed for all staff. Three staff members are due to receive this training in March 2007. The requirement issued to train all staff in adult protection from the last inspection has therefore been partly met. Medication one day training has been accessed for most staff that deals with medication administration. Due to the shortfalls in medication administration and procedures found on this inspection, the two senior carers should seek more comprehensive update training in the safe administration of medication to fully protect residents from any potential for harm and to ensure the home’s practices are in line with current good practice guidance. Some staff have undertaken dementia training. This specialist training is imperative for all staff that care for residents with this diagnosis’s in specialist registered home’s. The home exceeds the 50 standard for NVQ qualified staff, with 60 of staff trained. The manager stated that his goal is to have all qualified care staff on the team and to retain them. Staff were found to be highly motivated and keen to improve and develop their skills. Staff files evidenced all the requirements of regulation. The home has robust recruitment procedures in place. CRB/POVA checks are made on staff before they commence work to protect residents from any potential for abuse. The home’s induction procedures have improved but are still being further developed. Access to foundation training is not currently taking place. The Proprietor could evidence guidance from the ‘Skills for Care’ web site and is using this as a basis for the induction procedures under development. Residents spoke highly of staff and it was obvious that personal attachments exist between individuals. There is a key worker system in operation that appears to work to residents benefit. Staff spoken with were happy with the amount of training they receive and felt they had the skills to meet residents needs. Formal supervision of staff takes place regularly and records of supervision sessions were seen in staff files. Identification of the individuals training needs were included in the discussions. Staff understood their roles and responsibilities and knew what was expected of them. One of the home’s senior carers is undertaking the Registered Managers Award at NVQ 4 Level with a view to taking on additional operational responsibity in the home. The home has two senior staff trained at NVQ level 3. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from experienced and caring owner / managers who have plans for improvement which should result in better outcomes for people using the service. The home continues to address the training and supervision requirements of staff so they have the necessary skills to fully meet the needs of residents. Residents’ welfare and safety would be better promoted by improvements to water temperatures, which are regulated to meet the National Minimum Standards in the home and water being delivered at a temperature that avoids risk of injury and medication administration systems that protect residents from any potential for harm. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 25 EVIDENCE: The owners, Mr and Mrs Nicolaou manage the care home between them on a daily operational basis. Mr Nikolaou spoke of his plans to develop one of the senior carers, who had just started training for the Registered Managers Award at NVQ Level 4. Mr & Mrs Nikolaou demonstrated they have the necessary experience and knowledge to run the home. They have access to the Internet within the home and use this for maintaining their knowledge about specific areas of care. There are clear lines of accountability and responsibility within the home. Staff records complied with regulations and regular staff supervision had been implemented. Records seen indicated that the home was ensuring staff had received fire safety training or participated in fire drills. Access to staff training had improved on this visit and requirements awarded at the last inspection in this respect have been partly met. The home’s policies and procedures are reviewed annually. The last review was January 2006. The manager stated his intention to review them again shortly to ensure they complied with current legislation and good practice guidelines. All records were seen to be held securely in a manner that preserved confidentiality. The Proprietor described how residents and their representatives or relatives were regularly asked for their views about the service. Mr Nikolaou stated that he undertakes quality assurance exercises. He does not currently publish the results or share them with the Commission, but confirmed that feedback from stakeholders in the service continues to be good. Some completed quality assurance questionnaires were viewed and seen to be comprehensive in approach, results would clearly inform the annual business planning cycle for the home. Residents spoken with on this inspection and relatives/ representatives surveyed, felt the home was run with the residents best interests at heart. The home has developed a health and safety policy that generally meets health and safety requirements and the demands of legislation. Residents on the whole can be confident that their health and safety is protected. Some shortfalls were noted however in the home’s water temperatures, which should be regulated, to meet the National Minimum Standards guidance and provide evidence of good infection control measures being maintained. There is a need to avoid the possibly of scalds by the introduction of thermostatic mixer valves on water outlets in resident areas and medication administration systems are The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 26 in need of review to ensure residents are protected from any potential for harm. The home has very little to do with residents finances. The owners are responsible for invoicing residents’ relatives or representatives for any expenditure. The owners confirmed that they keep comprehensive records of this activity. Secure storage is available in the home if required. The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 28 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) (2) (b) (c) (d) Timescale for action Unless it is impracticable to carry 01/05/07 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. In that: The care planning system has some inadequacies and does not consistently provide staff with all the written information they require. The care plan must set out in detail the action which needs to be taken by care staff to ensure all aspects of the health, personal and social care needs of the service users are met. It should be regularly reviewed and signed by the resident or their representative to evidence their involvement in its formulation and their agreement to it. (Previous timescale of 20.09.06 partly met) DS0000029048.V327828.R01.S.doc Version 5.2 Page 29 Requirement The White House 2. OP9 13 (2) The registered person shall make 01/04/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in to the care home. In that: Improvements to staff knowledge and procedures in the home for the administration, storage and handling of medication detailed in the report must be addressed to ensure that residents are fully protected. 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; In that: All staff must be trained in Adult Protection to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. (Previous timescale of 20.06.06 partly met) 01/04/07 3. OP18 12 (1) 13 (6) 4. OP27 18(1) (a) (1) The registered person shall, 01/06/07 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; In that: The registered person shall make arrangements for staff to receive induction and DS0000029048.V327828.R01.S.doc Version 5.2 Page 30 The White House training in all aspects of care and safe practice and is to include: Induction Adult Protection First Aid Moving and Handling Care Planning Health & Safety COSHH Risk assessment Infection Control Fire Training Medication administration Food Hygiene. Dementia Care (Previous timescale of 20.09.06 now partly met) 5. OP38 OP25 OP19 12 (1) 13 (3) (4) (a) (b) 31/05/07 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; 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; (b) Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In that: 1. Hot water to be stored at a temperature of at least 60 C and distributed at 50 C. – This is to aid infection control measures in the home. 2.To prevent risks from scalding o o The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 31 to residents installation of preset valves of a type unaffected by changes in water pressure and which have failsafe devices should be fitted to provide water close to 43 C at the point of delivery. 3. Unprotected radiators within the home must be assessed for the risk they present to people using the service and action taken to minimize any identified risk. Risk assessments must be in writing. 4. Where a timescale has been set for compliance with any standard relating to the physical environment of the premises, a plan and programme for achieving compliance is produced and followed within agreed timescales and records kept. This was not met from the previous inspection report dated 20/03/06 o (Previous timescale of 20.09.06 not met) The registered person will provide an action plan to CSCI for compliance within the timescale stated. 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 OP12 Good Practice Recommendations It is recommended that the manager fulfil the stated intention to further develop the home’s activities DS0000029048.V327828.R01.S.doc Version 5.2 Page 32 The White House programme inside and outside the home. Special consideration should be given to meeting the needs of all capacities of residents and those with specific impairments. Residents’ individual interests should be recorded in their plan of care. Consideration should be given to allocating dedicated staff time to ensure the provision is consistently offered to residents. 2 OP13 The facilities provided for visitors to the home could be improved upon to ensure that visiting arrangements are provided in the best interests of the whole of the resident group. Residents should not be unnecessarily disturbed by visitors to the home unknown to them personally. Residents would benefit if it were made more apparent that an alternative choice of main meal is offered daily and not just an alternative offered if the main meal is not to their taste. Written menus should be made available to residents in formats that suit all capacities. The complaints procedure should be more freely accessible to residents and their representatives and made available in other formats to meet all residents’ capacities and those with specific impairments. It is strongly recommended that the manager further develop the home’s training matrix to provide a ready and clear overview of staff training needs. 3 OP15 4 OP16 5 OP30 The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The White House DS0000029048.V327828.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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