Inspection on 25/01/06 for The White House

This inspection was carried out on 25th January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The White House 19/06/07

The White House 05/07/06

The White House 20/07/05

The White House 08/12/04

The White House 17/05/04

The White House 09/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 White House (The) 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ Lead Inspector Stephanie Omosevwerha Unannounced Inspection 25th January 2006 10:00 DS0000032243.V280868.R01.S.doc Version 5.1 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 DS0000032243.V280868.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. DS0000032243.V280868.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service White House (The) Address 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ 01202 399471 01202 390473 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) Steadway Care Limited Mrs Sheila Mary Stimpson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places DS0000032243.V280868.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Further work needs to be undertaken to the window in Bedroom 8 prior to the registration of this room. Following the recommendation made by Dorset Fire & Rescue Service in their letter dated 28 August 2002, careful consideration needs to be given to the choice of service user who can be accommodated in the top floor rooms such that these service users should be able to evacuate the building unaided. Service users who have significant personal care needs or who present with very challenging behaviour will not be offered places. Two named persons (as known to the CSCI) to be accommodated in the category LD to be provided with one to one care. 20th July 2005 3. 4. Date of last inspection Brief Description of the Service: The White House is a large property on a corner plot in a residential area of the Boscombe. It is conveniently located for all the amenities of Boscombe that includes shops, restaurants, cafes, post office, library and places of worship. These are within a few minutes level walk of the home. Public transport is readily accessible close to the home and Bournemouth town centre is approximately 1 mile from the home. The home has its own transport that enables service users to conveniently access some of the towns leisure facilities, particularly when group activities are arranged. The homes mission statement states that that it aims to support and care for adults with autism along the path towards independence. The White House has three floors and there is bedroom accommodation on the first and second floors i.e. 2 on the second floor and 5 on the first. All bedrooms are single rooms and have en-suite WCs and baths and the décor and furnishings are the choice of the person occupying the room. Communal space is on the ground floor and comprises two lounges, a dining room, a large kitchen and a WC. Recent extension work has provided a larger management office, additional staff office and separate laundry room. The paved external garden area is accessible from one of the lounges and the dining room and contains a summerhouse. The facilities of the home and its décor and furnishing are domestic in character. The property is inconspicuous ensuring that its function as a care home is not obvious facilitating the promotion of the homes mission. DS0000032243.V280868.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over approximately 5 ½ hours. It was the second inspection of the home carried out as part of the planned inspection programme for care homes undertaken by CSCI and to address the recommendations made at the previous inspection. Evidence for this inspection was gathered from a variety of sources including discussion with the deputy manager, day care co-ordinator, training coordinator and 3 members of staff. The inspector also sat down with the service users over the lunchtime period and spent time with them afterwards during their craft session in the home. Most service users were unable to give verbal feedback, so the main evidence gathered for the outcomes of service users living in the home was from observation of activities and interaction with staff. Records and documentation was sampled including care plans, risk assessments and health and safety records. Information gathered from previous inspection reports and monthly review reports sent to the Commission by the responsible individual of the home were also taken into account. What the service does well: There is a clear leadership structure throughout the home with all staff demonstrating an awareness of their roles and responsibilities. For example the manager and deputy managers responsibilities are clearly set out and the home employs a training co-ordinator to organise staff training and a day care co-ordinator to organise daytime activities for service users. Excellent information is available about residents care needs. This provides the staff with a good knowledge and understanding of what support each resident needs. Discussion with members of staff also showed they knew the likes and dislikes of individual’s living in the home. Observation during the inspection showed that staff work positively with residents helping them complete tasks independently wherever possible rather than doing things for them. A great importance is placed in assessing individual risks to ensure these are well managed protecting service users from potentially harmful situations. The home liaises well with healthcare professionals to ensure residents well being. The inspector was particularly impressed with the way the home had worked to reduce one resident’s medication working on the presenting behaviours rather than relying on sedation. The home is well located and is just a short, level walk from the local shops. Residents are able to access the local community regularly and observation during the inspection showed they enjoyed going out with staff support both on an individual basis and in small groups. The home offers a range of DS0000032243.V280868.R01.S.doc Version 5.1 Page 6 daytime activities making use of their own allotment, local leisure facilities and adult education classes. The home provides comfortable accommodation with all service users having their own room with ensuite facilities. A good standard of hygiene is maintained and the home was observed to be clean and tidy. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000032243.V280868.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000032243.V280868.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standard was assessed and met at the last inspection. EVIDENCE: DS0000032243.V280868.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. There is a comprehensive and clear system of care planning in the home that provides staff with the information they need to ensure service users needs are met. Service users are supported and encouraged to make decisions where they are able with any restrictions being clearly recorded and evidenced in care plans as to why they are necessary. A great importance is placed in assessing individual risks to ensure these are managed effectively safeguarding the welfare of service users by reducing/minimising potentially harmful situations. EVIDENCE: A sample of 2 service users individual records was examined as part of the inspection. Each service users had a personal profile and an individual service user plan that addressed a whole range of needs including health care needs, personal care needs, communication, personal relationships, social and work/occupation/education needs, risk/safety factors, financial needs, domestic tasks, behaviours and routines. Individual needs were clearly DS0000032243.V280868.R01.S.doc Version 5.1 Page 10 identified and comprehensive guidance given about the staff support required. There was further evidence that regular reviews were undertaken by the home with review notes being recorded on individual files. There was evidence that service users were consulted prior to their reviews and had the opportunity to talk to their keyworker beforehand about any issues they wanted to raise in a pre-review questionnaire. The home have implemented a staff information file that is updated on a weekly basis that contains information including changes to service user care plans, policies and procedures and training information to ensure staff are kept informed of any developments in the home. Staff sign to confirm they have read this. Discussion with members of staff further evidenced their awareness of service users needs including individual’s personal preferences e.g. one member of staff discussed morning routines with the inspector and described how service users individual likes and dislikes were taken into account. There was evidence that service users were encouraged to make decisions in their daily lives. For example one service users plan described how the service user could “dress independently but not always appropriately” staff were asked, “to place selection of appropriate clothing out for X to choose from.” Observation during the inspection also showed service users being given choices e.g. choice of fruit at lunchtime and choice of activity during the craft session in the afternoon. Some residents’ choices had to be limited for example due to lack of independent skills, awareness and behaviour it was unsafe to leave some residents unsupported in the community. Where this was necessary, it was clearly documented in care plans, which had also been agreed and supported by other relevant professionals such as psychiatrists. There was a recommendation made at the previous inspection that the home explores advocacy services for information about promoting service user feedback in the home as due to the nature of autism some service users living in the home can only do this to a very limited extent. The deputy manager said they had made approaches to a number of local/national groups but had been unable to find a service that would provide a regular advocacy service to the home. The home had a comprehensive risk management framework with clear assessments and action plans in place to minimise risks. Assessments were carried out on a number of activities including personal care, domestic activities, community activities, social activities, physical intervention, aggression and communication. There was evidence to show that risks to the individual and other people had been considered and also any other risks such as damage to property. Proposed action plans were clear, e.g. two to one staffing needed whilst out in the community. DS0000032243.V280868.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15. A range of social and educational opportunities is provided with good links to the local community supporting and enriching service users lives. Service users are encouraged to maintain contact with their families although due to the nature of autism, service users find it difficult to form independent relationships and links outside the home relying heavily on support and guidance from the staff. EVIDENCE: The home provides a daytime programme to all of the residents and employs a day care co-ordinator whose role it is to specifically organise residents’ week time activities. The inspector spoke to the day care co-ordinator who confirmed individual programmes were set up according to service users preferences. The activities varied and included craft, walks, recycling, music trampolining, swimming, bowling, going to the gym and working on an allotment owned by the home. The day care co-ordinator said she had also used the Adult Education linking scheme to access courses such as cookery and essential skills, which had been very successful. One service user was supported to undertake a weekly paper round. DS0000032243.V280868.R01.S.doc Version 5.1 Page 12 Copies of each service users daytime activities were observed on their individual files. These were set out with some pictures to make the format more accessible to service users. Observation on the day of the inspection showed that 4 service users went out for a walk and a visit to a café in the morning and the other 2 service users were supported to carry out domestic tasks, cleaning and tidying their bedrooms. On their return some of the service users helped to unpack and put away the weekly shopping that had been delivered. After lunch service users took part in a craft activity of their choice e.g. colouring, threading beads or jigsaw puzzles. One service user was accompanying out into the community with staff support after lunch. Although service users were unable to give verbal feedback about their daytime activities, observation showed they enjoyed going out into the community. The home is able to provide a high staff ratio and on the day of the inspection there were 5 care staff on duty as well as the deputy manager, training co-ordinator and day care co-ordinator. This ensures that service users are able to access the community on a regular basis with staff support. It also allows service users to go out individually or in smaller groups. The home own a MPV vehicle that service users can use to go on longer journeys. There were pictures in the home of the group’s holiday to France in July 2005. Service users family contacts are clearly recorded on their files. The deputy manager confirmed visitors are welcome to the home although they do prefer these to be set up by arrangement in order to ensure they do not interfere with service users daytime programmes. All visits to family are noted on service users files and service users are also supported to contact their families e.g. by telephoning them. There was evidence that relatives were consulted about their views and these had been recorded on the service users’ review notes. Due to the home specialising in adults with autism, service users find it difficult to establish independent friendships or links outside the home and rely heavily on the staff for support and guidance. DS0000032243.V280868.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19. Personal support is offered in a way that promotes service users independence and takes into account their likes and dislikes. The health needs of service users are well met with evidence of multidisciplinary work taking place to provide further advice and expertise. EVIDENCE: Personal care needs were well documented on care plans and information was included concerning toileting, washing, bathing, washing hair, cleaning teeth, dressing, shaving, nails, hands and hair care. Discussion with staff indicated they were well aware of service users personal preferences e.g. “X likes to be woken in the morning then left alone for 5 minutes before being assisted to get up.” Observation of practice showed staff supported service users to complete tasks independently wherever possible rather than doing things for them. Health issues were clearly identified on care plans e.g. hearing impairment, mental health issues. There was evidence that service users were attending at least an annual health check and visits to G.P.’s, dentists and opticians were clearly recorded. There was further written evidence that referrals had been made to other healthcare professionals where necessary such as psychiatrists, psychologists. There was evidence of liaison over current behaviour DS0000032243.V280868.R01.S.doc Version 5.1 Page 14 management plans e.g. “the doctor has read through the service users current plan and is in agreement”. Service users current medication was recorded and the inspector noted that the home were currently working positively to reduce a service users medication and target the behaviours rather than using sedation. DS0000032243.V280868.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. Staff receive clear information and training to ensure they are aware of Adult Protection issues providing a safe environment to protect service users from harm. EVIDENCE: The home has written policies and procedures on the protection of vulnerable adults including abuse procedure, managing challenging behaviour, management of service users’ money and service user going missing. The inspector spoke to the home’s training co-ordinator who confirmed that there is a rolling programme to ensure all staff receive training in adult protection procedures. The home currently uses a training course that is run by the local authority. The training co-ordinator has also organised training courses in managing behaviour and breakaway techniques, which are taken place over the next couple of months. DS0000032243.V280868.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30. Standards of hygiene in the home are good with systems in place to control the spread of infection. EVIDENCE: On the day of the inspection the home was observed to be clean and hygienic. The home now has a separate laundry room that is sited away from the kitchen where food is stored, prepared and cooked. The home has a comprehensive health and safety file that includes information on infection control. However, this would benefit from being organised into a separate policy. The deputy manager is in the process of this and is currently seeking advice about a policy she has drafted to ensure it meets current legislative requirements. The home provides staff with protective clothing such as gloves and antiseptic wipes and staff are given training in the control of infection as part of their induction training. Additional training is also provided in the home in the form of a video and accompanying questionnaire. DS0000032243.V280868.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All the key standards were assessed and met at the previous inspection. EVIDENCE: DS0000032243.V280868.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. There is a clear leadership structure throughout the home with all staff demonstrating an awareness of their roles and responsibilities. The home has provided further consultation opportunities for relatives to feedback their views about the quality of the service. Practices in the home generally promote and safeguard the health, safety and welfare of the residents, however, an outstanding gas safety check needs to be completed to ensure this standard is fully met. EVIDENCE: The manager has many years of experience of working with service users with autism. She is currently undertaking her NVQ 4 Registered Managers Award and holds a certificate in supervisory management. A detailed written job description and person specification describing the post are available, and the managers and deputy manager’s individual roles and responsibilities in the home are clearly defined. DS0000032243.V280868.R01.S.doc Version 5.1 Page 19 The home’s quality assurance system was assessed at the previous inspection. It was suggested that relatives/care managers might be given an opportunity to provide comments/feedback at service users reviews to increase the availability of responses from external interested parties. The inspector noted that written comments had been recorded on the service users review notes evidencing consultation with relatives had taken place. Records showed that the home was meeting the requirements of other agencies such as Dorset Fire and Rescue Service and Environmental Health Department. Certificates were in place demonstrating that equipment and facilities were regularly serviced and maintained, apart from the gas safety check that was outstanding. The deputy manager said this had been organised for November 2005 but the contractor had cancelled and not been able to give the home a further date. This needs to be chased up as a matter of priority. A written health and safety policy for the home has been completed and records are maintained evidencing the home carries out checks for example fire precautions log book, water temperatures and a weekly vehicle check. The manager confirmed her awareness of relevant legislation and certificates were in place showing staff had attended various training courses in safe working practices. The accident book was seen and there had been 5 accidents recorded since the last inspection all involving staff. The deputy manager investigates all accidents in the home and completes a written report, which contains guidance to staff about avoiding future accidents. DS0000032243.V280868.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 2 X 3 X X 2 X DS0000032243.V280868.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA37 YA42 Regulation 9 23 Requirement The registered manager needs to complete NVQ 4 registered managers award. The home must ensure that gas safety checks are made within the specified timescale. Timescale for action 01/01/07 01/03/06 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 YA30 Good Practice Recommendations It is recommended that the home has a separate policy for infection to control for ease of reference and guidance to staff. 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