Inspection on 28/12/06 for The White House

This inspection was carried out on 28th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The White House 29/11/05

The White House 14/12/04

The White House 22/11/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The White House 334 Horton Road Datchet Nr Slough Berkshire SL3 9HY Lead Inspector Stewart Mynott Unannounced Inspection 28 December 2006 10:20 th The White House DS0000011298.V308584.R01.S.doc Version 5.2 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 DS0000011298.V308584.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 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. The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The White House Address 334 Horton Road Datchet Nr Slough Berkshire SL3 9HY 01753 541595 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) Choice Limited Post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th November 2005 Brief Description of the Service: The White House provides residential care for seven service users with severe learning and behavioural difficulties. There is a mix of younger men and women. Day services are provided as part of the care package. The White House is a large two-stories house with accommodation on both floors. There are extensive grounds and outbuildings, which are used for day services. A swimming pool is also provided. The house is situated approximately 2 miles from Slough and Windsor Town centres near the village of Datchet. The home has two house vehicles and other means of transport are sought as necessary. The basic fees in respect of this home range from £1789.36 to £2085.57 per week. (Correct at the time of this inspection). The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over a four-day period between the 1st and 28th December 2006, with an unannounced visit to the establishment occurring on the 28th December 2006 lasting for 4¼ hours. During the site visit a full tour of the premises was facilitated. Over 50 of the visit was spent with five service users, who were present during the day, as well as the staff on duty observing the everyday life at the home. Some service users have difficulty communicating verbally and views about their experiences were gained indirectly through observations and interactions with staff. Discussions also took place with all staff on duty including the manager. Some of the service users and the homes records were examined to support observations made during the day. The inspection also included reference to documents completed and supplied by the home to include a pre inspection questionnaire and staff training records. What the service does well: What has improved since the last inspection? Areas within the home have been redecorated since the last inspection to ensure service users benefit from clean, comfortable and homely surroundings. The home continues to retain an effective and stable staff team with a good mixture of skills and experience, which benefits the service users. The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The White House DS0000011298.V308584.R01.S.doc Version 5.2 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 The White House DS0000011298.V308584.R01.S.doc Version 5.2 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): 2 Quality in this outcome area is good. Prospective service users needs would be carefully assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear policy on the admission process for prospective service users and has an appropriate statement of purpose and service users guide. There have been no admissions since the last inspection. The White House DS0000011298.V308584.R01.S.doc Version 5.2 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 Quality in this outcome area is good. Service users current and future anticipated support needs are understood and recorded, to a good standard in their support plans. The staff team appropriately support service users with their daily decisions within their individual abilities with an appropriate management of associated risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three service users plans were viewed during the visit to the home. Each service user has an up to date plan of their care and support needs in place. Support plans were detailed identifying assessed needs with good individual detail of support required in each area of daily living. Care plans were recorded in a person centred manner to include preferences and important information about the individual. Care plans referred to individual support guidelines. Individual support guidelines were viewed and contain clear information to the support and intervention required by staff to support service users with identified behaviours. Care plans have been reviewed at six monthly intervals. Most service users have some degree of difficulty communicating verbally. Care plans clearly state how to communicate and include the interpretation of The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 10 non-verbal actions, which was viewed as good practise. Further work has been done to replace communication boards with files that are portable. Currently these mainly focus on day service activities with a good range of symbols and pictures. The staff spoken to understand each service users needs and were able to explain communication methods in detail. During the inspection it was clear that service users are able to exercise choice, make decisions and were engaged by the staff team for all activities of daily living. Care records also demonstrated support needed to make appropriate decisions. Three service users risk assessments were viewed and contained a variety of assessments to support independence wherever possible in identified areas of their daily life. Each service user benefits from possible risk being identified and strategies put in place to assist independence. The staff team and assistant psychologist had kept all risk assessments under review. Staff spoken to were clear about the use and understanding of each service users risk assessments. The White House DS0000011298.V308584.R01.S.doc Version 5.2 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, 15, 16 and 17 Quality in this outcome area is good. Service users are supported to have an enjoyable and fulfilling lifestyle, which includes suitable activities. The daily life in the home is relaxed and inclusive with service users support needs taking priority. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are supported to engage in a variety of planned social activities. The home was a weekly planner providing details of regular structured activities to include all day service opportunities for each service user. From information provided in the pre inspection questionnaire, care records and staff discussion, service users have a good range of social and educational activities provided to include use of the local facilities within the community, more specialist resources and various in house activities. Evidence was viewed that the provision of leisure and structured activities had been kept under review to ensure each individual continues to have an appropriate and relevant program based on need and observed preferences. During the visit five service users were at home being supported with their choice of individual activities. One The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 12 service user commented that they enjoy the daily activities and currently attend college to do a course that they are enjoying. The home has its own dedicated day services facilities on site. Earlier this year a flood had significantly damaged these facilities. These have recently been refurbished to include a gym area with suitable equipment, an arts and craft room and educational area. The home also has its own heated swimming pool. The daily routine of the home was observed to be relaxed with service users having unrestricted access to the communal areas as well as spending time in private in their rooms with staff support. Staff were observed to interact well with service users with emphasis on the individuals routines and support requirements. Staff were observed as inclusive, friendly and professional. Service users were enabled to assist with making their own drinks with staff support within their individual abilities. Staff were able to calmly deal with any behaviour observed during the initial part of the visit to ensure that there was no impact on other service users in the communal area. The staff at the home described that currently there is an eight-week menu used in the home. A sample of menus for the past two weeks was examined and demonstrated a variety of different meals. The assistant manager confirmed that each service user has their own choice of meal different to the menu on a regular basis. The cultural needs of one service user were explored with information about how to cater for these requirements clearly on display in the kitchen. Staff spoken to were clear on how to support this service users cultural requirements. During the inspection a support worker prepared the lunch for five service users who were at home. Lunchtime was observed to be relaxed with service users appearing to enjoy their meal, with assistance and encouragement provided in line with information contained in care plans. The White House DS0000011298.V308584.R01.S.doc Version 5.2 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, 19 and 20 Quality in this outcome area is excellent. Service users personal, physical and healthcare needs are fully met with support from the staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Through observation, discussion with the staff on duty and individual records it was confirmed that service users receive a good level of personal support from the staff team. They confirmed that timings for going to bed, rising, meals and other activities are flexible in accordance with service users preferences. Staff confirmed that personal care is provided in line with individual guidelines in private with a support worker of the same gender as the service user wherever possible. Daily records viewed for three service users provided further evidence of a good level of personal support. The religious and cultural needs for one service user was explored and the key worker described a good understanding of how to support religious and cultural needs. All service users have a key worker and two staff spoken to were able to fully describe this role. Additional records were viewed evidencing monthly ongoing The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 14 reviews completed by key workers and monthly meetings between key workers and service users. Service users health needs are closely monitored. The care records indicated access to local NHS facilities to include the doctor, dentist, and optician. Specialists are also consulted on a regular basis for more complex medical needs. The home also accesses the psychologists employed within CHOICE. The assistant psychologist visits weekly and reviews behavioural needs and advises staff when needed. For two service users health needs being case tracked each had a health action plan to detail current health needs and ongoing support required. One service users health needs have recently changed. The support required and ongoing monitoring was fully understood by the staff team with events and support clearly documented. The assistant manager explained how service users medication is managed within the home. There are appropriate systems for the ordering, collection, administration and disposal of medicines. Records relating to the administration of medicines for two service users were examined and completed clearly with no evident gaps over the past week. There are clear individual guidelines in place for the use of “as and when required” medicines. In addition medication administration is witnessed and records seen correlated with the administration records viewed. The records viewed for the administration and management of the medication system within the home were clear and of a good quality. The assistant manager advised that currently the senior team and shift leaders are responsible for administering medication. Training records viewed indicated that all staff have received the relevant training to be able to undertake this function. Regular six monthly assessments are undertaken by staff to ensure their continued competency with administering medication. A tracking list had been maintained evidencing this within the medication records. The White House DS0000011298.V308584.R01.S.doc Version 5.2 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): 22 and 23 Quality in this outcome area is good. Service users and their representative’s views will be listened to and acted upon. Service users are protected from abuse by the homes robust polices and procedures, that are fully understood by the staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which is available in pictorial format for service users. The manager advised that the format currently in use was being reviewed to further ensure its accessibility and ease of understanding for service users. In the pre inspection questionnaire confirmation was recorded that the complaints procedure has been explained to service users and this was recorded with the complaints information. Most service users would require assistance from staff to formally complain and staff spoken to were clear on what would constitute a complaint and how this would be reported. There are no recorded complaints since the last inspection. The have been no complaints or concerns received by the CSCI in respect of this home. The home has appropriate policies and procedures in place to respond to allegations of abuse and adult protection, which have been reviewed earlier this year. The home adopts the Berkshire inter agency policy and a copy of this is available in the main office. Staff spoken to were clear about how to respond and recognise potential signs of abuse and confirmed that they have received training. Training records viewed indicated that most staff have received appropriate training in this area. There has been no allegation of abuse reported to the CSCI since the last inspection. The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 16 Some service users can display behaviours that could lead to harm to other persons or themselves. Staff on duty supported one service user to prevent self-injury. Staff were clear about how to respond and provide support and guidance in a calm and professional manner ensuring the service user was respected at all times. Clear procedures in relation to the management of behaviour were viewed for two service users. Staff spoken to were able to demonstrate a clear understanding of these specific procedures associated with such behaviour. “Behavioural observation charts” are completed by staff that record all behaviour exhibited and completed records were viewed for one service user who had required support during the visit to the home. Forms are completed when any authorised restraint/intervention is required. The assistant manager confirmed that these are reviewed on a weekly basis by the in-house psychology team. Staffs training records demonstrate that staffs have received training in this area to include SCIP procedures. The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 17 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): 24 and 30 Quality in this outcome area is good. Service users live in a clean, comfortable and homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A limited tour of the building was facilitated by the assistant manager on duty to cover all communal areas, the grounds and four service users bedrooms. The home was seen to be clean and well maintained. Since the last inspection new flooring and items in the spacious communal lounge/diner have been provided enhancing a homely and comfortable feel. The laundry facilities were examined and found to be clean and clear. Staff explanation and observations during the inspection confirmed there are systems in place to prevent the spread of infection and maintain a good level of hygiene noted throughout the home. The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 32, 33, 34 and 35 Quality in this outcome area is good. Service users are supported by an effective staff team, present in sufficient numbers, which are supported in their role through a good training program. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the visit staff were seen to interact in a positive and professional manner with both staff and service users observed to be relaxed. During conversation and observation with staff members on duty all staff demonstrated the necessary skills and knowledge of individual service users needs and abilities. The staffing levels at the home were provided in the pre inspection questionnaire and examination of four weeks rotas. On the day of the visit there were four support workers together with the assistant manner and home manager during the morning and afternoon shift. From the rota there is two waking night staff provided. There is no reliance on agency staff to maintain the staffing levels at the home. The manager described the recruitment processes followed by the home. There is a coordinated process with the organisations head office to support the recruitment, selection and pre employment checks for prospective staff. The records for the last staff member recruited to the service were examined The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 19 evidencing that appropriate good practise is followed to safeguard service users welfare. The staff at the home commented that they felt that there is a good range of training available from the organisation and that they had attended all mandatory and some more specialist topics. The assistant manager has recently updated the “training matrix” to continue to identify current training completed by the staff as a whole and to identify and plan for training in the next year. Training records for all staff on duty were examined and found to confirm that staff have received appropriate training to the current needs of the service users to include regular refresher training as required. The manager advised that the organisation of the training scheduled for the next twelve months has recently been changed to improve access and frequency of training topics. There are eighteen staff currently employed excluding the new manager. Records seen indicated that four staff hold an NVQ level 2 or above with a further four progressing through this qualification. The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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 Quality in this outcome area is excellent. Service users benefit from a well managed home which is run in their best interests. The home promotes and protects service users health, safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new manager has been appointed four months and one week ago as the previous registered manager has moved to another position within the organisation. The new manager is suitably qualified and is currently completing the registration process with the CSCI to become the registered manager. Staff spoken to were positive about the new managers approach. The home has a comprehensive quality assurance system in place. These include annual surveys to ascertain views about the quality of the service. The manager advised that this process is due again next month and that work had been completed to ensure service users surveys would be in a format appropriate to their needs. The manager advised that service users families and staff were included in this process and from this an action plan would be The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 21 devised. The current action plan was examined and evidence that it has been monitored and progress evaluated was clearly evidenced from the manager’s notes recorded on the plan. The organisation also conducts regular and thorough regulation 26 visits that are recorded to a very high standard providing a clear focus on reviewing the management and quality of service experienced by service users with clear action plans. From information contained in the pre inspection questionnaire, all relevant checks and servicing of equipment have been completed to ensure the continued health, safety and welfare of service users and staff. During the inspection visit a sample of records was viewed to crosscheck information already provided. Records viewed included fire safety records and hot water temperature monitoring. All records viewed were up to date and appropriately maintained. Staff observed during the day were seen to work in a safe manner and able to describe their knowledge in relation to the safety and welfare of service users. The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 22 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 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 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 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 4 X X 3 X The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The White House DS0000011298.V308584.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!